How About Us?

Aviationurse · Nov 28, 2008

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I have extensive experience here in the U.S. as an RN who have done scientific and thorough nursing audits. Reading the posts here gives me the chills, how could Philippine-based nurses have 30-50 patients? I bet you, if I will do the same audits that we do here, the majority of the Philippine hospitals will not pass the safety audits that we do here in the U.S.A.
This should serve as a warning to many potential overseas Filipinos who are planning to retire in the Philiipines. They should consider the health care delivery system in the Philippines when they plan their retirement. I have written this warning before in this forum, and I am doing this again today.
I don't blamme the front line nurses for this. They are the ones who work hard day in and day out to give the best care they could give to their Filipino patients.
The blame should be directed to the Philippine government officials and hospital administrators who allow this very unsafe practices to exist and to continue unabated. They are responsible for the very dangerous conditions that are allowed to be practiced in the entire Philippine health care system. Human lives are being endangered. Something must be done.
I am calling on the responsible nursing leaders in the Philippines to stand up, organize and tell the Filipino people of what must be done to correct this dangerous conditions in Philippine hospitals.
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hi dalycity rn...Madame President Arroyo just recently left my neck of the woods and told the overseas filipinos during a brief conference

to go home and retire in philippines....ie best medical health care system....etc....great post dalycityrn.... :yeah:

swsh10 · Nov 28, 2008

Re question how can the nurses in the Phil be educated to current 21st century standards? The Phil is more westernized than most people think; the medium of instruction is usually in english from the get-go and nursing schools are (supposedly) NLN accredited. Most hospitals may not have ultra modern equipment, but the basics in nursing are still the same. For example, instead of programming IV rates on a pump, they may do manual calculations and count drops; instead of just hooking up a patient on a fetal heart monitor, they make use of the leopolds maneuver and manual contraction counting. My point is nursing is nursing; signs and symptoms don't change. I think nurses just need to take a personal responsibility in educating themselves; have a hunger for learning; read, read read and learn from other experienced people(this nursing site is a good learning tool for one). More than just being updated in the new stuff, I think nurses need to have a good head on their shoulders - that way they could be more assertive and advocate better for the patients. :wink2:

RN_Canada · Nov 28, 2008

I am just coming into this forum and I find it very interesting to read about the working conditions and "Paying" to be a volunteer?

It is so obvious that the workers need to unionize.

Such a practice would never be allowed in a unionized workplace. Union work is done by union members...period!

Unions have done well for nurses here in Canada

-Nurse patient ratio on a very busy surgical unit is 1:5 approx.

-starting salaries range at around $25/hr and max out at well over $30 per hour

-sick days, pension plans, ed leave, and lots of work.

Is there any such thing as a nurses union in the Philipines?

suzanne4, RN · Nov 28, 2008

Re question how can the nurses in the Phil be educated to current 21st century standards? The Phil is more westernized than most people think; the medium of instruction is usually in english from the get-go and nursing schools are (supposedly) NLN accredited. Most hospitals may not have ultra modern equipment, but the basics in nursing are still the same. For example, instead of programming IV rates on a pump, they may do manual calculations and count drops; instead of just hooking up a patient on a fetal heart monitor, they make use of the leopolds maneuver and manual contraction counting. My point is nursing is nursing; signs and symptoms don't change. I think nurses just need to take a personal responsibility in educating themselves; have a hunger for learning; read, read read and learn from other experienced people(this nursing site is a good learning tool for one). More than just being updated in the new stuff, I think nurses need to have a good head on their shoulders - that way they could be more assertive and advocate better for the patients. :wink2:

The nursing schools there are not under the NLN, they are under the CHED. There are issues with quite a few programs that have very poor passing scores on the licensing exam for a start, and then have clinical instructors that have no actual work experience before they begin to teach. You will not find this in any other country in the world.

And another issue is that we have seen nurses graduate from programs there that have never inserted a foley catheter or placed an NG tube because those procedures go first to the med students and/or residents. And they also do not have anything to do with IVs when they are in school either. So things are quite different. If you have not used a piece of equipment or know how it operates, then there are issues with that as well.

I would advise taking the time to do some reading on this forum and find out what is actually going on with things, the other issue is that there are not jobs in your country, so if one wishes to work in another country and that country uses all of this equipment, then that puts one at a major handicap. Don't you think?

RN_Canada · Nov 29, 2008

Suzanne

Do you think that has to do with the concept of public protection. I know that in Canada this concept is quite well developed. Canadian citizens expect to have RN's with the skills, ability, and judgments to keep them safe when they are sick and vulnerable.

This is not the case in all countries. In some countries people who are in hospital just expect the health professional to know what is best for them. Sort of the "Professional as expert" approach.

Here in Canada nurse must use the "professional as partner" approach.

Now how can a nurse form one system be successful in the other system if they do not know the basic underlying values and beliefs of the system?

In this respect nursing ins NOT nursing. In fact nursing is contextual to the society and the values of the health care system and in fact the large system of the society.

swsh10 · Nov 29, 2008

suzzane4

You ask a great question. I am a philippines trained RN who has now been practicing in the United States for 18 years. My husband is also a nurse and teaches at our local community college. Your last post sounds as if you feel I do not have a good grasp of nursing or nursing in the Phillippines.

While nursing has become much more techno and equipment dependent I am not familiar with any nursing licsensure exams that deal with how to setup or to use equipment. If one has a firm grasp of the science and art of nursing they should be able to pass any exam and then be able to adapt to any environment they then go to work in. While yes you may be at a disadvantage by not having the toys to play with, nursing is still nursing.

For example, I did not use IV pumps in the Philippines before coming to the US. Once here I had to read and study and prepare myself for practice. When you talk of skills going to medical students and residents, we have that problem here in the US as well. I have had to precept many nurses who had little to no skills experience. They could write care plans and theorize with the best of them but they cannot take care of more than one patient at a time. I am seeing many new nurse grads with no to little clinical experiences. It takes a good hospital and a good preceptor training program to help the new nurse assimilate into the nursing profession.

Nursing schools in the philippines are about the money. Many young filipinos see nursing as the way to make it over here to the US. The schools know this and thus crank out as many as they can. Yes many schools employ inexperieced and poor instructors as many just teach until they get their paperwork complted to leave to work somewhere else.

My husband is an american trained nurse and he was not allowed to even start an IV in nursing school. He had to do that in orientation on his first job. Now as a college professor he has to struggle to get his students quality clinical experiences.

So no I do not think that just because someone has not played with the high tech toys that they are at that much of a disadvantage. If trained aND educated properly a nurse should be able to adapt to practice in any environment. Our problem back home in the philippines is that many who enter into nursing school are fed false hopes and exagerated expectations.

My point in all of this for anyone trying to come here to the US is to study and become an expert in the basics of nursing. Then stick to it and keep studying as long as it takes. Yes it is difficult but worth it!

Ginger's Mom, MSN, RN · Nov 29, 2008

suzzane4
You ask a great question. I am a philippines trained RN who has now been practicing in the United States for 18 years. My husband is also a nurse and teaches at our local community college. Your last post sounds as if you feel I do not have a good grasp of nursing or nursing in the Phillippines.
While nursing has become much more techno and equipment dependent I am not familiar with any nursing licsensure exams that deal with how to setup or to use equipment. If one has a firm grasp of the science and art of nursing they should be able to pass any exam and then be able to adapt to any environment they then go to work in. While yes you may be at a disadvantage by not having the toys to play with, nursing is still nursing.
For example, I did not use IV pumps in the Philippines before coming to the US. Once here I had to read and study and prepare myself for practice. When you talk of skills going to medical students and residents, we have that problem here in the US as well. I have had to precept many nurses who had little to no skills experience. They could write care plans and theorize with the best of them but they cannot take care of more than one patient at a time. I am seeing many new nurse grads with no to little clinical experiences. It takes a good hospital and a good preceptor training program to help the new nurse assimilate into the nursing profession.
Nursing schools in the philippines are about the money. Many young filipinos see nursing as the way to make it over here to the US. The schools know this and thus crank out as many as they can. Yes many schools employ inexperieced and poor instructors as many just teach until they get their paperwork complted to leave to work somewhere else.
My husband is an american trained nurse and he was not allowed to even start an IV in nursing school. He had to do that in orientation on his first job. Now as a college professor he has to struggle to get his students quality clinical experiences.
So no I do not think that just because someone has not played with the high tech toys that they are at that much of a disadvantage. If trained aND educated properly a nurse should be able to adapt to practice in any environment. Our problem back home in the philippines is that many who enter into nursing school are fed false hopes and exagerated expectations.
My point in all of this for anyone trying to come here to the US is to study and become an expert in the basics of nursing. Then stick to it and keep studying as long as it takes. Yes it is difficult but worth it!

I see your point, from what I have read and seen, the nursing students in the Philippines don't get basic nursing. How can you with an instructor with no experience.

As a graduate of the Philippines why don't you educate the students about the realities?

suzanne4, RN · Nov 29, 2008

Suzanne
Do you think that has to do with the concept of public protection. I know that in Canada this concept is quite well developed. Canadian citizens expect to have RN's with the skills, ability, and judgments to keep them safe when they are sick and vulnerable.
This is not the case in all countries. In some countries people who are in hospital just expect the health professional to know what is best for them. Sort of the "Professional as expert" approach.
Here in Canada nurse must use the "professional as partner" approach.
Now how can a nurse form one system be successful in the other system if they do not know the basic underlying values and beliefs of the system?
In this respect nursing ins NOT nursing. In fact nursing is contextual to the society and the values of the health care system and in fact the large system of the society.

Things are quite different in many countries from how nursing is practiced in the US as well as Canada. We may see 40 to 60 patients if one is responsible for the patients in a nursing home, but to see 30 patients under one RN in an acute care hospital is just not going to happen. In the Philipines, there are usually 30 plus patients per nurse and the physicians are the ones that are responsible for the patient's assessment daily, not the nurse. Heart tones and breath sounds need to be learned when they come over here. It makes no difference about what is said, Thailand hospitals in the Bangkok area are actually some of the most advanced facilities that I have seen in SE Asia. They use much of the same physical equipment that we use in the US, including pumps, etc. Bangkok Hospital actually has a Gamma Knife as well, not all cities in the US have one of those.

The issue is that the training is quite different including responsibilities and then there are the issues with meds and lab values as well, and the addition of some diseases that are never seen there. One that easily comes to mind is Sickle Cell Anemia.

suzanne4, RN · Nov 29, 2008

suzzane4
You ask a great question. I am a philippines trained RN who has now been practicing in the United States for 18 years. My husband is also a nurse and teaches at our local community college. Your last post sounds as if you feel I do not have a good grasp of nursing or nursing in the Phillippines.
While nursing has become much more techno and equipment dependent I am not familiar with any nursing licsensure exams that deal with how to setup or to use equipment. If one has a firm grasp of the science and art of nursing they should be able to pass any exam and then be able to adapt to any environment they then go to work in. While yes you may be at a disadvantage by not having the toys to play with, nursing is still nursing.
For example, I did not use IV pumps in the Philippines before coming to the US. Once here I had to read and study and prepare myself for practice. When you talk of skills going to medical students and residents, we have that problem here in the US as well. I have had to precept many nurses who had little to no skills experience. They could write care plans and theorize with the best of them but they cannot take care of more than one patient at a time. I am seeing many new nurse grads with no to little clinical experiences. It takes a good hospital and a good preceptor training program to help the new nurse assimilate into the nursing profession.
Nursing schools in the philippines are about the money. Many young filipinos see nursing as the way to make it over here to the US. The schools know this and thus crank out as many as they can. Yes many schools employ inexperieced and poor instructors as many just teach until they get their paperwork complted to leave to work somewhere else.
My husband is an american trained nurse and he was not allowed to even start an IV in nursing school. He had to do that in orientation on his first job. Now as a college professor he has to struggle to get his students quality clinical experiences.
So no I do not think that just because someone has not played with the high tech toys that they are at that much of a disadvantage. If trained aND educated properly a nurse should be able to adapt to practice in any environment. Our problem back home in the philippines is that many who enter into nursing school are fed false hopes and exagerated expectations.
My point in all of this for anyone trying to come here to the US is to study and become an expert in the basics of nursing. Then stick to it and keep studying as long as it takes. Yes it is difficult but worth it!

You trained when things were quite different back there from what there is available now. That is the point that I am trying to make. There also were not 450 plus RN schools there or limited clinical experience as there is now for many. When you went to school, how many deliveries were you responsible for before you could take your exam and actually graduate? More like 50, if I remember correctly from that time, but now it is only five, and unfortunately I receive anecdotal notes quite often from those that have trained there about students not completing their requirements but actually going to the nursing offices in some facilities and actually buying information to complete their documentation. They never have in fact actually seen the patient or know anything else specific about them other than the information that is needed to complete the documentation to apply for licensure there.

Things have changed and not for the better. It is quite different from when you went to school for a start. Not one of your clinical instructors was a new grad that did not have any actual work experience as an RN but they are now teaching at the bedside and without the experience so that makes for a decrease in the skill level of everyone.

They are at a disadvantage when there is no work for them and without current clinical work experience, there is no way for many to be able to go to other countries to work and gain the experience first. Now with the US having the retrogression, there is going to be a long timeframe before anyone has a chance at a visa for the US, but we are still seeing posters quite frequently that want to know how they can get out of writing the NLE since they do not plan to work in the Philippines but with the long wait, where are they going to get to work? Every other country wants to see the local license, many others want to see paid work experience as well.

When I went to nursing school we did not have IV pumps and the first ones that came out did not have battery back up, they were only able to be plugged in so you could never use them for transport. Medications were mixed in a buretrol and they were eye-balled. That is not the issue that I am speaking of directly. Things have changed considerably in the US as well as other countries. It is much harder for one to get hired in another country since there are approximately 500,000 unemployed RNs at the moment and another 88,000 students have just written the exam or are in the process of writing it right now. When a facility is going to select an employee, they are going to want one that needs the least amount of training, they can pick and chose who they want; and they are doing exactly that. You also came to the US when there was a shortage of nurses and also when the H1-B was readily available. You were hired and then if you did not work out at that job, you were let go and it was easy to find a job at another facility. But that is most definitely not the case now. Even look at your students, I am sure that not are getting hired where they want or for the shifts that they want. There just are not enough new grad programs around in most cities here now. So if an American that does not need to go thru the immigration process and has trained in the US and is more than likely familiar with how things are done at the facility where they are applying to, what is going to happen to those that have no idea as to how things are done here? It comes down to money in the final stages of things, and with the changes in everything over here now, it is getting harder for a facility to wish to employ a foreign nurse that is going to need a longer orientation program. And this is not specific to starting IVs, but even having anything to do with them while they are in school. And I have had nurses that were hired by facilities that I worked at that could not draw a medication out of a vial or even give an IV med, this is something that every single student can do in the US. That tells me that there were issues with their clinical training at the very least.

You said it yourself, having a firm grasp as to how things should be done, that is the exact item that is sorely lacking from many of the programs there now.

Yes, I understand that so many of these schools have opened strictly to make money and nothing more, but tell me something. If the program that you were teaching in did not have one student that passed the NCLEX exam the first time, would that school still be licensed and operating in the US? No way. One of the reasons of the Exit HESI is to have the highest chance of the most of their students passing as this is what they are ranked on. If they cannot produce, they are put out of business. Yet, there are programs like this in the Philippines that seem to be able to remain open because of pay-offs to officials. This is actually a very well known fact.

Something needs to be done to the standards there that just are not the same. I am sure that if you went and spent a couple of weeks at some of the programs you would be in for rude awakening. This is my point, as well as the others here.

Ginger's Mom, MSN, RN · Nov 29, 2008

Suzanne, you mentioned Pedi drips and working with no IV pumps, I am part of that nursing generation. But there has been a huge Patient Safety movement in the USA and those practices have been deemed unsafe. Nursing needs to progress not regress to unsafe nursing practices.

IV pumps are not high tech toys, but a condition for Joint Commission Participation and part of the National Patient Safety Foundation.Beginning in 2003, the Joint Commission annually has released a number of National Patient Safety Goals, and mandated that all accredited healthcare organizations implement these goals. However, these efforts are more than just goals. They are mandatory practice changes modeled after best-practices throughout the world and supported by the Centers for Medicare and Medicaid Services. The goals, updated once a year, focus on a variety safety challenges that hospitals face on a daily basis and range from very simple to very complex.

Some international hospitals do adopt western standards, but I doubt that most foreign hospitals do ( I acknowledge some foreign hospital are Joint Commission Approved). Nursing is at point safe care is the standard.