The Curious State of Nursing Education in RP

[EwwThat'sNasty]

I recently answered a post that related to the introduction of the LPN classification and ended that post with this statement:

'I think that LPN is a desirable way to go, if and only if the quality of the graduate LPN is such that the NCLEX LPN exam overall pass rate is >80%! If this does not occur, I agree with the negative sentiment.'

The real problem as I (and clearly others) see is quality of education and the abysmal NLE pass rate country-wide in RP. During 2000-2004 only four RP colleges achieved the average pass rate that my no-name tiny American community college did. We averaged over the prior few years a >97% NCLEX pass rate, and my education was only a two year ADN (Associates Degree in Nursing) versus a four year course of study in the RP.

See: http://www.pcij.org/stories/2005/nursing-schools-performance1.pdf

Out of RP's entire 310 nursing schools in existence in 2004 only 12 achieved a reasonable pass rate (>89%) in my opinion. In 2006 there were 410 schools. That is a mere 3%.

That the RP Board of Nursing seems unable or unwilling to change this abysmal pass rate is evident by reading many prior posts. Supposedly there are 100,000 unemployed nurses in RP. I wonder if this is true. For if this is true we must assume that there is at least that number of nurses that failed the NLE and never even achieved RN status. (See above document: If only 73/410 schools achieved a >50% pass rate, then how many did not pass the NLE, for 337 schools saw a

I do not understand the reason for this nor do I understand why these schools are allowed to remain in business. Yet at the same time I shall not criticize for I do not understand the workings of RP. Arroyo's Nurses Assigned in Rural Areas (NARS) program is admirable. Bravo! Clearly RP is trying to address this problem and it is a dual one for the rural areas suffer.

But, if nurses must continue to pay to gain experience; if nurses must suffer through college with no acceptable connection to a hospital to gain meaningful experience; if student nurses must work with non-modern equipment; if there is insufficient money to feed its populace, then the country is faced with a condition of impossibility. Will the NARS nurses get adequate training--is this possible?

Then too RP's ways seem so odd to me. I cannot come and teach there, though I would for the experience, for free. I am not allowed to. I am not wanted. And too I have no BSN so regardless of my experiecne I cannot practice nursing there. I am not good enough.

The biggest singular cause of failure for RP nurses succeeding in America, from what I have heard is RP graduate nurses inability to cope with culture shock including "American" English.

Some years back the hospital where I worked in ICU, www.DHMC.org tried to import several groups of RP graduate nurses. From what I heard (though I do not know the exact facts) about 150 RP nurses were brought to America and were trained in group classes. They were not shoved out into the wards, they went through a multi-month training. Yet I heard that over half returned to RP. The reasons were inability to cope with the pace of learning; inability to transition to a different culture and difficulty with Americanized English. Though the program ended only two years before I worked there, I never once saw a single Asian nurse out of the 1000+ nurses there.

I do not know the answers to these problems, but I will point out that if an asteroid is going to hit the earth, and it is pushed sideways with only a few pounds of force, far enough away, it will miss the earth by millions of miles. It is simple physics.

None of us will change the world. But if enough of us become "change agents" even in small ways, the world will change.

The economic crisis will create devastation and it too will create opportunity.

Almost 10% of RP's national gross product (this term is inherently flawed, but I take it to mean the gross value of all goods and services in a year) is in remittances from RP's overseas workers returning money to RP. The sum is an astounding 738,000,000,000 peso or 15.7 billion US dollars.

Clearly RP's foreign workers including nurses are a treasure trove to the RP. I do not know why RP does not create a few medical centers for training, or even one. Build it in an area away from the top ten scoring colleges and/or ally lower scoring schools so that these schools can offer prospective nurses true clinical experience. Include teachers from England, Sweden, Australia, New Zealand, South Africa and maybe even some from America. There are many forms of English. Seek the best of the best graduates after they become experienced as educators for future nurses.

Let this medical center be both a development ground as a model for quality international medical tourism as well as it becoming a resource for those who must watch their parents or children die for want of the peso for medicine or the care that they cannot afford which seems all too often the case.

If successful this center can become profitable as the need for medical tourism is becoming and will become ever more needed due to the financial crisis, I fear, for the next decade or more. The experience afforded will raise the NLE scores, and offer true experience that is so necessary for the export of the many that would be employed RN's. Further the visitors who travel there for quality care will increase not only hospital revenue but also will spend coming there, staying there and leaving RP.

Though one hears of the potentially devastating and ill conceived "buy American" verbiage espoused by our President Obama we are one world, like it or not. New Zealand, America and other countries are faced with an ever aging population and even if the 'shortage of nurses' abates for awhile, the need for nurses worldwide will return and increase.

Arroyo's NAS program will cost

Were Arroyo to spend x amount to build a regional hospital/education center, there would be a real peso/dollar return. Further, the graduates from there would survive far more easily in foreign hospitals. Foreign medical tourists would spend getting there, staying there and leaving there. Multiple industries would see an increase in revenue. And the increase in exported quality trained/experienced RN's would return increased values in remittances, so why not? To me this seems win/win/win. The local populace would benefit both rich and poor. To me this seems an opportunity. Medical tourism returned over $20 billion dollars in 2005 worldwide (almost a trillion peso) and this will grow rapidly, especially due to the economic meltdown. RP has a small % of medical tourism income but its unique position as an English speaking/accommodating country places it is an extremely opportunistic spot to capitalize on growth.

Further, I suggest that RP ought to do something like this as its own stimulus. I predict that this economic meltdown will devastate so many countries including RP. I predict that waves of RP foreign workers will return home, forced out by the devastation this crisis wreaks. I predict that would-wide people will start to starve, unless we as a word wakes up.

Fertilizer sales have plummeted. As a result crop yields will turn erratic. There will be surpluses in some areas (vegetable oils/and grains formerly used for alcohol conversion) but as surplus drops the commodity price, overreaction might cause remarkable shortages and this may well lead to starvation.

I am ashamed that America espouses stimulus projects of bridges and railways (including a high speed railway from the richest American county in California to the gambling center Las Vegas) and has not uttered a word about: 'let's make sure that fertilizer trade continues,' 'let's make sure that crop shortages do not result in wide-spread famine.' No, we belch words as though making 10,000 construction flag-people, or cement pourers really will improve our state of being. (Note: I do not mean to make fun of professional cement workers. I can talk 'crete fairly well, and tell you which super-plasticizer to use to drop the slump to achieve a good pour and still maintain compressive strength. But will creating ten thousand new cement workers lead to a sustainable quality new America--I think not).

I do applaud recent comments about potential food shortages from England, bravo!

In short, if or when you start to agree, become a change agent, if you can, even in small ways. We are nurses for many reasons but one prime reason is that we are compassionate. If these words have sparked a reaction in a single reader than my reason for writing this has been met.

Thank you.

[meluhn]

I am surprised by what your saying about the lousy nsg schools in the Phillipines. I work with many many nurses from the Phillipines and they all seem perfectly competent.

[EwwThat'sNasty]

You are working with the top few percent. You never see the tens of thousands that go into debt to study essentially with little or no chance and ever becoming a practicing RN.

The document is not something that I made up. It is quite real, look at it. Yes there are 27/410 who afford a good nursing education, and afford alliance with a practicing hospital, but there is a huge number with a

I am not implying in the least that RP nurses are incompetent. Many that I have talked to can pass the NCLEX quite handily when I ask questions. But many fork over their life savings, or that of their parents, and in some cases literally mortgage "the farm," with essentially a zero chance of ever finding a true job.

What I say is simply an observation, and that upon 2000-2004 data. But from what have read here the number of schools have ballooned while the number who achieve a greater than >80% pass rate has not.

It is the situation that I question, not the individuals.

[NurseCubanitaRN2b, BSN, RN]

I have to agree, there are many competent Filipino nurses, however they received their education when it was superior...I've worked with many incompetent Filipino nurses who have (or supposedly) graduated within the last few years, and you can tell that they are lacking when it comes to critical thinking, medication, and your basic procedures. It's not their fault...They weren't taught properly...

[Hoss]

The worm is beginning to turn in Nursing Education here in the P.I., in that I believe intelligent recruiters are looking at WHAT school you graduated along with NLE exam rankings in assesing the training a new Nurse has received. The consistently top ranked 30 or 40 schools will be where the the recruiters will seek new hires.

CHED has made an attempt to shut down poor performing schools and were stopped cold by the courts. Injunctions and restraining orders were issued and the efforts to close these money grubbers failed at the start due to the "economic" considerations the courts seem to feel override the "quality education" aspect of training nurses. PITIFUL INDEED!

However, the past 5 or so years CHED has been ranking the schools themselves, along with the NLE passers, so that it is possible to see the numbers of failing schools. New Hires may very well be judged on the schools overall performance as well as the individuals academic and clinical gradings.

The newspapers are printing these school rankings, forums like ALLNURSES are posting the results as well, and I believe that it will be a challenge to students to carefully choose where you attend nursing school in the Philippines.

"From what school did you graduate?" will be a very heavily weighted question by competent recruiters.

IMHO

Hoss

[judeamaria, RN]

Wow, it seems to me you went to great pains in doing research on nursing in RP and even on our GNP. Very interesting post. Anyway, I agree with you on being a change agent. Indeed, small things can make a difference. I believe there are still nurses here who does that and probably unnoticed.

With regards to your suggestion on medical tourism, The Department of Health(DOH) has started a program to promote medical tourism in RP years back. Also, I've read in the news that one hospital was approved by DOH as their full medical tourism partner. It's St. Luke's Medical Center. Other hospitals are following suit though most of them are private ones.

With regards to your idea on a medical center that would be training ground for the new nurses, I don't know if it's feasible coz the budget that the government is alloting for healthcare in the country is enough for its needs at the moment. It seems health care is not in their priority. Also, just by looking at the abysmal state of most government hospitals in the Phils, I think we should just improve first on the existing hospitals before starting a new one.