What is the Phillipine 'secret'?

pickledpepperRN · Feb 9, 2004

I admit to not having all the facts. There are two issues that concern me.

1. Nurses working in the USA from other countries need to be treated fairly. They need to be free to advocate for their patients without fear of deportartion. They need the same wages and benefits as their American counterparts.

2. With high unemployment and long waiting lists for admission to schools of nursing we need to bring back the entry level BSN and ADN programs and create more opportunities for quality nursing education. Perhaps CNA to LP/VN to RN to BSN programs.

roxannekkb · Feb 9, 2004

Originally posted by -jt

That may be a common misconception. There was a news article posted here a while back that quoted Phillipine officials as saying their country is being depleted of nurses, it cant keep up with the demand (not just from the US but from the West), and it is experiencing its own "brain drain" and shortage. A search here might be able to pull that article up again.

It is a misconception. The PHilippines is being depleted of all of its experienced nurses. It is becoming a very big problem, as more nurses are leaving the country than are graduating each year. In fact, recruiters are now moving on to India, which is "wide open."

While I can certainly sympathize with nurses in developing nations who earn a pittance and want to work overseas, "first world" nations need to solve their own nursing problems. And not by siphoning off much needed staff from developing nations. This is becoming a tremendous problem worldwide. Instead of fixing the problems which are causing nursing shortages in places like the US and the UK, we are bringing in foreign nurses, who are bound by 2 and 3 year contracts to stay on the job. Since even the worst of our conditions are far superior to what they have back home, they are highly unlikely to complain and make demands.

pickledpepperRN · Feb 9, 2004

Well Dave:

We may be mistaken on the "brain drain" or too many nurses leaving the Philippines.

Anecdotally I think we ARE right in that there are many assertive effective patient advocates among Filipino nurses.

Tweety, BSN, RN · Feb 9, 2004

Originally posted by roxannekkb
It is a misconception. The PHilippines is being depleted of all of its experienced nurses. It is becoming a very big problem, as more nurses are leaving the country than are graduating each year. In fact, recruiters are now moving on to India, which is "wide open."

True, our hospital got a stack of applications from nurses in India wanting to work in Florida. I'm not sure if any of them got positions (see my other post for that at our management's like of insight into hiring available nurses).

Is your statement that they are being depleted of "all their experienced nurses" a bit of an exaggeration? Or is it truly that serious.

Dplear · Feb 9, 2004

I do personally know first hand the implications of the nurses leaving the Philippines...they ARE NOT causing a "brain drain" there. They do have many nursing schools there and they put out plenty of nurses. I have several inlaws that are nurses, doctors and even a hospital administrator and they have no shortage of nurses. In fact for many nurses right now it is HARD to find a job there. As fopr India. It always has been a fertile recruitment grounds for english speaking (abiet with a funny brit accent) NURSES.

Dave

roxannekkb · Feb 9, 2004

Originally posted by Dplear
I do personally know first hand the implications of the nurses leaving the Philippines...they ARE NOT causing a "brain drain" there. They do have many nursing schools there and they put out plenty of nurses. I have several inlaws that are nurses, doctors and even a hospital administrator and they have no shortage of nurses. In fact for many nurses right now it is HARD to find a job there. As fopr India. It always has been a fertile recruitment grounds for english speaking (abiet with a funny brit accent) NURSES.

Dave

I do have to disagree with you, and can send you information on it if you wish. I am in fact, writing an article on the subject of "nurse poaching" right now.

The Philippine economy depends heavily on exporting labor overseas, all kinds of labor--from highly skilled to low skilled. The money that they send up really keeps the economy there alive. In the case of nurses, they do train a lot of nurses. However, the nation is losing its experienced nurses. It is a major problem, and one of great concern. It is a brain drain. In fact, another problem is that many doctors are training as nurses, and then also leaving the country to work overseas.

There are still enough "warm bodies" to work in the Philippines. But after one or two years experience, 70% or more of the nurses leave the country. I don't know what your relatives have said, I can't debate with them. However, the situation is devastating enough that health officials, nursing school deans, universities and hospitals are all very concerned.

And the move to India, to take their nurses, came about in part because many recruiters believe that the Philippines is starting to "run dry" of experienced nurses.

The US isn't the only nation recruiting. Phillipine nurses are being recruited to the UK, to Canada, to various nations in Europe, to the Persian Gulf...

roxannekkb · Feb 9, 2004

Here is just one article from the Manilla Times, from last March.

Wednesday, March 26, 2003

Global congress to tackle nursing crisis in RP

By Jeremaiah M. Opiniano, OFW

Journalism Consortium

A forthcoming international conference on the global mobility of nurses hopes to deal with what local health experts and nurses see as a "nursing crisis" hitting not just the Philippines but the world.

The Nurses' Global Congress, to be held at the Manila Midtown Hotel from March 26 to 28, is expected to attract more than 300 local participants from medical associations, nursing schools, hospitals, government agencies, recruiters and civil society groups.

Organized by the Philippine Nurses' Association, the conference, "Nurses' Mobility: A Global Congress," intends to provide comprehensive, integrated and updated information about the global nursing shortage. The conference will carry the theme "Confronting the Nursing Shortage: The asean Perspective."A worsening health crisis.

At the rate the country is losing its skilled nurses to developed nations, and with the government's helplessness in offering strategic solutions, Dr. Jaime Z. Galvez-Tan, University of the Philippines-Manila vice chancellor, warned, "Expect a worsening of the health crisis already plaguing our country.""Very soon, the Philippines will be bled dry of nurses. Sadly, this is no longer a 'brain drain' but, more appropriately, 'brain hemorrhage,'" wrote Galvez-Tan in an unpublished paper titled "The National Nursing Crisis: Seven Strategic Solutions."

. Galvez-Tan, a "doctor to the barrios" in Samar during the 1970s, said that the local salaries of nurses and even doctors could never compete with the pay offered by foreign recruiters. He noted that nurses here get only US$150 to $250 a month compared with US$3,000 to 4,000 a month they could earn abroad. He called the US$300 to $800 take-home pay of doctors in the Philippines "a pittance."

Higher pay abroad

Higher pay abroad is the usual reason why local nurses get on the migration bandwagon, said Arturo Butaran, president of the PNA Zambales chapter, in a telephone interview.Although President Arroyo signed the 2002 Nursing Act, which increases the monthly salaries of public-hospital nurses from P9,000 to P15,000, Butaran said the exodus has continued. Butaran himself worked as a nurse for a government-run hospital in Riyadh, Saudi Arabia from 1984 to 1996. Even with the higher pay, Buturan says the majority of his nursing staff of 30 at the Public Health and Safety Group of the Subic Bay Metropolitan Authority have applied for work abroad. Although replacements are easy to find, he pointed out, those who leave are the skilled and trained, while those who replace them are fresh graduates who have yet to gain hospital experience.

Repeat of a '70s phenomenon

According to an article, "Analysis of Policy Options in Addressing Nursing Surplus and Globalization Effects in the Philippines" (Lorenzo et al.), published in the University of the Philippines Manila Journal (January-March 2000 issue), the current exodus of Filipino nurses is a repeat of the phenomenon in 1977, when the Middle East market opened up for Filipino caregivers, and countries such as the United States were looking for Filipino nurses.

When the foreign nursing market closed in 1999 and an oversupply of nurses occurred on the domestic front, the government allowed an accelerated nursing outflow especially to the United Kingdom. Some 10,720 nurses were deployed in the UK in 2001, a 120.3- percent increase from the 4,867 workers deployed in 2000, according to the Philippine Embassy in London. On May 29, 2001, the Department of Labor and Employment and the Philippine Overseas Employment Administration said in a press release that 33,964 nurses were deployed abroad from 1995 to 2000. In 2001 alone, the figure was 13,536. Galvez-Tan said the international demand, brought about by a global shortage of nurses, will last another 10 to 15 years. The US alone, he said, needs 10,000 new nurses annually--the same volume needed by the UK, Ireland, the Netherlands and the rest of Europe.

Aging populations in Western countries and the refusal of young people to take up nursing jobs due to "relatively difficult and riskier working conditions" have made these countries look to developing countries for caregivers. The great demand for nurses has encouraged doctors to train as nurses to be able to secure lucrative work abroad. Government agencies place the current number of doctors turned nurses at 2,000, which Dr. Galvez-Tan said represents a heavy loss to the country's health system.

Victim: the country's health system?

Galvez-Tan and Butaran are concerned about the effect of the nursing exodus on the country's health system. Butaran said health services in Zambales are already being affected by the exodus; his staff at the Public Health and Safety Group is having difficulty handling too many patients. He predicted that nurses stationed in Zambales' primary health facilities--barangay health centers, rural health units and urban health centers--will soon begin to feel the pressure of having to attend to the needs of so many patients. There is less than one nurse--0.4--for every 1,000 population in the Philippines, according to the book Health Sector Reform in Asia and the Pacific: Options for Developing Countries, published by the Asian Development Bank. The data further indicate that there is only 0.1 doctor and 1.4 hospital beds for every 1,000 Filipinos.In a recent article, "Nursing exodus weakens developing world" by Akhilesh Upadhyay carried by Inter Press Service, the World Health Organization (WHO) warned that health care in developing nations could be damaged as those nations continue to lose medical workers to industrialized nations."If the world's public health community does not correct this trend, the ability of many health systems to function will be seriously jeopardized," WHO Director General Gro Harlem Brundtland said in October.

Oversupply of nursing schools

The Philippines is known to produce more nursing graduates, and have more nursing schools, than any other country in the world. From 17 schools during 1907 to 1950 that produced 7,286 registered nurses, the country in 1999 had 186 nursing schools with the combined capability to produce more than 20,000 nurses a year, according to the UP Manila Journal (January-March 2000 issue; Corcega et al.).The oversupply of nurses, the authors wrote, incurs societal losses worth P28.9 billion: P2.2 billion for state nursing schools, which produce 10.7 percent of the total number of nurses, and P26.7 billion for private nursing schools, which produce 89.3 percent of the country's nurses. The problem involves not only the overproduction of nurses but also training institutions that were hastily established to meet the increase in demand, the article added. Nevertheless, Labor Secretary Patricia Sto. Tomas hopes to make the Philippines a global leader in the supply of health service personnel. In a speech before the Third National Conference on Health Education in UP Manila in October 2002, Sto. Tomas said the Philippines must not stop the deployment of nurses and should "aim for higher international standards.

"Filipino nurses, she added, are "very hardworking, adept, compassionate, and known for their eye on details." In a labor department press release (May 29, 2001), Sto. Tomas is quoted saying: "Filipino nurses are a group of highly acclaimed professionals who deserve to be emulated by others wishing to work overseas."

Tweety, BSN, RN · Feb 9, 2004

roxannekkb, thanks for the article, it was very interesting.

The last paragraph that more nursing schools evolved to meet the demand is interesting. Wish we could make that kind of commitment here, since there seems to be waiting lists for nursing schools.

It was interesting to note that when the market dried briefly abroad, it didn't seem long before the Phillipines had a glut of nurses. Another indication that they are deliberately a "factory" to produce nurses for abroad. Seems like though they've gone overboard.

roxannekkb · Feb 10, 2004

Originally posted by 3rdShiftGuy
roxannekkb, thanks for the article, it was very interesting.

The last paragraph that more nursing schools evolved to meet the demand is interesting. Wish we could make that kind of commitment here, since there seems to be waiting lists for nursing schools.

It was interesting to note that when the market dried briefly abroad, it didn't seem long before the Phillipines had a glut of nurses. Another indication that they are deliberately a "factory" to produce nurses for abroad. Seems like though they've gone overboard.

One of the problems in "mass producing" schools is that they do not meet the standards of accredidation, and students are not passing the boards in the Philippines. They cannot get licensed to work in the Philippines; therefore, they're not going overseas anytime soon.

They also have a shortage of qualified teachers there, since again, most of their experienced nurses are leaving the country.

Factory style education is not the answer. Not there, not here.

The main problem in the US is retaining nurses, not training them. We could double the number of US trained nurses, but unless working conditions change, the same percentage will be leaving.

roxannekkb · Feb 10, 2004

Here's another article about it.

Health experts, nurses call for policies to curb effects of migration on local health system

by JEREMAIAH M. OPINIANO

OFW Journalism Consortium

LOCAL health experts and nurses are calling for policies and benefit packages that will hopefully contain the effect of the international mobility of Filipino nurses on the country's health situation.

Participants at the international gathering on 'Nurses Mobility: A Global Congress' outlined strategies to help develop nursing locally even as the Philippines tries to fill a widening global shortage of these health professionals in developed countries.

Participants called for the creation of a National Commission on Health Human Resource Development, which would be a multi-sectoral body involved in nursing and medical human resources development through policy review and development.

Bilateral packages for local nursing development

The congress also urged bilateral negotiations with Northern countries importing Filipino nurses, such as the United States, United Kingdom, Saudi Arabia, the Republic of Ireland and the Netherlands to give the Philippines the opportunity to lobby for standards that will benefit both sending and receiving countries.

Through these bilateral negotiations, Dr. Jaime Galvez-Tan of the University of the Philippines-Manila said the Philippine government can ask for aid packages for nurses' training, the upgrading of nursing education, increases in nurses' remuneration, and nursing scholarships.

North-South hospital-to-hospital partnerships were also encouraged, where local hospitals can ask for remuneration for every nurse recruited from them.

Through this setup, the local hospitals will become a training ground for the needs of these foreign hospitals, said Roselle Aguerra, a nurse administrator at a private hospital in Batangas province.

"Foreign hospitals will negotiate with us, since local hospitals will be affected as we will have problems with regard to staffing," Aguerra said. She even proffered the suggestion that hospital nurses, if hired by their foreign counterparts, should be given a six-month leave to return and train local hospital's nurses.

Galvez-Tan said this arrangement is only just, since hospitals from developed countries "do not spend a single centavo in the production, development, education and licensure of Filipino nurses."

"They should be able to pay partially, if not fully, the cost of (the country's) nursing development since they are going to benefit from the services of those nurses for at least 25 years," added Galvez-Tan, who presented the paper, "The National Nursing Crisis: Nine Strategic Solutions" during the congress.

Institution of a National Health Service Act

The institution of a National Health Service Act (NHSA) was also proposed as a solution, even as there were complaints about a provision that calls on graduates from public-run nursing schools to serve locally for a number of years equivalent to their years of study.

Despite the criticism, Galvez-Tan said this approach would enable the country "to program scientifically the exit of our health professionals, thus ensuring a steady maintenance of health human resources in all health facilities, whether rural or urban."

The participants, among whom were members of the Philippine Nursing Association (PNA), the main conference organizer, also agreed to establish Philippine nursing registries that will serve as an information clearinghouse for the needs of nurses.

The nursing registries will negotiate for better remuneration, benefits, and working conditions so that "nursing welfare is high on its agenda," Galvez-Tan said.

Nursing consultant Lydia Cabigao of the Dr. Jesus Delgado Memorial Hospital said PNA must "exercise police power to prevent work-related exploitation," since there are local hospitals that do not offer salaries to nurses in exchange for volunteerism and residency requirements, compelling them to find opportunities overseas.

"Nursing directors should understand this very well. From a hospital point of view, I would not accept any (form of) voluntarism since you cannot give them responsibility. If they commit errors, who will be responsible?" Cabigon asked.

There will also be efforts to expand current nursing residency and practitioner-training programs that will focus on specialized areas such as intensive-care nursing, operating-room nursing, and psychiatric nursing.

National Council for Nursing Concerns

Participants also called for the creation of a Philippine National Council for Nursing Concerns that will become an oversight body for the implementation of all nursing policies, legislation, and regulations.

The congress delegates also called on President Gloria Macapagal-Arroyo to appoint a new undersecretary at the Department of Health (DOH) who will focus on nursing concerns, and who will chair the proposed council for nursing concerns.

Participants also vowed to pursue the active participation of the Philippines in international bodies such as the World Health Organization (WHO), which plans to formulate task forces to address the global nursing shortage.

Another strategic solution identified by the participants was the creation of one-stop shops or centers where all concerned government agencies will meet and provide information on the country's nursing concerns.

Absence of efforts from DOH?

Galvez-Tan lamented the absence of efforts from the DOH to meet and discuss the nursing mobility issue. Karen Castaneda of the Commission on Higher Education (CHEd) did say, however, that Health secretary Manuel Dayrit called for an inter-agency meeting early March, "and this will now meet regularly".

While he does not find anything wrong with the international mobility of Filipino nurses, Galvez-Tan said the Philippines should demand "just and fair terms-plus equity-in terms of nursing welfare" in the Philippines.

"They (foreign countries and hospitals) will give in because we have the skills and they need us," said nursing administrator Jesusa Chua of the Philippine General Hospital (PGH).

The nursing congress, held March 26 to 28 at the Manila Midtown Hotel, attracted over 500 participants. It was called to address the growing domestic shortage of nurses given the fact that the country continues to send Filipino nurses abroad.

Filipino nurses in demand

According to DOH, the country has produced 337,939 registered nurses in the last ten-years (1991-2000).

An article in the UP Manila Journal reported that 178,045 nurses are in demand in local and international markets. The bulk goes to the international market (150,865 jobs, or 84.75 percent), and the rest to local markets (27,160, or 15.25 percent).

Of the local nurses, 17,547 jobs are employed in various government agencies, 7,535 in privately run health facilities, and 2,078 in nursing educational institutions.

The Philippine Overseas Employment Administration (POEA) said some 33,964 nurses were deployed abroad from 1995 to 2000. In 2001 alone, the figure was 13,536, or 39.85 percent of the 1995 to 2000 deployment figures.

From January to August 2002, POEA deployed 7,855 nurses. The years 2000 and 2001 saw the opening of the market for nurses in the United Kingdom, aside the Netherlands and other European countries, and the United States.

Nurse-to-patient ratio

PNA president Ruth Padilla said that locally, nurses earn an average of P9,000 a month, with rural nurses earning even lower--from P4,000 to 5,500. In terms of nurse-to-patient ratio, Padilla said, one nurse caters to 30 to 50 patients.

Joy Sison de Guzman, vice-chair of Migrante International pointed out that if there are 4,274 public nurses working in local government units, and these are divided by the total population and number of barangays, there is one nurse for every 16,723 Filipinos, and approximately one nurse for every nine barangays.

Kathleen Fritsch of the World Health Organization (WHO) said there are "severe nursing shortages" worldwide, especially in the developed countries and in African states, because of an aging workforce and the countries' demographic and epidemiological needs.

This situation will compel the continued international mobility of nurses, said Fritsch, regional adviser for nursing of WHO's West Pacific Regional Office. For her part, Padilla predicted that the global shortage will rise to a million nurses by the year 2020.

Recruiting with reservations

Filipino-American nursing administrator Virginia Alinsao of the Johns Hopkins University Hospital in Baltimore, Maryland said her hospital went into recruiting nurses from developing countries "with lots of reservations." She wondered, "Are we taking the best? What will we (at Hopkins) do in exchange for that?"

While Alinsao is sensitive to the impact of nurses' migration on Philippine hospitals, Alinsao said that nurses who opt to leave should also get, prior to departure, training relevant to the hospitals they plan to serve abroad.

"You are doing a disservice if you are not subjecting yourself to hospital experience here," said Alinsao, director for International Nursing Recruitment at the Johns Hopkins Health System.

Is there really a global shortage?

But Migrante's de Guzman, who has held consultations with nurses' unions in the receiving countries, does not believe that there is a global shortage, aside from the fact that Filipino nurses "also experience the brunt of capitalist exploitation".

She called on stakeholders "to analyze the shortage of nurses beyond the numbers."

For his part, director Ricardo Casco of the Philippine Overseas Employment Administration said his agency is in a "promotion perspective" in terms of nursing outflow. Casco said, however, that while the migration culture is hard to reverse, nurses "must remember the sense of mission as professionals by looking at the impact of their exodus on the country's health system".

Galvez-Tan said piecemeal solutions will not work anymore to address the global mobility of nurses, and this should not only benefit a few countries. He also favors the "programmed departure of Filipino nurses".

"The global mobility of nurses, Filipinos included, really requires strategic thinking and long term approaches. Big resources are gained here. And I think the government should invest the economic returns we get from nurses' overseas work on nursing policies, protection and development," Galvez-Tan said. OFW Journalism Consortium

-jt · Feb 10, 2004

>

Thanks for re-posting that article.

Tweety, BSN, RN · Feb 10, 2004

Thanks Roxanne. I appreciate the insight. It's not a pretty picture when you look at it.

I also hear you loud and clear, that if we could just retain nurses and get the hospitals to hire them and pay them, then we'd be o.k. here as well.