Nursing crisis is here and getting worse

Column box-Dr. Carl E. Balita-Entrepreneurs’ Footprints

IT is alarming when a developed country is offering thousands of scholarships to Filipino nursing students so they can immediately migrate to work after passing the Nurses Licensure Examination. Worse is when developed countries are actively recruiting nursing students to pursue and finish their nursing education in a host country, which ensures the supply of nursing human resource. Who would refuse scholarships? Who would not want to obtain a college diploma in a developed country?

Worst of all is the fact that all of these are happening at a time when even the highest paying government specialty hospitals are having high attrition rates ranging from 16 to 27 percent due to nurses’ migration. The private hospitals are trying their best compete but can hardly match the law-mandated salaries and benefits in government hospitals.  Moreover, nurses’ salary in pesos can’t compare with the offers of developed countries, especially when converted to Philippine currency.

The Filipino nurses are the best for the Filipinos and the choice of the world, as envisioned in the Philippine Nursing Roadmap. 

The nursing shortage

Based on the WHO’s State of the World’s Nursing Report in 2020, the world will be short of 5.6 million nurses by 2030. The pandemic increased the health care demand and added strain on the human resource supply.

The recent DOH report said that the Philippines is short of 92,000 physicians and 44,000 nurses. 

But for the past 20 years, the Professional Regulation Commission has registered 606,428 nurses and 55,783 physicians. Prior to the pandemic, an average of 30,000 nurses are registered a year for the past 20 years, and there seems to be no reason for the country to have scarcity of nurses, if only we give our Filipino nurses reasons to stay in nursing and in the country.   

All these reveal that the problem is not really a shortage of nurses. On the contrary, we have a surplus of competent nurses. What we lack is societal compassion and the initiative to pay attention to healthcare workers’ needs and provide immediate sustainable solutions.

Migration is nurses’ right

There were issues during the pandemic about the migration cap that government imposed. But nurses have the right to pursue professional achievement through career mobility and to better the circumstances in which they live and work. Migration of nurses offers potential beneficial outcomes, including multicultural practice and enhanced learning opportunities.

However, a range of ‘push’ and ‘pull’ factors exist that lead nurses to seek employment outside of their country of origin. Examples of push factors include low pay, pay discrimination, poorly funded health systems and unfavorable working conditions. Destination countries often have pull factors, such as better salaries and conditions of employment, and career development opportunities.

Ethics in international migration

The WHO notes that the imbalances in funding between rich and poor countries means there is an increased risk of unscrupulous international recruitment that fails to adhere to ethical principles and leaves vulnerable health systems stripped of their most valuable asset, qualified nurses. It is crucial that all countries train and retain more of their own nurses and implement ethical recruitment practices when they employ nurses from overseas.

The WHO Global Code of Practice on the International Recruitment of Health Personnel establishes and promotes voluntary principles and practices for the ethical international recruitment of health personnel and the strengthening of health systems, including effective health workforce planning, education and retention strategies. As highlighted in the Code, the goal for all countries should be to have a sustainable national nursing workforce that focuses on a stable core of domestically educated nurses, while acknowledging and enabling the contribution of IENs and other health professionals.

The International Council of Nurses, in its position paper, condemns the targeted recruitment of nurses from countries or areas within countries that are experiencing a chronic shortage of nurses and/or a temporary health crisis in which nurses are needed. It acknowledges the adverse effects that international migration of nurses and other health professionals may have on healthcare quality in countries seriously depleted of their nursing workforce.

The proposed solutions

The WHO recommends that countries need to invest in massive acceleration of nursing education, create at least 6 million new nursing jobs by 2030 and strengthen nurse leadership.  

Investments in education, in all health science courses, are long-term solutions in forms of scholarships and subsidy for public and private institutions offering these health courses. Scholarships in graduate studies are needed to supply the scarce qualified instructors and educators in various areas of health sciences.   

The government needs to create and fill up plantilla positions for various nursing positions cognizant of the nurse-patient ratio, which is scientifically based on the acuity of care. The Nurse Deployment Program should be shifted to a more sustainable investment in health human resource that provides for security of tenure and positive practice environment. 

There may be a need to have a National Chief Nurse position in the Department of Health. Government may need to subsidize the private hospitals, specifically in their human resource development, to cushion the increasing cost of health care. 

In the short-term, there are solutions to increase the supply of healthcare professionals, specific to nursing, which may also provide for models in other health care disciplines. It includes the strengthening of the Expanded Tertiary Education Equivalency and Accreditation in nursing. Scholarships and subsidies should be provided for the drop-outs in nursing schools due to financial reasons. The Nurses Licensure Examination Competency Enrichment Programs may be institutionalized by the Centers of Excellence and Centers of Development among nursing colleges and universities, as an extension service to nursing graduates. There is a need to create a Bridging Program for those RNs who have left the practice of nursing and shifted to BPO, airline services, business, etc. We may also engage the repatriated overseas Filipinos who were health care workers abroad.

As Filipino nurses celebrate the 100 foundation years of the Philippines Nurses Association, we need to address the crisis before it is too late. 

For feedback, please send e-mail to drcarlbalita@yahoo.com.

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