Keeping Her Home

2002 Nursing Act tries to plug the brain drain, but will it work?

By Dennis Gadil

A projected remittance of US$8 billion by yearend, a significant portion of which comes from overseas Filipino nurses, and success stories of Filipino nurses doing great abroad could be the best arguments against passing a measure that would discourage nurses and caregivers from going overseas.

    But despite the staggering figure, Congress believes that something must be done soon before we lose our best nurses and doctors to foreign employers. Only this October, Congress passed the proposed Nursing Act of 2002. In signing the measure, President Gloria Arroyo hailed it as "a landmark law" that provides for the expansion of the nurse's role in the medical profession. The new law repealed Republic Act 7164 or the Philippine Nursing Act of 1991.

    Bill proponents from the House and Senate agree that bold measures must be instituted to stop the flight of Filipino nurses that has drained the country of vital human talent.

    House minority leader Carlos Padilla (Nueva Vizcaya) and Rep. Eduardo Nachura (Samar) said the preference of Filipino nurses to work abroad is enough reason to revisit existing laws and policies on the nursing profession. Senate president pro tempore Juan Flavier, who chairs the Senate health committee, said the signs were up that the country might soon face a shortage of qualified nurses unless Congress applied the needed remedies.

    House civil service chair Rep. Eladio Jala (Bohol), who steered the measure's passage in the House, said government nurses and doctors would be the next important civil servants to teachers as the country's health needs surge ahead owing to the growing population and the simultaneous decay of the environment. Jala said the health service sector should be nourished and protected if government leaders want to depend on them during times of national emergency and crisis.

All About Money

    One of the danger signals is that the country's hospitals would run out of nurses in the next five years if no incentives were put in place to make the local nursing profession more attractive and financially rewarding. The bottom line is that hospitals in the United States and Europe offer much higher wages to Asian nurses especially Filipinos, whose competitive edge in the international labor market may be seen in the number of print advertisements put out in Manila by foreign hospitals looking for recruits.

    Veteran nurse of 32 years Aida Llegado says the demand for Filipino nurses abroad must be so strong and urgent that foreign hospitals no longer just wait for immigrant nurses to come to them but are aggressively wooing them right here. She cited a posh California hospital that earlier looked down on employing Asian nurses but is now sending agents in the country to recruit Filipino nurses.

    Llegado attributed the sudden rise in the need for Filipino nurses to the dearth in qualified nurses in the US and Europe after their citizens stopped enrolling in nursing schools when AIDS made headlines.

    Llegado, a former clinical instructor, says money is the primary reason why nurses leave the country. "Siguro kahit taasan pa ang suweldo ng nurses, aalis pa rin sila dahil mataas talaga ang kikitain nila sa abroad, plus the prospect of bringing their families there," she says. She herself was lured by the prospect of earning dollars when she went to Canada to work for a hospital in Vancouver from 1974 to 1978. Llegado noted that back then, only 50 Filipino nurses were working in the Vancouver hospital. But when she came back early this year to visit some relatives, she found that most of the big hospitals there are staffed with Filipino nurses.

    As a consolation, some of these nurses have returned to get a retraining course and attend nursing seminars to hone their skills and land a promotion in the foreign hospital they work for. "They still see our nursing program here better than those offered abroad," Llegado says.

    Llegado plans to return to Canada next year and practice her profession. She and her family may also opt to stay there for good. If her plans push through, Llegado would be another statistic in the growing list of Filipino nurses lost to foreign shores.

    Official figures show that from January to May this year, about 4,700 Filipino nurses have left for overseas jobs. The figure represents 85 percent of this year's nursing graduates. In 2001, more than 14,000 nurses left for jobs in foreign hospitals and private nursing homes. Nursing and other allied courses like medical technology and physical therapy are now the most preferred courses in college next to information technology.

    Also, from January to July 2002, dollar remittances of overseas Filipino workers including nurses totaled $4.26 billion.

    With the prospect of earning dollars and relatively easy employment, more Filipino doctors have decided to shift profession by enrolling in nursing courses just to gain employment abroad.

    A small hospital in Metro Manila might just close shop if it fails to find replacement for their doctors and nurses who have left or are about to leave for jobs abroad.

Raising the Grade

    To government leaders and lawmakers, these alarming facts justify passing a law to plug the brain drain.

    For one, the 2002 Nursing Act raises the salary grade of public sector nurses from the current eight or nine to 15. That translates into a pay of at least Php15,810 a month compared to the current Php8,709 to Php9,318. The law also encourages private hospitals to calibrate their salary schedule with the prescribed rate in the public sector.

    But salary adjustment will have to take a backseat since the proposed 2003 National Budget does not have any appropriation for pay hike of government nurses. "Unfortunately the Nursing Act was signed after the proposed budget was submitted," House appropriations chair Rolando Andaya Jr. (Camarines Sur) lamented.

    To correct the situation, Rep. Andaya said Malacanang must submit a supplemental budget that would make way for the law's implementation. Or, the pay hikes of nurses can be charged against the Internal Revenue Allotment (IRA) shares of local government units, which have assumed control of public hospitals and health centers under the health devolution program.

    Andaya, however, warned that the additional budget obligation would find strong resistance from local government officials who are still protesting the delay in the release of their IRA funds after the national government decided to freeze it to plug the ballooning budget deficit.

    Secondly, the Nursing Act mandates the regular retraining of public nurses under the so called Comprehensive Nursing Specialty Program to be funded by the Philippine Charity Sweepstakes Office and Philippine Amusement and Gaming Corporation.

    The program aims to upgrade the level of skill and competence of government nurses in the country and bring them to par with their international counterparts. The Department of Health (DoH) and the Nursing Board will design the curriculum and modules with inputs from nursing organizations.

    To ensure that government money does not go to waste, beneficiaries of the special training are required to serve for two uninterrupted years in a government hospital before they could work for a private institution or abroad.

    The retraining, however, is limited, since only 10 percent of total nurses in government hospitals would benefit annually. National Statistics Office records for 2001 show 4,945 nurses serve in government hospitals and health centers all over the country with at least 849 assigned in the National Capital Region.

    The Nursing Act of 2002 also provides incentives and benefits-free medical care for nurses and their families, scholarship grants, and other noncash benefits-to government nurses who opt to stay in the country. It also mandates private and public hospitals to ease the load and improve the working environment of nurses by achieving a one-to-one nurse-patient ratio.

    To lure inactive and non practicing nurses back, a one-month didactic retraining and a three-month practicum would be offered to those who have not practiced for five years.

    But just like any good idea, the law would be reduced to a mere piece of paper if not effectively implemented by the concerned government agency. So Congress created a separate regulatory body outside the Professional Regulation Commission (PRC) to oversee the nursing profession.

    The Professional Regulatory Board of Nursing or the Nursing Board shall be composed of a chair and six members appointed by the President from among the nominees fielded by the PRC.

    Nursing Board members should hold a master's degree in nursing and have at least 10 years of continuous practice, five of them in the country. They will serve for three years. The Board has the following powers and duties:

•     Conduct nurse licensure examinations

•     Monitor and enforce quality standards of the nursing practice

•     Issue, suspend, or revoke certificates of registration for nursing practice

•     Recommend the closure of substandard nursing schools and programs to the Commission on Higher Education

•     Examine the prescribed facilities of universities and colleges of nursing or departments of nursing and those seeking permission to provide nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times

•     Conduct hearings and investigations on complaints against nurses for unethical and unprofessional conduct

•     Promulgate a Code of Ethics within one year from the date the law took effect.

    The new law is definitely a step in the right direction in improving the quality and standard of the nursing profession. But whether it would prevent nurses from opting to go work abroad remains to be seen.

    With a no-nonsense implementation of the law, the country could produce the best nurses in the world, which would only make them more attractive to foreign employers. The only change perhaps is that the stakes would be higher. Foreign hospitals would have to shell out more dollars to afford the world-class service of Filipino nurses. But this could be a downside in the long run just like what happened to our laborers in Saudi Arabia and seafarers who were eventually replaced by cheaper labor from India, Pakistan, Indonesia, and China.

    The law may be the right answer but it does not address the root cause of the brain drain.

    Even the President sounded vague by proclaiming that the law would make the nursing profession "more responsive to the ever-changing health needs of our country and the whole world."

    While the law's proponents insist that the measure is about discouraging nurses from leaving, the President was clearly setting her sights on the "world class potentials of Filipino nurses." And to confuse further her government's campaign to keep nurses at home, the President urged nurses to enter politics and run for party-list seats in Congress.

    In reaction, Rep. Padilla warned that we may succeed in convincing nurses to stay home and serve their countrymen but no longer as nurses but as politicians and lobbyists. "The Philippine Nurses Association should not be involved in politics," Padilla said referring to the group that lobbied hard for the measure's approval.

    Expectedly, instead of enticing Dolly, the Filipina nurse of Superman-in-wheelchair Christopher Reeves, to finally come home and share her nursing expertise, the law probably won't. Instead, she would be joined by more Filipino nurses once the law's implementation gets into full gear.

Photos By Boaner Medina