Nurses’ Lives – Hurtful Reality

By: Angelo G. Gonzalo

Article: Glut of Filipino Nurses Leads to Exploitation by Lynda Jumilla

Reflection by: Angelo G. Gonzalo

Summary

Attention was sought by the government after hearing several reports from different authorities
that there are rampant cases of experience-for-a-fee nurse volunteerism observed in various
hospital institutions. The author of the article cited different statements made by government and
non-government organizations regarding this matter. Dr. Teresita Barcelo, the President of the
Philippine Nursing Association (PNA) said that some hospitals resort with volunteerism-for-a-
fee which is indicated to be the payment for training programs which would be catered to
aspiring volunteer nurses – a practice which Dr. Barcelo finds unethical. She added that no one
files a formal complaint against these unscrupulous hospitals since they are also benefitting after
receiving a certificate of employment. Alvin Dakis of the Association of the Young Nurse
Leaders and Advocates (AYNLA) International advocates for the prohibition of this practice
because it is illegal.

Philippine Hospitals Association (PHA) Vice-President, Dr. Hermogenes Jarin agreed that this
issue should not be overlooked. He confirmed that some members of the PHA charge fees for
training programs which is allowed by both the Commission on Higher Education (CHED) and
the Professional Regulation Commission (PRC). Dr. Jarin stated that “…not all are rotten
apples.” and no one is forced to partake in these programs. Senator Antonio Trillanes suggested
to Dr. Jarin and as promised by the latter party to call on PHA members for the discontinuation
of collecting fees from nurse entrants in exchange for short-term work. Senator Pia Cayetano, the
Health Committee Chairperson said that the CHED and the Department of Health (DOH) should
toil directly on the guidelines for these training programs.

As final statements, Lynda Jumilla quoted Senator Ferdinand ‘Bongbong’ Marcos Jr. that
oversupply brings the issue of the exploitation of nurses. Sen. Marcos stated, “Many are willing
victims.” and he proposed to halt the production of more nurses.

Reflection

To let someone graduate a Nursing course is really expensive for families aiming to have a better
quality of life with higher income with the help of the nursing graduate in the family. With no
scholarships granted, you need about half million to pay for the tuition fee, daily allowance,
food, clothing, books, clinical paraphernalia, printing projects and the like. Before a nurse can
fulfill his or her dream of working abroad to earn for his or her family, one must gain clinical
experience and by duty, serve his country first. If work experience as a nurse is the need of
many, there are many career options which they can enter. Most minds are closed into working
in a hospital institution only but there are other fields that one can venture – be a nurse in a
company, a school, in community health centers or in a clinic. These are areas which are
commonly neglected when looking for possible employment.
Securing a position in a hospital institution is stressing. Passing your resume to every hospital
open for employment then only to find out that someone’s kin in the inside would be chosen for
the slot. It is hard to remove this practice which is already embedded in the Filipino culture. It is
true that as of today, only a few would really look into the credentials of the applicant. It is now a
matter of ‘who you know’ and not ‘what you know.’ This is another problem encountered by
nurses. We do not only experience exploitation; we also experience unfair treatment.

We all know that the ideal nurse patient ratio is not observed in most hospitals in our country.
Safe staffing is not practiced by most institutions. With overloaded patient assignments, you get
a salary which really does not compensate the services nurses are giving. Allocation of budget by
the government for health is not enough to suffice the needed money to pay for workers’ salaries
but then I find it awkward to see this similar case in a private institution. Before owning a
hospital facility, the proprietor should see to it that he or she has the available resources and
necessary means to run it. I would say, if you cannot cope with the salary demand for your
workers, better yet, reduce your bed capacity so as not to produce work overload for the
employed staff in case patient influx would be higher than expected. An employer must always
regard staff’s betterment because human resource is not just an expendable unit of a company.

It is undeniable that there is overflowing number of nurses in our country. A problem rooted
from a common choice made four years ago from the day of your graduation. As of today, many
hospitals (even though many deny the practice of collecting fees prior to volunteering) are
involved in the exploitation of the surplus of nurses. It is undeniably happening. For me, it would
be right to pay for training programs if there are really these trainings offered; but to pay for
something which you are not aware of having or acquiring is a big question. Nurses were already
trained and paid for it in their four year course. The ones being referred to as trainings post-
graduation should be specializations and not the usual nursing duty that is being tasked to these
volunteer nurses upon entering the institution. Corrupt hospital institutions substitute these
volunteer nurses to supposed-to-be actual and regular staff to cut employment cost.

With all those situations presented above, do nurses deserve this unethical and unfair treatment
from these institutions? The answer is, “Definitely not!” While writing this paper, I initially
stated that we nurses should be very vocal with our complaints so as not to diminish the dignity
being preserved in our profession. It is unsound for them to reason out that they are to exploit us
because of surplus. But then, it struck me when I stumbled into reading one literature by Paul
Feldstein (1999). Mr. Feldstein is a well renowned health care economist so I would like to quote
his statements in his book which are as follows:

“The effect of slower growth in demand for RNs and their shift to nonhospital
settings has exerted downward pressure on RN wages; demand for hospital care
decreased, therefore demand for RNs has increased more slowly than increases in
RN supply. Further, as RNs moved to the lower-paying nonhospital sectors, this
has also slowed their wage growth. Although these effects are occurring in all
states, they have been greatest in high managed care states.”
 If the effects of managed care continue in this direction, more hospitals will close
and hospital demand for RNs will continue to decrease, with the consequence that
RN wages will increase relatively slowly. Greater RN employment opportunities
will be in the nonhospital sector. As wage growth for RNs diminishes, nurse
enrollments will decrease, perhaps setting the stage for another dynamic shortage
at some future time.”

To correlate a similar situation, Feldstein cited a situation of physician surplus in a separate

chapter. It was indicated that,

“As prospective applicants perceive s lowering in their rate of return to a medical

education, fewer will apply to medical school; there will be a shift away from
those specialties in greater surplus; some physicians may decide to retire earlier,
while others move into management positions. Over time, the number of new
entrants into the profession will be less than those exiting and the smaller increase
in the physician supply will bring about a new equilibrium situation.”

The statement made by Paul Feldstein was an eye-opener. It made me realize that to remedy the
surplus that we have in spite of venturing different areas of nursing, is to be part of non-related
fields of practice to strive for a better living. Too much number of nurses caused this dilemma so
to solve this is to intervene from the root of the situation. Career Assessment Test done in the
secondary level of education should be strengthened. Career talk can be facilitated not only with
the students but also with the parents who are pushing their children to take up nursing or
courses which they are not really interested in. Parents and high school graduates should be
informed with the reality that there is a problem in the nursing profession regarding surplus of
nurses. A promising artist, lawyer or an engineer-to-be would be much wasted if he or she will
be inclined in a profession that he or she does not have passion to complete and undertake.

Other solutions for the exploitation of nurses are the strict implementation of policies regarding
labor and employment so as to stop the substitution of supposed-to-be regular nurses with
volunteers. Guidelines for hospitals who wish to offer training programs for a fee should be
clearly formulated so as to avoid misinterpretation of the institution’s intent. For the nurses, I
will not take back my statement that we should not diminish the dignity of our profession. If ever
you encounter institutions that seem to be unscrupulous, it is ethically, morally and legally right
to report such cases to prevent further exploitation.

As suggested by many, to control the influx of enrollees in the Nursing profession, strict
implementation of closing these schools with questionable performance and educational services
offered should be done by the PRC with the help of the Board of Nursing (BON) and CHED.
Implementation of this suggestion is not easy for involved parties because of the alleged political
bearing of the issue. Increasing the qualification requirements of the Nursing Licensure
Examinations (NLE) is a more feasible resort which may also lead to a positive result of
regulation.
Without a doubt, nursing is a vocation so care should be the nurse’s primary weapon to serve but
then, nursing is also a profession. A profession which entails compensation for the services
offered. Retain what is due for the individual as a dignified human being. We all live to strive
and to strive with insufficient finances is difficult – proven and tested by many.

References

Feldstein, P. (1999). Health care economics. Quezon Avenue: C&E Publishing, Inc.