Why our nurses are leaving
MANILA, Philippines – For 32-year-old Jimmy Carpon, being an overseas Filipino worker (OFW) is his destiny.
Many of his relatives have already migrated abroad, mostly to the United States, and his parents wanted the same for their children. "It was their dream," Jimmy said.
And so when the time came for Jimmy to choose a course in college, he didn't think twice about going to nursing school. Nursing, after all, was all the rage in the early 2000 – mostly because of the opportunity of working in countries where nurses are in demand.
With a scholarship, Jimmy finally graduated and worked as a nurse at St Luke's Medical Center. To further his career, Jimmy also got a masteral degree, which allowed him to be an instructor for different schools and review centers.
His stint as instructor when nursing was at its peak allowed him to earn big. Nursing programs were popping up everywhere and schools were producing more nurses than ever before. This brought in a massive increase in demand for reviewers.
But this success was short lived.
As the industry started to crumble due to the oversupply of nursing graduates in 2011, the Commission on Higher Education started phasing out substandard nursing programs. The clampdown was felt by review centers like the one Jimmy worked for, as the number of enrollees declined.
Struggling with his finances, Jimmy rekindled with his parents’ dream of sending him abroad.
Jimmy said: “2012, nag-apply na po ako sa iba-ibang agencies. Kahit saan basta makaaalis. Gusto ko sana pumunta ng Saudi, Qatar, o kahit saan. I was desperate that time kasi ako na lang din ang naiwan halos sa mga kakilala ko."
(In 2012, I applied to different agencies. Anywhere, as long as I get to leave. I wanted to go to Saudi, Qatar, anywhere. I was desperate because I was the only in my circle of friends who hasn't left.)
An opportunity came in 2013, when the German government announced that they will be hiring foreign nurses through the Triple Win program.
Jimmy immediately applied and passed the first requirement of the program as he could already speak German. By early 2014, he was finally sent to Tübingen, Germany for the familiarization phase of the program where they were trained for months.
He was one of the first 12 Filipinos sent to Germany for the Triple Win program, which has already sent more than 600 nurses to Germany by 2016. The last government program of its kind was back in the 1970s.
The first year was exciting, he said, facing new weather and culture. By November 2014, Jimmy was already a full fledged nurse for the University Hospital Tübingen.
"Naging maganda ang treatment sa amin ng German. Naisip po namin before na baka ma-discriminate kami pero wala po kaming experiences na ganu'n." (Germans treated us well. We thought we going to be discriminated, but we never had those experiences.)
The only difference with Philippine patients, Jimmy said, is that German patients are much more dependent on nurses. "Very family-oriented kasi tayo, kaya laging may bantay. Pero dito, since nasa work ang mga kapamilya nila, sa nurses [nakadepende] para sa lahat."
(We're very family-oriented, so someone is always there to watch over [the patient]. But here, since their relatives are working, they all depend on nurses.)
Now, Jimmy is already the assistant head nurse for their ward and the president of the Association of Filipino Nurses in Germany. His eyes are set on another promotion, and he is working toward his dream of becoming a supervisor.
The American dream
Unlike Jimmy, 23-year-old Marvin Bermillo had an easier time making it abroad.
Marvin’s parents are both United States citizens already, and they were able to bring him to New Jersey with them as soon as he graduated in 2015.
Marvin does not deny it: he took up nursing mainly because of the opportunity to work abroad. At the time when he went to college, the collapse of the local nursing industry was already apparent.
But Marvin said he wasn't scared, partly because of his parents. "I grew up with OFW parents so I know the struggle of those families looking for better oppurtunities abroad,” he said.
While getting there was easy, however, getting a job wasn’t.
Even though Marvin is a registered nurse in the Philippines, his license is but a piece of paper in the US. To be able to work there, he still had to pass the US’ own licensure exam, the NCLEX.
There were tons of other requirements, which were not really easy to comply with, Marvin said.
"I was visiting one office to another, following up the status of my application, doing phone calls to one point person and then ended up being transferred to another. My papers are going back and forth from the Philippines. Never-ending exams here and there," he shared. "Not to mention the amount I have to pay for all these transactions."
It took Marvin two years to finally get his license, a feat that he wouldn’t have been able to pull off if not for the privilege of having a family there.
Marvin was finally able to work as a nurse, starting with a long-term rehabilitation and nursing home. It was stressful, he said, because the facility was understaffed.
"I usually have 20 patients or more. Sometimes all their call bells are on and you don't know which room to go first,” he shared. "There are times that I fill the role of nurse and nurse's aid…I clean butts, (vomit), and wounds and I am already used to it."
But what's harder is seeing patients come and go.
"In a nursing home you'll always develop a special bond with your patients. I grew up with my grandparents so sometimes it's hard for me to witness elderly patients abandoned by their families. Some patients become close to us, only to pass away the next day. No matter how hard we tried to not let it affect us, it does."
He was eventually hired by a hospital, but he continued working for the rehabilitation center. Every week, he works for 3 nights at the hospital, then two nights at the center. It's hard, but it pays well.
A starting salary for a nurse in the US, Marvin said, is around $5,000 (P255,370). That's a dozen times more than the starting wage for nurses in the Philippines.
That's more than enough for him to be able to save and give back to his family.
Diaspora of nurses
Jimmy, meanwhile, said that nurses in Germany can take home as much as 1,500 euros or P90,857 (minus expenses) every month for their starting salary. Also a lot more than what he could've earned in the Philippines.
According to WorkAbroad.ph's 2016 Overseas Salary Report, healthcare remains to be the paying specialization for overseas Filipino workers, with OFWs in the industry getting an average of P111,620 per month. It’s also the top paying specialization for the high-paying countries of deployment like Canada and New Zealand.
This high salary attracts Filipino nurses to go abroad.
According to data from the Philippine Overseas Employment Agency (POEA), 92,277 nurses have left the country to work abroad since 2012. That's almost 19,000 nurses leaving every year.
Filipino Nurses United convenor Eleanor Nolasco said that the promise of high salary abroad, in contrast with the low wages in the Philippines, is a major push factor for our nurses to leave.
"Hangga't hindi nabibigay ang disenteng sahod, talagang mapupuwersa na lumabas ng bansa ang ating mga nurses," Nolasco said. (Until decent salaries are given, our nurses will be forced to leave.)
For years, Nolasco and their group have been calling for the government to raise the minimum wage for starting nurses to at least P25,000 a month, an amount that she says is not even that big nowadays considering current costs of living.
Two weeks before stepping down in 2016, then president Benigno Aquino III rejected the bill seeking to increase the pay of nurses because of "dire financial consequences" – both for the government and private and non-governmental health institutions.
Now the group is calling for President Rodrigo Duterte to make his promise of change happen for nurses, too.
"You said change is coming, that life should be better for Filipinos. Better status for nurses mean decent job and wages. It means better healthcare delivery system for our people. No more contractualization. 'Yun naman ang kanyang mga prinomise (That's what he promised). We're just reminding him," Nolasco said.
Contractualization is also a major problem in the industry, Nolasco shared. Even with a law that puts government nurses at Salary Grade 11, many nurses are hired on a contractual basis which lets employers skirt around the ruling, paying them below the minimum wage.
The problem lies with local government units (LGUs), whose priorities don't always include healthcare, Nolasco said.
Many LGUs refuse to fill up plantilla positions, often only hiring job order nurses to save costs. But aside from low salary, these nurses are deprived of employment benefits and security of tenure.
Now we have health care workers who can't even afford health services themselves and are at risk of losing their jobs anytime.
"There's even a case when a nurse was fired just because she liked a post by a doctor complaining about lack of hospital equipment,” Nolasco shared. "Ang daling mapatalsik." (It's easy to have people fired.)
Nolasco refuse to believe that there is an oversupply of nurses, which has been a common narrative by the government for years. "Underutilization" is a better term, she said.
"Hindi naman nag-o-open ng jobs kahit may pangangailangan (They're not opening job positions even if there's a need)," Nolas said. According to her, the current nurse to patient ratio here is one nurse per 40 patients.
Career growth and government bureaucracies are also push factors for nurses to leave.
According to Nolasco, the recently passed Continuing Professional Development Act of 2016, which requires professionals to earn a specific number of units before their licenses are renewed, has a huge impact on nurses.
Nurses, she said, not only have to use the little spare time they have to join these trainings but also spend so much to comply with the requirements. There is no explicit ruling that would require hospitals to pay for the training of their employees, which Nolasco said should be "their obligation to ensure that their health workers can give quality care."
But even with all these trainings and seminars, Nolasco said the working conditions in hospitals here won't allow nurses to practice with competence. Lacking equipment and with low wages, nurses continue to be demoralized and look at other countries to grow their career.
Unless these problems are addressed, Nolasco believes our nurses will continue to leave.
While there are perks to working abroad, it comes with various social costs.
Data from the Philippine Statistics Authority as of 2015 show that there are now at least 2.4 million OFWs. Migration breaks families apart and 4 to 6 million children of OFWs are left behind and at risk of losing parental care.
Both Marvin and Jimmy shared that they never really had trouble fitting in their respective host countries. But being separated from the people they know and love in the Philippines can be frustrating at times, too.
"Despite the perks of working abroad, there are times that you would really feel lonely and at some point, depressed. You are already stressed with your work and you also have to deal with homesickness," Marvin shared. "You miss your life back in the Philippines despite your hardships in the country."
"Mahirap kasi (It's hard because) we can only communicate with them online. Hindi naman po namin mayakap family namin, kahit Pasko at New Year (We can't hug our family, even on Christmas and New Year)," Jimmy said.
But when asked if they ever thought of working in the Philippines again, both Marvin and Jimmy were reluctant.
"Napapa-isip ka pa rin 'pag minsan kasi iba pa rin 'yung pakiramdam na nagtatrabaho ka sa sarili mong bansa. Pero maiisip mo rin na wala rin talaga mangyayari with the current situation of nurses in our country," Marvin shared.
(Sometimes you think about it because it feels different to work for your own country. But you will also think that nothing will happen with the current situation of nurses in our country)
Jimmy, meanwhile, said he'd consider if the country can finally offer nurses like him decent wage and security of tenure.
"Malaking bagay po talaga 'yung salary. Kapag okay po siya, why not po? Kung talagang masisigurado na may work na pangmatagalan na may career pathways," he shared.
(Salary is a really big factor. If it's okay, why not? If you're ensured of a long-term job with career pathways.)
So the two just press on despite the loneliness. And when homesickness kicks in, they remind themselves of the good they can do now with the extra money.
Marvin has finally started giving back to his parents, helping pay their bills at home, especially now that his younger sister is going to college.
"I am really blessed with all the opportunities that I received but with all these opportunities come with great sacrifices. There are many times that I really wanna give up but then I realize the main reason why I'm doing this in the first place – myself and my family," he said.
Jimmy, on the other hand, has finally bought a house for his parents in the Philippines. With his remittances, his parents also don't need to work anymore, and he's able to help send their youngest sibling to school. Now his eyes are set to get another promotion and is working towards his dream of becoming a supervisor.
"Do it for Germany, for youself, and for your family," Jimmy said. – Rappler.com
*$1 = P51
1 euro = P60.57