healthcare workers

[OPINION] Our policymakers don’t understand the plight of our nurses — and it shows

Juan Paolo Artiaga

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[OPINION] Our policymakers don’t understand the plight of our nurses — and it shows
'The claim of a nursing shortage in the Philippines is a fallacy'

The shortage of nurses in the Philippines has recently become a hot policy topic, with even the President, Cabinet secretaries, and members of Congress engaging in discussions. However, it is alarming that these top officials appear to be unaware of or misguided about the nuances surrounding the nursing shortage in our country.

On June 11, Quezon City Representative Marvin Rillo urged high school graduates to take up nursing if they want a stable and lucrative occupation in the years ahead. He justified this by saying that “nurses are in great demand while the supply is short.” Meanwhile, on July 10, President Ferdinand Marcos Jr., in a meeting with the Business Executives for National Security, attributed the nursing shortage to international demand, resulting from the Philippines’ “successful” pandemic response.

Both statements are not only incorrect but also dangerously misleading. The claim of a nursing shortage in the Philippines is a fallacy. Numerous surveys and studies have demonstrated that the country does not suffer from an absolute shortage of nurses. Rather, what we face is a scarcity of practicing nurses — an important distinction that demands a more thoughtful policy approach.

The proposals of our policymakers

Our country’s top policymakers, in different interviews, have outlined their solution to the nurse shortage problem. 

For the Department of Health (DOH), on one hand, Secretary Ted Herbosa announced his plan to tap nursing graduates who failed the board exams but scored at least 70-74 (passing is 75) to work in state-run hospitals. According to him, this was backed by both Department of Labor and Employment (DOLE) Secretary Laguesma and Professional Regulation Commission (PRC) Commissioner Jose Cueta Jr. 

On the other hand, Commission on Higher Education (CHED) finally lifted the 11-year moratorium on nursing schools. More recently, CHED announced its partnership with the Private Sector Advisory Council (PSAC) to introduce the Clinical Care Associates Program, which would allow hospitals to employ non-passers to perform “non-core” functions. 

Meanwhile, Representative LRay Villafuerte suggested that the DOH should go after licensed nurses who are either unemployed or underemployed or working in another industry. He urged the DOH to track these nurses down and convince them to work in the government instead to address the shortage of nurses in the country. 

The problem with all these suggestions is that they are geared towards generating more nurses, when we are already aware that most registered nurses prefer not to practice their profession in the Philippines. Generating more nurses will only lead to more unemployed and underemployed nurses if policymakers do not address the root cause of why nurses are not practicing here in the first place. Merely “convincing” them would be futile and would only waste government resources. 

What’s driving Philippine nurses to go abroad? 

According to Secretary Herbosa, the demand for nurses abroad is the only reason for the shortage. This, however, is inconsistent with what scholars have found in the past 30 years. In the topic of outward migration, there are always both push and pull factors at play. Aside from the mere existence of demand, high salary and career progression, among others, constitute the “pull” factor for nurses to work abroad. On the other hand, “push” factors or those factors from within the country that sways the worker to look for opportunities abroad include low compensation in the private sector, poor working conditions, and lack of career progression, among others. 

But why are there non-practicing nurses? A lot of them are those that got caught in what was called a migration trap. After several years of state-sponsored labor exportation of nurses in the early 2000s, the Philippines was able to generate an oversupply of nurses to send to the rest of the world. However, the global recession in 2008 happened, which slowed down the recruitment of Filipino nurses. These caused massive unemployment of nurses in the Philippines as the country produced thousands of nurses annually without any increase in both local and foreign demands. The massive underemployment and the unabated dream of nursing graduates to work abroad allowed the private sector to push down the wages of nurses to what it is today. Most of the “trapped” nurses eventually found themselves working in other industries to survive. Some went to call center industries, while some found work as domestic helpers. 

It’s not surprising, however, that nurses still avoid working in the Philippines 11 years after the first migration trap and even when employment opportunities have emerged. At present, wages remain low, working conditions remain inhumane, and the nursing profession still lacks specialization and career progression. The government’s treatment of nurses as export commodities (even bartered for vaccines) and its neglect of nurses during the pandemic also did not help.  

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What should the government do? 

Representative Marvin Rillo was correct when he said that the World Health Organization (WHO) believes that there will be a global shortage of nurses without action. But in the context of the Philippines, “action” should not only mean the generation of more nurses. 

WHO has advocated for coordinated policy interventions to address nurse retention. The labor market must be developed to absorb new nurses into the current workforce. Otherwise, these new nurses would migrate or transfer to other sectors again. Thus, CHED’s policy of merely increasing the number of nurses and creating “associate positions” to address shortage is very myopic if not combined with interventions that would make our nurses want to stay.

As Undersecretary Maria Rosario Vergeire said in an interview before, there must be a whole-of-government approach. Thus, policies done by CHED (in increasing the number of graduates), the PRC (in regulating nursing professionals), DOLE (in managing labor export), and Congress (in legislating laws) should not be done piecemeal but should be made in conjunction with each other, with the DOH leading the charge. 

Clearly, there has been no whole-of-government approach. To illustrate, while the DOH and Congress lament the lack of nurses, DOLE and the Department of Migrant Workers continue to facilitate labor export of nurses as part of the national labor export policy. More alarmingly, the Presidential Adviser on Creative Communications, Paul Soriano, directly promoted the export of our nurses in its recent “We Give the World our Best” campaign. These are mutually exclusive policies that deter progress towards our desired outcome. Notably, there are already several bills filed in Congress (by Anakalusugan and Senator Go) that legitimately address the problem in career progression of local nurses but have not been given appropriate attention by the administration.

As a final point, it bears stressing that everything here is just a reiteration of studies that have been available for years and even acknowledged by government agencies at some point. However, instead of listening to these studies and the demands of actual nursing groups such as the Philippine Nurses Association, our policymakers would rather cater to the demands of the private sector (like PSAC and the Private Hospitals Association of the Philippines), which, ironically, have been the source of most of the push factors driving our nurses away.

Our policymakers need to possess, at the very least, a basic understanding of the plight of the nurses to create empathetic, effective, and responsive policies to the nursing shortage problem. This is true not only for nurses but for any other problem that is afflicting the Philippines society. –

Juan Paolo Artiaga is a lawyer by profession, and currently a Master in Public Policy (specializing in Economics and Development) student at the National University of Singapore. Prior to becoming a lawyer, he worked in the House of Representatives for three years as a Political Affairs Officer.

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