With dreams dying, Filipino nurses ponder options, set new directions

Tens of thousands of registered nurses in the Philippines have neatly mapped out their career paths while they were still studying. Or so they thought.

Upon passing the Philippine Nursing Licensure Examination, they had hoped to work in 250-bed or more tertiary hospitals, preferably in urban areas for at least two years. On the side, they planned to review for the US nursing licensure examination for registered nurses, popularly called Nclex-RN (National Council Licensure Examination for Registered Nurses).

Sadly, after spending hundreds of thousands of pesos for their education and countless moments of difficulties, their hopes and dreams are either dying or in need of immediate resuscitation or better still, drastic redirection. Scores are considering setting aside for the long-term, if not totally abandoning, their plans of working in local hospitals due to the terrible lack of employment opportunities amid the ironic reported increasing global demand for their services.

Thousands of registered nurses have joined under-board engineers, accountants, and architects who have flocked to call centers, aside from those who have opted to become medical transcriptionists or managers of fast-food chains or run family business.

Nurses are drilled in theories and practical aspects of dealing with deaths of patients. One of the earliest lessons taught to student-nurses is to check their emotions, notably when handling patients’ concerns. But when it is their personal dreams that pass away or gasp for oxygen, the situation becomes messy and complicated. Like all deaths or near-deaths, it is difficult.

Ana, 26, is a tall, slender, and charming commerce graduate from a Catholic university who quit her Makati office job in 2004 to enroll in a nursing school. She graduated in March 2007 and passed the local nursing board examination the following June on her first take. Ana (not her real name) is currently reviewing for Nclex-RN, prompting her to forego her birthday celebrations. But as soon as she finishes her examination, she would keep her reviewers in a big box and start making handcrafted accent pieces to meet orders from friends in time for the Christmas gift-giving season.

Ana has grown weary of submitting her curriculum vitae to various hospitals and waiting for interview schedules which never came. She hesitantly confessed to having bouts of depression triggered by her inability to land a job as a nurse, adding she just wanted “to get and over with Nclex” because she has already paid for it. (Ana and all of those interviewed for this article have requested not to be identified.)

An applicant for Nclex-RN pays more than $400 to be able to take the examination. Additional expenses are incurred in mailing original documents, such as transcript of records and application forms, via special courier services. A two-month review for Nclex-RN can cost P25,000 at the minimum. All these expenses for just one exam, where the passing average for Filipino Nclex-takers in the Philippines is a “deplorable” 58 percent, decried one government official with a Cabinet rank. The passing average for the PRC administered nursing licensure examination is a measly 43 percent.

“Second courser” nurses

Violet is a 50-year-old registered nurse since June 2007. Like Ana, Violet surprised her colleagues by resigning from her managerial job of 16 years to become a nurse. Recently, she returned to Manila after unsuccessfully sitting in for her Nclex-RN in California. Being the only nurse in the family and unemployed, she has been given the responsibility of taking care of her aging parents. She looks forward to occasional forays outside their Quezon City house to have coffee with friends – most of them unemployed registered nurses – or to just meander in the malls. These trips offer her opportunities to dress up and put on make up: simple rituals that soothe the searing sorrows of her soul. During an interview, Violet complained of seeming hopelessness, lethargy, sleep loss, and poor appetite – signs of depression. Her life, she feels, has been put on hold for quite too long. This is not how she had envisioned it to be before resigning from her office job.

Ana and Violet are among the human faces of what it means to be a licensed, qualified, but jobless Filipino nurse in 2008 – the times of lingering US retrogression further worsened the unprecedented US financial carnage and the tightening immigration rules in countries such as Britain. Ana and Violet belong to a group labeled as the “oversupply of 400,000 nurses” recently disclosed by the Professional Regulatory Commission (PRC), which has also estimated that only 60,000 nurses could be totally accommodated by local public and private hospitals.

In 2007, an estimated 450,000 students were enrolled in nursing schools in the Philippines, soaring from the mere 30,000 in 2000, labor officials said. Considering the current sheer high cost of completing the nursing course, a significant chunk of 450,000 can be safely expected to fall out or shift to less expensive course eventually.

Licensed, qualified but unemployed nurses like Ana and Violet are at the center of an on-and-off national discourse playing out in the media involving, among others, the PRC, Philippine Nursing Association (PNA), Philippine Overseas Employment Agency (POEA), and local recruitment industry players.

Sometime in 1999, only a handful of medical doctors, dentists, physical therapists, and professionals with non-medical or allied health education background were brave enough to go back to school to take up nursing. Middle-aged student-nurses during those years were a rarity as nursing is not an easy course as many would like to believe. It entails a lot of nerve-wracking sleepless nights to memorize the wonderfully complex human anatomy, to understand the pathophysiology of plethora of diseases, to know fully the mechanism of action and correct dosage of multitudes of medications, not to mention the back-breaking hospital shifts or rotations, which give student-nurses hands-on experience and bedside exposure to patients in varying states: from emergency cases to post-operative.

In 2001, the handful but audacious professionals who ventured into nursing graduated, eventually passed the local nursing board the same year, and subsequently hurdled the Nclex-RN. During this period, nursing jobs in local hospitals still abound. After a year or two of working in local hospitals, they were able to find employment in the US. They were the very few fortunate ones. Upuntil 2003,it was somehow relatively easy to find work in local hospitals and leave for the US or any foreign destination. There were,however, high-profile disastrous cases such as the group of medical board top-notcher doctors-turned-nurses who were allegedly short-changed by their employer in New York. Their employer even sued them, worse. There were also quiet catastrophic cases which never made it to the newspapers’ front pages and primetime broadcast news.

Akin to the phenomena of hot pan de sal, lechong manok, and nata de coco and driven by a desire to better their future, thousands of Filipino middle-level professionals either began resigning from their jobs in 2002-2003 to pursue full-time nursing studies or worked on it on a part-time basis. “We are only doing this (nursing studies) for our children’s future,” is a common explanation given by married professionals who went into nursing when asked.

Due to market demand, a number of nursing schools sprouted in a bid to reap from the windfall of the exploding “nursing industry,” which alarmed and dismayed officials of nursing colleges affiliated with the traditional and big universities. One measure of the utter immensity of the number of professionals with non-medical background who took up nursing as their second or third course was the June 2007 nursing board examination. More than 90,000 student-nurses took the June 2007 board examination which went on record as one of the, if not the biggest, nursing board in Philippine history, with a significant number of examinees coming from the “second courser” category, a phrase that refers to those who took up nursing after receiving their first baccalaureate degree from other courses.

No jobs for nurses at local hospitals, no place for ‘old’ nurses

“I am running out of savings and I am desperate. I’ve personally submitted my application forms and curriculum vitae to almost all hospitals in Metro Manila and nearby provinces during the two full years that I have been job-hunting. The reply is becoming monotonous: No vacancy at the moment. Just leave your documents and we’ll call you,” lamented Tricia, 30, a former office worker.

Tricia took her Nclex-RN in Hong Kong in early 2006,when it was not yet offered in Makati. The Hong Kong trip further dented her dwindling savings. “I flew to Hong Kong because I viewed it as an investment which I could recoup soon. I was wrong. I am still jobless,” she recently said in Ortigas. She shelled out about P9,000 for an English exam she took 18 months ago, not to mention the English review class that cost her P500 per four-hour session.

“When you apply at recruitment agencies sending health workers overseas, the first question they ask you is: Are you currently employed? If you say no, they automatically utter the mantra: We require at least two years of experience in a 250-bed tertiary hospital. Or at the barest minimum, they want an applicant to be currently employed at a hospital. It is extremely tough to find a job in a local hospital.

So here I am, a qualified Filipino nurse with near complete credentials to go abroad such as the local nursing license, Nclex-RN passer, and an overall grade of 8.0 in my English examination. Still, I am jobless after spending hundreds of thousands of pesos. Theoretically, I should not find it tortuous to get a job in a local hospital. I am entering my third year of unemployment as a registered nurse,” she said.

A random sample of newspaper advertisements seeking local nurses for deployment overseas requires applicants, among others:

· “should be currently working for at least 4 months to qualify for an interview”

· “must have an updated license with at least 2-3 years continuous experience in area of specialty and presently working”

· “at least 4 years work experience and below 49 years old”

· “female, 22-35 years old, has 3 years experience in a 200-bed capacity hospital as a staff nurse (either local or overseas) after registration at PRC” (It is interesting to note this particular item that includes the enviable work experience in overseas hospitals by female nurses below 35 years old that is sure to squeeze out local nurses with little or no hospital experience from the already tight job market. Aside from those who had completed 2-3 years of local hospital work, most of the recent deployments were nurses whose contracts in Middle East or Singapore hospitals ended and decided to give the US, Canada, Europe, Australia, or New Zealand, or Ireland a try. A few have opted to work in Malaysian health institutions or colleges of nursing as instructors.)

To escape boredom and to prevent the onset of depression, Tricia currently volunteers as a nurse in a provincial hospital. Being a “volunteer nurse” is a tricky issue. A lot of recruitment agencies do not consider being a “volunteer nurse” as part of official hospital work experience. Agencies still insist on a continuous full-time staff nurse position as the only acceptable form of hospital experience. This maybe justifiable on the ground that only full-time staff nurses are officially allowed by health institutions to legally perform the full range of nursing responsibilities toward patients, most especially administering medication. Volunteer nurses, by virtue of their being volunteers, are limited in their dealings with patients.

In an orientation meeting for an advanced training seminar in a Metro Manila hospital, a group of 75 nurses assembled was asked to identify their hospital affiliation. No one readily volunteered an answer, prompting the facilitator to ask: “Did you just pass the nursing board?” The hall remained silent. Finally, there were participants who reluctantly said they passed the June 2005 board, others the December 2005, while scores the December 2006 and June 2007 board. Not one of the 75 has found employment yet. This was not an isolated incident.

“Data from the Department of Labor and Employment (DOLE) recently showed that only two of every 100 students taking up nursing are likely to qualify and get employed overseas,” a news report in the Sept. 22, 2008 issue of The Philippine STAR said. During 2000-2007, the POEA recorded a total of 77,947 nurses hired for overseas posting, with the highest number of deployment at 13,822 registered in 2001, the report said. Only 9,000 registered nurses found employment overseas in 2007, it added. Top destinations were Saudi Arabia with 6,633 Filipino nurses deployed, United Arab Emirates with 616, Kuwait with 393, the US with 186, and United Kingdom with 38. Note the small number of nurses who were hired by health facilities in the US and United Kingdom, which are viewed as the most desired destinations of Filipino nurses.

In a bid to make themselves more marketable and to arrest the onset of depression – and if money is not a problem – licensed, qualified but jobless nurses have resorted to taking up various specialized courses where they get further expertise and additional licenses. Among the popular courses are the basic life support, intravenous therapy, critical care nursing, and hemodialysis nursing. Cost for these special courses runs to thousands of pesos, if not tens of thousands of pesos for those lasting three months. There are those who went back to school after passing the local nursing board to study master’s in nursing which will qualify them to teach in local nursing schools.

“Both public and private hospitals could only accommodate 60,000 positions, so right now, we have an oversupply of 400,000 nurses,” Commissioner Ruth Padilla, of the Professional Regulatory Commission, was quoted as saying by the Sept. 1, 2008 issue of The Philippine STAR. On an annual basis, the Philippines issues 100,000 nursing licenses but the combined number of private and public hospitals in the country cannot absorb them, the report said, quoting Padilla.

Soundingoptimistic amid the lack of local employment for nurses, Padilla declared: “We will not have difficulty meeting the high demand for nurses abroad because we have an oversupply. We welcome opportunities outside the country.” The Philippines is holding talks for accords that will facilitate the deployment of Filipino nurses in various countries, she said, without naming the countries.

However, the POEA and the Philippine Nursing Association appear to be at variance in reading the present dreary situation.

The POEA has projected the continuous high demand for Filipino nurses’ services in years to come to cater to the needs of the rapidly aging population in highly developed countries. One the other hand, the Philippine Nursing Association declared the main reason for the local nurse oversupply is the rapid decline in overseas hiring.

Heart of the problem

Why the “nurse oversupply” in the face of various claims that there are thousands of nursing jobs to be staffed, particularly in overseas health facilities? A couple of years ago, nurses who were preparing to leave the country were unduly pilloried and vilified as if they were traitors to the Philippines. Now, a crisis has evolved over the non-deployment of the 400,000 registered nurses.

The heart of the problem is that these 400,000 nurses lack the minimum two to three years of fulltime work experience in a 250-bed tertiary hospital, which is a non-negotiable requirement when one looks for overseas employment. And as the PRC said, the local health system infrastructure can only absorb a total of 60,000 nurses. Another possible contributory factor to the current problems of the nursing profession is the “choosiness” of a lot of the unemployed licensed nurses.

The POEA has said it has unfilled job orders of more than 20,000 nurses for health facilities in the Middle East, Singapore, and several European countries, such as Norway and Belgium.

Several of the unemployed but licensed, qualified nurses interviewed for this article said if they can help it, they would rather work for health institutions in the US, Canada, Australia, or New Zealand and avoid at all costs the “hardships” of Middle East postings. Perhaps, what was left unsaid by those interviewed was they could not see themselves bringing their families to – if ever it were allowed – and eventually retiring in Middle Eastern countries or places they did not want to go. The allure of the US, Canada, Australia, or New Zealand is that nurses can see themselves and their families settling down in these countries. An additional pull factor of these destinations is that majority of them have family members who are residents or citizens of these countries who are more than willing to assist them in their acculturation process. Who has not heard of the rigid cultural norms that Middle Eastern countries adhere to or the problems of learning another language aside from English or the loneliness of long winters in some European countries?

“You cannot blame these nurses for being selective. They have sacrificed a lot already,” said one retired chief nurse who is working currently as a director of a health organization. “I can understand their concerns. A number of my former staff nurses call me long distance regularly to complain about the substandard working conditions in some of these countries in dire need of nurses. Don’t crucify these nurses if they choose to work in destinations where their safety and security are given importance or if they ask themselves: Will we be subjected to harsh cultural adjustments? How will our children cope with stringent cultural patterns? Can we fit in?”

She conceded, however, that high school students considering nursing as a career now should be given guidance counseling and be told honestly of the thorny situation licensed, qualified but unemployed nurses face. “These students must be sincerely counseled that they can stand up to their parents who may be pressuring them to take up nursing. Even those in their first year or second year of nursing education perhaps, just perhaps, may consider shifting in order to avoid the current hardships of the unemployed nurses.”

Challenge to the People Management Association of the Philippines

Ana, Violet, and Tricia said they are willing to consider going back to their previous careers before they become nurses given proper and stimulating opportunities to take a crack at them again. A good measure of the willingness of licensed, qualified yet unemployed nurses to find employment is their readiness to take the plunge in working for call centers and business processing organizations, without any qualms. They don’t see working at call centers and business processing organizations as demeaning or unworthy of licensed, qualified nurses. “One thing good with call centers and business processing organizations is they don’t take it against you if you’re in your late 30s or 40s or what course you took up in college. As long as you are able to pass their pre-employment requirements and exams, you can be hired,” said one licensed nurse, a mother of three, who is working in a Makati-based call center.

Nurses have formed informal groups in online social networking sites to assists each other, including sharing of information and tips, notably on non-health and non-medical companies whose people managers or human resources officers treat applicants shabbily, advising them to avoid particular companies or even naming certain people managers who had interviewed them. Likewise, there are those who give information on which firms are “good employers.”

For the People Management Association of the Philippines (PMAP), the challenge it must confront genuinely and seriously – as it addresses the imminent talent shortage in the labor market – is how to tap into a substantial percentage of the 400,000 licensed, qualified yet unemployed nurses who belongs to the “second courser” category, a proverbial veritable minefield of talents and experience. On their own, these “second courser” nurses are looking for jobs along the lines of their previous expertise using old contacts, and several have been successful in resuming their old professional lives as accountants and business managers, to cite a few.

The PMAP has acknowledged that a talent shortage in the labor market is about to send shockwaves to the local business community with the retirement of Filipino baby boomers. The association has called on the public and private sectors to craft a national human resources agenda to energize the international competitiveness of the Philippines. Creatively and appropriately handled, the legions of “second courser” nurses can play a crucial role in filling, even temporarily, the talent gap before the local business community suffers a fatal cardiac arrest.

Word of caution

It will be a costly mistake to interpret the current unemployed status of licensed, qualified nurses as a chance to bully them or to show them signs of unprofessionalism. It will be foolish to treat them with smug condescension and snobbery. Nurses, because of their years of dealing with people both the mighty and the lowly, are sensitive to hints of unprofessionalism. They will not hesitate to politely shun job offers if they think the company is not at par to their professional standards.

Out there, there are thousands of Ana, Violet, and Tricia – licensed, qualified but unemployed nurses – whose dreams of working in hospitals abroad may take longer to fulfill. They are looking for suitable jobs. But they are not dispirited or despondent enough to throw away standards of professionalism in a brash bid to land a job.

(About the author: A reporter since 1983, Ibarra C. Mateo took up biology and journalism at the University of the Philippines – Diliman, studied Japanese language, M.A. in Asian Studies, and Ph.D. in Sociology at the Jesuit Sophia University in Tokyo, and passed the Philippine Nursing Licensure Examination in June 2007. From April 1999 to March 2001, he was the first Southeast Asian in charge of the Asia-Pacific Desk – International Department of Kyodo News, Japan’s largest news and information provider. He currently writes about medical-nursing concerns and health-science issues, when not facilitating or speaking in training seminars or doing movie/stage reviews. Please send comments to ibarramateo@gmail.com.)

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