Nursing brain drain

The figures are stark and shocking.

In 2012, there were 44,731 nurses who passed the board exams in the Philippines. The number has dropped through the years, and I will just give the last three years’ figures: 12,949 in 2016; 9,757 in 2017; and 9,137 in 2018.

I was shown the figures by a hospital administrator, who also described a high nurse turnover rate in many hospitals, mainly private. The administrators are worried about this supply side, with so many nurses going overseas and with no new nursing graduates in the next two years because of the K-to-12 adjustment.

What’s happening here?

In the 1990s, the overseas demand for nurses was high, and we saw nursing schools mushrooming all over the country. Even doctors, yes people with MD degrees, were going back to school to take nursing so they could work overseas.

Then the importing countries began to close their doors, and we ended up with an oversupply of nurses. Many went on to other jobs, and never returned to nursing.

The overseas demand is beginning to pick up again, with many of the importing countries so desperate for nurses that they’ve even dispensed with work experience, ready to take in fresh graduates. Between 2012 and 2017, 92,277 nurses left to work overseas. That’s more than the total number of nurses who passed the board exams from 2015 to 2018.

Locally, the demand has also been growing, especially in government. The Department of Health has 28,000 plantilla positions for nurses and are offering monthly salaries upward of P20,000. Compare that to what private hospitals are paying: from P12,000 to P22,000. (Figures are from two years ago, but current salaries are still low.)

There’s also demand from the Armed Forces of the Philippines and the Philippine National Police.

There are even call centers that require a nursing degree for their agents. These are call centers that handle health-related accounts—for example, insurance.

The biggest losses are still from people going overseas. This brain drain is usually analyzed in terms of push and pull factors—why do people leave, why do they stay. In crude terms, it’s mainly money: low wages at home pushing people to go overseas. The pull factor, wages at home, does have important nuances here. For example, I have talked with many nurses who say they will stay if wages are decent enough. Many tell me it’s mainly to allow their children to get a good education.

The children can therefore be a push, or pull, factor. Sure, one nurse told me, you go overseas and earn dollars, but there are costs with the children left behind.

Working conditions are important, and we see a vicious cycle here: Because of the undersupply of nurses, they are made to handle more patients, which leads to more stress and alienation from their work and makes them leave. That then aggravates the shortage, and we end up with heavier and heavier workload.

The problem is not just the number of patients being handled. Nurses complain about having to do non-nursing work, from inventories of supplies to running errands, on top of their nursing duties.

Then, there’s the bullying they get from doctors, from fellow nurses and from patients. I found an article on overseas nurses in the United States complaining about “horizontal violence,” meaning bullying and intrigues from fellow nurses. I’ve suggested to my hospital administrator friends that they look into this horizontal violence in local hospitals, suspecting it might be as bad, or worse, than the situation in the United States.

It’s time, too, for government to be more proactive with the human resources development angle. We still play to global demands, which can be volatile. I talked with someone who works with US embassy medical requirements, and she observes that President Donald Trump’s hostile attitude to migration has discouraged many Filipinos, nurses included, from even applying. We have seen, too, how wars and political strife can erupt very quickly, forcing us to evacuate Filipinos overseas—including, again, nurses.

I looked at the passing rates for nursing and they are dismally low, always below 50 percent. Diploma mills are fooling poorer Filipino families, providing low-quality education that further aggravates our nursing shortage because of the low board passing rate.

Our nurses deserve better, and we can start by being more conscious, as patients or as relatives of patients, about treating them well, and showing our gratitude for their commitment.

There was a time when we had nurses who stayed many years with the same hospital, getting to know two, even three, generations of families who were suki(frequent customers) of those hospitals. These nurses loved their profession, their hospitals and their patients, and were loved in return—enough not to leave us, and the Philippines.

mtan@inquirer.com.ph