Cannibalizing the nursing curriculum

A DAY after the President ordered the Commission in Higher Education (CHEd) to offer solutions to the nursing shortage, a railroaded nursing curricular change was readily proposed. The major nursing stakeholders were not consulted, although there are nursing leaders embedded in the CHEd system who may have either been privy to the “proposed” solutions or were ignored in the process. The news circulated fast. And the nursing communities are stirred. Some, especially outside nursing, may argue that it is a brilliant solution. But on deeper analysis, it is a band-aid solution that will allow the real problem to rot and decay from within, without any promise of benefit to the public that the nursing profession vows to serve.

Imagine a situation in the hospital setting where a registered nurse oversees a team of aides, assistants, technicians or personnel who will perform a set of particular skills from a ladder of skills training within a nursing curriculum. As proposed, at first year level, students may exit and become “certified nursing assistants or nursing aides,” and at Level 2 and 3 they may become “Nursing Associate, Associate Community Health Nurse, and Associate Maternal and Child Nurse” holding a diploma. It is when they finish fourth year that they become Bachelor of Science in Nursing (BSN), ready for licensure examination and become Registered Nurses.

BSN is the only “nursing program” defined and recognized by the very law that professionalized nursing in the Philippines, RA 9173. Professional nurses hold the exclusivity in performing nursing functions in the interest of public safety and welfare. Registered nurses need to demonstrate competencies based on a set of standards prescribed by the nursing profession itself. Nursing had a long journey to professionalization since the time of Florence Nightingale, and in the Philippines was since 100 years ago through nursing pioneers like Anastacia Giron Tupaz, Dean Julita Sotejo, among others.

Imagine the world benefiting from the best of Filipino nurses, while the Philippine health care system is settling to less educated and half-baked trained personnel to perform “nursing functions.” And this is because we have not addressed the real problem — making professional nursing practice attractive enough for Filipino nurses to stay in the Philippines and to resist the global offer for migration. Simply put, manage migration while making a nursing career somehow palatable for Filipino nurses in the Philippines.

How serious is the problem?

The nursing shortage is global. Based on the WHO’s State of World Nursing Report in 2020, the world will be short of 5.6 million nurses by 2030, and the pandemic increased the health care demand and added strain on the human resource supply.

The 2022 DoH report expressed that the Philippines is short of 106,541 nurses out of 194,114 shortage of health care workers.

Is nursing supply an issue?

For the past 20 years, the Professional Regulation Commission has registered 606,428 nurses and 55,783 physicians. Prior to the pandemic, an average of 30,000 nurses are registered a year for the past 20 years, and there seems to be no reason for the country to have scarcity of nurses. In November 2022, a new set of 18,529 registered nurses took their oath.

Did you know that many nurses are still working as contractual “job orders” in government hospitals? Did you know that there are thousands of plantilla positions in government that are unfilled?

Even if the WHO Global Code of Practice on the International Recruitment of Health Personnel and the International Council of Nurses are clear about the ethics in international recruitment, there will be desperate attempts to lure Filipino nurses to migrate. And the nurses have the right to pursue professional achievement through career mobility and to better the circumstances in which they live and work. Migration of nurses offers potential beneficial outcomes, including multicultural practice and enhanced learning opportunities. A range of “push” and “pull” factors exist that lead nurses to seek employment outside of their country of origin.

The real solutions

The WHO recommends that countries need to invest in a massive acceleration of nursing education, create at least 6 million new nursing jobs by 2030 and strengthen nurse leadership.

The government needs to create and fill up plantilla positions for various nursing positions cognizant of the nurse-patient ratio which is scientifically based on the acuity of care while providing the positive practice environment to its health personnel.

There may be a need to have a National Chief Nurse position in the Department of Health. Government needs to subsidize the private hospitals, specific in its human resource development, to cushion the increasing cost of health care.

Scholarships in graduate studies are needed to supply the scarce qualified deans, instructors and educators in nursing. Then, the nursing scholarships may be massively funded with return service provisions, which is logical and just.

There are solutions to increase the supply of health care professionals. It includes the strengthening of the Expanded Tertiary Education Equivalency and Accreditation Program (Eteeap) in nursing. Scholarships and subsidies should be provided for the dropouts in nursing schools due to financial reasons. The review programs may be institutionalized by the nursing Centers of Excellence (CoE) and Centers of Development (CoDe) to help those who failed the board. The underboard may actually be the best alternative to perform some functions in the health care settings. There is a need to create a bridging program for those RNs who have left the practice of nursing and shifted to other fields. We may also engage the repatriated overseas Filipinos who were health care workers abroad.

There are solutions, but cannibalizing the nursing curriculum will not ensure a supply nor will provide the public the nursing service it deserves. It will dilute the nursing care of the Filipinos and will endanger them, even without saying it violates the Nursing Law. Passing the proposed New Nursing Law and Philippine nursing will be more relevant to our changing times. Leave nursing to nurses and they will be able to care for the Filipinos.