Overworked and underpaid, nurses are packing up, flying out

A Filipino nurse on hospital duty during the pandemic in the United Kingdom —TINIG UK

The demand for Filipino nurses in Europe is so high that Germany and the United Kingdom are reportedly talking directly with administrators of some nursing schools in the Philippines to recruit their students.  

But German Ambassador Anke Reiffenstuel recently took to Twitter to deny that Germany was “pirating” Filipino nursing students to fill the shortage of nurses at home, saying it was working closely with Philippine colleges and agencies in its recruitment drive. 

“Germany is not pirating PH students!” she wrote, explaining that its recruitment of Filipino nursing professionals is covered by a bilateral agreement called the “Triple Win Program.” 

Reiffenstuel’s disclaimer had been prompted by news that her country and the United Kingdom were offering “attractive packages” to second-year nursing students at De La Salle University Medical Center in Cavite to continue their studies there for free for eventual hiring.  

Vilma Garcia, president of the medical center employees’ union, told the Philippine Star that a fourth of their students had accepted the offer. 

Skill and experience

Nurses on duty in Solano, Nueva Vizcaya —PIA PHOTO

“Foreign countries are looking at the Philippines as a very good source of skilled and experienced nurses, nurses with a heart and proficiency to serve,” said Eleanor Nolasco, vice president of Filipino Nurses United (FNU).

But it comes at a price for Filipinos, Nolasco told CoverStory.ph in a phone interview. “Who suffers the most from their departure? Of course, it’s the patient,” she said.

The exodus of healthcare workers, including nurses, doesn’t come as a surprise given that the P35,000 monthly pay in government hospitals is a pittance compared to the entry-level pay of $3,800 (P209,000) in the United States, £1,662 (P111,000) in the United Kingdom, and $4,097 (P163,000) in Canada .

 The perks are too enticing to ignore: One can complete their course in the host country, enjoy free or subsidized housing and free healthcare, and relocate their family for long-term or permanent stay. 

“How do we compete with that?” Mary Rose Castillo Capili, a nurse supervisor at Tarlac Medical Center in Tarlac City north of Manila, told CoverStory.ph by phone. “Obviously, we can’t match the offer of other countries.”

Tarlac Medical Center opened in January 2021. Within the next six months of its operation, it lost at least 20 nurses who had pending applications with hospitals and private care homes in the United States, United Kingdom and Middle East.  

Choosing between a monthly pay of P20,000 in Philippine private hospitals and the maximum offer of $6,000 in US medical facilities was a no-brainer.

And this takes the cake: Passers of the National Council Licensure Examination who gain immigrant status can eventually petition for family members to live with them in the United States. 

One to a ward

“Chronic understaffing” has beset Philippine hospitals over the last few years and persists to this day largely due to the migration of nurses to other countries over inadequate pay, poor working conditions and nonrelease of benefits. 

“Of course, that weakens the public health system,” Nolasco said. She disclosed that some hospitals in Metro Manila and in the provinces had to shut down their wards because there weren’t enough nurses to serve as staff. 

At the height of the Covid-19 pandemic, the nurse-patient ratio surpassed the Department of Health (DoH) standard of one nurse for every 12 patients. There were instances, according to Nolasco, when one nurse attended to 20 patients, 60 patients, and even an entire ward, especially in public hospitals.  

At present, nurses attend to 20 to 50 patients per shift, working 12 hours to 16 hours, often without overtime pay, the FNU said.  

As the health crisis waned and other countries opened their borders last year, Filipino nurses, whether skilled or newbie, took advantage of the aggressive recruitment campaign by foreign medical institutions, exacerbating the inadequate staffing.  

Many felt hugely unappreciated by the government. Even as they were being hailed as modern-day heroes for serving as frontliners in the fight against the coronavirus, they had to fight tooth and nail to be able to receive the benefits and compensation, including the “SRA,”or “special risk allowance,” promised them. 

As things stand, Philippine hospitals and clinics are short of nurses. Health officials pegged the shortage at 106,000 in September 2022, and said in June of the same year that a third of the 915,219 registered nurses had migrated to other countries.  

With staff nurses at Tarlac Medical Center resigning one after the other in 2021, Capili said she had to take on some of their duties.   

To stem the exodus, the hospital owned by 100 doctors dangled a P10,000 “signing bonus” for nurses who agree to a one-year contract, and an additional P10,000 for those who are willing to stay for another year, beginning November 2022. 

Not enough

Filipino nurses find employment in the United Kingdom. —SHUTTERSTOCK

But that was not enough to make the new hires, especially those with pending overseas applications, stay. 

“They just keep on leaving. They don’t want to stay long in a job that offers paltry pay,” said Capili, who worked for 16 years as a nurse at Central Luzon Doctors’ Hospital, also in Tarlac, before moving to her current job.    

Still, the offer drew more applicants than the usual number, she said. 

Tarlac Medical Center has at least 80 nurses working 12-hour shifts and enjoying 14 days off in a month. It’s now operating 75 beds out of its full capacity of 100. At the peak of the pandemic, it allotted 15 beds for Covid patients. 

The workload is normal for a private hospital, but the pay—P15,000 for probationary nurses and P20,000 for regular nurses—leaves much to be desired for nursing graduates in these much-diminished times.

Some nurses stay because their spouses have saved enough money to buy their own house, car and other property, and pay for the education of their children.    

“In a manner of speaking, they’re established,” Capili said. “They’re the ones who have second thoughts about leaving.” 

Salary grade 15

Nolasco said applying the same salary grade 15 for nurse 1 or entry-level nurses (P35,000) to all, whether they’re serving in national hospitals or local-government hospitals, would encourage nurses to stay. 

Unlike their counterparts in national hospitals, nurses serving in provincial, city and municipal hospitals belong to salary grade 11 (P25,000). They get higher pay but with a heavier workload if they serve in first-class cities such as Makati and Manila. 

“They’re the exception rather than the rule,” Nolasco said. 

The Philippine Nursing Act of 2002 provides for salary grade 15 for nurse 1. Seven years after its passage, Congress authorized then President Gloria Macapagal-Arroyo to modify the compensation and position classification system of civilian personnel, leading her to reduce the base pay of nurses from salary grade 15 to salary grade 11. 

Ruling on the petition of a party-list group, the Supreme Court in October 2019 upheld the validity of the law’s provision: It said the minimum base pay of government nurses should not be lower than salary grade 15.  

Between then and now, that specific provision has been applied “depending on the availability of funds,” Nolasco said. 

Nurses and the DoH are rallying behind the passage in the House of Representatives of a bill seeking to set a minimum monthly salary of P50,000 for nurses in government and private hospitals. 

It would help much if the pay of private hospital nurses becomes “comparable” with that of their government counterparts, Nolasco said.

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