Nursing Shortage? Hire Nursing Graduates Who Failed the Board Exam!

New DOH Secretary Teddy Herbosa has sounded the alarm over the mass exodus of Philippine nurses abroad for better pay and working conditions. He says that if this issue is not addressed the number of nurses will be depleted within 3 - 5 years.

https://www.gmanetwork.com/news/topstories/nation/873429/herbosa-sees-ph-nurses-depleted-in-3-5-years-if-exodus-not-addressed/story/

Health Secretary Ted Herbosa said on Tuesday that the number of nurses working in the Philippines may be exhausted in a few years if the problem of them opting for better-paying jobs abroad is not addressed.

This is why, Herbosa said, he is pushing to grant temporary licenses to board-eligible nursing graduates and have them work as nurses in government hospitals.

He reiterated that 4,500 plantilla items for nurses are currently vacant in over 70 hospitals of the Department of Health (DOH) nationwide.

(That's why I'm focusing on it right now because if we don't do anything now, I can see that in a few more years, maybe three or five years, our nurses will run out. So I have to find a way to increase our nurses again.)

His immediate solution is certainly outside of the box, allow nursing grads who failed the board exams to be given temporary licenses. 

https://www.philstar.com/headlines/2023/06/20/2275114/government-hospitals-employ-nursing-grads-who-failed-board-exams

Nursing graduates who failed their board exam with scores between 70-74 percent will be employed in government hospitals, according to the Department of Health (DOH).  

“I will tap them, around 50 percent of those who took the board exam but did not pass – specifically those who achieved a 70-74 percent rating,” Health Secretary Teodoro Herbosa said in an interview at the DOH central office yesterday. 

The measure, supported by Labor Secretary Bienvenido Laguesma, will allow non-board passers to work in state hospitals under supervision and with temporary licenses. 

Non-board passers will be given four years to pass the Philippine Nurse Licensure Examination. 

After passing the board exam, they have to sign a four-year return service agreement and work in government hospitals before they are allowed to work abroad.

“The plan to hire unlicensed nursing graduates is because under the Universal Health Care, the core of any health system are nurses, that is why they are being pirated by other countries... They have the capability to build more hospitals so they would then be needing the services of more nurses,” he said. 

The private sector offered scholarships for the board review classes of unlicensed nursing graduates, Herbosa said. 

Rather than put a stop to foreign nations "pirating" Philippine nurses Herbosa thinks staffing government hospitals with failures will solve the problem. Several nursing groups are opposed to this idea for various reasons. 

https://www.gmanetwork.com/news/topstories/nation/873486/nurses-groups-oppose-plan-to-grant-temporary-licenses/story/

Several nurses organizations on Tuesday expressed disapproval on the proposal to issue temporary licenses to unlicensed nursing graduates to allow them to work in government hospitals.

Philippine Nurses Association (PNA) president Melvin Miranda said that Health Secretary Ted Herbosa should reconsider his plan to hire nursing graduates who scored 70-74% in the board exam even though they flunked, given that they retake and pass the board exam after a certain period of time.

(One of our doubts here is that it seems like those who scored 70-74% in the board exam who will be given a temporary license have a scope of practice that is not yet considered. Since they are not considered by our law to hold professional practice, the burden will fall on our registered nurses who have the accountability.)

Miranda stressed that their priority as nurses is the safety of their patients, thus the Department of Health (DOH) should give the plantilla positions to the professional nurses instead.

(If a nurse is recognized as licensed, his/her level of confidence and his/her competence will be compared to a professional. When we give temporary licenses, there is no definite study to prove that unlicensed nursing graduates have achieved a high level of confidence in performing their tasks.)

(I think this kind of situation is quite risky and should be given more thorough study.)

This was echoed by Filipino Nurses United (FNU) secretary general Jocelyn Andamo, saying that the DOH should focus on hiring registered nurses instead as there are around 120,000 of them who are not currently working in the field of nursing.

“FNU's stand is DOH should prioritize employing registered unemployed nurses or those working in non-nursing jobs. There are around 120,000 nurses categorized by DOH who are working in unspecified field of practice.These may be those unemployed and or those in non nursing jobs,” Andamo said in a message to GMA News Online.

She stressed that issues of nurses, particularly on salary and benefits, should be addressed by the government in order to keep them working in the Philippines.

“The wages should be increased to P50,000 entry salary, give them regular, permanent positions and provide adequate benefits,” she appealed.

So, there are around 120,000 unemployed nurses in the country? Why is that? Have they elected not to work due to the low pay and horrible wiring conditions or have they been unable to find someone willing to hire them? Why wouldn't Teddy tap this prime and ready workforce?

Several Senators have also turned thier thumbs down to this proposal. 

https://newsinfo.inquirer.net/1790966/senators-reject-doh-chiefs-plan-to-hire-nursing-board-flunkers

Several senators on Tuesday rejected Health Secretary Teodoro Herbosa’s plan to temporarily hire nursing board flunkers to address the dwindling number of nurses in government hospitals in the country.

Senate Minority Leader Aquilino Pimentel III said it would be better for the Department of Health (DOH) to institutionalize improvements in the salaries and benefits of state health workers instead of pursuing “Band-Aid solutions.”

“The proposal to allow non-board passers to practice nursing and grant them temporary licenses is a short-term solution,” Pimentel told reporters.

“The root causes of the shortage lie in the significant number of nurses leaving the country to seek higher-paying jobs abroad,” he noted.

It also expressed concern that such a move might compromise the quality of care provided to patients.

Pimentel said the proposal might also impact on the quality of the country’s nursing board exams.

“We have to protect the integrity of our testing system,” he said. “If they passed, that means they are ready (to become nurses). If they failed, then they are not yet ready… (The passing grade of) 75 means 75, not 74.5.”

Senators Nancy Binay and JV Ejercito shared Pimentel’s observations, with the latter pointing out that encouraging Filipino health professionals to stay in the country was one of the goals of the Universal Health Care Act.

“We cannot offer a genuine health care if there’s a shortage in healthcare workers,” Ejercito said. “If we can only give a (salary) raise that would be decent enough to sustain their family, (Filipino health workers) would choose to stay here.”

“The most practical thing to do is to prioritize the hiring of unemployed nurses,” Binay said.

It will compromise the quality of care and does not address the issue of nurses leaving the country. But when has the Senate ever addressed the OFW brain drain? 

One Solon appears to have found a working solution to this mess. A solution that makes Herbosa's plan conform to existing law. 

https://www.pna.gov.ph/articles/1204115

A House leader on Thursday proposed amending the Philippine Nursing Act (Republic Act 9173) with the creation of categories for nurse practitioners and nursing assistants who can lighten the workloads of registered nurses in medical facilities.

House Committee on Civil Service and Professional Regulation chairperson Alexie Tutor said the amendatory bill can be certified as urgent if the Department of Health (DOH) and Professional Regulation Commission (PRC) deem the nursing personnel shortage to be in "urgent crisis mode."

Tutor said DOH Secretary Teodoro Herbosa's plan to provide temporary licenses to nursing graduates who failed the mandatory board exam, but nearly passed with ratings of 70 percent to 74 percent has no basis in either the Philippine Nursing Act or the PRC Modernization Act (Republic Act 8981).

"Republic Act 9173 and RA 8981 do not provide for any circumstance or situation wherein either the Nursing Board or the PRC is authorized or empowered to issue any temporary license to practice the nursing profession. We are aware of no precedents for the issuance of temporary professional practice licenses," she said.

Tutor, however, pointed out that RA 9173 has a provision under Section 15 allowing those examinees to retake the exam for those subjects where they got ratings lower than 60 percent.

"Special examinations can be scheduled for those. This is one way for the DOH and PRC to achieve what they would like to happen: have more passers of the nursing boards," she said.

She also proposed that instead of hiring "near passers", the DOH should hire several unemployed passers of the nursing boards through filling up the vacancies for nurses of the DOH hospitals' plantilla items.

According to this Solon Teddy's plan is illegal as it is but he could adjust it to make it conform to the law. For his part the DOH Secretary says he would shelve his plan if it was found to be illegal. 

https://newsinfo.inquirer.net/1792631/doh-may-shelve-plan-to-hire-unlicensed-nurses

Health Secretary Teodoro Herbosa on Friday said he would consider shelving his plan of allowing unlicensed nursing graduates to work in public hospitals should it fail to hurdle the “legal roadblocks.”

At a press briefing, Herbosa pointed out that he would welcome other possible solutions to the understaffing of nurses in public hospitals, among them hiring board-eligible graduates as “nursing trainees” who would be put in a “training program.”

“I don’t want to do anything illegal … If an agency tells me it’s illegal, then it’s illegal… I can’t force the issue. But they (other agencies) are with me to find solutions,” he told reporters.

Section 21 of the Philippine Nursing Act allows the grant of a special or temporary permit for a limited period only to foreign nurses invited to the country for a program or medical mission.

This has been raised by the Philippine Board of Nursing, said Herbosa, and so he has proposed to some lawmakers that the law be amended to make the issuance of licenses to board flunkers possible.

“They told me, amendment is easy… but they said that the president has to make it urgent,” Herbosa said of his conversation with the Professional Regulation Commission. “That’s the legal side of the problem… I’ll leave it to the lawyers and legislators to help solve the problem,” he added.

Another option is the hiring of nursing assistants under the DOH’s human resources for health program. Under this position, Herbosa noted, unlicensed nursing graduates would be hired under Salary Grade9, equivalent to around P21,000.“It’s being offered as a solution, and that’s going to go forward. It will be open to graduates of college but [are] awaiting to pass exams,” he said. 

The big takeaway here is that DOH Secretary Teddy Herbosa has started a conversation. He has said the quiet part out loud, that the Philippines is bleeding nurses due to the OFW program, and he has offered a solution. It may not be a good or even legal solution but that can always be remedied and adjusted. When will the government stop lauding OFWs and recognize that they represent a massive brain drain which is detrimental to the nation?!