AYNLA Position Statement on Nurse Volunteerism & Unemployment Crisis at Senate Committee on Health Hearing

Senate Hearing of the Joint Committees on Health,
Finance, Labor, Employment & Human Resource Development
January 11, 2011 | Senator Pecson Room, 2nd Flr. Senate of the Philippines
Madam Chair of the Senate Committee on Health, committee members & distinguished legislators, colleagues and fellow leaders in healthcare & advocacy, ladies and gentlemen good afternoon.
We are the Alliance of Young Nurse Leaders & Advocates International – a network of nurse leaders & advocates voicing the rights of around 200,000 unemployed nurses in the country today. Together advocating with the Filipino Nurses Online Community, we form more than 200,000 online nurse supporters and also with our official registered members do hereby support all measures and initiatives to curb the sky-rocketing unemployment rate & exploitation of our prime health professionals in the Philippines.
According to the Professional Regulation Commission (PRC), the Philippines have already around 200,000 unemployed nurses and the number is growing inexorably in 2010. This huge number of unemployed nurses bothered the AYNLA since most of the nurses who are unemployed and exploited are our members. With huge numbers of unemployed nurses, thousands flocked in the hospitals to render their professional services free of charge. This now became the term Nurse Volunteerism. Nurse volunteers rendered their professional services without pay or charges but in contrast they are the ones paying the hospitals where they volunteer. According to the nurse volunteers, they pay hospitals from P3,000 to P5,000 or even greater in a span of 2-6 months “volunteering” in the hospital wards. They work similarly as those of paid regular staff nurses having similar workloads and reporting on similar 8-hour duty shift. For some unfortunate ones, they are asked to go on duty even for 16 or 24 hour duty straight. Nurse volunteers in the country go by batches and pay in batches as well. There is one report we got from our member who underwent volunteering in a hospital where it only provided one official receipt for their batch of 20 nurses.
As Merriam-Webster Dictionary would define a ‘volunteer’, it is a person who does work without getting paid to do it. But in the case of our nurse volunteers, “volunteering” would mean, paying hospitals exorbitant fees, providing professional nursing services without fee, getting to work like a paid staff nurse without getting compensation (or to some hospitals a few meal allowances of P30-50 a day), risking his/her professional license doing professional nursing services without getting protection, and expecting highly to be employed somehow when these hospitals would offer a rare vacancy because the hospital gave a promising statement that they will hire nurses who only volunteered in their hospital. These schemes are clearly forms of exploitation and abuse to our nurses of whom they grabbed the opportunity where our nurses would give their services for free just to obtain clinical experience. These hospitals lured the nurses by providing them certificates certifying them to have become “nurse volunteers or trainees” of the hospital. They have been told that these certificates as Nurse Volunteers or Trainees would be equivalent to a working experience and be credited for work abroad. Unfortunately this was not the case, and only the Middle East countries would accept this kind of certificates. In our network, we found out that this Nurse Volunteerism cum Training has been rampantly practiced all over the country. Some hospitals changed the name of the ‘nurse volunteer’ to a ‘nurse trainee’ to justify costs on “training”. Specialty training considered in nursing practice is meant for ‘advance practice’ and focuses on specialty areas such as but not limited to perioperative, dialysis, oncology, and critical care nursing. However, training in the ward that assumes the roles of a basic staff nurse is not specialty training. It is a basic training supposedly learned during the junior to senior years of the nursing course. 
The Philippine Nursing Act of 2002 or R.A. 9173 is the only legal basis of nursing practice in the Philippines. In it, it described a professional registered nurse as capable of providing professional nursing services and it shall be for a pay or fee where it further stated that an entry level for a professional nurse be compensated on Salary Grade 15, equivalent to around P20,000 today. This was never implemented since the law was amended and approved in 2002. Former President Gloria Macapagal-Arroyo even signed E.O. 811 increasing nurses’ salary from SG 10 to SG 11 in June 2009. But R.A.9173 clearly said that entry level for nurses should be on SG 15. Also, according to the Alliance of Health Workers, the Philippines had only about 25,000 plantilla positions for nurses in different public hospitals within our country, however the ideal number for plantilla positions that will effectively deliver health services for our hospitals is about 50,000 to 60,000. This becomes one of the main reasons why many hospitals cannot afford to hire additional nurses because they do not have enough financial capacity for their salary. And they used the concept of volunteerism or ‘nurse trainees’ so our poor nurses, eager to gain clinical experiences, became the hospitals’ chance of filling in the gaps without paying anyone. We find this is in violation of R.A.9173 and considered it illegal.
With the growing desperation of our colleagues having no work available in the hospitals for clinical practice and with the practice of paid volunteerism cum training, some of them resorted to work as call center agents, salesladies in malls, bell boys in hotels, domestic workers, and one club entertainer. We do not intend to disrepute these jobs but we are losing our rich licensed human resources for healthcare. And since there is a huge disparity between salaries received by our nurses in the country compared to our foreign counterparts, skilled nurses would opt to work abroad.
We therefore recommend the distinguished Madame Chair and the Senate Committee to:

  • Further investigate the growing Nursing Crisis in the country and similar investigations on the health professions;
  • Put a halt to the practice of Nursing Volunteerism cum Training and consider this illegal and exploitative;
  • Increase plantilla positions for nurses in the country ensuring a close to ideal nurse-patient ratio in contrast of the ratio today where 1 nurse in the ward is equivalent to more than 20 patients, and 1 community health nurse is equivalent to more than 50,000 residents;
  • Ensure that the minimum base pay of nurses working in the public health institutions shall not be lower than the 1st step or hiring rate prescribed for Salary Grade 15 pursuant to RA No. 6758 otherwise known as “Compensation and Classification Act of 1989.” as stated in Rule 6 Section 33 of the Implementing Rules & Regulations of R.A. 9173;
  • Ensure implementation of the Magna Carta for Public Health Workers (R.A. 7305) on the benefits applicable to nurses, such as having night differential pay, hazard pay and relevant allowances or benefits;
  • Create more public/rural health units and absorb nurses;
  • Train nurses for ICT such as medical transcription;
  • Provide opportunities to have seed funding for nurse-led health clinics & or cooperatives where nurses can perform primary healthcare, maternal & child care, reproductive health education & basic services, HIV pre & post test counseling & referrals and such other services bound in the practice of professional nursing in the country; and
  • Create a multi-agency Task Force or Commission overseeing the welfare of the Filipino nurses who compose the largest in the healthcare force. This Task Force shall be the main policy-making & enforcement body for nursing affairs to be chaired by either DOH or PRC and with members such as DOLE, POEA, CHED, DILG and all nursing organizations & health groups.  The Task Force also police for exploitation and proposes measures to curb down the huge unemployment rate.
  • Continue representing the voice of the nurses and actively help the country to maintain one of its prime human resources – our nurses;
  • Advocate for nurses rights and ensure that our rights are not exploited and abused;
  • Contribute to the entire investigation of the current nursing crisis on all ways possible; and
  • Keep watch of violations or responsible agencies and reports of abuses to nurses.

And to our end we vouch to:
We are glad that recently the President Aquino signed a 1.6 trillion budget for education and health services which is a 16.8 percent increase from the previous budget. We are furthermore glad to know that DOH plans to deploy nurses to the rural health units to take “midwife positions” where needed. We would like to be ensured that when nurses assume these positions, we will still adhere and follow with SG 15 as mandated by R.A.9173.
In closing I would like to quote the Philippine Nursing Act of 2002, Section 2 of R.A.9173. Its Declaration of Policy stated that “It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country.”
We hope for a better future of the nursing profession in the Philippines. Thank you!
Alvin Cloyd Hubahib Dakis, RN
Founder & National President, AYNLA International
World Bank 100 Young Leaders of Knowledge & Development
Alliance of Health Workers (AHW)
Professional Regulation Commission
R.A. 9173, The Philippine Nursing Act of 2002
R.A. 7305, The Magna Carta of Public Health Workers

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