(June 17, 2016)
In the light of the recent decision of President Benigno Simeon Aquino III to veto Senate Bill 2720/House Bill 6411, otherwise known as the Comprehensive Nursing Law of 2016 (CNL), the Alliance of Young Nurse Leaders and Advocates Inc. (AYNLA) expresses its dismay on the actions of the President.
While we respect the constitutionally-conferred power of the President to veto any act of the Legislature in exercising check and balance, we disagree on majority of the arguments underlying his disapproval of the proposed legislation. Furthermore, AYNLA believes that the non-passage of the CNL, as a farewell gift, is a real letdown to the nursing sector.
AYNLA presents its two-point argument against the decision of the President to veto the CNL:
- The CNL’s increase in nurses’ salary has positive health system implications.
The President’s argument against the passage of the CNL includes the possible negative impact on the financial capacity of the local government hospitals, private hospitals, and nongovernment health institutions. However, we find the so-called negative implications or repercussions as speculative, given no evidence has been presented to back such claims.
This action of the President also reflects that spending for nurses’ welfare is viewed as a cost rather than an investment.
The nurses represent the largest group of health service providers in the country and have been traditionally regarded as the “backbone” of health service delivery. In the United States of America, the costs of direct turnover per nurse in hospitals may reach over $64,000 due to direct and indirect costs including pre-turnover productivity losses.1 Consequently, the retention of nurses is critical in sustaining quality health service delivery at all levels.
Pay and income affect performance, morale, motivation, and the ability to attract and retain the health workforce. In low and middle income countries such as the Philippines, when the pay is low, health workers find alternative income sources and may extract informal fees from patients, or seek per-diem
payments by attending workshops and seminars.2 It is also a strong driving force for international migration. The current international migration of nurses in the country, as a result of poor working conditions and lack of domestic opportunities, should be seen as a symptom of the larger health system problems.
Investing in nurses has positive implications in the health system. According to the World Health Organization (WHO), nursing interventions can effectively contribute towards achievement of the Millennium Development Goals as well as in reducing the burden of non-communicable diseases (NCDs).3 It is a pre-requisite to realizing the universal health coverage. Task sharing with nurses to ensure universal health coverage in HIV and maternal health requires an investment in nursing education, retention, and professional growth opportunities.4 Optimizing these mix of health workers require policy reforms to address incomes and pay. These are all enshrined in the CNL.
The passage of the Comprehensive Nursing Law can be a good test case to rationalize the salary of other health professionals and examine the current health workforce strategy. The nurses are not competing with other professionals. We are one with the fight towards decent condition of health professionals and upholding their rights, free from exploitation.
- The CNL is more than just salary increase for nurses
The President’s disapproval of the aforesaid proposed legislation is an utter deprivation of the protective mantle the Legislature, in its due exercise of its police power, seeks to accord to all Filipino nurses, who happen to be an equally important component of the country’s allied health force. A judicious reading and examination of the proposed nursing law would reveal a more encompassing coverage, which focuses not only on salary per se, but more importantly on other equally viable aspects of the Philippine nursing profession as a whole – education and professional development, service provision, independent practice, and leadership and governance. Likewise, to block the full enactment and implementation of the CNL is to deprive Filipino nurses the protection of their substantive human and labor rights enshrined under the Constitution.
Moreover, the issue on equal protection of law relative to the provision on salary, should have not been raised in the first place, since the Salary Standardization Law 3 (SSL3)5, which is a mere Joint Resolution, is the one that diminishes the salary and benefits of nurses. In the current existing nursing law (R.A. 9173)6, it can be inferred that the intention of the lawmaking body is to peg the salaries of entry-level nurses at SG15, but the said SSL downgraded the salary to SG11. Hence, it is clear that the passage of SSL resulted to the diminution of benefits for nurses, which we believe as contrary to the constitutional mandate to protect the rights of workers and to promote their welfare, and afford labor full protection. The passage of the proposed CNL, is just a reiteration of what is long due for nurses.
Here are some important provisions of the proposed CNL:
Protection to Nurses. The CNL was created for the protection of nurses where many of us are longing to have. It’s been a decade since the so called “volunteerism-for-a-fee” came along to the journey of Filipino nurses, wherein they are being required to pay the hospital in order to render professional service. Many nurses complained about it but justice was never served because the current nursing law does not have any provision to protect the nursing profession against such unjust act. Volunteerism should be abolished.
One Nurse in every Barangay, School and/or Institution. This provision will not only provide jobs to nurses but also will promote quality care to Filipino patients, students and employees. The presence of nurses in these settings gives security to the community, schools and or institutions, as far as health issues are concerned.
Continuing Education and Advanced Practice Nursing Program (ANP). Medical science is a never-ending study. In order to meet the global competitiveness, nurses must have an update of their chosen field respectively. The CNL provides free or with pay (lesser amount) seminars and/or trainings. These updates are essential for the professional growth and advancement of their practice. Likewise, the CPL mandates certain authorities to formulate and develop an ANP that would upgrade the level of skill and competence of specialty nurse clinicians.
Appeal of young nurses
We appeal to President Elect Rodrigo Duterte, incoming Secretary of Health Paulyn Jean Rosell-Ubial and the Private Hospital Association to view investing in nurses as a capital asset of development rather than a cost and a burden to the health care system.
We appeal to our legislators to continue supporting the plight of the Filipino nurses. We urge the same proposed CNL be filed this coming 17th Congress and, if necessary, include additional measures that will further promote the general welfare and advance the rights of nurses.
We appeal for the unity of the nursing profession and its supporters, who are behind the initiatives to pass this important piece of legislation. Let us be vigilant to any activities that shall water down the provisions or impede the passage of the Comprehensive Nursing Law in the next Congress. /END/
Signed: AYNLA Board of Trustees
REIGNER JIREH D. ANTIQUERA, RN
BILLY JAY B. GUANSING, RN
JONATHAN D. MONIS, RN
MARIA KRISTINA D. SIUAGAN, RN
RAYMOND L. GARCIA, RN
NIKKON S. FORTUNATO, RN
MARY JUNILLEE C. ARAÑO, RN
JOHN PAUL M. PATRIARCA, RN
GUADA FATIMA A. HERNANDEZ, RN
1 Jones, C., & Gates, M. (2007). The costs and benefits of nurse turnover: a business case for nurse retention. Online Journal of Issues in Nursing, 12(3).
2 McCoy D, Bennett S, Witter S, Pond B, Baker B, Gow J, et al. Salaries and incomes of health workers in sub-Saharan Africa. Lancet. 2008;371:675-81.
3 World Health Organization (2013a). Enhancing nursing and midwifery capacity to contribute to the prevention, treatment and management of non-communicable diseases, Geneva
4 Kurth AE, Jacob S, Squires AP, Sliney A, Davis S, Stalls S, Portillo CJ (2016). Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage. J Assoc Nurses AIDS Care. 2016 May-Jun;27(3):344-54. doi
5 Joint Resolution Authorizing the President of the Philippines to Modify the Compensation and Position Classification System of Civilian Personnel and the Base Pay Schedule of Military and Unifored Personnel in the Government, and for Other Purposes. Retrieved in 17 June 2016: http://www.gov.ph/2009/06/17/joint-resolution-no-4-3/
6 An Act Providing for a more Responsive Nursing Profession Repealing for the Purpose Republic Act No. 7164 Otherwise Known as “The Philippine Nursing Act of 1991” and for Other Purposes. Retrieved in 17 June 2016: http://www.gov.ph/2002/10/21/republic-act-no-9173/