In June 2016, Former President Benigno Simeon Aquino III rejected the Senate Bill 2720/House Bill 6411, otherwise known as the Comprehensive Nursing Law of 2016 (CNL) just a few days before the end of the 30 day constitutionally-conferred veto power to the President. The President cited primarily the provision on salary increase and averred that the same may result to a distortion in the wage structure, not only among health care practitioners, but even among other professionals in the government service.
The nursing community was dismayed by the actions of the President as the CNL is not merely about salary modifications. The main objectives of the proposed legislation encompass the advancement of the nursing profession and protection of the rights and welfare of its cadre. Notwithstanding their positive impact on the health system of the country, these critical reforms were, in effect, relegated by the aforesaid veto.
In support of the plight of the Filipino nurses, Senator Angara and Senator Trillanes, among others, filed their respective versions of the Comprehensive Nursing Law at the 17th Congress of the Philippines.
We, the collective voice of young nurses, who are partners for change in the nursing profession, enormously support these and other initiatives to advance the nursing practice in the country and uphold the rights and welfare of nurses. Hence, we recommend that young nurses shall be invited to be part of the technical working group during the Committee hearings.
OUR PROPOSED PROVISIONS
We call for the consideration and inclusion of the following provisions, which we deem important for young nurses:
A. IMPROVING COMPENSATION AND OPENING MORE JOB OPPORTUNITIES
In the recent years, nurses experience a huge gap in salary or compensation as compared to other similarly situated professionals such as social workers, engineers, architects, call center agents, and Information Technology (IT) professionals. The recent survey of the Alliance of Young Nurse Leaders and Advocates (AYNLA) shows that 52% of 874 nurse respondents are receiving a salary of Php 10,000 and below monthly. Indeed, this is lower than the salary grade 15 (SG 15) prescribed by the Philippine Nursing Act of 2002 (Republic Act 9173). Majority of these nurses are within the age range of thirty and below, whose family have invested so much on their college education.
The salary of nurses has not improved significantly in the last ten years despite the expanding market potential of and the demand for healthcare. The World Bank data show that the percentage of the health expenditure increased from 3.21% in 2000 to 4.71% of the Gross Domestic Product (GDP) in 2014.1 Being the largest number of health professional and traditionally regarded as the “backbone” of health service delivery, nurses are not getting their proper share in the market profits.
B. PROTECTING NURSES AGAINST ALL FORMS OF EXPLOITATION
False volunteerism can be considered as today’s most discreet and insidious form of nurse exploitation – beguiling nurses to take on clinical duties without proper compensation and benefits accorded to them by the law. Newly graduate nurses are the most affected by the implementation of these malicious schemes, which put them into a disadvantaged situation and worst, drives young nurses away from the nursing sector to find better opportunities in other unrelated fields.
The legislative inquiry and formation of DOH ad hoc committee in 2011 reduced significantly the conduct of false volunteerism and other related nurse exploitation activities in the recent years. However, such practices were not totally halted. Reports show that different variations of false volunteerism have emerged to creatively justify deceptive acts of hospitals such as concealing it in the form of “training programs” without proper curriculum and due accreditation by the proper regulatory bodies.
Moreover, hospitals require nurses to comply with the so-called pre-employment requirements such as Basic Life Support, Advanced Cardiac Life Support, and Intravenous Therapy. However, these are training programs that are supposed to be provided by hospitals and other healthcare facilities as part of their continuing commitment to enhance the provision of quality services to their respective clients by ensuring and promoting competence and efficiency among their health care staff.
We appeal that the passage of a new law for the nursing profession shall institutionalize measures to stop these practices and thenceforth prevent health institutions from extorting exorbitant and unconscionable “training” fees from our nurses. Provisions that mandate investment on the country’s health care workforce, through comprehensive capacity development programs shouldered by hospitals and health institutions, shall likewise be added.
C. ADVANCING THE NURSING CARE PRACTICE
In countries with established independent nursing practice (INP), healthcare access potential has expanded. The quality of services provided by nurses is at par to those provided by doctors.2345
If the aforementioned practice would be instituted in the Philippines, other major aspects of the healthcare delivery system, aside from the nursing workforce, may benefit greatly. For instance, task-shifting can reduce the costs of health services.5 With INP, the services that are previously allowed only for and provided by doctors shall be catered by nurses. The increased options for services will enhance the health workforce pattern in the country.
The recent visit of Secretary Paulyn Ubial in Cuba concluded that 35,000 doctors are needed to copy the health care system model of Cuba. While it will take time to beef up such number of physicians in the country, the surplus of nurses armed with a more comprehensive mandate can address the service delivery gap.
We believe that the proposed Comprehensive Nursing Law (CNL) constitutes certain provisions that will institutionalize INP. However, it has to be supported with a sustainable health financing model for maintenance and stability. Consequently, we propose to the legislators to examine a package of essential nursing care services that the PhilHealth may reimburse.
D. YOUNG NURSES IN THE GOVERNANCE OF THE NURSING PROFESSION
Nurses, ages thirty and below, comprise the mass of professional nurses in the country. Thus, their voice and opinion is important in the policy tables that govern the profession. In this regard, we recommend that a youth advisory group to the Board of Nursing shall be formed to make sure that the policies and programs are responsive to the needs of the young nurses. It is a way to leverage intergenerational collaborative actions to make sure that all demographic levels of the profession are heard and consulted.
The youth advisory group is also a means to prepare our young nurses to leadership roles and responsibilities as they become more familiar and experienced in leadership and policy shaping work capacities. Engaging in the decision-making processes of their profession is a rare opportunity for young professionals, who work at highly clinically-oriented settings. It may also serve as a prospective model for youth engagement that other professions may adopt in the future.
In sum, it is asserted that nurses, as front-liners of the Philippine health care delivery system, are among the vital partners and key players in the attainment of country-wide health and wellness – an indispensable aspect in the realization of the State’s national goals and a means to achieve sustainable economic and social stability.