The worsening ‘toxic’ work condition of Filipino nurses

There are 200,000 unemployed nurses in the country. Yet those who work in government and private hospitals are overworked and underpaid.

By ANNE MARXZE D. UMIL

MANILA – When Jose (not his real name), a registered nurse, started to work in a public hospital in Manila, he didn’t think that he would be on-duty for 16 straight hours. It went on for a week and he thought of quitting his job. But for the sake of gaining experience, he stayed.

Health professionals and students commonly use the word “toxic” – not to mean poisonous, but might be just as hazardous – to describe a difficult situation, which could mean an overload of patients, multiple serious cases, and prolonged working hours.

Jose has been enduring his “toxic” work condition for six months. He said he would only finish his two-year contract with the hospital and would pursue his plan to work abroad.

Of course, he said, he’d love to serve his countrymen but the work of nurses in the Philippines, especially in the public sector, is no longer a source of dignity. For P18,000 ($418) a month, he said he is on-duty for 16 hours to a maximum of 24 hours. He handles one ward or at least 30 patients.

Jose’s working condition is only one of the many “toxic” stories told by nurses in the National Nurses’ Conference held last March 19 and 20. Nurses from the private and the public sectors and those who are serving in the community gathered in the two-day conference held in Manila.

Jose and others who agreed to be interviewed by Bulatlat.com asked not to be named and the hospital they are working out of fear of losing their job or being reprimanded by their supervisors.

Understaffing

Jose said they are forced to be on duty longer than the legally-mandated eight hours because the hospital lacks nurses. He said there are less than 30 nurses in the 120 bed-capacity hospital. If they cannot find a nurse to go on duty in their place, they cannot go home.

There are times, he said, that there is only one nurse in the emergency room and one nurse in the ward which severely affects the treatment of patients.

“I was once on-duty at the Emergency Room for 24 hours. I was the only nurse there at that time. It was very tiring, I have to assist the doctor, and I have to admit a patient. Sometimes due to exhaustion, I could not properly put IV (intravenous) insertion to the patient because I had been on my feet the whole day,” he said in an interview with Bulatlat.com.

Nurses’ long duty hours also affect patients’ recuperation. For example, medicines are not given to patients on time.

“If I was the only nurse on duty in one ward, the schedule of medication is affected because it takes me time to treat one patient before I proceed to another. If their medication is affected, they stay longer in the hospital.”

They suffer more if they object to working long hours. Jose said nurses who complain or refuse to be on duty beyond eight hours suffer the ire of the nurse supervisor. “It’s either you will be assigned in a ‘toxic’ ward or they will not put the next nurse on duty in your place.”

Jose said they have no choice but to follow their supervisors. “They said we work in the government, therefore we should act like it and be willing to work overtime even if we are tired.”

Volunteer, contractual nurses

In a private primary hospital in Leyte, Sunshine (not her real name) said volunteer nurses like her have not signed any contract in the hospital. They receive P6,000 ($134) a month without benefits. She said there are about seven nurses in the seven bed-capacity hospital where she is working. It is a small hospital, and Sunshine has been enduring working there for one year.

“We also work beyond eight hours; sometimes I am on duty from 12 to 16 hours a day. Sometimes exhaustion affects our performance. We cannot give the quality care that the patients should be receiving,” she said.

Sunshine is planning to find another work after another one year in the hospital. However, there is no assurance that she will get a certificate of employment because she has no contract with the hospital, to show that she is employed.

Henry (not his real name) is working as a volunteer nurse in a government hospital in Caloocan City where the nurse to patient ratio is 1: 35 to 1:50. He said he persisted as a volunteer nurse in the hope that soon he will be employed by the hospital.

He said there were many other volunteer nurses when he started last year. Later on, some of them left because of exhaustion. Like Jose, he too is often on duty beyond eight hours. There are nurses who initiate to help them, but often times they are left alone to do all the work.

Patronage system

What makes it hard for Henry to swallow is the fact that despite his hard work – being at the hospital and on duty for 16 hours even if he has no salary, he has not been employed by the hospital.

“Some of my batch mates were absorbed despite their absenteeism because someone backed them up in their application,” he told Bulatlat.com in an interview.

Henry and several other nurses in the conference reported a “backer system” in government hospitals. Volunteer nurses or even newly-graduate nurses who get backed up by other employees, nurses or officials in position have high chances of getting hired. The backer system exists mostly in government agencies and destroys fairness in the hiring process.

Hire the nurses

The Alliance of Health Workers (AHW) said there are 200,000 unemployed nurses in the Philippines. The burden of Jose, Henry and other nurses in the public sector can be addressed if these unemployed nurses will be hired by the government.

During the conference, majority of the nurses agree that with the government’s low budget for health, the nurses suffer from low wages and worse are working as volunteers.

Jossel Ebesate, chief nurse at Philippine General Hospital and president of the AHW, said nurses are vital workforce in every health facility but despite their significant contribution to the delivery of health services, they are the most exploited professionals.

“In fact even in Philippine General Hospital, the national university hospital, entry level nurses are hired as job order contractuals, receiving only a daily minimum wage, with no benefits and without job security,” said Ebesate.

Eleanor Nolasco, founding president of the Nars ng Bayan, also said nurses are in the forefront of patient care.

“The greatest responsibility of our nurses is to ensure the safety and well-being of the people they take care of. The lives of our patients depend on the nurses’ acute judgment and their ability to deliver appropriate intervention in critical situations. This responsibility is enormous since the nursing profession deals with human lives and yet in a private hospital, nurses only receive a minimum monthly take-home pay of P9,000 ($201) to P12,000 ($268) with little or no social benefits.”

The nurses formed Filipino Nurses United, an organization of nurses that will fight for their right to living wages and better working condition. The group believes that this is now the right time for nurses to stand, unite and show to the people and those in power that nurses are human too with needs.