The Philippines does not have a shortage of nurses.  In fact,  the Philippines has a vast surplus of nurses despite increasing numbers who are gaining employment in Canada, England, the Middle East and the United States.  Today there are in excess of 100,000 nurses in the Philippines who are working in other professions because they are able to earn more money working in call centers, retail stores, and other non professional positions. 

The Philippines has a long standing national  policy of training its’ young people for internationally in-demand occupations in numbers that purposely far exceed the domestic requirements in each occupational group in the hope that they will be able to secure employment abroad upon graduation.  It is important to realize that the Philippines is overpopulated and the demographic profile of the country is such that the number of working age persons is growing far more quickly than the number of persons retiring and the overall economy. 

In response to increased employment opportunities for RNs in several developed countries, enrollment in Philippine nursing colleges are at record high levels.   The number of new graduates continues to exceed the domestic demand for nurses in the Philippines.

While there are some Philippine hospitals that are reporting unfilled nursing positions the reason for this is not a shortage of nurses, rather it is due to a lack of adequate funding by the Philippine Government.  In an effort to cope with this funding crisis many Philippine hospitals are now requiring nurses to complete up to a first full year of their employment, which they refer to as an internship period, for no pay.  Why would any nurse agree to work full time for an entire year without pay?  The answer is that there are so many nurses in the Philippines seeking employment in their chosen profession that they are willing to make this huge sacrifice in order to secure a paid nursing position when, and if, this becomes available.  Some hospital employers now require prospective nurses to pay for their period of orientation. 

Having Filipino nurses work abroad provides both significant short term and long term benefits to the citizens of the Philippines.  In the short term it is estimated that Filipino citizens working abroad return 16 billion US dollars annually to their families in the Philippines.  These funds sustain many families as organized social programs are limited in the third world economy of the Philippines.  In the longer term, some of the Filipino professionals who work in developed countries return to the Philippines bringing back with them experience, advanced training and leadership skills that they are able to use for the benefit of Filipino society.

It is also noteworthy that the Philippine Ambassador to the United States has within the past few weeks lobbied the U.S. government for more stream lined procedures to expedite the immigration of nurses from the Philippines to the U.S.

While the recruitment of nurses from the Philippines is beneficial to that country, HealthStaff is sensitive to the fact that the recruitment of nurses and other health professionals is not appropriate in all countries.  HealthStaff supports to the position of the International
Council of Nurses (ICN) on the International Recruitment of Nurses.  A copy of the ICN position statement is posted on the HealthStaff website at www.healthstaff.org

National Public Radio (NPR) recently aired a report on the recruitment of Filipino nurses by international employers that in the opinion of HealthStaff did not fairly reflect the impact and implications of nurse immigration on the Philippine healthcare system and society at large.

The report included portions of an interview with a Dr. Hymie Tan, who recently completed research on this topic for a group known as the Philippines National Institute of Health.  Dr. Tan commented that the number of nurses leaving the Philippines has increased significantly in recent years.  This is true in that the number of nurses leaving in the mid and late 90’s dropped below historical levels due to immigration restrictions at that time in some countries including the U.S. Therefore while numbers are relatively higher now than in the recent past, they are not out of line with the relative levels of nurses that left in the 1960’s, 1970’s and 1980’s.

Dr. Tan also alluded to a failing health care system in the Philippines.  It is true that the Philippine health care system is under stress, however this is not due to a lack of nurses, it is due to a lack of government funding and the inability of the general population to purchase health insurance or pay for services privately. 

Dr. Tan clearly felt that nurses leaving the Philippines for employment elsewhere is inappropriate.  The NPR reporter did not ask Dr. Tan for his view on what should be done with the more than 100,000 unemployed nurses in the Philippines who are working outside of the profession because they can earn more money as sales clerks.

The report included portions of an interview with a senior nursing administrator at the Philippine General Hospital in Manila.  The nursing administrator commented that she fully understood why nurses were leaving and that their doing so usually benefited their families in a significant way.  The nursing administrator did say that the departure of nurses was impacting their operations but she did not say that they were unable to hire replacements.  You should be aware that it is standard practice at a hospital like the Philippine General Hospital to require nurses to sign a contract that specifies that the nurse will not leave the employ of the hospital for a period of one, two or three years.  Nurses who depart these facilities do so after completion of their employment contracts.

The report went on to include a portion of an interview with Philippine Government Cabinet Secretary Ricardo Saluto.  Secretary Saluto was clear that the Philippine government supported the continued recruitment of Philippine nurses by foreign countries and stated that this activity was important in generating foreign exchange, sustaining the Philippine economy and maintaining the Philippines international balance of payments.  He concluded by saying that the government would do everything possible to ensure that the door to nurse out-migration remained fully open.

The report included portions of an interview with the Philippine Undersecretary of Labor, Mr. Danila Cruz.  Mr. Cruz dismissed any claim that there was a shortage of nurses in the Philippines.

The NPR report did not make any reference at all to the fact that there are large numbers of unemployed and underemployed RNs in the Philippines today, that nursing school enrollments are at record high levels and that Philippine academia and health care have benefited from professionals who have worked abroad in the past and returned to transfer the knowledge and expertise gained in other countries back to the Philippines.

In considering the ethical implications of international recruitment, I would respectfully ask that consideration be given to the following:

1.       The American Hospital Association (AHA) which is comprised of many for profit and faith based not for profit institutions strongly advocates for the international recruitment of nurses and at present is calling on the U.S. government to streamline the process.

2.       Nurses in the Philippines like every human being on earth have the inherent right to self determination.  Philippine nurses come to the U.S. because they want to and because they want a better life for their immediate family and for their family members who remain in the Philippines.

I trust that these comments will be helpful in promoting further dialogue on this topic.