Nurses for a global market

There was a time in the late ‘70s when enrolments for a nursing degree declined like those for teaching.  At the University of the Philippines, the faculties that trained nurses and teachers shrank in size, mirroring the dearth of students in these traditional academic units.  The perception is that if you were good enough to enter UP, you would probably not study to be a teacher or a nurse.

Things have changed.  UP applications for nursing, and to a limited extent education, have picked up in a phenomenal way  The demand is market-driven, and the labor market that is sending students to nursing and teacher schools is global, not local.

The numbers for nursing are particularly astounding.  In academic year (AY) 2001, 721 high school graduates applied for admission to the UP School of Nursing.  The following year, AY 2002, that figure rose to 2282.  In AY 2003, the number tripled to 6065.  This year, the applicants for admission into the UP System who put nursing as their course of first choice swelled to 11260!  Almost 3000 of these, by the way, are male. This makes the UP School of Nursing the most sought after school in the entire university system, attracting 18% of the total number of applicants for admission into UP.  The nursing faculty can hardly meet the demand.  It is constrained by limited resources and personnel to accept only 70 students every year.

Given the very stiff competition for its limited slots, one would have to be at least of cum laude caliber to get into the UP nursing school.  It is intriguing to note from the data compiled by Dr. Ly Sycip at the UP Admissions Office that graduates from the country’s top high schools are among the hopeful applicants.  This year, for instance, 473 are graduates of the science high schools of Manila, Quezon City, Makati, Visayas, and Bicol.  So far, there’s no one yet from the premier Philippine Science High School, where students are required by their contract to go into science and technology courses.  But we have 50 applicants from the UP-administered high schools.  The UP nursing course has attracted 7010 applicants from the private schools, including the elite ones like Ateneo de Manila, Assumption, Poveda, Xavier, La Salle Greenhills, Miriam and Woodrose, indicating a general leveling of career choices among various socio-economic groups.  Not surprisingly, 474 of the applicants this year reported an annual family income of more than P1 million.

It is safe to assume that these students are not necessarily thirsting to serve in the understaffed hospitals and medical facilities of the Philippines.  One may even ask how many of them are committed to the ethos of selflessness and service that is the spirit of the nursing profession.  The driving factor instead, as one may guess, is the desire to enhance their chances of migrating to North America.

In the past four years, American hospitals and nursing homes have been recruiting Filipino nurses by the tens of thousands.  To the highly qualified and experienced ones, they offer incentives that are unheard of in the Philippines. The pay is very high.  Lump-sum signing bonuses are typical. More importantly, nurses bound for the US are allowed to bring their spouses and children with them.  They are guaranteed working visas and the opportunity to become permanent residents and citizens after a few years.  Not since the great exodus of Filipino professionals in the 1960s has the country seen anything like this. The demand reflects the urgent health care requirements of ageing residents in the affluent world.  We have responded to this demand at a heavy cost to our own hospitals.

What is interesting is that the exodus of nurses is not matched by a similar rise in the number of departing doctors.  One reason for this, I am told, is the extremely tough board exams that have to be hurdled by doctors in the host countries. This explains the bizarre phenomenon of full-fledged Filipino doctors giving up medical practice to go back to nursing school, with the hope of applying abroad as nurses.  So now we have a reversal of the pecking order in hospital corridors. In a globalized world, nurses have indeed become the new aristocracy of the professions.

If the UP were a private school and not a state university, it would probably not hesitate to expand its nursing program to accommodate this spectacular rise in demand.  Using the Philippine General Hospital as its training base, it could spin its small nursing school into a separate campus unto itself, catering not only to Filipino students but to other Asians as well, and charging the full cost of such training. To do this, it would have to reorient its curriculum to make it conform to the needs of patients in the developed countries, and to the content of the state board examinations in the countries of destination.

I do not see how UP can move in this direction without betraying its basic mandate.  As a state university, UP’s main function is to help craft and achieve a vision of a better Philippine society.  It is not to continually adjust its curricula to accommodate the demands of a fickle world market.  How long it can remain faithful to its mission as a national university in a post-national world is a big dilemma.

Globalization has made national planning superfluous.  Countries like ours have lost their way in the drive to perennially adjust to the world market.  In a world like this, national politics is almost senseless.  For, whoever runs the nation-state under these circumstances would have little choice but to surrender it to global forces.


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