HEALTHCARE HEROES
Miranda undoubtedly understands how challenging it is to be a nurse in the Philippines. Despite this, he himself still finds fulfillment in being one. He also attempted to become a doctor but instead prioritized paying his parents back by looking for a job right after graduation. He chose to work in a hospital where he earned a pittance. “Can you imagine earning Php3,000 to Php4,000 a month as a nurse? But it did not discourage me from continuing because of the fulfillment I got from it,” he says. He adds that the people around him were already encouraging him to quit, considering his salary. But he opted to stay because he was provided with opportunities to grow professionally. Through his commitment and hard work, he was later on promoted as chief nurse.
Miranda shares the same passion with the rest of the Filipino nurses. He even shared one story of a chief nurse in one hospital in Malabon who risked his own life serving the public during the pandemic. When Miranda visited the hospital that time, most hospitals did not have a COVID-19 vaccine yet and fear and anxiety was all over the place. While others backed out and no longer reported for duty, the chief nurse showed remarkable service. He led the swabbing team, unmindful of the risks to his health. He eventually contracted the virus and suffered critically but fortunately recovered. Upon coming back from sick bay, he continued to serve and lead the hospital’s team of nurses.
While these stories may be perceived as either positive and admirable, there is always this side to the profession that is prone to burnout. Miranda uses figures to illustrate the common experience of hospital-based nurses. He says that the standard nurse-to-patient ratio is 1:12. But in a real hospital setting, one nurse manages the whole ward which has 30 to 40 patients. He adds that each patient has a minimum of five medicines that a nurse should monitor and their level of patient care also varies. Patients classified as critical, for example, need more attention because they have risks of possible cardiac or respiratory arrest. “Eight hours may not be sufficient to manage all of these 30 patients. That’s why nurses feel burnt out,” he says.
FILIPINO NURSES’ COMPASSION TOWARD PATIENTS, DEDICATION TO DUTY, AND GENERAL ATTITUDE TOWARD WORK IS VALUED BY FOREIGN EMPLOYERS.
The ability of Filipino nurses to manage this kind of situation may be the biggest factor why they are patronized by other countries, according to Miranda. He enumerates three characteristics of Filipino nurses that hospital administrators in foreign countries appreciate: compassionate, dedicated, and rarely complaining about work. He however clarifies that the last may be perceived as positive or negative but he emphasizes that this pertains to the nurses’ willingness to accept whatever task is given to them because they are committed and compassionate. This attitude is what foreign employers see as the “Tender Loving Care” brand of Filipino nurses.
MANAGING MIGRATION
The year 2008, according to Miranda, was when the demand for Filipino nurses abroad reached its peak. And while the country initially saw this as a great opportunity for Filipino nurses, it eventually became a challenge to the local health sector because while the Philippines continued to produce thousands of registered nurses, it was now being deprived of their services. The problem became even more complex because of what he calls as “unethical recruitment.” This happens when the recruiters do not pass through the Department of Migrant Workers (DMW) and the Commission on Higher Education (CHEd).
Miranda, who is also dean of the MCU College of Nursing, reveals that even in the academe where he works, recruitment agencies and other countries are already offering scholarships for students and guaranteeing them work abroad upon earning their degree and license. What sways the students more is the lucrative offers of benefits that extend to their family members. He admits that this is tempting but as the local government or private hospitals cannot match these offers, officials cannot bar nurses from going abroad.
A major problem Miranda is concerned about is the lack of regulation when it comes to “unethical recruitment.” With this practice, professional nurses are not safeguarded with regard to the legalities of the contracts they enter into. The PNA head has raised the concern to DMW, seeking that the association be involved in the process of renewal of bilateral and multilateral agreements to protect professional nurses.
“One thing that we have addressed to the DMW is that if other countries need manpower, we will be deprived. There will be continuous migration, and at the end of the day, tayo ‘yung mawawalan (we will face a shortage of nurses),” Miranda shares. What they are proposing is to impose the agreement of return of service wherein the countries or agencies who need nurses from the Philippines should subsidize their scholarships, and after they graduate, the nurses will be required to serve the country for two years before being allowed to leave. He says that this had been implemented in the University of the Philippines Manila during the time of President Rodrigo Duterte. However, not all state universities and colleges have this agreement because they too cannot deprive the students of their chance to choose. But for Miranda, they supported it because at the same time, the Filipino people also cannot be deprived of the services that they deserve when it comes to health matters.
MAKING THEM HEARDAt the end of the day, the challenge is how to keep the nurses at home to serve the country while providing them the dignity and the benefits that they need and deserve. This is where PNA comes into the picture, amplifying the voices of Filipino nurses. Miranda claims that as of the LEAGUE interview, there are bills pending in the two chambers of Congress with regard to increasing the starting salaries of nurses to Php50,000. According to studies and surveys, this is the amount that nurses consider as a living wage, the amount that could allow them to meet their basic needs. Such a starting salary could make nurses stay in the country.
"ONE THING THAT WE HAVE ADDRESSED TO THE DMW IS THAT IF OTHER COUNTRIES NEED MANPOWER, WE WILL BE DEPRIVED. THERE WILL BE CONTINUOUS MIGRATION, AND AT THE END OF THE DAY, WE WILL FACE A SHORTAGE OF NURSES."
Miranda recalls that In 2019, PNA members staged a rally near Malacañang to fight for the implementation of giving nurses compensation equivalent to Salary Grade 15, as provided for in the Nursing Act of 2002. Miranda laments that it took too long for the salary grade provision to be implemented, this being realized only in 2019. As for other concerns, Miranda also expresses his frustrations. “Moves to amend the law started in the 16th Congress. We are now in the 19th Congress. So what’s wrong? What is the problem? Are we the ones lacking in effort? Or could the government no longer realize our importance?” Miranda laments.
Two important proposals are the improvement of the basic nursing program and the establishment of a graduate program. The former aims to institutionalize a National Nursing Admission Test for prospective students as well as community immersion for nursing students in order to encourage them to eventually work in community settings. Meanwhile, the latter envisions a post-baccalaureate program that will build upon the experiences and skills of nurses and prepare them for leadership positions in the field of nursing and beyond.
Despite delays in the approval of the bills, Miranda is already grateful with the developments and how the government is already reaching out to and involving the PNA in making decisions. The association already has strong links with different government agencies, which is also why PNA leaders do not want to burn bridges with them.
PNA MANDATE
Aside from the above, Miranda is also working hard to ensure that the other parts of the PNA mandate are realized. These include ensuring continuous professional development; providing training and seminars; as well as improving members’ clinical competencies. Also part of the organization’s mandate is attending to the concerns of nurses within its 95 chapters in the country and 15 overseas chapters. Therefore, PNA’s assistance extends even outside the country. On top of these, PNA also provides legal services to its members, with nurse-lawyers providing free services to their fellow members. Whenever there are concerns in a specific region, they will be referred to the volunteer nurse-lawyer in their area. The PNA then connects the nurses with the appropriate agency that could act on their concerns. “That’s the advantage of having a strong network. If there is a problem, we could immediately refer members to the appropriate agencies,” Miranda shares.
Through the years, PNA’s efforts have paid off. It has also been given recognition by the government, having been named as the Most Outstanding Accredited Professional Organization by the Professional Regulation Commission (PRC) in 2003, 2014, 2016, and 2020-2021. Miranda reveals that the PNA leadership is still working on further improving the association for it to better represent Filipino nurses, primarily by serving as their voice.
“Ensuring the welfare of Filipino nurses is the concern not only of the Filipino Nurses Association. But we stand in the forefront, serving as a unified voice to lead members of the profession toward a more secure future. Our support to amend the Nursing Act is part of efforts to prepare future professionals, and our healthcare system in general, to provide universal healthcare. We thank the public, who are beneficiaries of care, for the recognition they have given us. However, we also need the support of the public to ensure the welfare of our Filipino nurses,” Miranda ends.
"AT THE END OF THE DAY, THE CHALLENGE IS HOW TO KEEP THE NURSES AT HOME TO SERVE THE COUNTRY WHILE PROVIDING THEM THE DIGNITY AND THE BENEFITS THAT THEY NEED AND DESERVE. THIS IS WHERE PNA COMES INTO THE PICTURE, AMPLIFYING THE VOICES OF FILIPONO NURSES."
