Nurses: To Volunteer or not?

Thursday, December 16, 2010

ANGELS in the sickroom.

That’s how nurses are perceived traditionally donning their unblemished, well-pressed white uniforms as they nurse back to life the wounded of mind, body and soul. Such a noble profession, who would not want to be one?

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They went through a rigorous screening procedure just to be admitted to the school of nursing. Upon admission, their parents have stretched their peso to the possible limits to sustain the financial demands of a quality nursing education. Upon graduation, they had to squander thousands of pesos again just to sit in a review class and then the licensure exams. Not to mention the months-long of waiting for the results to be released. All these troubles just to append the initials “R.N.” next to their names.

If you’re a new RN or about to take the board exam this weekends, read along to catch a glimpse of what’s to happen next to your professional life.

One milestone to another and after earning their licenses, all they ever dream of is to practice their craft. As professionals, these RNs are entitled to all the benefits at par to all other registered professionals rendering their professional services to private and government institutions -- hospitals, infirmaries, clinics, etc... More so, if the RN is government employed as stipulated in RA 7305 or the Magna Carta of Public Health Workers. By benefits, we mean PhilHealth insurance, entitlement to sick leaves, hazard allowances, overtime pays and night differential pays.

Unfortunately, new RNs in the Philippines are caught in an inevitable web as they must render their professional services for free as volunteers for a certain period of time before any employment or job offer takes place.

Furthermore, only those with close family lineage in government hospitals are seemed to be immune in this nepotistic recruitment policy like a disease that has corrupted the Philippine health care system.
According to Webster dictionary, the term volunteer means to offer or bestow voluntarily, or in the absence of solicitation or compulsion. What is ironic with the nurse volunteerism that is being openly practiced in our country is that it’s a prerequisite to any RN wanting to be employed in the hospital.

Forced volunteers, is the more appropriate term to use.
And volunteers of every government hospitals in Northern Mindanao alone have their horrid stories to tell.

Alexis D. Ebajay, a 23-year-old volunteer nurse of a government-owned tertiary hospital, stood up to tell his story.

Ebajay earned his bachelor’s degree and passed the licensure exam for nurses in 2007. His wanting to practice his profession and earn clinical experiences to make him eligible to work overseas in the future have brought him to apply in a government hospital in Cagayan de Oro City.

With perseverance, he passed the screening procedure of the said hospital and was accepted as a “Trainee” in its surgical ward for a period of three months as hospital policy applies.

From the start, the term “Trainee” has been such an ambiguous term in the nursing workforce.

According to an online dictionary, the word “training” means the acquisition of knowledge, skills and competencies as a result of the teaching of vocational or practical skills and knowledge that relate to specific useful competencies.

Simply put, being a trainee means to be trained by a person or a certain training body and passing all the time-honed skills- clinical- to them. The clinical skills are such skills like administering injections to patients, reading ECG strips, administering therapeutic and life-saving maneuvers to patients, etc…

Perhaps the biggest irony with the usage of the term is that Trainees from government hospitals are left on their own to capture and hone the skills they are seeking on the first place. Worse, the trainees teach the staff medical stuff. As a matter of fact, these trainees do not receive training manuals and learning materials to learn from. There is also no concrete training curriculum that most hospitals may use to achieve its goal of training the new-breed nurses.

What’s even more tormenting in the life of trainees is that most of the time, they are being taken advantage by the staff nurses assigned to “train” them.

Ebajay shares: “Sa amu ward, naay 35-45 patients. Pero two to three ra ang staff nurses. Then four to five ang trainees. Most of the time, pasagdan ra mi sa staff. Kami trabaho tanan gikan sa pag trapo, pag alsa, pag hatag sa tambal ug pag chart sa patient. Pati pangasaba sa doctor pag masayop mi, amua ra pud. Usahay, dili na mi maka kaon sa ka daghan sa trabaho gina tambak sa amua. To think, sila ang gina sweldohan, dili kami. “

During duties, trainees assume the role of a regular employed staff nurse only they are not given voice during decision-making. It’s sardonic enough to think trainees do and know more than the staff, they spend more time with the patient yet they are not given the opportunity to exercise their autonomy in decision-making. They are treated more like students. Worse, like assistants to the staff doing all the “dirty” work for them while all the credits go to the staff. This is an obvious case of an exploitation, no less.

Meanwhile, Dr. Jose Chan, hospital chief of Northern Mindanao Medical Center (NMMC), believes otherwise.

For him, the purpose of nurse volunteerism is to train nurses and give them hands-on clinical experiences.

Dr. Chan believes that a four-year bachelor’s degree and a license in nursing are insufficient to equip a nurse with all the clinical competencies to assume full responsibilities in patient care.

“Sa kadaghan sa nursing students ug schools ug sa kagamay sa number sa training hospitals, dili jud ni sila ma train enough. They need more exposure to hone themselves and this is where volunteerism becomes a perfect venue,” he said.

Dr. Patricia Gaid, consultant of the pediatrics department of NMMC, expresses her support to the point-of-view of Dr. Chan.

“You cannot leave a new nurse to assume work alone. The four years of college education nurses receive will only make them good theoretically but not clinically,” she says.

In 2009, the Commission on Higher Education released CMO 14, which enumerates the competencies expected of a BSN graduate.

Simply put, once an individual graduates BSN, he/she is expected to have the beginning skills or competencies to assume the role of a nurse.
Under RA 9173 or the Philippine Nursing Act of 2002, nursing graduates wishing to practice nursing needs to pass a licensure exam. After successfully hurdling the exams, they are entitled to all the rights and privileges due in the practice of their profession to include salary.
Republic Act 9173 does not say anything about volunteerism as a stepping stone or condition to employment.

Dr. Chan also denies the claims that there is no structure in “training program” for nurses offered by NMMC and they do not collect any fees compared to other hospitals in Visayas and Luzon areas that charge P500 to P3,500 per nurse volunteer.

The concept of volunteerism in nursing practice has caught the attention of everybody concerned especially by the academic community.

On the other hand, Dr. Ramona Heidi Palad, dean of Xavier University’s College of Nursing, expresses her non-support for volunteerism.

“Volunteerism should be discouraged and not allowed to prosper. I am not for it!” she says.

Dr. Palad further believes that volunteerism is a form of exploitation.
But the question is why do nurses succumb to volunteerism?
The answers may be the following: (1) There is an oversupply of nurses; (2) There are not enough hospitals to practice in the Philippines; (3) Lack of employment opportunities.

So where do thousands of nurses go to earn the two-year clinical experience required for them to work overseas?

Meanwhile, in Dr. Chan’s words, he referred to this as, “Starvation in the midst of plenty” to pertain to the imbalance equation of demand and supply for nurses in the workforce.

“As much as we need more nurses to man our stations, we can only employ a little due to budget issues by the national government,” Dr. Chan says.

Nurses are left with no option but to volunteer just to make them “more qualified” in the future.

Dr. Palad argues that for nurses to earn the experiences they need, they have to be taken as professionals -- hire and pay them -- give them the chance to hone, discover their expertise and allow them to grow.

“Volunteerism is like begging for opportunity. Imagine, you have to pay them (hospital) just to get hired. Anybody who is fully qualified should be paid for the services they render,” Dr. Palad shares.

Dr. Palad also stressed that it is possible that hospitals will no longer increase the plantillas for nurses as there are volunteers. “Why would they [hospital admin] hire and pay nurses when they can get volunteer nurses anytime?”

In the current scenario of the flourishing nurse volunteerism, volunteers render at least three months of nursing service for free. At the end of the three-month period, the volunteer may reapply for another season or so.

And if you think being a volunteer means you can disappear anytime you please, well, you better think twice. In some hospitals if the volunteer fails to finish at least two months of the season, they will not be awarded with a certificate.

They also had a stringent retention policy on absenteeism. A volunteer cannot be absent more than 10 days all throughout the season.

Perhaps the worse situation a volunteer can find himself is that being assigned in a highly communicable disease patient or ward and not given the benefits or hazard allowance due to them.

There is even a certain TB pavilion in the city with at least 25 patients confined with tuberculosis.

According to some volunteers who requested not to be named, there is only one staff nurse assigned to that pavilion. The rest, around 10, are all volunteers, who do not even receive any hazard allowance or meal allowance.

But volunteer nurses find themselves trapped. Powerless but to render volunteerism inevitably.

Dr. Palad stresses: “There will be no exploiters if there are no willing victims-volunteers!” At the hype of this nurse volunteerism, there has also been a clamor among new RNs flocking the graduate and professional schools to earn their master’s degree and increase their marketability for employment. They think that having an extra edge -- a master’s degree -- will enable them to widen their career options amidst the very steep competition as new RNs triple their number every year.
Records culled from the national office of the Professional Regulations
Commission reveals that in 2008 alone, there had been 63,220 new nurses.

By 2009, there had been 70,144 new nurses added to the roster.
In an interview with Dr. Teresita Tumapon, dean of the Graduate School of Liceo de Cagayan University, she discloses: “In the past two years, there has been a dramatic increase of enrollees for the masters program in nursing”.

Although Dr. Tumapon was not conclusive that nurses pursued graduate studies to make them more marketable, she did notice that for the past years, graduates of masters in nursing are getting younger compared to the last decade.

It must be emphasized though that not all training programs for nurses are abusive in nature. There are trainings that really require a nurse to take out money like trainings in the hemodialysis or intravenous trainings and these trainings really train nurses and not just for pecuniary interest.

In a random interview done to discover the future plans of graduating nursing students, Nicole Valdehueza of Xavier University said she’s thinking about volunteering after earning her license as this is the practice, “this is the status quo in our country.”

The concept of volunteerism may be insidious and subtle. But it can be compared to a piece of a shinning coin.

Like the two sides of a coin, volunteerism has both the negative and positive sides.

On one side, being a volunteer would help a novice nurse capture the skills needed to become a good clinician, which is an indelible mark of a Filipino nurse worldwide.

Volunteerism also brings back nursing to its very root, which is a vocation, a calling to serve the sick.

On the other side of the coin, there is a thin line separating learning from abusing. Nurses may be abused in the process of volunteerism.
As of writing, the coin is tossed and still flipping on air, waiting for the most favorable outcome for all nurses. (Comments may be sent to
paul_careline@live.com)