After nine years of donning a nurse’s cap, Sarah Daño has seen it all. 

She used to handle 17 patients at once as a nurse trainee in a poorly-funded public hospital. She had to change diapers, wipe bums, and wash the clothes of her elderly patients when she shifted to private duty. She took jobs as a volunteer nurse, a school nurse and a dialysis nurse, each falling short in either pay or her professional growth. 

Daño also worked for the Department of Health (DOH) where she was paid a decent salary, but eventually had to resign after the Dengvaxia issue put her license at risk. As one of the nurses assigned to inject the vaccine, she wanted to limit her involvement with the institution in case the vaccine would prove illegal.

For her, being a nurse in her own country had lost its luster, and the only thing left to do is to fulfill what she calls “every nurse’s dream” that is, to leave the country. 

“Umasa ako nang malala doon sa DOH kasi it’s one of the most exciting work plus good pay. I was shaping my future with that work, but God destroyed my plans. Siguro nga gusto niya ako mag-abroad. Kaya tuloy ngayon gustong-gusto ko nang umalis ng bansa,” she said.

Daño put off migrating because she didn’t want to leave her family behind. However, an overseas job offered her twice her current salary with better benefits and superior working conditions. 

Saying no could not be more difficult.

She is only one of the many nurses who find themselves at the crossroads of a profession that was once one of the country’s most in-demand jobs. 

As of 2016, the number of registered nurses in the country has depleted to less than a million, putting the nurse-to-patient ratio at up to an estimated 1:60, Ang Nars Party-list representative Leah Paquiz said.

This is a far cry from DOH’s recommended ratio of 1:12 and even farther from neighboring ASEAN countries’ 1:4, Filipino Nurses United representative Maris Abenojar said.

Number of nurses leaving the country (1)
The Philippine Overseas Employment Administration reports that 19,551 nursing professionals have been deployed overseas in 2016. / Graphic by Tatti Hermoso

“Hindi ganoon kadali ‘yun eh. Kinukulang talaga sa taong mag-aalaga. Imagine-in mo ‘yung magpapainom ka ng gamot sa 40 o 50 [patients]. Sa National Center for Mental Health, ang ating mga nurse doon minsan 200, 250 patients ang isa,” Abenojar added.

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Reports from the Philippine Statistics Authority and the Department of Health show that based on the 2017 total population of the Philippines, a nurse is expected to cater to 1,155 Filipinos. / Graphic by Jefferson Losito via Flourish

Burnout from understaffing 

Both public and private nurses in the Philippines borderline on severe stress due to understaffing and work overload.

This has led to cases where lone school nurses like Myra Almario would have to look after more than 200 children and juggle administrative tasks, while taking care of her own health at the same time. 

With overlapping tasks at hand, she says stress inevitably takes a toll on her own well-being with only the students’ affection as her reward. 

“From all the workload, hindi ko minsan namamalayan [na] bumibigay rin yung katawan ko kasi sabay-sabay [yung trabaho] eh,” she said.

According to the Philippine Heart Center, nurses subconsciously absorb negative energy when interacting with patients. This leads them to experiencing secondhand traumatic stress and eventually, burnout. 

A study shows that in UP Manila’s Philippine General Hospital (PGH) which sees 647,000 patients annually, almost half of the nurses report sick due to headaches, coughs and colds, back pain, leg cramps, and sleep disturbances. 

For Alexia Victoria, a BS Nursing graduate from UP, training under one of the busiest hospitals in the Philippines is an “abundant learning opportunity.” However, this implies a much darker reality. 

“Due to the increased workload of the actual nurses, they would be more than happy to delegate tasks to us,” says Victoria, “but once the student nurses are no longer around, the situation turns into an environment that is prone to unsafe clinical practice such as the wide nurse-to-patient ratio for the regular workers.”

A 17-year fight coming to an end

Since the Philippine Nursing Act (RA 9173) was passed in 2002, nursing groups have remained steadfast in lobbying for what is rightfully – and legally – theirs.

The law states that government nurses are entitled to an entry-level Salary Grade (SG) 15 amounting to P30,000. However, the salary mandate was never implemented due to a provision in the same law stating that the SG may be adjusted according to the financial capability of local government units (LGU).

“During the first year, nagko-cope na, magkakaroon na ng pagbabago yung sweldo ng mga nurses, tataas. Pero the following year hindi pa rin tumaas kasi unfunded daw,” Abenojar said.

To add insult to injury, former President Gloria Macapagal-Arroyo signed Executive Order (EO) 811 in 2009 mandating that entry-level salary for nurses should only be at SG 11 or at most P20,754 – almost P10,000 less than what the law requires.

There were attempts to amend the law and fix funding loopholes, but these were vetoed by then-president Benigno Aquino III after private and public hospital associations lobbied against the additional expense.

However, the efforts of nursing groups are beginning to see fruition after years of lobbying.

In December 2019, a new Salary Standardization Law (SSL) which sets the entry-level pay of government nurses, including contractual and part-time workers, to P32,053 was approved on its second reading in Congress. This was after the Supreme Court favored Ang Nars party-list’s petition to acknowledge the provisions of RA 9173 in October.

All eyes are now on President Duterte as the bill awaits its final approval. Once signed, the salary increase is expected to take effect as soon as January 2020.

Raise long overdue

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Nursing groups led a Day of Unity protest on November 8 to demand the immediate implementation of SG 15 for nurses. Protestors marched to Liwasang Bonifacio wearing black armbands and button pins bearing the words “SG-15 now.” / Photo by Ingrid Alexandrea Delgado

While the latest ruling is a monumental victory for nurses around the country, it is not the last of their hurdles. 

With private nurses excluded from the impending salary increase, nursing groups continue to lobby for just wages and humane labor practices, especially in the private sector.

“Dapat pantay-pantay yan kasi pare-pareho naman ng ginagawa, pare-pareho din yung risk involved in taking care of our patients” said Bethel Villarta, a retired professor at the UP College of Nursing. 

However, Abenojar notes that legislators are taking great interest in improving the working conditions of privately-employed nurses. 

The Makabayan bloc in October 2019 filed The Magna Carta for Private Nurses (House Bill 5184) to bridge the disparity between the prescribed wage for public and private health workers. The bill also seeks to improve working conditions and protect the rights of private health workers.

Kenny*, a nurse of three years in a private institution, only earns P16,000-P18,000 a month. The most he can take home is P20,000, but only after he works overtime for 24 hours. 

Despite continuous efforts to raise their wages, nurses like Kenny do not think a mere pay increase is enough to make them stay in the country, especially when job offers abroad offer more money for significantly less work.

“Kahit taasan nila ang sahod namin, which is still low compared sa salary na nari-receive ng mga nurses abroad, hindi pa din fair yung nurse-patient ratio,” he said.

According to the Commission on Filipinos Overseas (CFO), the top destinations for registered Filipino emigrants in healthcare are the United States of America, Canada, Australia, New Zealand, and Japan consecutively. / Map by Geraldine Pearl Santos via Datawrapper

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The top overseas destinations for Filipino health professionals offer up to an average salary of up to 3.7 million pesos per year for hospital nurses. / Graphic by Geraldine Pearl Santos

Meanwhile, Victoria lamented the declining number of nurses in the country.

“Our country produces the best nurses in the world, but the Philippines refuses to provide a conducive work environment for our nurses to stay and serve the country instead,” she said.

The new salary legislation is a welcome development in the country’s healthcare system. However, for nurses like Victoria, Daño, and Kenny, staying in the country merits more than receiving just wage.

With prevailing concerns over their safety and workload, nurses have a long way to go, especially when their victories are few and far in between.

Note: The name of the interviewee* has been changed at his request.

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