Empowering Nurses to Engage in Self-Care Practices During and Beyond the COVID-19 Pandemic in the Philippines

Dear Editor,

In a recent article, Bernardes et al. (2023) highlighted the physical detriments of prolonged standing among nurses. Among their recommendations, they emphasized that there is a need for occupational strategies that promote nurses’ self-care. The World Health Organization (2022) defines self-care as the “ability of individuals, families, and communities to promote their own health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker.” It can include pregnancy tests, HIV self-testing, exercise, stress management, mindful nutrition habits, and sleeping behaviors (Perera & Agboola, 2019; World Health Organization, 2022). In addition, it is cost-effective and may effectively promote health and well-being and reduce health care utilization and expenditure (Perera & Agboola, 2019). Hence, nurses, with their tremendous work demands, may benefit from regularly practicing self-care activities. Nonetheless, self-care requires resource allocation, especially time. For example, in the Philippines, nurses might have limited time to practice self-care due to understaffing and low wages (Alibudbud, 2022).

In the Philippines, there was a ratio of 1 nurse to 50 patients in a 12-hour shift, especially during the COVID-19 pandemic (Philippine Daily Inquirer, 2022). This ratio is far from the suggested ratio of 1 nurse to 12 patients by the Philippine Department of Health (Tamayo et al., 2022). Moreover, their salaries may be as low as 8,000 PHP per month (about US$160), while a majority of nurses in private hospitals earn 10,000 PHP per month (about US$200) (Chia, 2021). These salaries may not be enough to cover their daily needs. For instance, in Metro Manila, the largest urban center in the country, the estimated living cost is PHP 50,798 (about US$1,080) (Alibudbud, 2022). Thus, some nurses start sideline businesses, such as selling trinkets, to supplement their low wages (Chia, 2021). However, some pursue better salaries and work conditions abroad (Alibudbud, 2022; Chia, 2021). This chronic understaffing and low wages may lead to exhaustion, burnout, and eventual resignation (Alibudbud, 2022). Thus, while nurses in the Philippines might highly benefit from self-care, sufficient time by adequate hiring and wages is needed to empower and enable them to practice self-care activities.

Given the possible benefits of self-care among nurses in the Philippines, several steps can be undertaken to provide, enable, and empower them to engage in self-care practices. First, the low wages of Filipino nurses can be addressed by providing them with available positions with higher pay. For instance, about 16,000 contractual nurses work for the Philippine Department of Health without job security and benefits (Philippine Daily Inquirer, 2022). They can have better pay and benefits by hiring them in the 22,000 vacant regular positions with much higher pay grades and benefits in the Department of Health (Philippine Daily Inquirer, 2022). Second, the government can fund the proper implementation of the Philippine Nursing Act of 2002, which raises the pay grade of nurses to PHP 33,575 per month (about US$670; Chia, 2021). Third, sufficient hiring of nurses in both the public and private sectors can be supported by subsidizing or giving tax incentives to hospitals and health care institutions that meet the suggested ratio. Fourth, training programs and guidance on self-care practices can be promoted by government agencies to encourage nurses to practice self-care.

Overall, with an enabling work environment and government policies, nurses may be empowered to care for themselves as they care for their patients. By doing so, nurses may reap the positive effects of self-care practices and, in turn, effectively demonstrate and promote these practices to their patients.