Advancing Filipino Healthcare: The Plight of Filipino Nurses in a Postpandemic World

Abstract

This commentary explores the future of nursing in the Philippines, with a focus on post-COVID-19 solutions to address existing challenges. The Philippines, known for exporting nurses worldwide, faces urgent issues such as understaffing, inadequate infrastructure, low wages, and limited educational opportunities within its healthcare system. The COVID-19 pandemic intensified these challenges, leading to burnout, personal protection equipment shortages, and mental health struggles among nurses. To shape a resilient future, data-driven solutions are proposed in a post-pandemic world such as investing in education, improving compensation and working conditions, enhancing mental health support, integrating telehealth, fostering public–private partnerships, and considering international collaboration. The lessons from the COVID-19 pandemic can bring positive change, ensuring Filipino nurses receive the recognition and support they deserve in strengthening the nation's healthcare system in a post-pandemic world20.

Introduction

In 2020, as part of a global initiative to increase nursing's visibility, the World Health Organization (WHO), the International Council of Nurses, and Nursing Now released the first State of the World's Nursing report, which outlined a global nursing strategy (WHO, 2020a). The document presents a compelling case for considerable investment in nursing education, jobs, and leadership. Lopes-Júnior (2021) argued that Advanced Practice Nurses have already regulations in many countries such as Australia, Belgium, Canada, the USA, Finland, France, Ireland, Japan, Poland, the United Kingdom, and the Czech Republic, among others. However, many developing countries such as the Philippines need to provide ways to help their nurses. The COVID-19 pandemic has highlighted the invaluable role of nurses in healthcare systems worldwide, including the Philippines. As the nation grapples with the aftermath of the pandemic, it is crucial to address the challenges faced by Filipino nurses and plan for a resilient future. A recent article published in this journal highlighted that burnout has become a persistent issue for Filipino nurses (Alibudbud, 2023a). A global nursing workforce issue that already existed has been made worse by the COVID-19 pandemic. (Alibudbud, 2022; Robredo et al., 2022). Burnout has been recognized by the WHO as a major health problem and classified as an occupational phenomenon in the ICD-11, the 11th version of the International Classification of Diseases. Nurses are reported to battle the most with burnout symptoms among healthcare employees, which has major repercussions for patients, other healthcare professionals, and healthcare organizations (Woo et al., 2020).

Globally, nurses’ well-being and morale are low, and a substantial percentage of them plan to leave the field (Alibudbud, 2022). Nearly 4,500 posts at public hospitals in the Philippines go empty because certified Filipino nurses are reluctant to work there due to low pay, long hours, and a lack of benefits (Asia Pacific Foundation of Canada, 2023). Labrague (2021) also examined the influence of COVID-19 pandemic fatigue on clinical nurses’ mental health, sleep quality, and job contentment, with resilience as a mediator. This commentary explores the future of nursing in the Philippines, focusing on insights and solutions to ongoing problems.

Discussion of the Topic

The Philippines has been a top global exporter of nurses, with thousands of Filipino nurses working abroad. In 2019 alone, at least 17,000 Filipino nurses signed overseas contracts (Robredo et al., 2022). However, the domestic healthcare system has faced multiple challenges such as understaffing, inadequate infrastructure, low wages, and limited educational opportunities (Robredo et al., 2022). Alibudbud (2022) cited that understaffing, low wages, unsafe working conditions, and deployment bans are some of the common sentiments of Filipino nurses. First, there is an inadequate number of nurses in the Philippines. The shortage of nurses has persisted for years, leading to heavy workloads and compromising patient care (Robredo et al., 2022). The COVID-19 pandemic has highlighted the issue of the shortage of practicing nurses in the Philippines, which has been a problem for years. Some nurses reported that they experienced discrimination during the pandemic (Corpuz, 2022) even if nurses are among the highest population who are at risk of exposure to the virus. Second, there is an inadequate infrastructure in the Philippines. Many healthcare facilities in the Philippines lack essential equipment, technology, and infrastructure, which impacts the quality of care provided (Alibudbud, 2022; Robredo et al., 2022). Third, Filipino nurses face low wages or salary scale (Alibudbud, 2022). Robredo et al. (2022) also highlighted the unfair pay and poor working conditions faced by Filipino healthcare workers, particularly nurses were forced to work longer hours. Some nurses are even contractual workers (Corpuz, 2021a). Despite their critical role, Filipino nurses often receive relatively low wages, making it difficult to retain workforce domestically (Alibudbud, 2023a). Many nurses quit their jobs once they had amassed sufficient professional experience to be eligible for employment abroad because the nursing profession in the Philippines is export-oriented. Lastly, Filipino nurses face limited educational opportunities. Access to quality nursing education remains a challenge in rural areas, further exacerbating the nursing shortage.

Current Insights and Interpretations

While the pandemic underscored the dedication and resilience of Filipino nurses, it also exacerbated existing issues. As highlighted by Alibudbud (2023a), nurses have experienced extreme burnout due to long working hours, high patient loads, and the emotional toll of caring for COVID-19 patients. Mass resignations at the height of the pandemic worsened the nurse shortage. According to Morales and Lema (2021), a year and a half into the pandemic, 40% of nurses working in private hospitals had resigned. Additionally, the shortage of personal protective equipment endangered healthcare workers’ health and safety. At a time when the Philippine health system was already overwhelmed, this mass exodus by some of the most important healthcare workers severely limited the country's pandemic response. Robredo et al. (2022) cited the outmigration of Filipino nurses has led to many consequences such as shortage of workers, reduction of services, and longer waiting times for essential services. In addition, nurses faced increased levels of stress, anxiety, and depression, calling attention to the need for better mental health support (Corpuz, 2022).

Moving forward, several data-driven solutions can reshape the future of nursing in the Philippines. First, there is a need to invest in quality education. To address the shortage of nurses, there must be increased investment in nursing education, especially in underserved regions. Educational and employment opportunities should be offered to future Filipino nurses by giving them scholarships and grants that can make nursing programs in the Philippines more accessible (Robredo et al., 2022). In the context of ASEAN, mobility mechanisms for nurses are common among the 10 countries. ASEAN also regularly exchanges information on the policies related to nursing services (Corpuz, 2023). Second, the Philippine government must improve the compensation of nurses. Raising nurses’ wages is crucial for retaining talent within the country. This should be accompanied by efforts to ensure nurses are paid fairly based on their skills and experience. The Philippine government must make sure that nurses receive their wages and benefits are met. Third, there is a need to create safe and supportive working environments, along with reasonable nurse-to-patient ratios, that can help combat burnout. WHO (2020b) estimates a projected shortfall of 18 million health workers by 2030 to meet the Sustainable Development Goals. A vast number of nurses are needed now and for the post-COVID-19 pandemic recovery. WHO (2022) identifies the following key areas of potential policy interventions: (1) production – training and adapting the nursing workforce; (2) better managing mobility and flows of nurses; (3) improving recruitment and retention of nurses; and (4) addressing inefficiencies and maldistribution of nurses. The Philippine Department of Health addresses the inequalities in the Philippines by augmenting the health workforce in barangays, sitios, or barrios through a program called Doctors to the Barrios program (Robredo et al., 2022).

Fourth, mental health support for nurses is urgently needed. Establishing comprehensive mental health programs for healthcare workers is essential for addressing the psychological and psychosocial toll of the pandemic and everyday stressors. Nurses must value their mental health and have easy access to these services to lower the risk of depression, anxiety, burnout, and suicide.

Leveraging technology such as telehealth and online consultations can extend the reach of healthcare services, particularly in remote areas. Training nurses in telehealth can help bridge the gap in access to care by offering them alternative solutions to overcome these limitations. For instance, exploring the training of nurses in self-care activities (Alibudbud, 2023b). Lastly, a multisectoral approach is needed to help the plight of nurses in the country (Corpuz, 2021b). Collaboration between the government, private sector, and nonprofit organizations can facilitate investments in healthcare infrastructure, ensuring that healthcare facilities are adequately equipped. While it is beneficial to have Filipino nurses working abroad, the government should also explore ways to encourage them to stay in the country by giving them higher salaries, and monetary incentives and hiring regular positions in the Department of Health (Alibudbud, 2023b). Additionally, the rights of Filipino nurses working abroad should be protected by the host government, employer, and the Philippine government.

Conclusions

The future of nursing in the Philippines holds promise, but it requires a novel approach and data-driven approach to address ongoing challenges brought about by the pandemic. Investments in education, improved working conditions, mental health support, and a strengthened healthcare infrastructure are essential to creating a resilient nursing workforce. The lessons learned from the COVID-19 pandemic can serve as a catalyst for positive change, ensuring that Filipino nurses receive the recognition and support they deserve as they continue to play a vital role in the nation's healthcare system in a post-pandemic world.