nursing research in the philippines

Research in UPCN

Research at the College of Nursing highlights its role in developing and advancing nursing science and in influencing policy decisions at all levels of decision-making. The faculty are actively involved in research activities based on the set research agenda of the College.

Most of the researches are funded particularly by the Philippine Council of Health Research and Development, Department of Health, and the UP Manila-National Institutes of Health.

The following are the research areas of the College:

• Non-communicable Disease Prevention And Control
• Care Of Older Persons And Those With Chronic Illness
• Women’s Health And Care Of Children
• Nursing Education
• Community Health Nursing
• Human Resources For Health

A. Non-communicable Disease Prevention And Control

This includes studies on identifying factors influencing compliance, service utilization, management, and effectiveness of intervention such as but not limited to smoking cessation, diabetes education, diet and physical activity strategies. This also includes mental health promotion.

The following are researches done by the faculty of the college on the area of non-communicable disease prevention and control.

Research Title

Compliance and Diabetes Management among the Faculty and Staff of the College of Nursing of UP Manila

Mejico, Merle F.

Development of a package of nursing services for the prevention and control of non-communicable disease

Tejero, Lourdes Marie S. Maderal, Vanessa Manila Tuazon, Josefina A.

Integrative Review on Hypertension among Filipinos

Dela Cruz, Felicitas Tuazon, Josefina A. Tejero, Lourdes Marie S. Santos, Marinelli

The Effects of Blood Pressure (BP) Measurement Educational Interventions on Adherence to BP Measurement Guidelines by Public Health Nurses (PHNs) 

Pagsibigan, Jesusa S.

The Development of Service Packages and Clinical Pathway Guidelines for Non-Communication Diseases

Lorenzo, Fely Marilyn E. Maderal, Vanessa Manila Poblete

The Validity and Effectiveness of an Investigator-designed Hypertension Training Program for Advanced Practice Nurses in the Philippines

Duller, Sarla F. Tating Dan Louie Renz P. Tejero, Lourdes Marie S.

The family as primary caregivers for the mentally Ill Patients in a psychiatric ward

Mejico, Merie F.

Effectiveness of eHealth Cardiac Rehabilitation for Health Outcomes of Patients with Coronary Heart Disease in China

Su, Jing Jing Paguio, Jenniffer T. Doris Sau Fung Yu

Effect of Training in Brief Advise on Smoking Cessation on Nurses’ Knowledge, Skills, Attitude and Practice

Cariaso, Josephine E.

B. Care Of Older Persons And Those With Chronic Illness

Concerns with improving support for older persons by establishing evidence on the effectiveness of intervention in the care of the elderly and identifying gaps in services among older persons.

The following are researches done by the faculty of the college on the area of care of older persons and those with chronic illness.

Fall Risk Among Urban Community Older Persons

Valera, Mary Joan Therese

Caregiver’s Burden and Context of Caregiving of Dementia Patients

Manahan, Lydia T.

A Phenomenal Journey in Compassionate Care for a Person with Dementia

Anonuevo, Cora A.

Nursing Interventions of Stoma Nurses and the Quality of Life of Patients with Fecal Ostomy (Thesis)

Batalla, Mary Grace Ann P. Balabagno, Araceli O.

Factors Affecting Adherence to Antiretroviral Therapy of Filipinos Living with HIV (Thesis)

De Torres, Ryan Q. Tuazon, Josefina A. (Thesis Adviser)

Are Health Behaviors and Risk Factors for Atherosclerotic Cardiovascular Disease Interrelated Among Older Filipinos in Underserved Communities

Flores, Jo Leah A. Cacciata, Marysol C. Hernandez, Mary Abigail A. Leyva, Erwin William A. Tuazon, Josefina A. Evangelista, Lorraine S.

Evaluation of the Effectiveness of an IAD Prevention Protocol on the Incidence of IAD among Acutely-ill Geriatric Patients in a Tertiary Hospital in Spain

Gaspar, Aldin D.

Assessing the Spiritual Well-Being of Filipino Cancer Patients: A Nursing Perspective

Tupaz, Alyssa Jenny E. Balabagno, Araceli O. (Thesis Adviser)

Health Impact of Climate Change in Older People: An Integrative Review and Implications for Nursing: Climate Change, Ageing, and Nursing

Leyva, Erwin William A. Beaman A Davidson PM

Loneliness Among Older Adults in Norway: A Longitudinal Study

Soberano, Julienne Ivan D.

Gerontology Nursing: Innovation in Education and Practice

Attitudinal outcomes of an interprofessional training program for health workers in the care of older adults in the Philippines: a longitudinal analysis

Siongco, Nakamura, Moncatar, Canila, Lorenzo, Seino

Resilience and Health-related Quality of Life of Filipino Older Persons in Flood-prone Communities

Leyva, Erwin William A. Patricia Davidson PhD RN FAAN Elizabeth Tanner PhD RN FAAN

C. Women’s Health and Care of Children

This includes studies on preconception care, postpartum care, and the first 1,000 days of the child.

The following are researches done by the faculty of the college on the area of women’s health and care of children.

The Role of Ayod Community Health Teams in Promoting Maternal and Infant Health in a Municipality in Ifugao, Philippines

Ngaya-an, Floreliz V.

Migration of Women from the Philippines: Implications for Health Care

Tejero, Lourdes Marie S.

Evaluation the Compliance of Essential Intrapartum Newborn Care Among Nurses in Selected Hospitals in Manila

Iellamo, Efrelyn A.

Culturally Congruent Health Promotion for Ifugao Women

Maternal Mortality in the Philippines: A lifecourse Perspective (Review of Data)

Peralta, Arnold B. Pacquiao, Dula F.

Patterns of Post Partum Home Visit and their Relationship with General Well-Being and Self-Efficacy of the Mother, Breast Feeding, Weight of the Infant, and Immunization (Dissertation)

Maternal and Child Health Promotion for the Ifugao in the Philippines

Ngaya-an, Floreliz V. Pacquiao, Dula F. De Torres, Ryan Q.

Promoting Parent-Adolescent Communication to Reduce Adolescent Sexual Risk Behaviours

Alvarez, Carmen Ngaya-an, Floreliz Abad, Peter James Maderal, Vanessa

Parental Role Affirmation of Parents of Children with Complex Health Needs for Home Care

Maderal, Vanessa Manila

Care Needs of Parents of Children with Cancer (Thesis)

Banayat, Aprille C. Peralta, Arnold B.

The Effectiveness of ParentUp as a Strategy to Provide Health Information among Pregnant Women and Mothers with Newborn from Low-Income Families

Iellamo, Efrelyn A. Raquedan, Regnard Raquedan, Liza

Decisional Conflict Among Parents of Children with Congenital Heart Disease: Towards Development of a Nursing Model (Dissertation)

So, Iris Chua Tuazon, Josefina A. (Dissertation Adviser)

Breastfeeding Practices and Level of Support Among Mothers in District 5 Manila

Tubera, Sophia A. Rosal, Melvin Joseph D. Stephanson, Zoe O. Tabungar, Kaezzy Ila B. Turingan, Angelo Joseph Uy, Kathleen Nicole T. Vibieda Jade Louise L. Villanueva, Mary Grace B. Ngaya-an, Floreliz V. Tuazon, Josefina A.

An Integrative Review of Home Visiting Programs for Mothers and Infants from Birth to 12 Months in Developed and Underdeveloped Countries

Ngaya-an, Floreliz V. De Torres, Ryan Q. Tejero, Ludy Marie S. Fowler, Cathrine

Strategies for Febrile Neutropenia in Children with Cancer: A Narrative Synthesis

Banayat, Aprille C.

D. Nursing Education

Studies under this area include impact evaluation of curricular programs in Nursing as well as testing effectiveness of teaching-learning methodologies.

The following are researches done by the faculty of the college on the area of nursing education.

Assessing Core Competencies and Professional Values of Faculty and Senior Nursing Students as Input to a competency-based Curriculum

Tuazon, Josefina A. Valera, Mary Joan Therese

Integration of the Promotion of safe motherhood in the nursing competency based curriculum

Peralta, Arnold B.

Teaching Learning Activities and Learning Experiences as Demonstrations of Integration of Safe Motherhood in the Nursing Competency- Based Curriculum

Status of Geriatric Nursing Education in Philippine Nursing Schools

Balabagno, Araceli O. Dela Vega, Shelley Ann F. Manahan, Lydia T. Abad, Peter James B.

Evaluation of the Implementation and Outcomes of Project RNHeals Batch 4 (Registered Nurse for Health Advancement and Local Service) in Enhancing Competencies and Employability of Entry-Level Nurses as Input to Policy and Programmatic Directions for Sustainability

Tuazon, Josefina A. Valera, Mary Joan Therese Abad, Peter James

Evaluation of a Government Deployment Project (RNHeals) for Unemployed Nurses as Input to Policy and Programmatic Directions

Evaluation of Process Recording as a Teaching/ Learning Tool in Mental Health Psychiatric Nursing Course

Student Attrition and Retention in the BSN Program as input to a Holistic Student Development Plan

Leyva , Erwin William A.

A Study on the Admission, Enrollment, Attrition and Graduation Patterns of Graduate Students accepted in the Master of Arts in Nursing & Doctor of Philosophy in Nursing in the College of Nursing

Tuazon, Josefina A. Denola, Mary Joy

Building Infra-structure for Health Education and Evidences Based Learning Programs to Promote Health Filipino Societies(I-HELP- FILIPINOS)

Tuazon, Josefina A. Hernandez, Mary Abigail Evangelista, Lorraine

Development of a Faculty Evaluation Scheme for UP College of Nursing

Peralta, Arnold B. Maderal, Vanessa

Relevance and Effectiveness of UPCN BSN Competency and Value based Curriculum towards an Outcome Based Curriculum

Peralta, Arnold B. Dones, Luz Barbara, Manahan, Lydia

Status of Interprofessional Education (IPE) Implementation in Asian Nursing Schools

Ngaya-an, Floreliz V. Peralta, Arnold B. De Torres, Ryan Q. Tuazon, Josefina A.

Technology in Open Nursing Education: Models in Teaching Nursing Research Online

Evio, Bettina

Student nurses’ level of satisfaction on the clinical learning experience in intensive care units

Formative evaluation of Philippine eHealth Strategic Framework and Plan

Bonito, Sheila R. Evio, Bettina D.

Transformative Scale UP of the “Tacloban Experiments” Post-Haiyan School of Health Sciences

Sana, EA, Atienza, Melflor A. Salvacion, Maria Lourdes Dorothy S. Peralta, Arnold B. Dones, Luz Barbara P. Paguio, Jenniffer T. Pastor, Claire D. David-Padilla, Carmencita M.

Role of the Nurse in Newborn Screening: Integrating Genetics in Nursing Education and Practice

Abad, Peter James B. Sibulo, Ma. Salve K. Sur, Aster Lynn D

Ethical Issues in Nursing Research

Tuazon, Josefina A.

Promotion of Safe Motherhood in the Nursing Competency-Based Curriculum

Peralta, Arnold B. Sana, Erlyn A.

Evaluating the Implementation of Urban Community-Oriented Health Initiatives and Activities within a Curricular Context

Hernandez, Mary Abigail A. Leyva, Erwin William A. Virtudazo, Jessa Mae P.; Dones, Luz Barbara P.

The usefulness of case studies in a Virtual Clinical Environment (VCE) multimedia courseware in nursing

Bonito, Sheila R.

Learning compassionate care: Experiences of nursing students

Su, Jing Jing Paguio, Jenniffer Torralba Masika, Golden Mwakibo Wang, Mian Redding, Sharon R.

Leadership Behavior of Dean’s of Colleges of Nursing and Faculty Job Satisfaction and Commitment

Ballena, Naressia S.

Developing the key competencies of the UP-Nurse Scientist: preliminary work to Ph.D. in Nursing curricular revision

Ngaya-an, Floreliz Paguio, Jenniffer Leyva, Erwin Peralta, Arnold Siongco, Kathryn Bonito, Sheila

Expanding the faculty capacity to help meet the increased national demand resulting from the addition of nursing informatics in the baccalaureate program: A Philippines experience

Pajarillo, Edmund J.Y. Bonito, Sheila R. Paguio, Jenniffer T. Cariaso, Josephine E.

Nursing Students’ Experience in High-fidelity Simulation-based Learning on Critically-ill Adult and Pediatric Patients

Gaspar, Aldin D. Banayat, Aprille C.

Use of Standards of Best Practice in Developing Simulation Scenarios in Nursing Education

E. Community Health Nursing

Concerns with establishing roles of the advanced practice nurses in public health nursing as well as validating indicators for community competence.

The following are researches done by the faculty of the college on the area of community health nursing.

Perceptions on Poisoning among Adult Urban Community Members

Valera, Mary Joan Therese Salvosa, Daity

Assessing Development Designing Better Indices of Poverty and Gender Equity Phase I & II

Anonuevo, Cora A. Castillo, Fatima Palaganas, Erlinda

Understanding Poverty and Gender: Narratives from the Field

Anonuevo, Cora A. Castillo, Fatima Palaganas, Erlinda Bracamonte, Nimfa

Cultural Beliefs on Disease Causation in the Philippines: Challenges and Implications in Genetic Counselling

Abad, Peter James B. Tan, M. L. Baluyot, M. M. P. Villa, A. Q. Talapian, G. L. Reyes, M. E. Laurino, M. Y.

Developing Community Based Health Program in Low Urban Settings

Leyva, Erwin William A.

Genetic Counseling in Asia: Profile of the Profession and Roles of Genetic Counselors

Abad, Peter James B. Laurino, Mercy Lee, Juliana Kejriwal, Saahil

Communication about Congenital Adrenal Hyperplasia: Perspective of Filipino Families.

Abad, Peter James B. Anonuevo, Cora & Daack-Hirsch Sandra & R. Abad Lorna & Padilla Carmencita & Laurino Mercy

Prevalence and Correlates of Depression, Anxiety, and Distress among Filipinos from Low-Income Communities in the Philippines

Flores, Jo Leah A. Hernandez, Mary Abigail Leyva, Erwin William Cacciata, Marysol Tuazon Josefina Evangelista, Lorraine

Normalizing Advanced Practice in Public Health Nursing in the Philippines: A Foucauldian Analysis

Posadas, John Joseph B. Dones, Luz Barbara P. Abad, Peter James B.

Facilitators and barriers to condom use among Filipinos: A systematic review of literature

De Torres, Ryan Q.

Fostering Partnerships between the Academe-Government and Community in the Covid-19 Pandemic Response in the Philippines

Tomanan, Kristine Joy L. Mabale, Maria Angela A. Abad, Peter James B. Bonito, Sheila R.

Building Leadership and Management Capacities of Public Health Nurses in the Philippines

Posadas, John Joseph B.

Promoting School Health Updating Urbani School Health Kit

Bonito S Iellamo E Abad PJ Hernandez MA

An Integrative Review of Interventions to Promote Culturally Congruent Care for Sexual and Gender Minorities

Competencies and Training Needs Assessment of Public Health Nurses in the Philippines

Cariaso, Josephine E. Sheila R. Bonito DrPH Luz Barbara P. Dones MPH Christiane Jannie B. Sebastian, RN

Oral Health Education Program and Competencies Among Nurses Whose Recipients are Totally Dependent Patients. (Thesis)

Ragotero, Ina G.

The Effectiveness of a Training Program for Advanced Practice Nurses in the Philippines on the Care of Patients with Primary Hypertension

Duller, Sarla F. Tating, Dan Louie Renz P. Tejero, Lourdes Marie S.

F. Human Resources for Health

Nurse-Patient Dyads: Linking Nurse and Patient Characteristics to Patient Satisfaction

The mediating role of nurse-patient dyad bonding in bringing about patient satisfaction

Development and validation of an instrument to measure nurse-patient bonding

Policy Baseline and Recommendations for Allied Health Disciplines

Lam, Hilton Y. Shelley Ann F. dela Vega, Maria Concepcion C. Cabatan, Vicente O. Medina III, Araceli O. Balabagno, Tejero, Lourdes Marie S.

Determinants of Rural Retention of Human Resources for Health

Tejero, Lourdes Marie S. Leyva, Erwin William Abad, Peter James Santos, Marinelli

Global Perspectives of Caring: An Integrative Review

Link 1   Link 2

Leyva , Erwin William A. Peralta, Arnold B. Tejero,Lourdes Marie Santos, Marinelli A.

Parental Efficacy in Nursing Practice: A Concept Analysis and Derivation

Patient Safety Culture & Perceptions on Event Reporting in the National University Hospital

Paguio, Jenniffer T. Sy, Alvin Duke R. Co, Homer U.

Work on Environment of Nurses in the Philippines: A Preliminary Study

Dones, Luz Barbara P. Paguio, Jenniffer T. Bonito, Shiela R. Balabagno, Araceli O. Pagsibigan, Jesusa S.

Paguio, Jenniffer T. Caballes, Alvin B. Co, Homer U. Sy, Alvin Duke R.

Evaluation of Readiness of the ASEAN Members for the Mobility of Nurses in these Countries

Tejero Makimoto Said Koy Tungpunkom

Safety Culture & Safety Attitudes of Nurses in the National University Hospital

Paguio, Jenniffer T. Pajarillo, Edmund J.Y.

Transnational Care Workers from the Philippines and Indonesia under the JPEPA

Añonuevo, Cora A.

Social media use profile, social skills, and nurse-patient interaction among Registered Nurses in tertiary hospitals: A structural equation model analysis

Mariano MCO Maniego JCM Manila HLMD Mapanoo RCC Maquiran KMA Macindo JRB Tejero, Lourdes Marie S Torres, Gian Carlo S

Nursing Workforce in the Philippines

Bonito, Sheila R. Pagsibigan, Jesusa S. Balabagno, Araceli O. Serreneo, Kate Anjelyn C.

Perceived Roles and Professional Identity of Psychiatric Mental Health Nurses in selected Hospital-Based Psychiatric Settings in Metro Manila (Thesis)

Mabale, Maria Angela A. Mejico, Merle F. (Thesis Adviser)

Determinants of Anticipated Turnover of Nurses in Selected Hospitals in Metro Manila (Thesis)

Adajar, Gracielle Ruth M. Tuazon, Josefina A. (Thesis Adviser)

Determining the Required Skill Mix to deliver Primary Health care Services Across Various Rural and Urban Communities

Dones, Luz Barbara P. Abad, Peter James Medina, Vicente Cordero, Anthony

Medication Errors Among Adult Patients in Acute Care Settings: An Integrative Review

Improving Nurses Work Environments (NWE) in the Philippines

Paguio, Jenniffer T. Doris SF Yu, PhD

Capacity Needs Assessment of Primary Health Care Providers in Selected Municipalities in Cavite

Almoneda, Irma A. Bonito, Sheila R. Dones, Luz Barbara P. Tuazon, Josefina A.

A Mixed Methods Study to Evaluate the Effects of a Teamwork Enhancement and Quality Improvement Initiative on Nurses’ Work Environment

Defining Compassionate Nursing Care

Su, Jing Jing Golden Mwakibo Masika Paguio, Jenniffer Torralba Reding, Sharon R.

Systematic review of interventions to improve nurses’ work environments

Paguio, Jenniffer T. Yu, Doris SF. Su, Jing Jing.

Skill Mix in Delivering Primary Health Care Services: Context and Implications to Public Health Nursing

Dones Abad Medina III Cordero Hernandez MA

Production, Recruitment, and Retention of Health Workers in Rural Areas in the Philippines

Tejero, Lourdes Marie S. Erwin William A. Leyva, RN, MPH, PhD Peter James B. Abad, RN, MSc Diana Montorio, RN Ma. Leoant Santos, RN

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study

Sue Kim Tae Wha Lee Gwang Suk Kim Eunhee Cho Yeonsoo Jang Mona Choi Seoyoung Baek David Lindsay Sally Chan Regina L. T. Lee Aimin Guo Frances Kam Yuet Wong Doris Yu Sek Ying Chair Yoko Shimpuku Sonoe Mashino Gigi Lim Sheila Bonito Michele Rumsey Amanda Neill Indrajit Hazarika

Capacity building of primary health care providers in 10+3 Southeast and East Asian Nursing Education and Research Network (SEANERN) countries

Bonito, Sheila R. Tuazon, Josefina A. Dones, Luz Barbara P.

Disaster Nursing Competencies: Nurses’ Perceived Competence and Need for Training

Developing Capacities of Professional Nurses on Disaster Risk Reduction and Management in the Philippine Nurses Association

Evio, Bettina D. Bonito, Sheila R.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations

Kevin K. C. Hung Hung KKC Mashino S Chan EYY MacDermot MK Balsari S Ciottone GR Della Corte F Dell’Aringa MF Egawa S Evio, Bettina D. Hart A Hu H Ishii T Ragazzoni L Sasaki H Walline JH Wong CS Bhattarai HK Dalal S Kayano R Abrahams J Graham CA.

Barriers and facilitators of productivity while working from home during pandemic

Seva, Rosemary R. Tejero, Lourdes Marie S. Fadrilan-Camacho, Vivien Fe F.

Methods of Culturally Sensitive Disaster Nursing Focusing on Pacific Rim Island Countries

Tuazon, Josefina A. Miki Muratani Mihoko Uebayashi Yukiko Anzai Kame Takase Sanae Haruyama Hiroko Okuda Nahoko Harada Tuazon, Anna Cristina

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• Research article
• Open access
• Published: 25 November 2020

Quality of nursing education programme in the Philippines: faculty members perspectives

• Stella Appiah 1  

BMC Nursing volume  19 , Article number:  110 ( 2020 ) Cite this article

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The subject of continuous improvement in the quality of nursing education programme is an extremely sensitive issue worldwide, particularly in the Philippines where a high number of trained registered nurses are exported to both developed and developing countries. The assessment of the quality of nursing education programme is usually measured using pass rates in licensure examinations by several government organizations. However, few studies have indicated that various categories of faculty members view the quality of nursing programmes differently, this study probed further and determined whether the quality of nursing education programme differs according to the profile of faculty members in Philippines colleges of higher education.

A cross-sectional survey study design was employed in this study. One hundred and eight-five (185) faculty members in fifteen (15) higher educational institutions were selected for the research using purposive-census sampling. The study was carried out from January 1 to June 30, 2017. Close-ended structured questionnaires based on study objectives were used to collect data. Frequency and percentages were used to analyse the profile of faculty members whereas weighted means from a four Likert’s scale was used to interpret the extent of perceived quality of nursing education programme.

Majority, 39 and 46% of faculty members had 1–5 years’ clinical experience and 6–10 years of teaching experience respectively. Faculty members strongly agreed with a grand weighted mean of 3.84 out of 4.00 that nursing education programme is of good quality in the Philippines and is synonyms with other universities in the world. Teaching experience of faculty members showed significant relations in the quality of mission/vision/goals/objectives ( p -value = 0.008), curriculum and instruction ( p -value = 0.038), administration of nursing programme ( p -value = 0.025), faculty development programme ( p -value = 0.003), physical structure and equipment ( p -value = 0.016), student services ( p -value = 0.017), admission of students ( p -value = 0.010) and quality assurance system ( p -value = 0.009).

Faculty members strongly perceived nursing education programme to be of good quality in this study. Teaching experience of instructors showed a significant relationship with the quality of nursing education programme in all the quality assessment indicators. However, clinical experience and job category of faculty members rather showed that the quality of nursing education programme is the same throughout all the higher educational institutions. The study implies that the teaching experience of faculty members is a strong predictor of quality of nursing education programme and employing faculty experienced in teaching is substantial for the continuous improvement of nursing education programme.

Peer Review reports

Quality of nursing education programme is a complex topic that involves the combination of teaching and learning materials, human resources, teaching and learning processes, curriculum, teaching and clinical experiences, teacher’s attitudes and commitment that are necessary to achieve set learning expectations and produce an exceptional performance of nursing students [ 1 ]. In essence, the nursing education programme can be classified as excellent or of high quality if it can be rated high (at least 80%) in all criteria used in its assessment.

The fundamental focus of nursing education programme is to produce nursing professionals that are clinically competent and can contribute immensely to the provision of quality and safe nurse care [ 2 , 3 ]. Quality nursing education can be attained if nursing faculty obtain a balanced experienced in both theory and clinical areas. Consequently, this vast knowledge may results in nurses workforce that can apply the theory and lessons learnt in simulation laboratories into the delivery of health care in everyday living [ 4 ].

Worldwide, nurses are known to play a vital role in the rendering of health care services including many fundamental health-related services, particularly in rural areas. The increase of workforce without compromising on quality is imperative to help achieve Sustainable Development Goals (SDGs) targets that are set by the United Nations and its member countries, especially the one focused on universal health coverage [ 5 , 6 ]. Quality of nursing education programme can be viewed as a long-term contributor to attaining quality universal health coverage in the production of qualified nurses.

The assessment of the quality of nursing education programme globally has usually been based on the pass rates in licensure examinations by several government organizations [ 7 ]. Although, several quality factors such as accreditation, students’ practical exposure and profile of faculty are sometimes considered to some extent [ 8 ]. The issue of quality of nursing education programme in Philippines colleges of higher education is extremely sensitive due to the high number of trained registered nurses exported to other countries such as the United States of America, United Arab Emirates and Germany [ 9 , 10 ].

The quality of nursing education programme has been strongly associated with quality of curriculum, faculty and resources. These resources such as teaching materials and facilities are required to assist instructors in their delivery of nursing education [ 11 ]. The World Health Organization has also affirmed some standard criteria or area that quality of nursing education programme should be measured with of which faculty profile or development is included [ 12 ]. This activates the discussion into whether the quality of nursing education programme hinges on the profile of the faculty.

Aside from the challenge of quality of faculty members in nursing education programme, there are also problems of shortage of nursing instructors which usually affects the clinical teaching and learning environment and this clinical training feature of the nursing education programme results in long term detrimental effects in practising nurses if not well taught [ 13 ]. Also, other issues associated with quality of faculty members which consequently affects the quality of nursing education programme includes aging nursing faculty, less attractive faculty positions and length of education required to secure a faculty appointment [ 14 ].

According to a study conducted in Ghana, shortage of qualified instructors and insignificant upgrade of the previous infrastructure are critical issues facing the quality of nursing school and subsequently nursing education programme [ 15 ]. As far back as 27 years ago, some authors have connected the quality of nursing education in the aspect of teaching and practical gap to nursing faculty inability to assume a commanding role in clinical learning and teaching [ 16 ]. Earlier researches have related quality of nursing education to the quality of nursing instructors and this study, therefore, determined the quality of nursing education programme. This paper also found out whether the quality of nursing education programme differs according to the profile of faculty members using Philippines colleges of higher education as a case study, in addressing this, the study was based on the null hypothesis (Ho), there is no significant difference in the quality of nursing education programme by the respondents (faculty members) when grouped according to their profile.

Study design

A cross-sectional survey study design was used in this research. This was executed by employing a purposive-census sampling method to recruit one hundred and eighty-five (185) faculty instructors in fifteen (15) higher educational institutions. The use of Purposive sampling was based on the belief that the researcher’s knowledge about the population can be used to hand-pick respondents [ 17 ] and in this case HEIs. This approach did not necessarily mean HEIs known to the researcher were selected but those who met the criteria of inclusion were used for the study. Census sampling, on the other hand, is the process of taking the total population of the locale and retrieving an adequate number of respondents (faculty) as a sample of the study. The use of the two approaches complimented each other for the recruitment of the HEIs and study respondents Questionnaires centred on the aim and study objectives of the study were self-administered after the consent of participants was sought. The study was carried out with the period of January 1 – June 30, 2017.

The study was conducted in fifteen (15) private-owned higher educational institutions in the National Capital Region (NCR) of the Philippines. Ten out of fifteen of these higher educational institutions had existed for more than 45 years whilst the rest had been in existence for less than 45 years. Although 7 of these institutions were granted autonomous by a regulating body called CHED, 8 of them were still monitored by the same regulatory agency. Also, 12 of these institutions were owned by private non-sectarian organizations, however, 3 were owned by private sectarian establishments. The central government seat is in the National Capital Region and the city holds the highest number of higher education institutions which comprises those offering nursing education programme. Majority of these institutions offer health-related programmes at both undergraduate and postgraduate levels, however, the study concentrated on the nursing education programme at the undergraduate level.

Sampling procedure

An initial number of all twenty-two (22) recognized higher national institutions owned by private entities in the NCR were contacted to take part in the study, yet, a considerable number of fifteen (15) institutions approved for their school and faculty members to partake in the study. The number of faculty in the twenty-two (22) higher national institutions targeted for the study summed up to two hundred and twenty (220), nonetheless, one hundred and eighty-five (185) faculty members consisting of deans, program coordinators, and faculty instructors on full and part-time contracts consented and were recruited into the study. The made the study achieve a response rate of 84.1%.

Inclusion criteria

All teaching and clinical instructors who have spent more than 1 year in their educational institution were recruited to partake in the study.

Exclusion criteria

All other instructors who had not completed 12 months in their educational institutions were not allowed to be part of the study.

Tool for data collection

A questionnaire was specifically developed to undertake this study. In doing so, three areas were considered in the design of a close-ended questionnaire used for the study. These were; 1) aim and objectives of study 2) policies and standards of nursing schools in the Philippines and 3) World Health Organization (WHO) guidelines on quality assurance and accreditation of nursing and midwifery educational institutions in the South-East Asian countries. A four (4) Likert scale with standard questions were used to evaluate the quality of nursing education programme. The criteria for the assessment of the quality of nursing education programme included mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system. Pretesting of the questionnaire was done in one of the accredited colleges of nursing in NCR with nineteen (19) respondents to measure the reliability of the tool before it was employed for the study. In doing so, the questionnaire was subjected to Cronbach’s alpha reliability test to determine its consistency and validity. The overall result showed .989 indicating a high consistency and reliability.

Data analysis

Information from the completed questionnaire was entered into Microsoft Excel and imported into SPSS statistical software version 22 for editing, cleaning and analysis. Frequency and percentage were employed to analyse the profile of faculty members while weighted means from a four-Likert scale was used to interpret the extent of perceived quality of nursing education programme as assessed by faculty members. The scales for assessing the quality of nursing education programme; 1.00–1.49, 1.50–2.49, 2.50–3.49 and 3.50–4.00 was interpreted as strongly disagree, disagree, agree and strongly agree respectively. One-way ANOVA was used to test for the differences in quality of nursing education programme in the eight (8) thematic areas (mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system) concerning the profile of faculty members. A P -value of less than 0.05 was considered significant in this study.

Profile of faculty members in higher educational institutions (HEIs)

A majority, 73 (39.0%) of the 185 participants that partook in the study had 1–5 years’ clinical experience whilst few, 15 (8.0%) had 16–20 years of clinical experience. Almost half, 85 (46.0%) of respondents had taught for 6–10 years nonetheless a small number, 14 (8.0%) had 16–20 years of teaching experience. A little below two-thirds, 121 (65.0%) were doing both clinical and classroom teaching whereas very few, 8 (4.0%) were deans of the nursing department in their institutions (Table  1 ).

Quality of nursing education Programme as perceived by faculty members

At the end of the assessment of the nursing education programme, an average of the grand weighted mean of 3.84 resulted, which means participants strongly agreed that nursing programme is of good quality. However, administrators who were faculty members rated the quality of nursing education programme higher with a mean of 3.88 compared to a mean of 3.81 by faculty who were only instructors. The quality of the mission/vision/goals/objectives of the nursing education programme was appraised highest with a mean of 3.91 while the least valued was the admission of students with a mean of 3.76 (Table  2 ).

The difference in quality of nursing education Programme according to profile of faculty

Significant differences existed in the quality of mission/vision/goals/objectives ( p -value = 0.008), curriculum and instruction ( p -value = 0.038), administration of nursing programme ( p -value = 0.025), faculty development programme ( p -value = 0.003), physical structure and equipment ( p -value = 0.016), student services ( p -value = 0.017), admission of students ( p -value = 0.010) and quality assurance system ( p -value = 0.009) in relation to teaching experience of faculty members. On the contrary, the quality of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system did not differ significantly with regards to clinical experience and job category of faculty instructors (Table  3 ).

The excellence of nursing education programme and to a large extent nursing institution has often been linked to success in licensure exams undertaken by nursing students while other studies have associated it to the quality and shortage of nursing instructors [ 7 , 13 ]. The findings of this study also sought to unravel another concept of whether the profile of faculty in terms of clinical experience, teaching experience and job category cause significant differences in the quality of nursing education programme in the areas of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.

According to this study, participants strongly agreed with a score of 3.84 out of 4.00 that quality of nursing education programme offered by institutions in the Philippines is similar to ones run by other universities. This high grading of the quality of nursing education programme may have resulted because of the majority, 39 and 46% of faculty members had 1–5 years’ clinical experience and 6–10 years of teaching experience respectively. Also, this is consistent with the requirement that nursing instructors should have at least a year each of clinical and teaching experience [ 18 , 19 ]. Again, clinical experience particularly is important to close the gap between classroom lessons and simulation classes and in the long run improves the quality of nursing education programme [ 4 ].

Besides, this study also found that about two-thirds, 65% of faculty members were both classroom and clinical instructors. This result has a direct influence on the high grading of the quality of nursing programme because is very suitable if instructors who taught a particular group of students takes them through the practical component of the course. This leads to a better delivery of the curriculum of nursing education programme according to [ 11 ], which consequently leads to a high quality of nursing education programme.

The World Health Organization emphasized vision as a key requirement for the quality of nursing education as part of the global standards for the education of professional nurses and midwives [ 12 ]. In a study on quality assurance in higher education, mission/vision/goals/objectives were rated higher as the driving force for the quality nursing education programme. This was also congruent with the finding of this study where mission/vision/goals/objective was rated highest, 3.91 out of 4.00 compared to the other quality matrix that was used in the assessment of nursing education programme.

Even though, many studies have emphasized on the importance of clinical experience on the quality of nursing education programme [ 4 ], clinical experience and type of faculty did not show a significant difference in the quality of nursing education programme in all the eight quality matrix in this study. This implies that the quality of nursing education programme will be the same throughout all the nursing colleges in the Philippines with regards to clinical experience and job category of instructors.

Conversely, teaching experience of faculty revealed a significant difference in the quality of nursing education programme in all the criteria used for monitoring the quality of nursing education programme. This underlines the importance of teaching experience in the quality of nursing education [ 20 ]. Experienced faculty members are usually needed in the development of mission/vision/goals/objectives, curriculum and instruction of a nursing programme [ 21 ]. They are also practically involved in the administration of nursing education programme and even report gaps in a curriculum where and when is necessary [ 21 , 22 ]. The nursing lecturers who have enough teaching experience had usually undergone series of faculty development programme and have the experience in advising management on the needed physical structure and equipment that are necessary for the running of quality nursing education programme [ 23 ]. Also, these faculty members have the knowledge in the calibre of students to be admitted and the type of student services that should be provided to ensure the best of nursing education. This finding on the teaching experience of faculty members discloses its importance on the quality of nursing education programme and hence worth considering in enlisting processes.

Faculty members strongly perceived nursing education programme to be of good quality in this study. Majority of these nursing instructors had sufficient years of both clinical and teaching experience. No significant difference was found in all the quality criteria of nursing education programme with regards to the profile of instructors; clinical experience and job category. However, teaching experience revealed a significant difference in the quality of nursing education programme in the area of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.

Recommendation

The study, therefore, encourages management of higher educational institutions to emphasize teaching experience as one of the criteria that merit consideration for the recruitment of faculty members for a nursing education programme. This will guarantee continuous improvement of quality of nursing education programme in higher educational institutions in the Philippines and other countries.

Although Likert scale was used by study participants to measure quality of nursing education programme in all the criteria in the quality matrix used in this study, respondents may have been biased in the answering of questions concerning nursing education programme using this scale where they intentionally avoid extreme answers and choose options that are expected than the real situation the study sought to find.

Availability of data and materials

The study data and materials are in the custody of the corresponding author and can be made available on reasonable request.

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Acknowledgements

The author appreciates the management and faculty of all higher educational institutions in the Philippines for their involvement which made the conduct of the study successful.

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The author holds a PhD in Nursing Administration from Our Lady of Fatima University, Valenzuela City, Philippines. Dr. Stella Appiah is currently a Senior Lecturer and Head of School of Nursing, Valley View University, Ghana. Her speciality is in Nursing Administration, Nursing Research Methods, Family Health Crisis Intervention, Pharmacology and Therapeutics.

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Quality of nursing education programme assessment tool. A four Likert scale questionnaire for the assessment of nursing education programme on eight thematic areas.

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Home Issues 14 Philippine Nurse Migration: Asses...

Philippine Nurse Migration: Assessing Vulnerabilities and Accessing Opportunities during the COVID-19 Pandemic

This chapter studies Filipino nurses’ skilled migration, factoring in their lived experiences during the onslaught of the COVID-19 crisis. Anchored in the targets of the Sustainable Development Goals (SDGs), the chapter contributes to the existing literature and policy discussion on nurse mobility in healthcare during a global crisis and on the nexus between migration and development. A key aim is to underscore the particular vulnerabilities of nurses as frontliners in both their host and home countries. Ultimately, the goal is to provide a Policy Comment that takes into consideration the question of ‘brain drain’ while also attempting to address the challenges the country faces as it seeks to promote better conditions for its highly skilled medical workforce and creating a more nuanced understanding of a nurse’s role in public and global health during a pandemic. The qualitative study described in this chapter uses semi-structured, open-ended interviews with Filipino nurses working in different parts of the world to elicit exploratory perspectives and understand respondents’ views on nurse migration and policy.

En este capítulo se estudia la migración de enfermeras filipinas cualificadas, teniendo en cuenta las experiencias que vivieron durante la embestida de la crisis de la COVID-19. Basado en las metas de los Objetivos de Desarrollo Sostenible (ODS ), el capítulo contribuye a la literatura existente y al debate político sobre la movilidad de las enfermeras en el sistema de salud durante una crisis mundial y sobre el nexo entre migración y desarrollo. Un objetivo clave es subrayar las vulnerabilidades particulares de las enfermeras, que se encuentran en primera línea tanto en sus países de acogida como en los de origen. En última instancia, el objetivo es ofrecer un comentario de política que tenga en cuenta la cuestión de la ‘fuga de cerebros’, al mismo tiempo que intenta abordar los retos a los que se enfrenta el país al tratar de promover mejores condiciones para su personal médico altamente cualificado, y crear una comprensión más sutil del papel de una enfermera en la salud pública y mundial durante una pandemia. El estudio cualitativo que se describe en este capítulo utiliza entrevistas semiestructuradas y abiertas con enfermeras filipinas que trabajan en diferentes partes del mundo para obtener perspectivas exploratorias y comprender las opiniones de las personas encuestadas sobre la migración de las enfermeras y las políticas públicas que la acompañan.

Ce chapitre étudie les migrations d’infirmières philippines qualifiées, en tenant compte des expériences qu’elles ont vécues pendant la crise de la COVID-19. S’appuyant sur les Objectifs de développement durable (ODD), ce chapitre contribue au débat politique sur la mobilité des infirmières dans les systèmes de santé et les liens entre migrations et développement. L'un des principaux objectifs est de souligner les vulnérabilités particulières des infirmières, qui sont en première ligne tant dans leur pays d'accueil que dans leur pays d'origine. Le chapitre commente la politique de migration en prenant en compte la ‘fuite des cerveaux’. L’auteure analyse les défis auxquels le pays est confronté, notamment : la volonté de créer de meilleures conditions pour son personnel médical hautement qualifié et la nécessité d’une compréhension plus nuancée du rôle d'une infirmière dans la santé pendant une pandémie. L'étude qualitative s'appuie sur des entretiens semi-structurés et ouverts réalisés auprès d’infirmières philippines travaillant dans différentes parties du monde afin d'explorer ces perspectives et comprendre les points de vue des répondants sur les migrations et les politiques les concernant.

Index terms

Thematic keywords: , geographic keywords: , 1. introduction.

1 This chapter calls for greater attention to be paid to the mobility of nurses in order to assess both source and host countries’ abilities to achieve the United Nations Sustainable Development Goals (SDGs) during a pandemic. Here, I look at complementary targets: SDG 3 on global health and SDG target 10.7 on ‘orderly, safe, regular and responsible migration and mobility of people’ (UN DESA, 2020, para 1). I examine the extent to which healthcare practitioners receive adequate access to healthcare, given the risks experienced by Filipino nurses during the onslaught of COVID-19 as local frontliners and as migrant workers at the heart of the global pandemic. This Policy Comment also delves into issues that nurses encounter related to factors such as mental health, questions of diversity and inclusion, and gender. It recognises the ‘brain drain’ phenomenon (Beine, Docquier and Rapopor, 2008) and ‘high-skill migration’ (Hart, 2006) in the Philippines and its population of nurses.

2 The chapter starts by providing a background on nursing as a global profession and the mobility of Filipino nurses. Integrated into the Comment are interviews with Filipino nurses working in different parts of the world; these were conducted from January to August 2020, online and using questionnaires. The chapter also captures responses from nurses on the frontlines of the pandemic, before concluding with policy recommendations.

2. Background

3 On 1 August 2020, over 80,000 doctors and a million nurses from 80 groups sent a collective note to Philippine President Rodrigo Roa Duterte lamenting that the country was on the brink of defeat in its battle against COVID-19 (Morales, 2020) and underscoring that it was critical to formulate a cohesive and clear action plan (Hallare, 2020). The note called for the national government to return Metro Manila, which had the most infections, to the stricter enhanced community quarantine (ECQ) regime for two weeks. Medical frontliners cautioned that the healthcare system could, without tighter controls, collapse under the continuously escalating number of infections. Following warnings from health workers, the president approved the extension of the quarantine regime (Parrocha, 2020). Effectively, the order to stay at home was back for the Philippine population. During that very month, the number of health workers testing positive for the coronavirus reached 5,008 (Tomacruz, 2020), with most contaminations found among doctors and nurses.

4 According to McLaughlin (2020), the coronavirus pandemic has revealed the fragility and inequity present in systems and societies around the globe, including in the healthcare sector. In the war against the coronavirus, health workers are the frontline soldiers. Arguably, the risk to health workers has been one of the significant vulnerabilities of the healthcare system during the COVID-19 pandemic. Those working in hospitals are handling a massive rush of patients while also usually dealing with a lack of personal protective equipment (PPE) and the worry of acquiring the virus, coupled with an increased workload and less time for rest (ILO, 2020).

5 Nursing has been identified as an ‘indispensable profession, discipline and occupation’ (Thuon Northrup et al., 2004, 55). In developed countries the recruitment of foreign nurses is seen as an appropriate way of catering to the needs of growing, resource-intensive healthcare services coupled with ageing populations (Buchan, 2006). Because of this outward movement of nurses, however, source nations may struggle to meet their own need for health workers (Mackey and Liang, 2012).

6 The World Health Organization’s (WHO) State of the World’s Nursing – 2020 reveals that unless appropriate interventions take place there will be a shortfall of 4.6 million nurses worldwide by 2030 (WHO, 2020b). Over the years, the number of healthcare practitioners in the Philippines has increased. Abrigo and Ortiz (2019) capture this robust growth in their study on healthcare professionals employed in the Philippines, comparing data from 1990, 2010 and 2015 based on the 2012 Philippine Standard Occupational Classification (PSOC) and from the Census of Population (see Table 9.1).

Table 9.1. Number of selected healthcare workers by year (who responded that they were employed in the professions in question)

Source: Abrigo and Ortiz (2019).

7 The 2015 Census of Population, meanwhile, revealed that the Philippines had 488,800 health professionals for a population of over 100 million (2015 census cited in UPPI and DRDF, 2020), while the 2018 National Migration Survey estimated that under 1 per cent of working Filipinos in the Philippines are employed as health professionals (PSA and UPPI, 2019). Within this small demographic, the majority (59 per cent) are nurses, 12 per cent are medical doctors, and 11 per cent are midwives (PSA and UPPI, 2019). If the country fails to invest more in retaining its nursing population, it is looking at a deficiency of 249,843 nurses by 2030 (WHO, 2020b). The Philippine Nurses Association (PNA) has stated that 60 per cent of the 500,000 Filipino registered nurses work in other countries (PNA cited in Malig, 2020). Further, in 2014, according to the Philippine Overseas Employment Administration (POEA), 19,815 nurses emigrated from the country (POEA, 2014).

3. Filipino Nurses, Global Nursing, and Healthcare

8 Filipino nurses are important frontliners in the Philippines and abroad. At the onslaught of the deadly pandemic, the Philippines tried to curb the rise in infections within its borders while also dealing with reports of infections, even casualties, from overseas. Inside the country, the opportunity to react effectively to those in need of medical treatment and support was hampered as a consequence of insufficient numbers of health professionals, while there was also an increasing demand for facilities.

9 The Philippine experience is unique because the country is engaged in a balancing act, simultaneously attempting to manage the healthcare personnel shortfall within its borders while meeting the healthcare needs of the global community. The manner in which the Philippines navigates demands for models that respond to new pandemics and the ecology of global health is worth investigating, especially as it relates to attempts to achieve the SDGs.

3.1. Nursing and the Sustainable Development Goals

10 In 2015, the United Nations General Assembly approved the 2030 Agenda for Sustainable Development, which gives ‘a shared blueprint for peace and prosperity for people and the planet, in the present time and for the future’ (UNOSD, 2015). Nursing has an essential function with regard to Sustainable Development Goal 3: to ensure healthy lives and promote well-being for all at all ages (UNOSD, 2015).

11 The active mobility of nurses, meanwhile correlates with the SDGs’ aims with regard to migration, and in particular Target 10.7, to ‘facilitate orderly, safe, regular and responsible migration and mobility of people, including implementing planned and well-managed migration policies’ (UN DESA, 2020, 1), which is part of SDG 10, ‘to reduce inequality within and among countries’ (UNOSD, 2015). The intersection of nurse migration with sustainable development and human rights, such as the right to movement, is supported by targets set by the international community.

3.2. The State of Global Nursing

12 The revival of interest in nurses’ international migration is a consequence primarily of the global shortage of nurses in recent years (Buchan and Calman, 2004). According to the WHO report on the State of the World’s Nursing – 2020 , the result of the collaborative effort of 191 countries, nursing is the largest category in the health sector, with nurses accounting for 59 per cent of all health workers. In the period 2013–18, nurse numbers grew by 4.7 million worldwide (WHO, 2020b). Given nurse-to-population ratios, however, this increase is marginal and barely matches the pace of population increase, resulting in just a small increase in these ratios.

13 The global nursing workforce currently stands at 27.9 million, with 19.3 million of these considered professional nurses (WHO, 2020b). Around 6.0 million (22 per cent) are associate professional nurses, and 2.6 million (9 per cent) do not fall into either of these two categories (WHO, 2020b).

14 These figures reveal that worldwide nursing numbers are not proportionate to the demands of universal healthcare or to the targets regarding inequality reduction set out in the SDGs. The shortfall in the number of nurses worldwide fell slightly from around 6.6 million in 2016 to 5.9 million in 2018 (WHO, 2020b). Around 5.3 million of that shortfall, however, involves low-income and lower-middle-income countries (WHO, 2020b). Figure 9.1 shows the diversity of densities of nursing personnel to populations, revealing major shortages in countries in Africa, the eastern Mediterranean, Southeast Asia and Latin America.

Figure 9.1 Density of nursing personnel per 10,000 population in 2018

Source: WHO (2020b, 3).

15 In its report Human Resources for Health: Overcoming the Crisis (2004), the Joint Learning Initiative explains that providing a supportive climate and sharpening human resources for health is vital to efforts to shape ‘sustainable health systems’ globally and to combat healthcare disasters in the world’s most vulnerable countries (Joint Learning Initiative, 2004). The World Health Report 2006: Working Together for Health (WHO, 2006) underscores this message and encourages efforts to understand what motivates the mobility of health professionals and the effect that this mobility has on society.

16 According to a study carried out by the Institute for Immigration Research of George Mason University (Hohn et al, 2016), 13 to 15 per cent of working nurses in the United States are foreign-born, which indicates how crucial immigrants are for the long-term performance of the healthcare market (Hohn et al., 2016). The same report predicts a shortfall of more than one million new and replacement nurses by 2022. The US Bureau of Labor Statistics, meanwhile, suggests that another 372,000 registered nurses will be needed by 2028 (Smiley, 2020).

17 The Philippines is the second most populous country in Southeast Asia. Despite this, many of the country’s registered nurses remain either unemployed or ‘mis-employed’ (Dabu, 2019). In 2017, the Philippine Statistics Authority reported that, with 90,308 practising nurses in private and public hospitals, the healthcare system fell short of the target nurse-to-patient ratio (see Table 9.2). In the Philippines, the target ratio in government institutions is 1:60, as revealed by the Philippine Nurses Association (Cortez, 2020). This is some way from the Department of Health’s (DOH) ideal ratio of 1:12 (Cortez, 2020).

Table 9.2 Population of nurses in the Philippines

* Human resource development

Source: UP COVID-19 Pandemic Response Team, 2020.

18 An irony of the Philippine health sector is that even with the numbers of health professionals the country trains each year, there are not enough staff to cater to the needs of the growing population (UPPI and DRDF, 2020). Even before the COVID-19 pandemic, the Philippines suffered from an estimated shortfall of 23,000 nurses according to the Private Hospitals Association of the Philippines (PHAP, cited in Maru, 2020). The Philippine situation runs contrary to the WHO’s Global Code of Practice on the International Recruitment of Health Personnel (hereafter, WHO Code), which frowns upon recruiting health personnel from countries that have a shortage (WHO, 2010). With its lack of nursing personnel, the Philippines is ill-placed to encourage the mobility of its healthcare human resources.

3.3 Filipino Nurses and Their Migration

19 The presence of Filipino nurses in the United States, writes Dr Catherine Choy in her book Empire of Care: Nursing and Migration in Filipino American History (2003), can be mapped back to the point at which the Philippines became a US territory, when new professions such as nursing were introduced to the country in time making the Philippines ‘the leading exporter of nurses in the world’ (Choy, 2003). Nursing schools sprang up in the Philippines beginning in 1907 and were interlaced with an Americanised medical training that equipped Filipino women to be employed as nurses in the United States, not in the Philippines (Choy, 2003). Today the country is ‘the leading exporter of nurses in the world’ (Lorenzo et al., 2007, 1406).

20 From 2008 to 2012, close to 70,000 Filipino nurses worked abroad according to government data from the Philippine Statistics Authority (cited in McLaughlin, 2020). In 2017, some 145,800 Filipinos worked as registered nurses in the United States according to the Washington-based Migration Policy Institute (cited in Batalova, 2020). According to government data, around 18,500 Filipinos were employed in the UK National Health Service in 2020 (McLaughlin, 2020). Japan has been recruiting nurses from the Philippines to care for its elderly population. Filipino nurses are also present in great numbers in the Gulf States, including Saudi Arabia (McLaughlin, 2020). Spain, meanwhile, announced in early 2020 that it would fast-track Filipino nurses’ entry to relieve its straining healthcare system, especially during the COVID-19 pandemic (Aboy, 2020).

21 Many nurses leave the Philippines unofficially. Many, moreover, are selected via direct recruitment by overseas employers, while others depart on immigrant visas. These three types of mobility are not reflected in the Philippines’ international employment estimates. Hence, the nurse mobility estimates found in Philippine government must be treated with caution (Pang, Lansang and Haines, 2002). The POEA and the Commission on Higher Education estimate that from 2012 to 2016 the country trained an annual total of around 26,000 licensed nurses, while around 18,500 moved overseas each year (Lopez and Jiao, 2020), meaning that the emigration rate for trained nurses was 71 per cent.

22 The Philippines is a preferred source of nurses because of its exceptionally well-educated workforce, which is a result of the Philippine education system and the quality of training the population receive. The country’s overseas population is an enormous source of remittances, which help the national economy greatly, and thus transnational mobility has enjoyed widespread support. Even at the height of the pandemic, Filipinos living abroad sent USD 2.9 billion home (Focus Economics, 2021). Philippines nurses working in Philippine public hospitals and government offices, meanwhile, had to campaign for almost two decades before they secured a pay increase required by law (de Vera, 2020), the pandemic ensuring that the increase was, finally, approved. Budget Secretary Wendel Avisado released Budget Circular No. 2020-4 (Department of Budget and Management, 2020) in July 2020, thus officially bringing Section 32 of Republic Act No. 9173—also known as the Philippine Nursing Act—into effect. This gave nurses a monthly salary equivalent to the government’s Salary Grade 15, of PHP 28,890 (USD 580) to PHP 33,423 (around USD 671) in state-run health institutions. As the COVID-19 pandemic swept through the Philippines, details of the working conditions and pay shortfalls of nurses were discovered and brought to the national attention.

23 With 233 nursing schools, and producing more than 20,000 graduates per year since 1999, the Philippines’ strategy for healthcare migration is reflected in the country actively training a surplus of registered nurses that cannot be absorbed by the local market, with the intention of providing for the international market (Corcega et al., 2002). The number of nursing schools has increased over time, illustrating the country’s approach of creating a workforce for export with the expectation that the results of this tactic will be instrumental to the country’s progress (Ortiga, 2017).

24 As noted in a study commissioned by the International Council of Nurses, the local health system in the Philippines needs to support the growth of nursing as a profession and to address the dilemmas present with regard to work environments and pay (Buchan, 2020). A balance must be achieved between assisting in the provision of global healthcare expertise by the relocation of Filipino health workers and ensuring that no capacity gaps exist in the Philippines itself (Buchan, 2020).

25 Work in a much more advanced society offers many nurses the opportunity to change their lives for the better and to secure the quality of life they aspire to (Xu and Zhang, 2005). Which explains why many nurses consider moving and working overseas as one of their future goals. Over 80 per cent of interviewees of the present study admitted that migration was always a part of their plans (Figure 9.2).

Figure 9.2 Respondents’ answers to the question, ‘Was migrating to another country a plan from the beginning?’

Source: author.

26 In the Philippines as in other source countries, people study nursing with the intention of working abroad, an intention that is not only accepted but is also supported by their families and the government (Dussault, Buchan and Craveiro, 2016). This rationalisation seems to be supported by responses to the question, ‘What was your reason for getting a nursing degree?’

27 One nurse respondent in the UK explained:

Ever since I was a kid, it was always my dream to become a nurse and work abroad. One of the things that motivated me to pursue a nursing degree is my passion for caring for the sick since when I was growing up I […] [saw] my grandparents suffer from different illnesses. Second is the ongoing demand for nurses all over the world and lastly, the endless learning opportunities. Working as a nurse, we have the opportunity to interact with doctors and other medical staff as well as patients daily, which allow[s] us to learn from other people and allows us to improve our interpersonal skills.

Nurse 1, UK

28 Several respondents also mentioned that they were pressured by family members, especially their parents:

‘Nursing was never my choice. It was my mom’s. I just did it for the sake of my parents. I never really liked or loved it at all, even after graduation. Until I was exposed to Emergency Nursing. My perception was changed then [and I] started loving it’ (Nurse 2, UK).

‘My mom and sisters are nurses so [there was ]a bandwagon effect’ (Nurse 3, UK).

‘It was my aunt who was also a nurse who motivates me to become a nurse. Since I was a child, I really wanted to become one to help the sick’ (Nurse 4, US).

‘[It was my] parent’s choice’ (Nurse 1, the Philippines).

‘My mother told me to study nursing’ (Nurse 5, the Philippines).

‘I come from a family of nurses and the nursing profession offers a more stable employment in Europe’ (Nurse 6, Switzerland).

29 The International Centre on Nurse Migration has stated that there are several ‘push’ factors that encourage nurses to leave their home countries, including constrained access to educational and career opportunities, low pay, a lack of resources, limited social benefits, political instability and the absence of safe and secure conditions, that last of these including the incidence of HIV/AIDS (Li, Li and Nie, 2014). ‘Pull’ factors that attract nurses to developed countries include better working conditions, job security and advancement, avenues to improve skills, and travel opportunities. (Aiken et al., 2004). It can be argued that these push and pull factors are reflected in the Philippine migration experience, especially as it relates to nurse mobility.

30 There are more women than men in the diaspora, and this been referred to as the feminisation of migration (Camlin, Snow and Hosegood, 2014). Nurse mobility is no exception to this rule. Around the world 90 per cent of nurses are women (WHO, 2020b). In the Philippines 74.1 per cent of nurses are female and 25.9 per cent are male (2015 figures) (Figure 9.3) (PSA, 2016).

Figure 9.3 Gender of nurses in the Philippines

Source: PSA, 2016.

31 Women can play an active role in migration, particularly among healthcare workers. A majority of the world’s nurses are female (Brush and Sochalski, 2007). Women migrants are, however, particularly vulnerable to the ‘dark side’ of migration. While they may have decided on their own mobility pathways, as reported by the WHO (2019b), a considerable number in the healthcare workforce encounter partiality and discrimination as well as harassment (WHO, 2019b). Migration is highly gendered and understanding female nurse mobility therefore calls for a gender-responsive approach.

3.4. Filipino Nurses during the COVID-19 Pandemic

32 Through the POEA, the government—in its bid to protect healthcare workers—issued Resolution No. 9 on 2 April 2020, stopping nurses from departing the Philippines pending the lifting of the national state of emergency (POEA, 2020). Some days after this memorandum was released, the Department of Foreign Affairs Secretary announced that health workers with an existing overseas contract, signed before 8 March, were allowed to leave (Cheng, 2020). New applications for healthcare positions in other countries were, however, halted. Citing Republic Act 8043 or the Migrant Workers and Overseas Filipinos Act of 1995, Section 5 on the Termination or Ban on Deployment, the Administration argued that it was within its rights to have implemented the ban. The Act states, ‘Notwithstanding the provisions of Section 4 the government, in pursuit of the national interest or when public welfare so requires, may, at any time, terminate or impose a ban on the deployment of migrant workers’ (Republic of the Philippines, 2010). A respondent, Nurse 9 living in the UK, shared that

During the pandemic, a lot of fellow Filipino nurses working here in the UK were affected. Some [even] lost their lives while taking care of COVID-19-positive patients. It was a difficult time for us, knowing that every time we [went] to work we [could] be affected by the virus […]. For some of my colleagues working in intensive care units it is […] challenging and difficult for them to work a 12-hour shift with complete personal protective equipment on and [have] only a specific toilet and water break as well as time for them to have their lunch. For me, working in the post-operative cardiac ward, I would say that I am very lucky in […] that [I] can continue taking care of our patients using our comfortable scrubs. Here in the UK, I still feel lucky despite the fact that we are at great risk of being affected by the virus, because we were able to have free transportation for a short while going to work and even free food during our shift provided by our hospital.

33 The same respondent also related their anxiety and their fear for themselves and their family members, noting that it is their faith that keeps them going.

Emotionally we are very much affected in [the] way that this is our calling and we have no other choice but to work. Going to work with our anxiety levels […] sky[-high] because we are directly taking care of […] COVID-19 patients. We are scared for our [lives] and our family member[s] if we get infected. But on the other side, I believe that this is the only way we can pay back God’s blessings to us and that he will cover us with his mantle of protection.

Nurse 9, UK

34 Over 25 per cent of the Filipinos in the New York–New Jersey region work in the healthcare sector. According to a report produced by the non-profit ProPublica, in this region alone there were 30 deaths in the community of Filipino frontliners between the end of March and early May 2020 (cited in Martin and Yeung, 2020). Al Jazeera, in its documentary ‘Filipino Nurses: New York’s Frontliners’, reported that at the peak of the outbreak Filipino nurses were fighting to protect Americans on the front lines of New York’s COVID-19 disaster, with some risking their lives (Al Jazeera, 2020).

35 Nurse 10, living in the UK, made a parallel assertion:

When COVID-19 peaked here in the UK, Filipino nurses were placed ahead of all the frontliners. We were sent to the ICU and placed in the COVID-19 wards with no proper PPE. If you look into the statistics and reports, the highest cases of frontliners that died during the peak of the pandemic were Filipinos. Because of the resilience of our race, we still continue to provide high-quality care to our patients in spite of the fact that our lives are at risk. We need to think about the welfare of our patients before our own.

36 In California, with the highest concentration of Filipinos and Filipino-Americans in the world, 20 per cent of all nurses are Filipino, and they have noted a lack of PPE as one of the primary routes to exposure to the virus (McFarling, 2020). Many health workers are too nervous to complain because they fear they could be punished by being given longer shifts, which would increase their risk of exposure (McGannon, 2020).

It affected us in so many ways. We have always been resilient and flexible. However, being in [that] personal protective equipment for hours is no joke. Some of us get pressure sores and end our shift with a terrible headache due to dehydration. Psychologically, very traumatic. As we often say, we feel like we are in a battle without guns, and we can’t see our enemies. It was tough knowing that we can get infected. Especially when we had patients who are also nurses in our hospital. I work in ICU, so I’ve seen the worst COVID-19 can do. Nevertheless, the bond we have with our fellow nurses became stronger than ever. We looked out for each other every time we prepare[d] to enter the COVID-19 zone. And we see to it that we talk to each other in order to release the stress.

Nurse 12, US

37 Frontline medical staff are vulnerable not only to physical but also to psychological consequences of COVID-19 (Adams and Walls, 2020). According to a Lancet study conducted in Wuhan, which is thought to be where the virus emerged, frontline nurses encountered tremendous mental health problems, including the ‘prevalence of burnout, anxiety, depression, and fear’ (Hu, et al., 2020, 6). Caregiving roles such as raising small children, having a family member that has acquired the disease, and financial problems were shown to be correlated with negative mental health effects in research into the social effects on healthcare workers employed during an epidemic of any infectious disease (Kisely et al., 2020). The respondents of the present study shared similar observations:

Nurses are dealing with a lot of emotional stress from working in these times. From wanting to stay at home to keep their families safe and working to keep others safe, nurses are battling with mental and emotional stress in dealing with this pandemic. Many nurses were broken-hearted from working tirelessly for others and get little to no assurance from the company/government they are working [for] about the hazard they are dealing with. The uncertainty that this pandemic has brought to light made the nurses rethink how passionate they are about their profession. Some even contracted the disease and got discriminated against at work. I personally encountered discrimination for working in an area catering to patients with moderate-to-severe cases of COVID-19. Even inside our workplace, we are sometimes denied […] some basic services just because we work in COVID-19 areas and are asked to go back when we are off duty. Nurses’ plans on working abroad had been halted due to restrictions in travel.

Nurse 8, Switzerland

38 The Philippine Department of Health recognised this problem. In response to the growing mental well-being needs of frontline workers and repatriated overseas Filipino workers (OFWs), the Department unveiled its Telemental Health Response programme, a virtual platform that provides psychosocial help (DOH, 2020). Even the University of the Philippines’ Psychosocial Services, with its 100 volunteers, has offered free tele-psychotherapy sessions.

39 Another challenge faced by nurses during this pandemic is discrimination. Nurse 13 (US) shared that ‘most are being bullied and harassed in the community thinking that nurses are carriers of the virus’. Yet another, Nurse 14, said, ‘A lot of nurses were being thrown out of their apartments just because they work inside the hospital’. Meanwhile, the Philippine National Police reported attacks on and discrimination against health workers during the lockdown (Santos, 2020). This prompted the Department of the Interior and Local Government (DILG) to urge all local government units (LGUs) nationwide to pass and enforce anti-discrimination and anti-harassment ordinances to protect frontline workers. Many LGUs responded to this mandate and enacted laws to protect frontliners and overseas Filipino workers, many of them nurses. The country’s Congress also issued House Bill (HB) No. 6817 (Philippine House of Representatives, 2020b), which outlaws discrimination against persons either directly involved in or affected by the COVID-19 pandemic. The bill is currently awaiting its counterpart from the Senate. Once it becomes a law, it will be used to punish those who commit these crimes, with jail sentences of between six months and ten years and fines ranging from PHP 50,000 to PHP 1 million (between 1,000 and 20,000 US dollars). The WHO had already issued a guide to preventing and addressing the social stigma associated with COVID-19 (WHO, 2020c).

40 Nurse 20 (the Philippines) lamented her experience:

Working as a nurse in the Philippines, [one of the] common challenges we’ve encountered [is] working beyond duty hours to complete all necessary paperwork. Sometimes, you offer possible solutions to certain problems encountered in your area that may help in revising old protocols and creating new ones that may benefit the workers and the hospital, but then you get no response or even alternate solutions from the management. Discrimination is one of the challenges any nurse is dealing with at this time of the pandemic.

41 Even prior to the current pandemic research (Gee et al., 2006) had found that daily experiences of prejudice were linked to Filipino Americans’ chronic health conditions. And de Castro, Gilbert and Takeuchi (2008) had discovered that the self-reporting of occupational discrimination was associated with worse health outcomes among Filipino Americans, the authors concluding that it is important to consider the work setting as a specific source of discrimination when studying health disparities.

42 As these words are being written, the WHO-Western Pacific Region COVID-19 Incident Manager, Abdi Mahamud, is expressing concern over the infection rate of 13 per cent in the Philippines (CNN Philippines, 2020). The vulnerabilities of Filipino health frontliners are twofold: they are at risk if they stay in the Philippines but are also exposed if they are deployed abroad.

3.5. The Evolving Role of Nurses in Global Health

43 The WHO, the International Nurses Council and the global campaign Nursing Now emphasise the role of nurses in contributing to national and global health priorities, including the achievement of the SDGs, in their report on the State of the World’s Nursing (WHO, 2020b).

44 In an interview carried out for the present study, Nurse 17 (UK), in affirming the role of nurses, confidently shared , ‘We are pretty much the blood that runs [and keeps] the hospitals alive’. Other respondents also stated that nurses are essential. Nurses ‘care for the sick and the dying’ (Nurse 1, the Philippines) and ‘help the community get better, and provide education on prevention of diseases and spread of infection’ (Nurse 11, UK). All respondents believe in nurses’ vital role in the world as ‘role models of health practices and healthy living’ (Nurse 20, the Philippines). Nurses play a vital role in the community. Regardless of race, age group or cultural diversity nurses have the ability and capability to give the best possible care. Nurse 17 shared, ‘nurses are the caregiver[s] of those who are ill and needing hospitalisations; nurses can be agents of change health-wise by providing people [with] […] information regarding health education and prevention of illness’. Nurse 14 (US) stated emphatically: ‘I believe that our role in the global community always focuses on health promotion and disease prevention. And the primary goal for us nurses is always to protect and promote the health of all people from different age group[s], gender[s], race[s], etc.’.

45 Nurse 15 (UK) said, ‘The role of nurses is crucial, especially in the provision and promotion of the healthcare delivery system to the global community’.

46 The World Health Assembly (WHA) resolution WHA64.7 (WHO, 2011) directs its Member States to support nursing and midwifery through a number of initiatives, such as using nurses’ skills and integrating them into the development of human capital for health policy. Moreover, the framework set by the Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 gives the WHO and other actors the platform to ‘develop, implement and evaluate nursing and midwifery accomplishments to ensure accessible, acceptable, quality, and safe nursing and midwifery interventions’ (WHO, 2020a, 12).

47 Recognising the importance of ‘adequate and accessible’ health personnel, the WHA has approved a guide to ensuring secure conditions for people taking part in foreign migration. This WHO Code proposes a series of non-binding guidelines for state and non-state players participating in foreign health worker recruitment (Efendi et al., 2017). Based on principles of fundamental human rights, the Code was created to encapsulate rights to health, including the right to find work abroad (Efendi et al., 2017).

48 Nurse 16, based in the US:

With the pandemic right now, being a nurse has a great impact on the community. We are the frontliners; we are the ones who directly take care of sick patients.

The calling of a nurse is to assess the well-being of individuals, families and the whole community. To be the advocate for all […] patients and to promote justice and equality. To uphold everything mentioned in the ‘Nightingale […] Pledge’ when we took our oath.

A nurse is many things. But for me, the best role of a nurse is being the mediator. You are the only bridge between the patient and the rest of the healthcare team and even to the relatives. The information you relay will be the basis of care plans, therefore expecting good outcomes. Through the nurse, you also protect the patient’s privacy and dignity, ensuring that nobody insignificant to the care of the patient is getting important information.

49 During times of crisis and disaster, nurses are strategically positioned not only to contribute but to lead. With their experience and education as well as their role in society, they can push for partnerships and collaborations and for a new health paradigm that is more efficient, inclusive and responsive.

4. Policy Recommendations and Moving Forward

50 Global health has evolved not only due to the emergence of new diseases but also because of our increasingly interconnected and interdependent world. Recognising that policy is an essential part of the ecosystem of health sciences, the following recommendations are offered to the international community, and to the Philippines.

4.1. Recommendations for the International Community

51 In a study commissioned by the International Council of Nurses (ICN), Buchan (2020) mentions three main factors of concern for national nursing associations (NNAs): The first is maintaining secure minimum staffing levels while nurses are unavailable due to COVID-19 symptoms, and ensuring that personnel and patients are protected. Employers have to ensure that nurses are provided with sufficient protective equipment as well as the right planning and training. A second concern is the shortage of adequate PPE, which has been identified in all countries. The third is ensuring the impartial treatment of staff who report back to work and those on provisional contracts (Buchan, 2020). A further challenge, ensuring ‘ethical’ recruitment, includes guaranteeing that migrants have the same access to working standards and job prospects as locals do. This goal of ensuring ‘ethical’ recruitment is intended to protect migrant professionals’ interests in areas where unions are not so prominent, such as in private clinics, hospitals, or households (Dussault, Buchan and Craveiro, 2016).

52 In an attempt to respond to the needs of nurses worldwide, the State of the World’s Nursing – 2020 lists guidance measures for future nursing staffing policies, including the need for countries with nursing crises to raise investment in order to train and recruit, collectively, at least 5.9 million nurses (WHO, 2020b). Furthermore, countries should improve their ability to collect, analyse and use health workforce data. Nurses’ mobility must be efficiently supervised and handled professionally and ethically. The same report stresses that leadership and governance are essential (WHO, 2020b). Authorities should boost nurses’ participation in decision-making on matters that affect their lives and practice. Actions should, in order to ensure decent work for nurses, be harmonised between those in charge of policy, human resources and standards.

53 Connectedly, the International Covenant on Economic, Social and Cultural Rights, specifically Article 7, contains guidelines for ‘just and favourable’ working standards, such as the ‘right to secure working conditions’ (UNGA, 1966). In the General Comment on the Right to Work, respect for workers’ rights and individuals’ fundamental rights, respect for workers’ physical and mental integrity, and appropriate remuneration are elucidated as the main components of decent work (UNCESCR, 2006). In relation to this, the International Labour Organization’s (ILO) Decent Work Agenda provides four strategic goals: encouraging sustainable jobs, guaranteeing workplace security, promoting dialogue and ensuring social security (ILO, 2016).

54 Ultimately, the aim is for both origin and source countries to benefit while ensuring the protection and rights of health workers moving abroad (ILO, 2009). Bilateral and multilateral guidelines and codes of ethics have been established in collaboration with partner nations to devise and enforce agreements that specifically discuss standards and policies for the nursing profession. There are also reciprocal arrangements that lay down the rules and regulations, as well as the performance criteria, for health staff hired from source by destination countries. There needs to be a consistent review and monitoring of these arrangements, intertwined with a regular assessment of their implementation.

4.2 Recommendation for the Philippines

55 When asked if the Philippine government should do a better job in its response, Nurse 22, based in the US, answered:

Yes. I think the government should step up in its action towards flattening the curve. The community must do its part in preventing the spread of the disease. We must strengthen our campaign towards promoting prevention, starting from our homes. We should all step up in realising that we have to live with the new normal for the next couple of years. The government should start distributing or localising jobs in municipalities so as not to overwhelm cities with people returning for work. The government needs to rebuild the distribution of jobs to promote a safe workplace.

56 The Philippines’ battle against COVID-19 is far from over, and the Department of Health reports that more health personnel will be required for COVID-19 facilities. As a result, the Department began an emergency recruitment campaign to treat COVID-19 incidents. A guaranteed 20 per cent bonus over the government’s minimum wage levels, accommodation, hospitalisation benefits and even compensation of PHP 1 million (USD 20,000) in case of loss of life are all on offer (Lopez and Jiao, 2020).

57 One of the priority measures identified by Philippine President Rodrigo Duterte in his State of the Nation Address (Duterte, 2020) was passing the Advanced Nursing Act, which seeks to modify some aspects of the Philippine Nursing Act of 2002 to create an advanced nursing education program. Senator Bong Go, the bill’s sponsor in the upper chamber, hopes to persuade Filipino nurses to remain in the Philippines rather than work abroad. Senate Bill No. 395 will mandate higher learning institutions approved by the Commission on Higher Education to develop harmonised basic and graduate nursing education programs (House of the Senate, 2019). Lower House Deputy Speaker and Camarines Sur 2nd District Rep. Luis Raymund Villafuerte Jr. provided the lower house version of the bill (House of Representatives, 2020).

58 Nurse 24, who had just returned to the Philippines from the Middle East, recommended that the Balik Scientist programme, an existing programme of the Department of Science and Technology, should ‘allow willing Filipino health professionals to return to share their skills and talents gained from experience with[in] the destination country without risk of job loss’ and that this should also be included in the provisions of bilateral agreements with host countries.

59 Indeed, apart from legislation, there needs to be support given to improving the practice of nursing in the Philippines, support that also includes the strengthening of research and innovation. There also has to be an exchange of best practices and a space in which migrant Philippine health workers can contribute to their home country.

60 Acknowledging the stories of Filipino nurses on active duty in the Philippines and abroad while taking stock of the frameworks created by the UN, WHO, and other agencies advances the need not only for a mapping exercise that tracks geographical nurse mobility but also for becoming conscious of the leaky faucets that disturb the career trajectories of nurses. Measures to ensure that standards are followed, codes are committed to, and concerns are addressed must be implemented in partnership with different sectors, but, more importantly, guarantee that the voices of nurses are heard and valued, as they inform both policy and a more inclusive, safe and secure work environment.

5. Conclusion

61 During the COVID-19 pandemic, the profile of the nursing population from the Philippines has shed light on two issues: the challenges the current health system holds for health workers, in particular nurses, seeking to provide services to the country during a crisis such as the pandemic, and the question of Filipino nurses’ ability to work abroad and their working and life conditions as they navigate the uncertainties and vulnerabilities brought about by a deadly virus.

62 This chapter has attempted to relate the perspectives of nurses themselves in order to understand the impact of migration on their lives through their experiences and to capture their lived realities, hoping to provide solutions that are practical, inclusive and sustainable. These contributions are critical to designing policies for source countries such as the Philippines.

63 Health workers in the Philippines during the COVID-19 outbreak hoped, via their unified call, to convince national governments and receiving nations to look deeper into their daily lives and recognise that improving their conditions, positions and pay would benefit society as a whole.

64 At the height of the health crisis, the government tried to dissuade nurses from leaving the Philippines, especially given the loss of frontline personnel to the disease, a loss that exacerbated the dearth of responders who would be required if the country was to successfully combat this insidious virus. However, as echoed by nurse respondents to the present study, the international migration of nurses can serve as a means of empowerment, and of providing spaces for nurses’ engagement and collaboration. This has the potential to enable their wider participation, particularly in decision-making.

65 Nurse migration and the health ecosystem are multidimensional and complex. The UN, the WHO and local counterparts have attempted to put safeguards in place to ensure the safety and well-being of nurses and other health workers. The challenge of dealing with COVID-19, however, has pressured the global community to reassess its methods. And it is important for host countries to have a better grasp of the needs of its migrant population, especially those on the frontlines. Further, the intersection of the issue of nurse migration with other issues—including those of diversity, inclusion and gender—has to be more closely examined.

66 As is often said, a crisis is a terrible thing to waste. It is hoped that the common experience of dealing with COVID-19 ignites a fire in Filipino nurses, encouraging them to take a more active role in global health and migration policy. And that while the world tries to ‘build back better and stronger’, nurses will be able to take the opportunity to address the leaky faucets that impact their careers, and create an enabling environment in which they themselves will flourish, since doing so will proportionately benefit the global health system and the entire environment of care.

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Jenny Lind Elmaco , “ Philippine Nurse Migration: Assessing Vulnerabilities and Accessing Opportunities during the COVID-19 Pandemic ” ,  International Development Policy | Revue internationale de politique de développement [Online], 14 | 2022, Online since 25 April 2022 , connection on 16 March 2024 . URL : http://journals.openedition.org/poldev/4853; DOI : https://doi.org/10.4000/poldev.4853

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Jenny lind elmaco.

Jenny Lind Elmaco is the Regional Coordinator in Asia for EURAXESS, a European Commission research platform. She is Vice Chair for Asia Pacific of the Global Women Inventors and Innovators Network and a University Fellow at Wesleyan University. She has been academically connected with Royal Roads University in Canada, Complutense University of Madrid, the University of Muenster, Vienna School of Business and Economics and the University of Ljubljana. Her research interests include science diplomacy, peace and security, gender and diversity, international affairs, governance, and sustainable development.

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Quality of nursing education programme in the Philippines: faculty members perspectives

Stella appiah.

School of Nursing and Midwifery, Valley View University, P. O. Box DT 595, Oyibi, Accra, Ghana

Associated Data

The study data and materials are in the custody of the corresponding author and can be made available on reasonable request.

The subject of continuous improvement in the quality of nursing education programme is an extremely sensitive issue worldwide, particularly in the Philippines where a high number of trained registered nurses are exported to both developed and developing countries. The assessment of the quality of nursing education programme is usually measured using pass rates in licensure examinations by several government organizations. However, few studies have indicated that various categories of faculty members view the quality of nursing programmes differently, this study probed further and determined whether the quality of nursing education programme differs according to the profile of faculty members in Philippines colleges of higher education.

A cross-sectional survey study design was employed in this study. One hundred and eight-five (185) faculty members in fifteen (15) higher educational institutions were selected for the research using purposive-census sampling. The study was carried out from January 1 to June 30, 2017. Close-ended structured questionnaires based on study objectives were used to collect data. Frequency and percentages were used to analyse the profile of faculty members whereas weighted means from a four Likert’s scale was used to interpret the extent of perceived quality of nursing education programme.

Majority, 39 and 46% of faculty members had 1–5 years’ clinical experience and 6–10 years of teaching experience respectively. Faculty members strongly agreed with a grand weighted mean of 3.84 out of 4.00 that nursing education programme is of good quality in the Philippines and is synonyms with other universities in the world. Teaching experience of faculty members showed significant relations in the quality of mission/vision/goals/objectives ( p -value = 0.008), curriculum and instruction ( p -value = 0.038), administration of nursing programme ( p -value = 0.025), faculty development programme ( p -value = 0.003), physical structure and equipment ( p -value = 0.016), student services ( p -value = 0.017), admission of students ( p -value = 0.010) and quality assurance system ( p -value = 0.009).

Faculty members strongly perceived nursing education programme to be of good quality in this study. Teaching experience of instructors showed a significant relationship with the quality of nursing education programme in all the quality assessment indicators. However, clinical experience and job category of faculty members rather showed that the quality of nursing education programme is the same throughout all the higher educational institutions. The study implies that the teaching experience of faculty members is a strong predictor of quality of nursing education programme and employing faculty experienced in teaching is substantial for the continuous improvement of nursing education programme.

Quality of nursing education programme is a complex topic that involves the combination of teaching and learning materials, human resources, teaching and learning processes, curriculum, teaching and clinical experiences, teacher’s attitudes and commitment that are necessary to achieve set learning expectations and produce an exceptional performance of nursing students [ 1 ]. In essence, the nursing education programme can be classified as excellent or of high quality if it can be rated high (at least 80%) in all criteria used in its assessment.

The fundamental focus of nursing education programme is to produce nursing professionals that are clinically competent and can contribute immensely to the provision of quality and safe nurse care [ 2 , 3 ]. Quality nursing education can be attained if nursing faculty obtain a balanced experienced in both theory and clinical areas. Consequently, this vast knowledge may results in nurses workforce that can apply the theory and lessons learnt in simulation laboratories into the delivery of health care in everyday living [ 4 ].

Worldwide, nurses are known to play a vital role in the rendering of health care services including many fundamental health-related services, particularly in rural areas. The increase of workforce without compromising on quality is imperative to help achieve Sustainable Development Goals (SDGs) targets that are set by the United Nations and its member countries, especially the one focused on universal health coverage [ 5 , 6 ]. Quality of nursing education programme can be viewed as a long-term contributor to attaining quality universal health coverage in the production of qualified nurses.

The assessment of the quality of nursing education programme globally has usually been based on the pass rates in licensure examinations by several government organizations [ 7 ]. Although, several quality factors such as accreditation, students’ practical exposure and profile of faculty are sometimes considered to some extent [ 8 ]. The issue of quality of nursing education programme in Philippines colleges of higher education is extremely sensitive due to the high number of trained registered nurses exported to other countries such as the United States of America, United Arab Emirates and Germany [ 9 , 10 ].

The quality of nursing education programme has been strongly associated with quality of curriculum, faculty and resources. These resources such as teaching materials and facilities are required to assist instructors in their delivery of nursing education [ 11 ]. The World Health Organization has also affirmed some standard criteria or area that quality of nursing education programme should be measured with of which faculty profile or development is included [ 12 ]. This activates the discussion into whether the quality of nursing education programme hinges on the profile of the faculty.

Aside from the challenge of quality of faculty members in nursing education programme, there are also problems of shortage of nursing instructors which usually affects the clinical teaching and learning environment and this clinical training feature of the nursing education programme results in long term detrimental effects in practising nurses if not well taught [ 13 ]. Also, other issues associated with quality of faculty members which consequently affects the quality of nursing education programme includes aging nursing faculty, less attractive faculty positions and length of education required to secure a faculty appointment [ 14 ].

According to a study conducted in Ghana, shortage of qualified instructors and insignificant upgrade of the previous infrastructure are critical issues facing the quality of nursing school and subsequently nursing education programme [ 15 ]. As far back as 27 years ago, some authors have connected the quality of nursing education in the aspect of teaching and practical gap to nursing faculty inability to assume a commanding role in clinical learning and teaching [ 16 ]. Earlier researches have related quality of nursing education to the quality of nursing instructors and this study, therefore, determined the quality of nursing education programme. This paper also found out whether the quality of nursing education programme differs according to the profile of faculty members using Philippines colleges of higher education as a case study, in addressing this, the study was based on the null hypothesis (Ho), there is no significant difference in the quality of nursing education programme by the respondents (faculty members) when grouped according to their profile.

Study design

A cross-sectional survey study design was used in this research. This was executed by employing a purposive-census sampling method to recruit one hundred and eighty-five (185) faculty instructors in fifteen (15) higher educational institutions. The use of Purposive sampling was based on the belief that the researcher’s knowledge about the population can be used to hand-pick respondents [ 17 ] and in this case HEIs. This approach did not necessarily mean HEIs known to the researcher were selected but those who met the criteria of inclusion were used for the study. Census sampling, on the other hand, is the process of taking the total population of the locale and retrieving an adequate number of respondents (faculty) as a sample of the study. The use of the two approaches complimented each other for the recruitment of the HEIs and study respondents Questionnaires centred on the aim and study objectives of the study were self-administered after the consent of participants was sought. The study was carried out with the period of January 1 – June 30, 2017.

The study was conducted in fifteen (15) private-owned higher educational institutions in the National Capital Region (NCR) of the Philippines. Ten out of fifteen of these higher educational institutions had existed for more than 45 years whilst the rest had been in existence for less than 45 years. Although 7 of these institutions were granted autonomous by a regulating body called CHED, 8 of them were still monitored by the same regulatory agency. Also, 12 of these institutions were owned by private non-sectarian organizations, however, 3 were owned by private sectarian establishments. The central government seat is in the National Capital Region and the city holds the highest number of higher education institutions which comprises those offering nursing education programme. Majority of these institutions offer health-related programmes at both undergraduate and postgraduate levels, however, the study concentrated on the nursing education programme at the undergraduate level.

Sampling procedure

An initial number of all twenty-two (22) recognized higher national institutions owned by private entities in the NCR were contacted to take part in the study, yet, a considerable number of fifteen (15) institutions approved for their school and faculty members to partake in the study. The number of faculty in the twenty-two (22) higher national institutions targeted for the study summed up to two hundred and twenty (220), nonetheless, one hundred and eighty-five (185) faculty members consisting of deans, program coordinators, and faculty instructors on full and part-time contracts consented and were recruited into the study. The made the study achieve a response rate of 84.1%.

Inclusion criteria

All teaching and clinical instructors who have spent more than 1 year in their educational institution were recruited to partake in the study.

Exclusion criteria

All other instructors who had not completed 12 months in their educational institutions were not allowed to be part of the study.

Tool for data collection

A questionnaire was specifically developed to undertake this study. In doing so, three areas were considered in the design of a close-ended questionnaire used for the study. These were; 1) aim and objectives of study 2) policies and standards of nursing schools in the Philippines and 3) World Health Organization (WHO) guidelines on quality assurance and accreditation of nursing and midwifery educational institutions in the South-East Asian countries. A four (4) Likert scale with standard questions were used to evaluate the quality of nursing education programme. The criteria for the assessment of the quality of nursing education programme included mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system. Pretesting of the questionnaire was done in one of the accredited colleges of nursing in NCR with nineteen (19) respondents to measure the reliability of the tool before it was employed for the study. In doing so, the questionnaire was subjected to Cronbach’s alpha reliability test to determine its consistency and validity. The overall result showed .989 indicating a high consistency and reliability.

Data analysis

Information from the completed questionnaire was entered into Microsoft Excel and imported into SPSS statistical software version 22 for editing, cleaning and analysis. Frequency and percentage were employed to analyse the profile of faculty members while weighted means from a four-Likert scale was used to interpret the extent of perceived quality of nursing education programme as assessed by faculty members. The scales for assessing the quality of nursing education programme; 1.00–1.49, 1.50–2.49, 2.50–3.49 and 3.50–4.00 was interpreted as strongly disagree, disagree, agree and strongly agree respectively. One-way ANOVA was used to test for the differences in quality of nursing education programme in the eight (8) thematic areas (mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system) concerning the profile of faculty members. A P -value of less than 0.05 was considered significant in this study.

Profile of faculty members in higher educational institutions (HEIs)

A majority, 73 (39.0%) of the 185 participants that partook in the study had 1–5 years’ clinical experience whilst few, 15 (8.0%) had 16–20 years of clinical experience. Almost half, 85 (46.0%) of respondents had taught for 6–10 years nonetheless a small number, 14 (8.0%) had 16–20 years of teaching experience. A little below two-thirds, 121 (65.0%) were doing both clinical and classroom teaching whereas very few, 8 (4.0%) were deans of the nursing department in their institutions (Table  1 ).

Quality of nursing education Programme as perceived by faculty members

At the end of the assessment of the nursing education programme, an average of the grand weighted mean of 3.84 resulted, which means participants strongly agreed that nursing programme is of good quality. However, administrators who were faculty members rated the quality of nursing education programme higher with a mean of 3.88 compared to a mean of 3.81 by faculty who were only instructors. The quality of the mission/vision/goals/objectives of the nursing education programme was appraised highest with a mean of 3.91 while the least valued was the admission of students with a mean of 3.76 (Table  2 ).

Quality of nursing education as perceived by faculty members

Legend: 1.00–1.49 Strongly Disagree (SD), 1.50–2.49 Disagree (D), 2.50–3.49 Agree (A), 3.50–4.00 Strongly Agree (SA), Grand Weighted Mean (WM), Qualitative Description (QD)

The difference in quality of nursing education Programme according to profile of faculty

Significant differences existed in the quality of mission/vision/goals/objectives ( p -value = 0.008), curriculum and instruction ( p -value = 0.038), administration of nursing programme ( p -value = 0.025), faculty development programme ( p -value = 0.003), physical structure and equipment ( p -value = 0.016), student services ( p -value = 0.017), admission of students ( p -value = 0.010) and quality assurance system ( p -value = 0.009) in relation to teaching experience of faculty members. On the contrary, the quality of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system did not differ significantly with regards to clinical experience and job category of faculty instructors (Table  3 ).

Difference in Quality of Nursing Educational Program according to Profile of Faculty

The p -values denoted by ‘*’ are significant at a level of p  < 0.05, Ho – denotes null hypothesis

The excellence of nursing education programme and to a large extent nursing institution has often been linked to success in licensure exams undertaken by nursing students while other studies have associated it to the quality and shortage of nursing instructors [ 7 , 13 ]. The findings of this study also sought to unravel another concept of whether the profile of faculty in terms of clinical experience, teaching experience and job category cause significant differences in the quality of nursing education programme in the areas of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.

According to this study, participants strongly agreed with a score of 3.84 out of 4.00 that quality of nursing education programme offered by institutions in the Philippines is similar to ones run by other universities. This high grading of the quality of nursing education programme may have resulted because of the majority, 39 and 46% of faculty members had 1–5 years’ clinical experience and 6–10 years of teaching experience respectively. Also, this is consistent with the requirement that nursing instructors should have at least a year each of clinical and teaching experience [ 18 , 19 ]. Again, clinical experience particularly is important to close the gap between classroom lessons and simulation classes and in the long run improves the quality of nursing education programme [ 4 ].

Besides, this study also found that about two-thirds, 65% of faculty members were both classroom and clinical instructors. This result has a direct influence on the high grading of the quality of nursing programme because is very suitable if instructors who taught a particular group of students takes them through the practical component of the course. This leads to a better delivery of the curriculum of nursing education programme according to [ 11 ], which consequently leads to a high quality of nursing education programme.

The World Health Organization emphasized vision as a key requirement for the quality of nursing education as part of the global standards for the education of professional nurses and midwives [ 12 ]. In a study on quality assurance in higher education, mission/vision/goals/objectives were rated higher as the driving force for the quality nursing education programme. This was also congruent with the finding of this study where mission/vision/goals/objective was rated highest, 3.91 out of 4.00 compared to the other quality matrix that was used in the assessment of nursing education programme.

Even though, many studies have emphasized on the importance of clinical experience on the quality of nursing education programme [ 4 ], clinical experience and type of faculty did not show a significant difference in the quality of nursing education programme in all the eight quality matrix in this study. This implies that the quality of nursing education programme will be the same throughout all the nursing colleges in the Philippines with regards to clinical experience and job category of instructors.

Conversely, teaching experience of faculty revealed a significant difference in the quality of nursing education programme in all the criteria used for monitoring the quality of nursing education programme. This underlines the importance of teaching experience in the quality of nursing education [ 20 ]. Experienced faculty members are usually needed in the development of mission/vision/goals/objectives, curriculum and instruction of a nursing programme [ 21 ]. They are also practically involved in the administration of nursing education programme and even report gaps in a curriculum where and when is necessary [ 21 , 22 ]. The nursing lecturers who have enough teaching experience had usually undergone series of faculty development programme and have the experience in advising management on the needed physical structure and equipment that are necessary for the running of quality nursing education programme [ 23 ]. Also, these faculty members have the knowledge in the calibre of students to be admitted and the type of student services that should be provided to ensure the best of nursing education. This finding on the teaching experience of faculty members discloses its importance on the quality of nursing education programme and hence worth considering in enlisting processes.

Faculty members strongly perceived nursing education programme to be of good quality in this study. Majority of these nursing instructors had sufficient years of both clinical and teaching experience. No significant difference was found in all the quality criteria of nursing education programme with regards to the profile of instructors; clinical experience and job category. However, teaching experience revealed a significant difference in the quality of nursing education programme in the area of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.

Recommendation

The study, therefore, encourages management of higher educational institutions to emphasize teaching experience as one of the criteria that merit consideration for the recruitment of faculty members for a nursing education programme. This will guarantee continuous improvement of quality of nursing education programme in higher educational institutions in the Philippines and other countries.

Although Likert scale was used by study participants to measure quality of nursing education programme in all the criteria in the quality matrix used in this study, respondents may have been biased in the answering of questions concerning nursing education programme using this scale where they intentionally avoid extreme answers and choose options that are expected than the real situation the study sought to find.

Supplementary Information

Acknowledgements.

The author appreciates the management and faculty of all higher educational institutions in the Philippines for their involvement which made the conduct of the study successful.

Author’s contributions

The sole author conceptualized, designed, analysed and interpreted the study. The author also prepared the manuscript for publication of the study. The author read and approved the final manuscript.

Author’s information

The author holds a PhD in Nursing Administration from Our Lady of Fatima University, Valenzuela City, Philippines. Dr. Stella Appiah is currently a Senior Lecturer and Head of School of Nursing, Valley View University, Ghana. Her speciality is in Nursing Administration, Nursing Research Methods, Family Health Crisis Intervention, Pharmacology and Therapeutics.

The author self-sponsored the study.

Availability of data and materials

Ethics approval and consent to participate.

The Research Development and Innovation Centre of Our Lady of Fatima University reviewed and gave ethical clearance before the conduct of the study. Approval was also granted by the ethical review committees of the Higher Educational Institutions of study participants. An informed consent was also given by study respondents by appending their signature on a written consent form before asked to complete the study questionnaire.

Consent for publication

The author declares her consent for the publication for the study.

Competing interests

The author declares no competing interest concerning the publication of the research.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The online version contains supplementary material available at 10.1186/s12912-020-00508-9.

Nursing research in the Philippines

Affiliation.

• 1 College of Nursing, University of Florida.
• PMID: 3291914

Publication types

• Child Health Services
• Community Health Nursing
• Education, Nursing
• Maternal Health Services
• Nursing Services / organization & administration
• Philippines
• Primary Health Care
• Specialties, Nursing
• Students, Nursing / psychology

Development of Framework for Clinical Nursing Research Fellowship in the Philippines

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Jonathan D. Cura , RN, PhD

Fellowship programs serve as alternative means to bridge the gap between undergraduate education and nursing practice. The purpose of the study was to develop a framework for a Clinical Nursing Research (CNR) Fellowship Program in the Philippines. A sequential non-dominant mixed method design was used. It comprised the following: identifying the competencies needed by clinical nurses in research and EBP; the training needs of clinical nurses in research and EBP; the core competencies, functional competencies and tasks of CNR fellows; and describing potential fellows’reactions and preferred ways of learning. Categorical analyses were done to analyze qualitative data. Descriptive statistics was used to analyze training needs and consensus agreement of experts. There were nine core competencies and 70 tasks of a CNR fellow that were distributed to the Beginner, Intermediate and Advanced Levels. Potential fellows prefer learning that is active, reflective, sequential, cooperative, guided by experts, personalized and involves use of technology. After learning the basics, they would need to learn more intensively on competencies that would help them become more capable of contributing to clinical practice. The CNR Fellowship Program framework seemed to contain contextually-relevant core competencies in clinical nursing research that are needed to augment basic nursing research education and to benefit clinical nursing practice.

Keywords : Evidence-Based Practice, Training Needs, Sequential Mixed-Method, CNR Fellow, Clinical Nursing Research Fellowship Program

About the Author

Jonathan D. Cura , RN, PhD, obtained his Doctor of Philosophy in Nursing Education from Holy Angel University, Angeles City. He is a graduate of BS Nursing at Holy Angel University (HAU) and MS Nursing, Major in Adult Health Nursing at University of the East-Ramon Magsaysay Memorial Medical Center, Inc (UERMMMCI). He also had units in MS Genetic Counseling at the University of the Philippines- Manila. He is a Nursing Research Manager and OIC-Department Manager of Nursing Research, Systems Management and Accreditation (NRSMA) Department at St. Luke’s Medical Center- Quezon City. He is a faculty member in the graduate schools of HAU and UERMMMCI. He is member of the Philippine Nurses Association, Inc. and Philippine Nursing Research Society, Inc.

PHILIPPINE NURSES ASSOCIATION, INC. 1663 F.T. Benitez Street, Malate, Manila 1004 Telephone Nos: 521-0937, 400-4430 Telefax: 525-1596 Email: [email protected]

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History of Nursing in the Philippines

History does matter. This statement must have been self-evident over the years, decades, and centuries past. It is inescapable. Far from being a ‘dull and boring’ subject, its depth excitingly connects things through time and encourages starters to take a long view of such connections for a better understanding of their chosen path.

Nursing in the Philippines has a deep and enigmatic history. This article illustrates the considerable weight and influence of nursing history while at the same time disclosing the challenges of applying the past to the present.

Table of Contents

Early care of the sick, health care during the spanish regime, nursing during the philippine revolution, hospital school of nursing’s formal training (1901 – 1911), the start of nursing practice (1911- 1921), a much established professional organization: 1921 – 1931.

• Public Health Nursing Development: 1931 – 1941

Other Schools of Nursing

• The Degree of Bachelor of Science in Nursing: 1941 – 1951
• The First Colleges of Nursing in the Philippines

Proliferation of Nurses as a Workforce: 1951 – 1971

Nursing profession development: 1971 – 2001, further changes in nursing law: 2001- to present, in a glance, early beliefs & practices.

Two words—mysticism and superstitions. These were the early beliefs of health and illness in the Philippines. The cause of a disease was primarily believed to be due to either another person, whom which was an enemy, or a witch or evil spirits. In the early times, Filipinos were very cautious not to disturb other people or the evil spirits for the good of their health. These evil spirits could be driven away by persons with power to banish demons.Belief in special gods of healing, with the priest -physician (called “word doctors” ) as intermediary. If they used leaves or roots, they were called herb doctors ( “herbolarios” ) Filipinos who became sick were usually cared for by the female family members or friends in the home.

The early Filipinos subscribed to superstitious belief and practices in relation to health and sickness. Herb men were called “herbicheros” meaning one who practiced witchcraft. Persons suffering from diseases without any identified cause were believed bewitched by “mangkukulam” or “manggagaway” . Difficult childbirth and some diseases (called “pamao” ) were attributed to “nunos” . Midwives assisted in childbirth. During labor , the “mabuting hilot” (good midwife) was called in. If the birth became difficult, witches were supposed to be the cause. To disperse their influence, gunpowder were exploded from a bamboo cane close to the head of the sufferer.

The context of nursing has manifested through simple nutrition , wound care , and taking care of an ill member of the family. Certain practices when taking care of a sick individuals entails interventions from babaylan (priest physicians) or albularyo (herb doctor). In 1578, male nurses were acknowledged as Spanish Friars’ assistants for caring sick individuals in the hospital. These male nurses were referred as practicante or  enfermero.

The religious orders exerted their efforts to care for the sick by building hospitals in different parts of the Philippines. The earliest hospitals were:

Hospital Real de Manila (1577) – it was established mainly to care for the Spanish king’s soldiers, but also admitted Spanish civilians; founded by Gov. Francisco de Sande.

San Lazaro Hospital (1578)  – founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy .

Hospital de Indios (1586)  – established by the Franciscan Order; service was in general supported by alms and contributions from charitable persons.

Hospital de Aguas Santas (1590)  – established in Laguna; near a medicinal spring, founded by Brother J. Bautista of the Franciscan Order.

San Juan de Dios Hospital (1596) – founded by the Brotherhood of Misericordia and administered by the Hospitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general health service to the public.

In the late 1890’s, the war between Philippines and Spain emerges which resulted to significant amount of casualties. With this, many women have assumed the role of nurses in order to assist the wounded soldiers. The emergence of Filipina nurses brought about the development of Philippines Red Cross.

Josephine Bracken — wife of Jose Rizal, installed a field hospital in an estate house in Tejeros. She provided nursing care to the wounded night and day.

Rosa Sevilla de Alvero —  converted their house into quarters for the Filipino soldiers; during the Philippine-American War that broke out in 1899

Dona Hilaria de Aguinaldo —  wife of Emilio Aguinaldo who organized that Filipino Red Cross under the inspiration of Mabini.

Dona Maria Agoncillo de Aguinaldo  — second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during the revolution, President of the Filipino Red Cross branch in Batangas.

Melchora Aquino a.k.a. “Tandang Sora”  — nursed the wounded Filipino soldiers and gave them shelter and food.

Capitan Salome — a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat.

Agueda Kahabagan —  revolutionary leader in Laguna, also provided nursing services to her troops

Trinidad Tecson  (“Ina ng Biak-na-Bato”) — stayed in the hospital at Biak na Bato to care for wounded soldiers

Hospitals and Nursing Schools

Americans began training the first Filipino nursing students in 1907. Nursing students in the Philippines studied many of the same subjects as nursing students in the U.S. However, it was believed that the curriculum in the Philippines “was never a mirror-image reproduction of the American nursing curriculum” and involved more than a simple transfer of knowledge from American nurses to Filipino nurses. The first Filipino nursing students also studied subjects that were more relevant to their patients, such as “the nursing of tropical diseases” and “industrial and living conditions in the islands,” as described by Lavinia L. Dock’s 1912 book A History of Nursing: From the Earliest Times to the Present Day with Special Reference to the Work of the Past Thirty Years.

Formal training in hospital school of nursing transpire. This began when American missionary doctors and nurses realized that they manpower is insufficient. Thus it resulted to a decision of training Filipino nurses that would be catering to the hospitals that Americans established in the 20th century.

The first hospital in the Philippines which trained Filipino nurses in 1906 was Iloilo Mission Hospital, established by the Baptist Missionaries. When this health institution was built, there were no strict requirements for the applicants as long as they are all willing to work. This has been the beginning of development of more nursing schools in the country. In this period, Pensionado Act of 1903 (or Act 854) was mandated, allowing Filipino nursing student to study in United States. Among of the first wave of nurses who went to United States

Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)

It was ran by the Baptist Foreign Mission Society of America. Miss Rose Nicolet, a graduate of New England Hospital for Women and Children in Boston, Massachusetts was the first superintendent for nurses. It moved from its present location to Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse , took charge of the school in 1942. In April 1944 graduate nurses took the first Nurses Board Examination at the Iloilo Mission Hospital.

Saint Paul’s Hospital School of Nursing (Manila, 1907)

The hospital was established by the Archbishop of Manila, Jeremiah Harty under the supervision of the Sisters of St. Paul de Chartres located in Intramuros. It provided general hospital services. It opened its training school for nurses in 1908, with Mother Melanie as superintendent and Miss Chambers as Principal.

Philippine General Hospital School of Nursing (Manila, 1907)

PGH began in 1901 as a small dispensary for Civil officers and Employees in the City of Manila and later grew as a Civil Hospital. In 1906, Mary Coleman Masters, an educator advocated for the idea of training Filipino girls for the profession of nursing with the approval of Government officials, she first opened a dormitory for Girls enrolled at the Philippine Normal Hall and the University of the Philippines.

In 1907, with the support of Governor General Forbes and the Director of Health and among others, she opened classes in nursing under the Auspices of the Bureau of Education. Admission was based on an entrance examination. The applicant must have completed elementary education to the seventh grade. Julia Nichols and Charlotte Clayton taught the students nursing subjects. American physician also served as lecturers. In 1910, the Act No. 1976 modified the organization of the school placing it under the supervision of the Department of Health. The Civil Hospital was abolished and the Philippine General Hospital was established.

St. Luke’s Hospital School of Nursing (Quezon City, 1907)

The hospital is an Episcopalian Institution. It began as a small dispensary in 1903. In 1907, the school opened with three girls admitted. These three girls had their first year in combined classes with the PGH School of Nursing and St. Paul’s Hospital School of Nursing. Miss Helen Hicks was the first principal. Mrs. Vitaliana Beltran was the first Filipino superintendent of nurses and Dr. Jose Fores was the first medical director of the hospital.

Mary Johnston Hospital and School of Nursing (Manila, 1907)

It started as a small dispensary on Calle Cervantes (now Avenida). It was called the Bethany Dispensary and funded by the Methodist Mission for the relief of suffering among women and children. In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley and Gertude Dreisbach, organized the Mary Johnston School of Nursing. The nurses’ training course began with three Filipino young girls fresh from elementary as their first students.

Philippine Christian Mission Institute Schools of Nursing

The United Christian Missionary Society of Indianapolis, Indiana- a Protestant organization of the disciples of Christ operated three schools of nursing.

Sallie Long Read Memorial Hospital School of Nursing (Laoag Ilocos Norte, 1903)

Promulgation of Act No. 2493 which amends Medical Law (Act No. 310) allowing the regulation of nursing practice transpired during this period.  However, in 1919, the First True Nursing Law was enacted through Act 2808. During this period the Board Examiners for Nursing was also created. The first nursing board examination was given on 1920. The first executive officer of the Board Examiners for Nurses is a physicians.

Mary Chiles Hospital School of Nursing (Manila, 1911)

The hospital was established by Dr. WN Lemon in a small house on Azcarraga, Sampaloc, Manila. In 1913, Miss Mary Chiles of Montana donated a large sum of money with which the preset building at Gastambide was bought. The Tuason Annex was donated by Miss Esperanza Tuason, a Filipino Philanthropist.

Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912)

San Juan de Dios Hospital School of Nursing (Manila, 1913)

In 1913, through the initiative of Dr. Benito Valdez, the board of inspectors and the executive board of the hospital passed a resolution to open school of nursing. The school has been run by the Daughters of Charity since then. Sister Taciana Tinanes was the first Directress of the School

Emmanuel Hospital School of Nursing (Capiz, 1913)

In 1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo to Capiz for the purpose of opening a hospital. Miss Rose Nicolet assisted him. The school offered a 3-year training course for an annual fee of Php 100.00. Miss Clara Pedroso was the first principal

Southern Islands Hospital School of Nursing (Cebu, 1918)

The hospital was established in 1911 under the Bureau of Health. The school opened in 1918 with Anastacia Giron-Tupas as the organizer. Miss Visitacion Perez was the first principal

During this period, the precursor to the accredited professional organization in the Philippines was created. The Filipino Nurses Association was established on October 15, and the organization initiated the publication of Filipino Nurse Journal. Later, this journal was changed to The Philippine Journal of Nursing. Amendment of certain sections of the Act 2008 was conducted in 1922 under Act 3025 passed by the 5th Legislature. This policy is entitled An Act Regulating the Practice of Nursing Profession in the Philippine Islands, which necessitates all nurses who are practicing the profession to register yearly. In 1929, the organization also became a member of the International Council of Nurses.

Through the 1930s, Philippine schools of nursing continued to adopt those aspects of American professional nursing they deemed relevant and appropriate, such as higher admission standards and the specialization of public health nursing.

Public Health Nursing Development: 1931 – 1941

In 1933, the nursing institution have increased their requirement. During this period, they have implemented that to enter nursing education an applicant must be able to complete secondary education. The first collegiate nursing graduates of the Philippines graduated from University of the Philippines School of Public Health Nursing in 1938.

1. Zamboanga General Hospital School of Nursing (1921) 2. Chinese General Hospital School of Nursing (1921) 3. Baguio General Hospital School of Nursing (1923) 4. Manila Sanitarium Hospital and School of Nursing (1930) 5. St. Paul School of Nursing in Iloilo City (1946) 6. North General Hospital and School of Nursing (1946) 7. Siliman University School of Nursing (1947)

Nursing during World War II

With the occurrence of the largest and most violent armed conflict in the history of mankind, there was a re-emergence of nursing needs as well as new programs to entice women into training. In the US, the government empowered the women to contribute. In fact, more women worked outside of the home and as well as growth opportunities involving nurses multiplied.

While in the Philippines, World War II made public health nurses in Manila assigned to devastated areas to attend the sick and the wounded. A year after, thirty one nurses who were taken prisoners of war by the Japanese army and confined at the Bilibid Prison in Manila were released to the Director of the Bureau of Health. And just like in the US, a lot of public health nurses joined the guerillas or went to hide in the mountains during this time.

In 1946, post war records of Bureau of Health showed that there were 308 public health nurses and 38 supervisors compared to the pre-war 556 public health nurses and 38 supervisors. It was in the same year when the creation of the Nursing Office in the Department of Health was recommended by Mrs. Genera De Guzman, technical assistant in nursing of the DOH and the President of the Filipino Nurses Association.

The Degree of Bachelor of Science in Nursing: 1941 – 1951

A nursing curriculum which was based on the thesis presented by Julita V. Sotejo, graduate of the Philippine General Hospital School of Nursing, tackles on the development of a nursing education within a University-based College of Nursing. This dissertation was the beginning of nursing curriculum that have made the Nursing Institution of the country as a baccalaureate course. During this period, College of Nursing was also created.

When the Japanese occupied the Philippines in 1942, training and practice at the hospital schools of nursing in Manila was “violently disrupted.”  However, U.S. colonial patterns in Philippine nursing education soon returned after the U.S. reclaimed the country in 1945 and even after the Philippines gained independence from the U.S. July 4, 1946.

The First Colleges of Nursing in the Philippines

University of Santo Tomas-College of Nursing (1946)

In its first year of existence, its enrollees were consisted of students from different school of nursing whose studied were interrupted by the war. In 1947, the Bureau of Private Schools permitted UST to grant the title Graduate Nurse to the 21 students who were of advanced standing from 1948 up to the present. The college has offered excellent education leading to a baccalaureate degree. Sor Taciana Trinanes was its first directress. Presently,  Associate Professor Glenda A. Vargas, RN, MAN serves as its Dean.

Manila Central University-College of Nursing (1947)

The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and served as the clinical field for practice. Miss Consuelo Gimeno was its first principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its Dean.

University of the Philippines Manila-College of Nursing (1948)

The idea of opening the college began in a conference between Miss Julita Sotejo and UP President. In April 1948, the University Council approved the curriculum, and the Board of Regents recognized the profession as having an equal standing as Medicine, Engineering etc. Miss Julita Sotejo was its first dean. Presently, Professor Josefina A. Tuason, RN, MAN, DrPh is once more reappointed as the Dean of UP Manila College of Nursing

The Philippine Nursing Law was approved under the Republic Act No. 877 on June 19 1953. Then further amendment was created in 1966 which limits that practice of among nurses 21 years old and above. The increasing number of nurses in the Philippines have also brought about the celebration of Nurses’ Week which was proclaimed by President Carlos P. Garcia under the Proclamation No. 539. The continuous of nurses had also resulted to the first round of migration, particularly in United States. In fact, between 1966 and 1985 about 25,000 Filipino nurses have migrated to United States.

Regulation of the practice of health care providers, the Presidential Decree No. 223, was mandated which brought about the establishment of the agency, Professional Regulation Commission. During this period, the Philippine Nursing Act of 1991 was also amended under Republic Act No. 7164 which expanded nursing practice to other roles such as management, teaching, decision making, and leadership. The qualification of nurses or faculty’s in the academe was also updated to Master’s Degree in Nursing or equivalent. Another important event in Philippine Nursing history is the creation of Nursing Certification Council in 1999 under the Board of Nursing through Resolution No. 14 which supervise the new programs’ implementation conducted by Specialty Certification Boards. This improvement also prompted the start of Advanced Practice Nursing (APN) in the Philippines.

During this period, the Philippine Nursing Act of 2002 was enacted under the Republic Act No. 9173 which entails changes on existing policies under Republic Act No. 7164. These changes underscore on the requirements for faculty and Dean of the Colleges of Nursing, as well as the conduct for Nursing Licensure Exam.

College of Nursing

• UST College of Nursing – 1st College of Nursing in the Phils: 1877
• MCU College of Nursing – June 1947 (1st College who offered BSN – 4 year program)
• UP College of Nursing – June 1948
• FEU Institute of Nursing – June 1955
• UE College of Nursing – Oct 1958
• 3 female graduated as “qualified medical- surgical nurses”
• The 1 st  Nurses Law (Act#2808) was enacted regulating the practice of the nursing profession in the Philippines Islands. It also provided the holding of exam for the practice of nursing on the 2 nd  Monday of June and December of each year.
• 1 st  board examination for nurses was conducted by the Board of Examiners, 93 candidates took the exam, 68 passed with the highest rating of 93.5%-Anna Dahlgren
• Theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery. Practical exam at the PGH Library.

• Filipino Nurses Association was established (now PNA) as the National Organization Of Filipino Nurses
• PNA: 1 st  President – Rosario Delgado
• Founder – Anastacia Giron-Tupas
• Republic Act 877, known as the “Nursing Practice Law” was approved.

Though it was not always considered as a profession, Nursing has already been existing for centuries. Its significance of today will definitely not be proven real if not because of its remarkable history. And now, the value of Nursing has stood the test of time and is becoming more visible in the eyes of many not only because of its past, but also due to its considerable contribution in the society.

6 thoughts on “History of Nursing in the Philippines”

Hi Gil, the history is very informative. I finished my degree in 1980. We were the first graduate of a 4 year BSN program at CPU [ Iloilo Mission Hospital] Currently taking my masters at University of Toronto. I am the only Nurse in this group. The program is called Education Scholars Program. There are 17 of us in a variety of profession. Doctors, Pharmacist,Organisational developers. Our focus is education and educators of the present and future clinicians. I will be completing my research project on the clinical preparedness between RPN and RN program. I am hoping to help CPU Central Philippine University set up the Intra- professional program through faculty development.

Hello Meriam Amy!

Thank you for sharing your story. You are an inspiration to all nurses and aspiring nurses!

Your support for Nurseslabs certainly contributed to our success, and we want to thank you for that.

Good luck on your masters!

Hi Gil, Congratulations on your article. Very informative. I graduated from FEU-IN, Class 1985. I’m just wondering if you can touch on the history of the Association of Deans of Philippine Colleges of Nursing Inc. (ADPCN) It’s website says they are celebrating its 60th anniversary this year in October so that would put their founding year in 1959. But its website’s past presidents started only in 1982- Dr Lydia Palaypay, incidentally our Dean in my time. So who were the previous officers of ADPCN before 1982? Anyway, I was just wondering. Perhaps in your free time, you can include this in your research. Thank you and more power. Ms. Amor Collera

Hello… My I inquire. We are currently on our Nursing Research in our 3rd year. May we ask for any information with regards to the history of Nursing Research during the 1990s? thank you.

hi, i am studying nursing in Turkey. I have an assignment about nursing in the philippines. Can you help me with nursing planning in the Philippines?

Hi, I’m aspiring to be a nurse. This is very informative thank you soo much!

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