Nursing Controversy Letter

FOLLOWING my Manila Moods column two weeks ago about the leakage of the nursing board exam answers in the Philippines, I got a flood of angry emails from readers attacking me for saying that all the June 2006 exam takers should be asked to retake sections III and V of the exam, since it was answers to those questions which were leaked through several review centers.A few days after that column appeared I received the following letter from Erlinda Castro-Palaganas, past governor of the Philippine Nursing Association for Region 1, in which she basically agreed with all of the points I had raised.The letter is so good that I have decided to include it here in it's entirety:

Dear Rasheed,

Thank you for your holistic and analytical lens at looking at issues related to the nursing leakage. It is heartening and very comforting to note that there are still media advocates who believe in our cause. Comrades from all over the country call us, The Baguio Braves because we dared come out against the giants when we said, “there is a leakage” in the last June 11-12 nursing licensure examinations.

In one of our public statements, we, The Baguio Braves Alliance, whose members include those who exposed the leakage in the June 2006 local nursing board examination and nursing leaders, denounces in the strongest possible terms the reckless manner with which the Professional Regulation Commission handled the fraud that attended the said professional test. Particularly, we take notice of the following:

1. PRC exerted every possible effort to cover up the fraud. Even if it had overwhelming evidence thereof in its hand, it still audaciously claimed in a public statement that there was no leakage.2. When it could not cover up the leakage, it insisted on conducting the investigation amidst resounding calls for an independent investigating body. What were the fruits of the PRC investigation? Nothing. It only acknowledged that there was leakage but it could not determine the culprits. Was this an admission of PRC incompetence? Or was its decision to turn over the investigation to the NBI occasioned by the fact that it stumbled upon evidences that could implicate “friends and associates” and did not want to be the one to nail them? Pontius Pilate still lives!3. It prematurely released the result of the board exam, never mind if several questions remained unresolved. In correcting the papers, it applied a statistical treatment that made a mockery of the standards of the nursing profession. Imagine arbitrarily assigning scores to a core nursing subject!4. When invited to the Senate for inquiry, PRC Chair Leonor Tripon-Rosero agreed to attend. But there was a condition: she and the other Commisioners should be given the list of the questions to be asked. (This was witnessed by Dr. Erlinda Castro-Palaganas and Atty. Cheryl Daytec-Yañgot.) Even elementary school pupils are not entitled to that privilege!5. PRC swiftly conducted an oath-taking of the board passers to overtake the action of the judicial branch on the issue of validity of the results of the board examination. The kangaroo court that convicted Jose Rizal was not as fast!6. After the Court of Appeals issued a Temporary Restraining Order (TRO) preventing PRC from administering oaths to the June board passers, it launched a signature campaign among the passers for the junking of the retake position. It is sickening that the very agency mandated to ensure the standards of the different Philippine professions is the one spearheading the submission of the determination of nurses’ competence to a game of numbers. Is the competence of the nurses an election matter that will be decided by numbers and not by standards?

Every move of the PRC gives rise to more problems. The current crop of Commissioners is obviously incompetent and without iota of respect for the law. And yet, why do they behave with seeming impunity? Why do they stick to their positions like leeches? If they have any decency left in them, they should resign! The Philippine nursing profession’s image has been dented by the leakage issue and PRC’s actions have further battered it.

The leakage is an eye-opener. It exposed the bitter truth that our government is groping in the dark in its handling of fraud. It tells us that cheating is endemic in our system. And it also shows the damage wrought by a commercialized and substandard nursing education. The Commission on Higher Education has in recent years further liberalized and deregulated the operation of nursing schools. This resulted in substandard nursing education whose products are not adequately prepared to deliver quality health services, let alone pass a board examination. Because of the competition among them, review schools resort to all means to up their passing rates and the unscrupulous ones even buy and give leakage in their effort to gain comparative advantage over the others. At the end of the day, profit is the name of the game. Worse, when students pass the board exam, the same is attributed to the review school and not to one’s alma mater!

Philippine society is now confronted with the issue of whether or not the June 2006 examinees should retake or not. The honest examinees who passed never deserved the aggravation of facing the prospect of losing their licenses. Had the PRC first explained its criterion standards in checking the examination and accommodated and resolved all objections thereto before it released the result, the competence of the current board passers would not be covered by a cloud of doubt. With the questionable statistical treatment adopted by the PRC, even the exam result is now being questioned. Board passers cannot find jobs because the hospitals and other prospective employers doubt their competence. If reports are to be believed, patients are even asking the attending nurses if the latter belong to the June 2006 batch. We cannot blame the patients because one’s life cannot be subjected to chance. But the stigma is also something that the batch does not deserve.

The Baguio Braves Alliance commiserates with the board passers. If we ask them to retake, they will suffer an injustice. They will go through the same stress associated with taking an examination, not to mention the costs they will necessarily incur. If they will not retake, they will likewise suffer the injustice of their capabilities being doubted by the public. This early, employers have sounded off loud and clear that they will not hire nurses who became so by virtue of passing the June board exam. What good then would the nurse’ license be if it is a stumbling block to the his/her employability?

In other words, the passers of the June exams are caught between the devil and the deep blue sea. Painful as it may be, retaking the spoiled portions- Tests III and V- of the examination is the less unjust course to adopt. This gives the examinees the opportunity to shake off the stigma caused by the leakage, assures them that employers will not turn them away because of the conviction that they are incompetent, and regains the integrity of the nursing profession. The retake must happen soon because the examinees’ fate cannot remain in a state of suspended animation.

Let not the debate on whether or not the June passers should retake detract us from a more compelling concern – the liability of those responsible for the mess we are in. We call on all decent Filipinos to help us urge the government to go after the perpetrators. We urge fellow nurses and professionals who care for the nursing profession like the UST group led by Prof. Rene Tadle and Dante Ang, to realize that the leakage in the Nursing Boards is just a symptom that involves several players namely: Review Centers that are proliferating and unregulated; resorting to all kinds of marketing; charging exorbitant review fees; Nursing schools that are mushrooming with thousands of enrollees and churning out thousands of graduates; and Board of Nursing certain members of whom are ‘fraternizing’ with owners of review centers. We urged comrades in this struggle to look at the bigger picture such as the increasing commercialization of nursing education. With the latest count of nursing schools in the Philippines of 475, the profit orientation in running the schools manifested in high tuition fees, point to the survival of business interests as the primary motive. The regulation of schools are not enforced because of gargantuan factors such pressures from politicians, Malacanang and prominent owners of schools/Businessmen. This leads to more pressing issues such as “flying deans”, unqualified faculty to teach; increase faculty to student ratio; lack of base hospitals/clinical facilities for student training; and mediocre graduates. It must be noted that proliferation of nursing schools does not lead to increasing number of qualified nurses who pass the Boards.

We must acknowledge that the reasons behind the commercialization of the Nursing Education are rooted to the Foreign demand for Filipino nurses that leads to migration/nurse exodus to countries that promise high salary & incentives. The pull factors for this scenario include the high salary (at least USD 3,000/month) and the Global nursing crisis (fewer women train or remain in nursing workforce in developed countries, favoring improved job opportunities in other sectors). The push factors include economic crises; unstable political condition; and the general climate of hopelessness. This is not to discount the fact that there is the export policy of the government, nurses bringing in the much needed dollars to prop up the shrinking economy; overseas contract labor/employment. On top of this is the obligation of the Phil government to observe GATS-WTO (General Agreement on Trade & Services of the World Trade Organization) obligations and commitments. Health services and health professionals are identified as commercial good & services that can be traded across & among countries in need of additional health care services, just like the sectors in banking and finance, education, communication, and tourism. Thus, nursing education and movement/distribution of nurses are dictated by local & foreign economic forces and government policy.

We urge examinees blinded by the selfish motivation of “no retake” stand and other colleagues in the nursing profession to understand the implications/effects of this nursing situation and realize that these root causes lead to the following: deterioration of the quality of nursing education and its decreasing relevance; health care crisis (threat to safe nursing practice due to incompetent graduates; loss of trained & experienced nurses as an effect of migration; high nurse-patient ratio; and closure of hospitals & other health care facilities due lack/no health care workers to run the facilities); continuing deterioration of the health status of the Filipinos; and the commodification of health vs. health as a basic human right.

It is for the above analysis of the nursing leakage issue/concern that we urge every concerned nurse and advocate to continue to question actions of PRC & BON in their attempts to “tone down” the leakage scam; conduct education fora among nursing faculty, students and alumni; organize groups of concerned nurses and nursing students; pursue legal battle against those who are in involved in the leakage scam; strategically, initiate reforms in nursing education to maintain educational standards; propose legislation to regulate review centers; and work for mechanisms for self regulation within the profession. Collectively, let us call on the government to pass stricter measures to prevent incidents like this in the future.

Change does not come in a silver platter. We have to work for it. It is a struggle that can be a painful process. Meaningful changes can not happen if we choose to remain in our comfort zones. If we do not maximize this opportunity, we loose the battle forever.

Thank you, Rasheed, for taking time to read this litany. Talking about the situation of my profession nowadays gives me a high. I just feel sad and frustrated when fellow nurses give color to our struggle. I see this to be protracted struggle, but we will pursue. Fighting for the truth is victory in itself. No harm passing on the light.

In service of the Filipino nurses and people,

For the Baguio Braves

Erlinda Castro-Palaganas, RN, Ph.D.Past PNA Governor, Region IAdviser, PNA Baguio City Chapter and PNA Regional Council – I and CARDirector, Institute of Management, University of the Philippines Baguio