US needs staff nurses, not only supervisors

The nurse shortage in America is expected to remain at 200,000 a year for the next five years. The Philippines, eyeing to fill the demand, is able to field only less than a tenth. And that’s because it may be sending the wrong type of nurses.

Gregory T. Howard of the US-Commission on Graduates of Foreign Nursing Schools (CGFNS) says American hospitals have long been hiring licensed practical nurses (LPNs) from abroad. Most of the latest hires are Indians and Chinese, but hardly any Filipinos whom doctors and patients prefer. It appears that the nurses produced by the Philippines are registered nurses (RNs) who are overqualified and thus not tapped for the vacancies.

LPNs are the nurses who "do the dirty work," as hospital staff would say. Having undergone 12 to 18 months’ training in patient care, they assist the RNs who supervise the nursing shifts and sections.

There are no LPNs in the Philippines. Their closest equivalents are nursing aides, trained by their respective hospitals based on internal needs. There is no common standard for such training too, says Dr. Leah Samaco-Paquiz, president of the Philippine Nurses Association. Caregivers looking for jobs in Canada are better off in having basic curriculums approved by the Technical Education and Skills Development Authority (TESDA).

The Philippines churns out every year about 80,000 graduates of the four-year BS Nursing course. Less than half, about 32,000, pass the Professional Regulation Commission licensure exam, and of that number less than a tenth are able to pass the US-Nursing Council (Of State Boards) Licensing Exam (NCLEX) on the first try. Only NCLEX passers may seek employment in America.

The Philippines exports about 19,000 nurses per year. Some go to Europe and the Middle East. About half, NCLEX-RN passers on the first or next tries, find jobs in American hospitals, doctors’ clinics or care homes. Depending on work experience, seniority and shift, they may receive $18-$22 per hour, plus housing privileges and immigration assistance. In states where the nurse shortage is more acute, like California, newly graduate RNs command $27-$29, while experienced ones get $28-$32.

Howard, himself a licensed practical nurse from Alabama, says that the US demand for LPNs is just as big as that for RNs. That’s why there’s a separate NCLEX-PN for them. But Filipino nurses, for whose work ethics Howard has the highest praises, take only the NCLEX-RN because that is what they’re qualified for.

Not for long, says engineer Arthur Lacuesta, who has set up the Philippine Paramedics and Technical School for LPNs, with campuses in Las Piñas, Cebu and Davao cities. The LPN course runs for 18 months, and there’s a separate 24-month diploma course for associate nurse (ASN), both authorized by the TESDA. The school also offers training for paramedics and hospital equipment technicians.

Lacuesta intends his graduates to fill in the demand that Howard talks about. He has shown him the LPN and ASN curriculums if suitable for American employment.

The LPN’s pay in America ranges from $12-$18 per hour, but those assigned to acute or convalescent patients can get up to $18-$22. Again in nurse-short California, the range for newly graduate LPNs is $17-$22.

If there has been a demand for LPNs since the 1960s, how come the Philippines, where a string of administrations have pinned jobs programs on overseas placements, has been sending only RNs? It’s like sending only engineers when technicians were the ones listed in help wanted.

Lacuesta blames the Nursing Act, which was recently amended to recognize only RNs. By limiting the scope of the nursing profession, he says, the law in turn forced educators to offer only the four-year bachelor course. Ironically, nursing schools have turned into profit-raking diploma mills, mass-producing by the thousands graduates who only flunk board tests. In the end, there is a growing number of BS nursing graduates who cannot find jobs in the Philippines, while there is a shortage of LPNs in America who don’t need college grads so long as they pass the NCLEX-PN.

Samaco-Paquiz sees another culprit: immigration restrictions. She says that all these years, the nurse association has been receiving reports of US immigration preference only for BS nursing graduates. Surprised to hear Howard’s announcement, she also worries about discrimination, against which her association fights.

Whatever the reason, the Philippines definitely has missed the boat on LPN employment. It must play catch-up.

Howard is in fact surprised to learn about the immigration issue. The CGFNS chairman for licensed practical nurse standards in 2002-2006, he sees no problem with Filipinos clearing immigration if there’s an acute lack of American LPNs. His branch of the CGFNS helps fill up LPN vacancies with foreign recruits in various states.

The CGFNS is a non-profit organization assigned by the federal government to set licensing standards and evaluate credentials of foreign nurses who wish to work in America. It administers three qualifying exams per year in 30 countries, including the Philippines. The tests are not for licensing, but only to determine if the takers would make it or not in either the NCLEX-RN or NCLEX-PN. A good part of the exams are in written and spoken English.

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For more on the issue, catch Linawin Natin on Monday at 11:45 p.m., on IBC-13. Chairman Gregory Howard, Dr. Leah Samaco-Paquiz and Engr. Arthur Lacuesta share their insights on possible nursing placements.

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