In the Philippines, several issues are being associated with nurses. Nurses are being tagged by their patients and society as rude and stubborn. This is not only rampant in tertiary hospitals and/or Medical Centers and small institutions in Metro Manila, but as well as in the provinces and municipalities in the country. It is a commonplace in the profession, and it has become a widely accepted notion to the public. The incivility of nurses is a disease in the nursing profession that the nursing authorities should carefully uncover.
Several aspects must be considered and appraisal should be done in order to determine what provokes these nurses to act that way. There may be several factors that greatly affect the attitude of nurses towards their patients, colleagues and the profession itself.
SENIORITY and “KAPIT” SYSTEM
Nurses in the Philippines know exactly what is meant by “Seniority” in Nursing. It is a known culture that anyone who has worked in the institution for a long period of time would have a huge chance for promotions and would have the opportunity to be given a desirable and higher position or rank and other services being offered. Years of service is not a question for qualification, but the expertise is. Let us admit that not all nurses have acquired the necessary expertise they are required of despite of being exposed to the clinical setting for many years. Nurses work in an environment that is constantly changing, and it is our responsibility to improve our knowledge and skills through educating ourselves further about the recent advancements in all aspects of the nursing profession. The idea is that, as we embrace the culture of seniority in this profession, many undervalued nurses are not given a chance for a rightful position they deserve. There are many adroit Filipino nurses who are neglected and unrecognized, that is why they end up working outside the country or changing careers as they feel that they are not needed in the profession.
If there is one thing that kills the dignity of the nursing profession, it would be the “Kapit” system that is rampant these days. Just so you know, being a nurse isn’t an easy task, but being hired as one is more difficult, frustrating and heart-breaking. Do you know why? Your excellent qualifications are no match to those nurses who have ironclad influences in the institution you are applying for. It is also an advantage if you have a relative who is already an employee inside the hospital because you do not have to worry about being hired and/or undergoing the process of applying for the position you want because it’s good as hired. We have nothing against the “dynasty” of nurses in the hospital, but if this completely affects others’ job opportunity, then it is definitely something that should not be taken for granted. We do not lack employment for nurses. As a matter of fact, there are many Plantilla positions offered to hundreds of aspiring nurses, but only few are being hired because the positions are already reserved for others. Let us not forget the virtue of veracity and equality. It is a moral, personal and professional obligation of the institution to give an equal and fair opportunity to all applicants who wish to be part of their institution. They should not take sides.
The impact of seniority and “kapit” system in the profession is that, everything is determined by it. It’s as if nurses are using their seniority and influences to take advantage of the situation. They have a better chance to choose and change their schedules so that it would be more convenient to them. The odds of getting horrible vacation options are lesser too. They also have an edge among those budding nurses who also aspire to be assigned to a good-performing area or be retained as a nurse at a certain area they need to have an experience in. I just do not understand why it is so hard to bloom and prosper in this field no matter how hard you work for it. This is one of the reasons why highly skilled and competent nurses and nursing graduates work abroad. They do not have placements…no, there are no more opportunities in the first place.
LOW SALARY and VOLUNTEERISM
Salary is also a major factor to consider. Nurses in the Philippines are not well compensated and they do not start a regular position as Nurse I. There are several stages a nurse must undergo to be fully accepted and be given a position. Based from personal experience, a job order* nurse has a starting salary range of 2,000 php to no more than 4,000 php/month.
*Job order in the Philippines can be described through Section 2 of the Civil Service Commission Policy Guidelines for Contract of Services, RESOLUTION NO. 020790.
Section 1. Definitions. The terms hereunder shall be construed, as follows:
Individual Contract of Services/ Job Order – refers to employment described as follows:
The contract covers lump sum work or services such as janitorial, security, or consultancy where no employer-employee relationship exists between the individual and the government;
The job order covers piece work or intermittent job of short duration not exceeding six months and pay is on a daily basis;
The contract of services and job order are not covered by Civil Service law, rules and regulations, but covered by Commission on Audit (COA) rules;
The employees involved in the contract or job order do not enjoy the benefits enjoyed by government employees, such as PERA, ACA and RATA.
Services rendered thereunder are not considered as government service.
Institutional Contract of Services – refers to a contract of services entered into between the hiring government agency and a private firm or non-governmental agency, through public bidding or negotiated contracts and subject to pertinent COA rules and regulations.
In an institutional contract of services, the contracted agency is engaged to provide personnel who shall perform lump sum work or service related to or incidental to the hiring agency’s functions and operations, for a specific period of time not exceeding six (6) months. Provided, that such contract of services shall be entered into when it is impractical or more expensive for the hiring government agency to directly undertake such service.
The personnel rendering the service remain the employees of the contracted agency and are precluded from entering into an employer-employee relationship with the hiring government agency.
Piteous nurses who are being hired by institutions from the different sectors of the government are also becoming a big concern. They are being exploited with no chances of getting anything good in return. Sometimes, they end up accepting contracts without payment because they need to acquire a good clinical experience, as one of the requirements in applying for a job opportunity abroad. Institutions happily accept these nurses in order to fill the gap of vacancies they need in many areas at no cost. And most of the time, these nurses receive more extensive tasks and heavier workloads than those paid nurses. They are the ones who are at a higher risk of getting sick, acquiring illness from patients and hospital environment and experiencing physical exhaustion, and emotional and psychological trauma from their working environment. Not only that they are easier to be managed, they can be easily held responsible/liable if something went wrong.
For nurses hired by the institution but are only job orders in the contract, the starting salary would be more or less 6,000 php depending on the rules of the institution. Some regular nurses may have higher salary than job order nurses but it is still low as compared to the salary of other professionals. Other unfortunate nurses need to pay the hospital in order to render their services voluntarily to the hospital as part of the process of their application and for them to acquire hospital experience. These are not true to all hospitals because different rules may be existing.
Bullying and discrimination are important issues our society is facing in this day and age. The problem is not only limited to children and teenagers in schools and social groups, but it can also be experienced by vulnerable adults of various professions in their workplaces – one of which, is the nursing profession.
It is one of the most understated issues in today’s modern nursing culture. As a matter of fact, bullying is one of the major reasons why many dedicated nurses choose to leave the country and their families or have a change of careers to look for a more worthy and satisfactory work experience.
According to the Center for American Nurses,
“Workplace bullying, a serious issue affecting the nursing profession, is defined as any type of repetitive abuse in which the victim of the bullying behavior suffers verbal abuse, threats, humiliating or intimidating behaviors, or behaviors by the perpetrator that interf e re with his or her job perf o rmance and are meant to place at risk the health and safety ofthe victim. Often workplace bullying involves abuse or misuse of power and authority within an organization.”
Source: Center for American Nurses, 2007; Felblinger, 2008; Longo & Sherman, 2007; Murr a y, 2008a
There are many nurses who experience maltreatment from other nurses.
The following examples will help nurses determine if they are being bullied:
- Despite a nurse’s attempt to learn a new pro c e d u re or complete a task, the supervisor is never pleased.
- A nurse is called to unplanned meetings with the supervisor (and perhaps others who are witness or participants) where only further degradation occurs .
- The workplace bully continually undermines and torments a nurse who is trying simply to do his or her job.
- Despite having expertise and a history of excellence in the are a of practice, a nurse is accused of being incompetent.
- No matter how many times a nurse asks for help, and the senior leader tells the nurse action will be taken, the bully continues to interfere with the nurse’s job performance.
- The bully screams or yells at the nurse in front of others to make him or her look bad.
- Colleagues are told to stop interacting with a nurse at work and in social settings.
- A nurse constantly feels stressed and fearful waiting for additional negative events.
- When a nurse asks an organizational leader for help, he or she is told to “get a tougher skin” or “work out your diff e re n c e s . ”
- Co-workers and senior leaders s h a re the nurse’s concern that the bully is a problem but they take no action to address the concern in the workplace.
Source: (Felblinger, 2008; Longo & Sherman, 2007; Murray, 2 0 0 8 a ; )
In the Philippines, modern-day workplace bullying includes making false statements/stories against a co-worker, giving the nurse heavy workloads or assigning them to toxic patients, re-assigning them to other areas, making the victim feel that they have bad manners and letting anyone else know about it, not helping the nurse in times of great distress, offering less to no opportunity for any hiring and/or promotion and many more.
These circumstances do not only give nurses physical and emotional stress,they also suffer psychologically. It is morally wrong to treat other people (esp. a co-worker) that way. It could lead to undesirable patient outcomes and lack of job satisfaction. Most importantly, it casts down one’s dignity and sense of self-worth.