The health care industry has bemoaned the nursing shortage for more than a decade, and that more will be needed for additional patients as the Baby Boom generation ages. The U.S. Bureau of Labor Statistics projected in 2005 that more than 3.1 million registered nurse jobs would be available by 2014, which would add an additional 700,000 new jobs for nurses (Moore, 2007).
The United States has ramped up its importation of foreign-trained nurses mainly sourced from Africa (mainly Nigeria and South Africa), India, Canada and the Philippines (Vujicic, 2004). U.S. hospitals and health care agencies choose the Philippines because the country is a former American colony with school curriculum based on the American education system, classes are taught in English and nurses earn a four-year bachelor's degree, sometimes more than what American nurses obtain.
Thus, the learning curve for Philippine-trained nurses in the United States is minimal (Jenkins, 2003). The Filipino nurses’ work ethics is the primary reason why they comprise 83 percent of foreign nurses in America and are the most preferred by hospitals, doctors’ clinics and care homes according to U.S. National Council of State Boards of Nursing (NCSBN) (Bondoc, 2007). The Philippine Nurses Association of America (PNAA) reported that there are around 90,000 Filipino nurses in the United States. Every year 12,000 to 14,000 Filipino nurses migrate to the U.S. (OPS, 2007).
Nurses’ licensing examinations is offered abroad to bring more foreign-born nurses to the U.S. and help alleviate the acute nursing shortage that is crippling American health care. Most of the foreigners taking the mandatory U.S. licensing nursing exam came from the Philippines, India, Canada, Nigeria, Korea, United Kingdom and Commonwealth of States (formerly USSR) according to National Council of State Boards of Nursing. Of those, more than half were from the Philippines, which educate thousand more nurses than what the country needs (Friess, 2002).
The U.S. is a net importer of medical and nursing professionals from the Philippines. The issue on the June 2006 nursing board exam leak in the Philippines has snowballed, settling on a query to Filipino nurses’ credibility and ability in the provision of health care and safety to American Community, not only to solve nursing shortage crisis in America.
This paper discusses the important issue of irregularities in nursing board exams. After introducing the topic, a discussion on the essence of nursing ethics is made. The next section briefly presents the recent Philippine Nursing Board exam to the U.S. nursing practice, followed by a critical analysis on this issue. The summary, conclusions and recommendations are presented in the last section.
In Respect to the Nursing Insignia
The nursing insignia, although it disappears, the meaning still embarks the true identity of the nurse in the nursing practice as a health care provider with caring attitude possess knowledge symbolizes by the nursing cap, the crowning glory of intelligence and the uniform is a picture perfect of purity and cleanliness living with ethics and morale which are molded inside the nursing school.
Although the profession of nursing is as ancient as medicine, and may have the greatest right to the Cup of Hygieia as its symbol, most of the nursing tradition use a lamp or candle, which is not only in memory of Florence Nightingale, but which represents the light of knowledge, the central emblem of quality health care.
The level of knowledge of nursing graduates is measured by nursing board exams—a licensure examination to eligibly practice the nursing profession. The exam regulates the legal nursing practice as a profession by assessing the basic nursing level competency which considers the objectives of the nursing curriculum, the broad areas of nursing and other related disciplines and competencies.
The integrity of foreign licensing systems ultimately affects the health and safety of patients in the United States, a primary consideration of CGFNS in its role in evaluating candidates under U.S. immigration law (The Manila Times, 2007).
Impact of Philippine Nursing Board Exam Leakage to U.S. Nursing Practice
The Philippines is the leading source of nurses to the United States, with several thousand Filipino nurses migrating there each year. However, the U.S. National Council of State Boards of Nursing (NCSBN) and the National Council Licensure Examination (NCLEX) delayed their approval for the Philippines’ accreditation as a testing center of the U.S. National Commission on Licensure Examination (NCLEX) for nurses.
The shelved application is caused by the direct repercussion of the nursing board exam leak scandal. It capped two hours of grilling earlier on Philippine assurances of exam security and housecleaning after fraud marred its own nursing board tests last June 2006 (Bondoc, 2007).
The United States Commission on Graduates of Foreign Nursing Schools (CGFNS) obliged all Filipino nurses with 2006 licenses, who wished to work in the US, to retake the two sets of tests that investigators said were leaked to several nursing review centers in Manila, the Philippine capital (Cabreza, 2007). The retake of the tests is to allow nurses who passed the leak-tainted 2006 nursing board and are wishing to work in the United States to secure UV Visa-Screen certificates as required by the CGFNS (Rodis, 2007).
The Philippines’ status as one of the world’s top producers of nurses could be threatened as it significantly tainted the credibility of Filipino nurses abroad due to the recent examinations irregularities. The scandal allegedly involved leakage materials of the June 2006 Philippine nursing board examinations of at least 200 questions. Some members of the nursing board were accused of receiving bribes from the owners of nursing review centers in exchange for leaking some test questions (Asian Pacific Post, 2007).
Sometime after the board exam was held, the whistleblowers who exposed the said irregularity wrote to the PRC in June 2006 to report that handwritten copies of two sets of examination were circulated among examinees who took their review at a particular review center during the actual examination period (Cabreza, 2007). The initial charges were made by students who said that the president of the Philippine Nurses Association, who apparently is the owner and director of a nursing review center and a nursing school, had given the exam questions to students who had taken his coaching classes with the final coaching at SM Cinema in Manila (The Filipino Express Newspaper, 2007).
Many of the whistleblowers who exposed cheating have decided to take a new licensure test to remove the stigma of the scandal (Cabreza, 2007). Only 68.96% (9,198) have passed the nursing board retake out of 13,338 nurses who voluntarily retook, concluded that the quality of education is becoming a real issue, especially in light of the recent cheating/leak in the said board exams (Philippine Daily Inquirer, 2007; Rodis, 2007).
After the said disclosures were made, officials and industry experts cautioned that the country's status as one of the top sources in the world for nurses would inevitably be adversely affected (Conde, 2006). In fact, this scandal has already demonstrated far-reaching impact on Filipino nurses—aside from some untoward incidents regarding racial discrimination in primetime American shows—indicating that such scandal inevitably involved the entire Philippines.
For one, one episode of the hit ABC series “Desperate Housewives” involved Teri Hatcher insulting the Filipino community when she malignly depicted that Philippine medical schools are producing substandard, inferior and—worse—inept medical practitioners. Another is Jay Leno’s similar remark on his late night show “The Tonight Show”. Unfortunately, the above incidents gave rise to some political humors across America.
A Critical Analysis
The nursing board exam leak scandal in the Philippines brought legal, ethical and political issues confronting professional nursing today, including in the U.S., as the Philippines is its prime source of manpower to address the ever-escalating shortage of nurses. Better compensation packages—or simply a better life for the nurse and her/his family—have been achieved notwithstanding ethical and moral of standards of nurses everywhere.
The Philippines has had a long history of corruption and low standards of ethics especially in politics and business. The Philippine nursing schools’ “diploma mills” and review centers, for years, have been earning significantly, capitalizing on the nursing shorted in the developed world. In a country where cheating with impunity has become the norm rather than the exception and where remittances from "exported" skilled professionals literally keep the economy afloat, the leaks that marred the last nursing board exam and the desperate effort to preserve the examination's credibility in the aftermath were bound to happen.
The issue of the scandal is the issue of pathetic dreamers who damage the long-untainted credibility of the nursing institutions in the new era in spare for some cheap dollars. That there was a leak in the Board of Nursing exams is nothing more than a symptom of the nation's deep cancers.
However, the response of the academe, the Board of Nursing, the NCLEX, the CGFNS, the hospitals, the physicians and the other professionals abroad could form part of the cure. In fact, indications are that there is a collective effort of many quarters to do directly address the issue. For one, the resignation of the president and the vice president of the Philippine Nursing Association and the Board of Nursing would properly set the tone for reforms within the nursing practice as well as in the academe.
The report that some prestigious hospitals, clinics and recruitment agencies around the globe would not accept Nursing graduates from 2006 unless steps were taken to ensure that they indeed are worthy of the title of ‘Registered Nurse’, and the battle being waged by deans of prestigious nursing schools to stop the Philippines’ Professional Regulation Commission from administering the professional oath to "successful examinees" until the issue is resolved, all provides some sense of hope that there are still many among who refuse to allow precious nursing institution from prostituting itself.
This is not an accident that this resolve has come from those involved in caring for people's health. It reflects a sentiment now sweeping across the country and other concerned countries among health professionals. It has little to do with dollar remittances and the promise of a good life.
Hence, this battle to preserve the integrity and credibility of the nursing board exam is much more than that. It goes beyond making sure that the nurses who assist in the operating room or administer medicines to patients don't end up doing harm, although this is a big part of the issue. The battle is but a part of a bigger struggle to restore decency, integrity, and honor in country long-plagued by political instability and economic woes.
The nursing insignia is being deprived of its cleanliness and purity of morale and intelligence. The white uniform is being stained with the filth of dishonesty and devious acts of betrayal to the nursing profession as the profession of cleanliness and purity. The light of knowledge taught by nursing schools has been diminished with darkness and blindness in the search for greener pastures.
The real oppression is to the successful examinees who did not cheat, the hardships should not been paved with shame just because they are being called to participate in something beyond themselves. The only way cheating can be avoided in the future would be if those investigating the leak could pinpoint those who benefited from them and have only these persons retake the subjects. Needless to say, the perpetrators must be punished.
It was Gandhi who said that "our values become our destiny." What will happen to the destiny of those nurses with prejudiced values and what will happen if those nurses will hold the health of the American community? What will be the destiny of the American health care system if the healthcare provider’s credibility remains a big question?
The nursing exam scandal is an opportunity to rediscover and reclaim the values that have been forced to be denied and even discarded—just for the sake of surviving. This unfortunate scandal can, however, prove to be one of the greatest blessings for this nation, because it might finally drive home the point that there can be no true progress and success unless they have their hearts in the right place. Call it a counterculture of sorts, or simply a natural reaction to anything in excess.
But the fact is that all over the Philippines, doctors, nurses and other health professionals are starting to heed the call to be more than just healers. There is a growing realization that Filipino nurses must use their professions to help begin a revolution of the heart from the bottom up. It might be the only way to eventually force genuine change at the top.
Summary, Conclusions & Recommendations
The American Dream, the reverie of greener pasture in the land of milk and honey, has driven the perpetuators to commit the crime against nursing profession and the morality. The opportunities brought about by nursing shortage and nursing exodus has forced the nursing system failures.
The quality of nursing education is becoming the real issue as there are 460 nursing schools in the Philippines and 50 of which have already been ordered by the Professional Regulation Commission of the Philippines to be closed down as nothing more than diploma mills (Rodis, 2007). The exam fraud was but a part of the bigger problem of nursing.
And there is also the issue of poor education. Schools, cashing in on a surge of enrolments from news of a nurse shortage in America, were churning out around 80,000 graduates per year. But only 32,000 or so are able to pass the board test, and only 2,000 easily get jobs in top hospitals (Bondoc, 2007). The nursing shortage is not the number one problem in America, but if one takes a closer look, this may arise to a greater problem of hiring half-baked nurses.
The illicit release of exam questions in the Philippines is an indication of deeper problems plaguing the Philippine health care system. Desperate to pass the nursing exam and work abroad, many students easily fall victim to such scams. Diploma mill nursing schools and review centers have exploited this desperation and will do anything to compete for more students and more profits. In the end, the quality of nursing education, profession and the whole health care system suffers.
Nurses in the United States involved directly or indirectly in the recruitment of nurses from the Philippines should consider only candidates with a minimum two- to three-year work experience and completely desist from hiring fresh graduates. By doing so, the Filipino nursing community in the United States would help ensure the continued flow of only qualified and well-trained professionals into the American healthcare system.
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