Philippines offers nurse transfusion

By JIM LANDERS / MANILA, Philippines – At 47, electrical engineer Victorio Mangalindan is back in school, studying for a new career as a nurse. His classmates include three lawyers and 10 accountants.

Mr. Mangalindan says the foul air and water of Manila will only get worse as his 2-year-old son grows up. He wants to raise the boy in the U.S., and “the surest way to get a working permit or a visa is nursing.”

Many Texas hospitals would be glad to have him. There are 28,000 job openings for nurses in the state. Texas colleges and universities are graduating just 6,000 nurses a year. By 2010, the federal government estimates, Texas will have a shortfall of almost 42,000 nurses. The nationwide shortage is expected to be 10 times as large.

What may be good for Mr. Mangalindan and Texas hospitals is also a window into the broken labor markets of the United States and the Philippines.

Worldwide demand for Filipino nurses is so high that it’s starting to deplete that country’s hospitals, banks and courtrooms as professionals such Mr. Mangalindan go back to school to become nurses and emigrate. The number of nursing schools has doubled in five years to 420.

And as migrant nurses join U.S. hospitals, tens of thousands of American women and men can’t get into nursing schools because there aren’t enough teachers and classrooms.

Dr. Elizabeth Poster, dean of the school of nursing at the University of Texas at Arlington, blames the faculty shortage on an inability to compete with hospital salaries.

“There are lots of people who would want to teach but cannot afford it,” she said. “They’re earning $60,000 to $80,000 a year as nurses. With what we’re currently paying, we can’t get them.”

And the nursing shortage feeds on itself. Half a million registered nurses have left the U.S. workforce. Nursing advocates say many are reacting to increased workloads stemming from hospital budget cuts.

For decades, the Philippines has educated far more nurses than its labor market can absorb. Many recent graduates work in hospitals as unpaid volunteers; a few even pay the hospitals for a chance to get work experience.

After a year or two on the job, however, nurses tend to join the exodus. A quarter-million Philippine nurses – 85 percent of nursing school graduates – work overseas. The best often come to the U.S., where between 50,000 and 75,000 Filipinos or Filipino-Americans work as nurses.

“The Philippines is the leading exporter of nurses in the world,” said Kathleen Fritsch, regional adviser in nursing for the World Health Organization’s Manila office. “Of course, the country’s health care delivery system is endangered because they are losing the cream of the crop.”

The nursing school at the University of Santo Tomas in Manila accepts 520 students a year from nearly 14,000 applicants. Dean Glenda Vargas says 95 percent of her graduates find work abroad.

“Sometimes we refer to our college as the departure area,” she said.

St. Luke’s Medical Center, a 650-bed hospital in Manila, loses about 45 nurses a month to overseas recruiters, said Veronica Honculada, a quality assurance manager at the hospital. That adds up to an annual turnover rate of nearly 90 percent.

“We have epidemic migration,” she said. “So we keep training new graduates, and they keep leaving. … We have nurses with six months’ experience who wind up as supervisors because they have the seniority.”

Mrs. Honculada knows both sides of the situation. She worked as a nurse in New York for 14 years, sending home money that put her four children through private schools. Two of them graduated from medical school.

“They’re all grown now,” she said. “That’s why I was able to come back and take care of myself.”

Since the 1960s

The Philippines has sent nurses to U.S. hospitals since the 1960s to help fill periodic shortages. Its nursing curriculum follows a U.S. model set up during 50 years of colonial rule, and all classes are taught in English.

Alice Dometiza-Hoffman came to Dallas in January 1975 with 11 other nurses to work at the old Granville C. Morton Cancer and Research Hospital off Harry Hines Boulevard. The women, all in their early 20s, lived in three side-by-side apartments near Bachman Lake.

“I was thinking, ‘Now you can see other places, better yourself and help your parents in the land of opportunity,’ ” Mrs. Dometiza-Hoffman said. “It was lonely here, and cold. But I stayed.”

Today she’s a nurse manager at the day surgery section of Baylor Medical Center at Irving and a leader in the Philippine-American community.

She’s been back to the Philippines twice in the last five years to help Baylor recruit nurses and estimates there are now about 500 Filipino nurses working in the Dallas-Fort Worth area. She’d like to see U.S. immigration laws eased to make it easier for foreign nurses to come to the U.S.”

Victorio Mangalindan is back in school, because he wants to raise his son in the U.S. The 47-year-old electrical engineer has returned to school to take nursing classes with the hope of migrating with Victor and his wife, Maria.

As populations age and women get more career opportunities, nursing shortages have spread to most other developed countries. The oil-rich countries of the Middle East rely almost exclusively on migrant health care professionals. Both phenomena create demand for Filipino nurses.

Money is the most powerful magnet drawing Filipinos abroad. A nurse in the Philippines might earn $200 to $400 a month. For physicians, pay averages $700 to $1,000 a month. U.S. nursing salaries of $4,000 a month and higher are drawing all sorts of Filipino professionals to nursing school.

Former Health Minister Jaime Galvez Tan says 10,000 physicians have gone into nursing schools or are working abroad as nurses.

“Salaries here could double or triple, and we still would not be able to compete,” said Dean Vargas of the University of Santo Tomas. “We hope the countries who are benefiting from our professionals would also assist us in some way. We cannot drain forever.”

The Philippine government is still looking for more overseas opportunities for its professionals. Negotiations over a recent free-trade agreement with Japan were concluded after Japan agreed to accept as many as 500 Filipino “caregivers” each year in return for lower tariffs on Japanese autos entering the Philippines.

More than 8 million Filipinos – 10 percent of the population and a quarter of the labor force – work overseas, sending home more than $12 billion a year. It’s one of the mainstays of the economy.

“The nurse in the family comes to the USA and becomes the family’s economic engine,” said Rosario May Mayor, president of the Philippine Nurses Association of America. “Many of the nurses here in the United States have sent their siblings through college.”

Market distortions

The distortions between the U.S. and Philippine health care labor markets bother many in both countries. Dr. Galvez Tan argues that the Philippines should seek compensation from developed countries like the U.S. for the loss of professionals educated in the Philippines.

Judy Wright Lott, dean of the Baylor University School of Nursing, says Texas business leaders should support expanding nursing schools.

“I would like to see the business community realize the dimensions of the nursing shortage we’re facing,” she said.

Cincinnati nursing recruiter Bill DeVille runs a company called Global Scholarship Alliance that brings Filipino nurses to the U.S. for graduate studies and 18 months of work at a U.S. hospital.

Once their U.S. contracts are complete, the nurses are obliged to return to teaching positions or hospital management posts in the Philippines.

The challenge, Mr. DeVille admits, is getting them to stay there.

Arlington-based Texas Health Resources, the largest hospital chain in North Texas, pioneered another approach. After years of filling shortages with migrant nurses, the company is training its own technicians, receptionists and secretaries to become nurses.

So far, the chain has graduated 57 nurses, and 150 are attending classes, said Michael Evans, executive vice president for learning.

“There’s an ethical problem with recruiting nurses from foreign countries that have their own shortages,” Dr. Evans said. “We’ve traveled the world looking for nurses and ignored the mother lode – our own employees.”

Nursing professionals here suggest another approach: Send U.S. students to the Philippines to study nursing and then return them home to work.

“We have so many nursing schools, some of the U.S. hospitals want to put students here in the Philippines,” said Annabelle Borromeo, interim dean of nursing at Manila’s Far Eastern University.

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