By Nurse Anne
The recent promotional video of a Nursing College from a Western country featuring a Filipino nurse educator enumerating the differences of working in the Philippines and in that particular country had provoked considerable controversy amongst Filipino nurses.
I have seen their reactions and gathered their thoughts in different social media platforms and clearly many were infuriated by the content of the video. She mentioned the differences in professional communication, assessment skills, technological advancements, and specialisation. Initially, I thought about how she was turning down the practice of nursing in the Philippines but after a thorough reflection, some of it is true to some degree.. at least with my experience as a nurse in the Philippines.
I wouldn’t speak for anyone else because we all have different work experiences as nurses and it is extremely subjective. However, I know that we can somehow agree with some issues such as low salary, work culture, slim chance with career progression and heavy workload. And do you know the common denominator amongst us? We decided to look for opportunities abroad and Filipino nurses are literally everywhere! Scattered globally to ease staff shortage in other countries and at the same time make our lives better and more comfortable.
It was mentioned in the video that in the Philippines, we rarely communicate to patients and especially to the doctors. I have found this such a harsh assumption for Filipino nurses in general. Communication is an integral part of our practice. We gain verbal consent from patients before we carry out even the simplest procedure, we explain what we’re doing, we give health teachings and we ensure that we’re at the same page with the consultants and registrars we’re working with to provide the right treatment to our patients. It is the same principle wherever we are. That’s what we ought to do as nurses. However, it is a sad reality that some of us may have experienced a work culture in the Philippines where doctors are far superior from nurses. This can make it difficult and arduous to challenge them especially to new nurses.
I think that this is what she wants to convey but wasn’t delivered in a constructive way. I know that everyone speaks up and questions the doctor’s orders if necessary. But wouldn’t we all agree that we have been more assertive when we’ve started working abroad? Here in the UK, we’re encouraged to do so and we have policies and procedures supporting us to speak up, assert ourselves and escalate if needed. It’s actually part of our 6 C’s in nursing… Courage. I believe that working in the UK allowed me to be brave enough to break the barriers of communication which includes hierarchical differences for the safety of our patients. I learnt not only from training, simulations and resources but also from observing how my colleagues challenge bad practice, clarify interventions and value effective communication. I’m not saying I’m an expert, but I can attest that I have improved a lot over the years.
She also touched upon how the College will hone the student’s assessment skills as they will have a hands-on experience compared to the Philippines where registrars and interns usually do the assessment. I think Filipino nurses are regarded to be knowledgeable wherever they work and even when I was in the Philippines, I assess a patient and refer any deviations to the doctor. But then again, in the UK, I was able to improve my assessment skills because most of the time our department has just got nurses. The doctors in each speciality (medical, surgical, etc) will be looking after other wards as patients are referred. Hence, when assessing a patient I need to practise my clinical judgment whether I can provide independent nursing intervention or I need to refer for further treatment. We also have tools and scoring systems to logically ascertain the condition of the patient. I agree that in the Philippines, it is quite physician-centric, but I have also learned a lot practising as a nurse but I had a better hands-on experience and autonomy here in the UK.
Now when it comes to technological advancements, there is no doubt that first-world countries supersede the Philippines. We’ve got devices and equipment that make our work more convenient and safer for the patients. Most of the items are disposable for infection control, we have monitors to assess vital signs, pumps to regulate IV drop rate, hoists and mechanical devices for moving and handling. Those are just simple things that make our lives easier as nurses but there are whole loads of complex devices that possibly lack or are limited in the Philippines. However, as we’re restricted with technology in the Philippines, wouldn’t you agree that we have been resourceful and mindful of the equipment that we use as we charge everything to the patient especially for private hospitals? I believe that in conjunction with technology, our training with limited resources and reliance on our senses and judgment of a patient's condition have a massive impact on how we practise as nurses here in the UK. It’s all about integration, competence and adaptability.
Lastly, she spoke briefly about how nurses practise within a certain specialty and therefore regarded patient safety. This is true with my experience. Again, each institution differs, but where I used to work, part of our rotation as a nurse was to go to ITU on some days and it terrified the heck out of me when I did my first shift. Although, after a few shifts I felt more comfortable as I’m always with the senior nurse anyway. I gained extra skills and experience as a nurse. Here in the UK, each nurse has a role to play whether it be in the wards, A and E, Operating Theatres, paediatrics, neuro or cardiac. You can choose your specialisation and build up your skills in that particular area. There are also specialist nurses that look after a group of patients per condition with extended roles. Whilst training in different clinical areas in the Philippines had given me a broad range of nursing skills, specialising in a certain aspect meant that I could concentrate to gain expert knowledge on the field that I have chosen. Whilst I believe that specialism increases quality and safe provision of care, I wouldn’t despise my nursing experience in the Philippines because it had given me a broad general knowledge and skills as well as resilience to difficult situations.
I know you have stories to tell as well as any nurse who trained overseas. We had good times and bad times just like any shift that we do wherever we are around the world. I’ve written this article to find a common ground and an open mind to hopefully clear the quality of our training in the Philippines as well as the reputation of our fellow Filipino nurse. As she humbly apologised, may we come together as one who had been on the same boat once. Trained in the Philippines, we all sought for better opportunities abroad which possibly made our lives so much better in the process. Some of what she said may be true but let this be a lesson for us that no matter where we go, our roots and foundation have moulded us to become the nurse that we are today.