Before the general elections on May 2013, Senator Cynthia Villar’s statement on “room nurses” drew ire from many Filipinos, especially those associated to the nursing profession. In a senatorial debate, she stated that Filipino nursing students do not need to finish a BSN degree since they are directed to becoming room nurses or caregivers in America or other countries. The Philippine Nursing Association was quick to slam Senator Villar’s label by saying that “patient care or home care is only one aspect of [the] nursing profession.” (Calonzo, 2013)
The mentioned incident may be indicative of the underdeveloped nursing profession in the Philippines. According to the American Academy of Nurse Practitioners (2011), there are 33 countries which practice advanced nursing roles. This includes neighboring countries in Asia such as South Korea, Hong Kong, Japan, Thailand, and Singapore among others. Conversely, the Philippine’s current nursing law does not provide implementing guidelines for the practice of Advanced Practice Nursing.
Statement of the position
However, the proposed amendments to the Philippine Nursing Act of 2002,ot herwise known as RA 9173, includes coverage of Advanced Practice Nursing. The National Nursing Career Progression Program (NNCPP), as stipulated in Article VII, Section 31 of the said amendments, shall be implemented by the Board of Nursing along with the Department of Health and accredited professional organizations.
This program will provide opportunities for nursing specialty programs and additional remunerations for Advanced Practice Nurses (APNs). We view this as a good revision of the current nursing law as this paves the way for the ongoing progression of Philippine nursing and how it may fare in terms of global nursing standards in the future.
Mosby’s Medical Dictionary (2009) defines an Advanced Practice Nurse as a registered nurse having education beyond the basic nursing education and certified by a nationally recognized professional organization in a nursing specialty, or meeting other criteria established by a Board of Nursing. Advanced Practice Nurses demonstrate a “greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and significant role autonomy.”
(O’Grady, 2004) Furthermore, APNs encompass certified nurse-midwife (CNM), certified registered nurse anesthesist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP).
In Article VI, Section 27 of the amended version of RA 9173, the roles of a nurse practitioner are mentioned as well as the requirements to become one in the Philippines. Salient points include the requirement of a master’s degree for entry level, and certification based on the Board of Nursing protocol.
Discussion of both sides of the issue
According to Blais, Hayes, Kozier, & Erb (2002), “Nursing education and advanced practice roles will need to develop in tandem if nursing is to be effective in preserving the best of what nursing has been and to take the profession into the future of health care.” Through the implementation of Advanced Practice Nursing, the nursing profession in the Philippines may play a bigger role in the healthcare system of Filipinos.
Furthermore, the quintessential stereotype of nurses being the “doctor’s assistant” can be curtailed. According to the American Nurse’s Association, “APNs can provide 60% to 80% of primary care services as well as or better than physicians, and at a lower cost.” (as cited in Huston, 2006, p.413)
Nurse practitioners can provide complete physical examinations, diagnose and treat many common acute and chronic problems, interpret laboratory results and x-rays, prescribe and manage medications and other therapies, among others (O’Grady, 2004). In the Philippines where there is a scarcity of doctors in the rural areas, nurse practitioners may also be able to fill in the gap with their ability to provide primary care to different age groups.
According to Edwards & Davis (2006), because there are differences in educational preparation and clinical practice worldwide among nurses, it is essential to gain an understanding of nurses’ perception of their clinical competence. Through advanced nursing roles, an overall increase in the morale and confidence of Filipino nurses may thus follow.
Lastly, opportunities for continued development in the nursing profession may provide a solution to the surplus of registered nurses in the Philippines. According to Julito Vitriolo, CHED Executive Director, there are around 400,000 unemployed nurses in the Philippines today (Dioquino, 2013). The Department of Labor and Employment has even urged jobless nurses to seek for alternative employment instead of waiting for job vacancies in medical facilities (Jaymalin, 2013). By motivating newly registered nurses to pursue graduate schooling, they may have a greater chance for well-paying jobs in the future under the same profession.
However, there are some impediments and fallbacks that may be encountered with the implementation of the proposed amendment on Advanced Practice Nursing. The difference in nursing practices across the globe can lead to ineffective adoption of advanced nursing roles. According to Sherman & Eggenberger (2008), the “autonomy of the nurse and the level of collaboration between nurses and physicians are different across cultures.”
In the Philippines where nurses are largely dependent on physicians for a patient’s medical management, the attitude towards a widened scope of practice may be met with some resistance by a number citizens. This can be made worse with the fact that “payers insist on ‘paying for performance’” in terms of physician-delivered care (O’Grady, 2004).
Furthermore, there may not be reliable training institutions in the country to shoulder Advanced Practice Nursing. Today, there is no school in the Philippines that offers the depth and breadth of knowledge and skills required for advanced practice (Domocmat, 2012). This can severely affect the efficacy of Filipino nurse practitioners as they do not get the same quality of education and training compared to their foreign counterparts. In this regard, role expectations may also not be clear to them as work settings will be far from countries considered as forerunners of Advanced Practice Nursing such as the United States.
Lastly, O’Grady (2008) mentions that “the rapid growth and success of the APN movement has been described as a disruptive innovation—in that APNs can in many ways provide the same care or better care than physicians, at a lower cost in a more convenient setting.” This may lead to professional turf battles that may altogether affect quality of care and patient’s safety. According to Safriet (2002), physicians have “prevented the creation of scopes of practice that accurately define the type of care being provided by new groups of health care providers” such as advanced practice nurses (as cited in Huston, 2006, p. 422).
Thailand, which can be seen as having similar healthcare needs and limitations as the Philippines, has greatly benefited from their implementation of Advanced Practice Nursing. A study in 2007 concluded that majority of APNs in Thailand are in the primary setting and that advanced roles has led to Thai nurses feeling “more useful” as their confidence is enhanced (Hanucharurnkul, Suwisith, Piasue, & Therathongkum, 2007).
The need to advance practice can be seen as a necessary step to improve the role of the nursing profession in the country’s healthcare system. We believe that opportunities for continuing education and training for nurses can only lead to a more competent workforce that may be able to adapt better to the needs of the Filipino people. The Philippines may follow suit with Singapore where APNs undergo a period of clinical internship as an APN-intern under the mentorship of a medical consultant in a particular area (Singapore Nursing Board, 2011).
Although much remains to be seen for the future of Advanced Nursing Practice, its implementation can be seen as a movement towards improving the nursing profession as a whole in the Philippines.
American Academy of Nurse Practitioners (2011). NP Fact Sheet. Retrieved from American Academy of Nurse Practitioner database http://aanp.org/
Blais, K., Hayes, J., Kozier, B., & Erb, G. (2002). Professional nursing practice. New Jersey: Pearson Education, Inc.
Calonzo A. (2013). Nurses’ group slams Cynthia Villar’s ‘room nurse’ tag. [ONLINE] Available at: http://www.gmanetwork.com/news/story/298011/news/nation/nurses-group-slams-cynthia-villar-s-room-nurse-tag. [Last Accessed 02 September 13].
Dioquino R. (2012). Nursing profession plagued by unemployment, poor-quality schools. [ONLINE] Available at: http://www.gmanetwork.com/news/story/248540/news/nation/nursing-profession-plagued-by-unemployment-poor-quality-schools. [Last Accessed 2 September 13].
Edwards, P. & Davis, C. (2006, November 01). Internationally Educated Nurses’ Perceptions of Their Clinical Competence. Journal of Continuing Education in Nursing, (6), 265, Retrieved from http://elibrary.bigchalk.com
Huston, C.J. (2006). Professional issues in nursing. Philadelphia: Lippincott Williams & Wilkins
Hanucharurnkul, S., Suwisith N., Piasue N., & Terathongkum S. (2007). Characteristics and working situations of nurse practitioners in Thailand. Retrieved September 1, 2013 from International Council of Nurses database http://www.icn.ch./
Jaymalin M. (2013). DOLE advises nurses to seek alternative jobs. [ONLINE] Available at: http://www.philstar.com/headlines/2013/02/26/913217/dole-advises-nurses-seek-alternative-jobs. [Last Accessed 2 September 13].
Mosby’s Medical Dictionary (2009). 8th ed. Elsevier.
O’Grady, E. (2004) Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality. Retrieved 2 October 2013 from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/OGradyE_APRN.pdf
Sherman, R. & Eggenberger, T. (2008, December 01). Transitioning Internationally Recruited Nurses Into Clinical Settings. Journal of Continuing Education in Nursing, (12), 535, Retrieved from http://elibrary.bigchalk.com