Addressing the Burnout and Shortage of Nurses in the Philippines

Abstract

Burnout among Filipino nurses poses a significant threat to an understaffed Philippine healthcare system, leading to resignations, change of profession, and migration to other countries, thereby exacerbating the shortage in the local nursing sector. While workplace mental health programs and interventions can help alleviate burnout, it is crucial to address the structural factors contributing to burnout among Filipino nurses, such as low salaries, delayed benefits, understaffing, overwork, and job insecurity. Therefore, mobilizing existing resources and improving policies are critical steps that need to be taken to effectively address burnout among nurses. Measures such as increasing salaries, timely provision of benefits, and filling vacant government regular positions can contribute to improving the working conditions for nurses in the Philippines. Moreover, by undertaking these measures, the Philippines can advance just working and living conditions for nurses, while also mitigating the challenges posed by the shortage of nurses within its healthcare system.

Introduction

Promoting mental well-being among nurses is crucial to address issues that may arise from their burnout and psychological distress (Watson, 2023). In the Philippines, burnout has emerged as an ongoing challenge confronting Filipino nurses. Aside from decreased work productivity, burnout among Filipino nurses can lead to resignation, change of profession, and eventual migration to other countries (Alibudbud, 2022). Despite being a significant exporter of nursing professionals worldwide (Alibudbud, 2022; Buchan & Catton, 2020), the healthcare system of the Philippines faces a shortage of about 127,000 nurses, impeding the optimal provision of healthcare services (Lalu, 2023)

Nonetheless, the leader of a local nursing organization estimated that about 200,000 to 250,000 nurses have left the profession and are not working as nurses in the country (Jackson, 2021). Furthermore, the International Council of Nurses (ICN), in a 2020 report, recognized the country as a major supplier of nurses to the Organisation for Economic Co-operation and Development (OECD) countries, with around 240,000 Filipino nurses working abroad (Buchan & Catton, 2020). Therefore, while the Philippines have a shortage of nurses, a surplus of Filipino nurses exists in other sectors within the country and abroad.

Discussion of the Topic

Nurse burnout, as evident from a review of studies spanning the Americas, Asia, and Europe, can lead to detrimental outcomes, including reduced job performance, compromised quality of care, patient safety issues, negative patient experiences, medication errors, and intentions to leave the profession (Dall’Ora et al., 2020). In the Philippines, burnout among nurses poses a significant challenge to its healthcare system (Alibudbud, 2022; Lalu, 2023). For instance, during the COVID-19 pandemic, the shortage of nurses in Philippine hospitals has led to the downsizing of hospital operations, decreasing their capacity to accommodate patients with COVID-19 (Alibudbud, 2022).

The potential ramifications of nurse burnout, including subsequent resignations and migration, have been highlighted by the ICN in its statement, cautioning that this issue could undermine future pandemic response and the effectiveness of health systems across the world (Buchan & Catton, 2020). Hence, the ICN emphasized the significance of implementing policies that foster nurse retention and attend to their needs (Buchan & Catton, 2020).

While the Philippine government instituted policies to address the shortage of nurses, some of these policies have been met with criticism and frustration (Alibudbud, 2022; Ortiga et al., 2022). These policies include deployment bans to restrict nurses from seeking higher-paying opportunities abroad despite their low wages and delayed benefit disbursement (Alibudbud, 2022; Ortiga et al., 2022).

Another policy proposed in June 2023 involves issuing temporary licenses for those who almost passed the Philippine Nursing Licensure Examination and scored between 70% and 74% (Ombay, 2023). Local nursing organizations emphasize that the government should prioritize hiring licensed nurses working in other sectors and raising their salaries to retain and encourage their participation in the nursing profession instead of providing temporary licenses (Ombay, 2023).

Overall, despite the implementation of certain reforms and proposals to improve nurses’ conditions, these initiatives have faced criticism for their failure to adequately address the needs of Filipino nurses. Therefore, in line with the ICN emphasizing the importance of addressing factors influencing nurse burnout, the present paper explores strategies to address the structural factors contributing to nurse burnout as exemplified in the Philippine context. By doing so, the country can uphold nurses’ mental well-being and mitigate the challenges posed by nursing shortages in its healthcare system beyond existing government policies.

Current Insights and Interpretations

While workplace mental health interventions can contribute to addressing burnout (Watson, 2023), several structural problems can facilitate the burnout of Filipino nurses, including low salaries, chronic understaffing, heavy workload, job insecurity, and delayed disbursement of benefits amidst the rising cost of living, inflation, economic hardship, and the emergence of more economically rewarding jobs can contribute to the flight of Filipino nurses from the Philippine healthcare system (Alibudbud, 2022; Buchan & Catton, 2020). Consequently, in addition to workplace mental health programs, addressing these structural challenges is crucial to mitigate burnout among Filipino nurses.

Low Salaries, Delayed Benefits, and High Cost of Living

Firstly, entry-level nurses can earn 33,575 PHP (about 610 USD; using a conversion rate of 55 PHP to 1 USD) per month in a public hospital. However, most of them work on short-term contracts, lowering their earnings to 22,000 PHP (about 400 USD) without benefits (Alibudbud, 2022; Jackson, 2021). The pay of nurses in private hospitals can be as low as 8,000 PHP (About 145 USD) (Alibudbud, 2022; Jackson, 2021). On the other hand, the cost of living in the Philippines can be quite substantial. In 2021, a report shows that Manila, one of the country's major urban centers, ranked third among the most expensive cities to live in Southeast Asia, with an estimated cost of living per month of 50,800 PHP (about 923 USD) for a single person (Alibudbud, 2022; Dumlao-Abadilla, 2021). This cost of living can worsen with the inflation rates from 5.4% to 8.7% between May 2022 and 2023 (Mapa, 2023).

Consequently, the combination of low salaries and high cost of living, especially in urban centers, can heighten the risk of burnout and frustration among Filipino nurses, discouraging their commitment to the profession. As one Filipino nurse reiterated in a news interview, “You studied for four years to become a nurse and worked hard to obtain your license only to get paid a salary that could no longer be called a living wage. Where's justice in that?” (Reuters, 2023). Therefore, with the rising cost of living, Filipino nurses can be pushed into economic hardship, necessitating them to seek more economically rewarding jobs.

To address these challenges, the Philippine government must heed the call of local nursing organizations to institute measures that secure the official salary rate of nurses and gradually increase them (Jackson, 2021; Ombay, 2023). Moreover, since private hospitals outnumber public hospitals in the country (Silva et al., 2020), the government can consider subsidizing the low wages in private hospitals to make them comparable to those in the public sector. This action would help alleviate the shortage of nurses in private healthcare facilities during health emergencies, such as the COVID-19 pandemic.

Aside from salaries, local nursing organizations have also expressed their dismay about the delayed disbursement of their benefits, such as hazard pay and special risk allowance during the COVID-19 pandemic (Casas, 2020). As such, Filipino nurses may feel exploited, intensifying their distress and burnout within the Philippine healthcare system. As emphasized by a leader of a local nursing organization, “… government agencies have all the resources and power to implement the mandated salaries and benefits for health workers, and yet they become culprits in exploiting the frontline health workers at midst of COVID-19 battle” (Casas, 2020). Therefore, the Philippine government needs to ensure the timely provision of salaries and benefits to nurses. In general, the Philippine government must strive to provide just living conditions and livable salaries to Filipino nurses, as a step towards encouraging them to practice their profession and remain in the country.

Understaff, Overwork, and Job Insecurity

In the Philippines, the nurse-to-patient ratio typically stands at 1:20 but can escalate to 1:50, far exceeding the 1:12 standard set by the Philippine Department of Health (Tamayo et al., 2022; Villanueva, 2023). This heavy nurse-to-patient ratio can lead to shifts lasting 12 to 16 h without overtime pay (Villanueva, 2023). Additionally, job insecurity is prevalent, with many nurses in public hospitals reported to be on short-term contracts with lower pay (Jackson, 2021). Therefore, the working conditions and job contracts experienced by Filipino nurses can be characterized as highly challenging, ranging from suboptimal to exploitative. Wherein these nurses often endure heavy workloads and inadequate staffing levels, while their job security and remuneration are constrained by contractual limitations.

These challenges can be addressed by filling permanent positions within the Philippine Government. For instance, the government can hire nurses in the 22,000 vacant regular positions in the Department of Health, allowing them to gain job security, higher salary, and benefits (Alibudbud, 2023; Philippine Daily Inquirer, 2022). Furthermore, the government can increase the number of regular nursing positions to cater to the growing Filipino population. Similarly, expanding the nursing workforce in the public sector can supplement private hospitals in providing optimal nursing services during health emergencies. Generally, efficiently utilizing available resources, such as vacant government regular positions, can help address the structural factors of burnout among Filipino nurses. By doing so, the government can provide job security and favorable working conditions for nurses in the Philippines.

Conclusion

Overall, burnout among Filipino nurses can lead to resignations, change of profession, and migration to other countries, exacerbating the shortage of local nurses and posing a significant threat to the Philippine healthcare system. While mental health programs and interventions may help address burnout, structural factors affecting burnout, such as low salaries, delayed benefits, understaffing, overworked conditions, and job insecurity, must be addressed. As a start, it is necessary to mobilize existing resources, such as hiring nurses to permanent government positions, and improve policies to address burnout among Filipino nurses.