Nursing Must Return To The Bedside

July 9, 2007 Courant.com/news/local

Last week, The Courant stated that by the year 2010, Connecticut will have 11,000 too few nurses. I assume that means 11,000 too few nurses who would be giving direct patient care.

UConn's board of trustees approved a proposal to help alleviate this nursing shortage ("hemorrhage" is more like it) by adding a master's entry-level program for nursing at two of its branches, graduating 64 new master's prepared nurses each year. Candidates need only a bachelor's degree in any major to be considered. There are two major flaws to this proposal. First, the obvious: 64 vs. 11,000 ... still hemorrhaging! Second, master's prepared nurses typically do not provide direct patient care.

During the last couple of decades, nursing became more focused on credentials and less focused on the patient. Nursing education itself became more academic oriented and less clinical or patient oriented.

All hospital-based schools of nursing closed; LPN's and nurse's aides lost their hospital jobs. We threw away our caps and white uniforms (except on TV), leaving a guessing game of who's who in the scrubs.

Hospitals initiated programs called "nursing ladders" where nurses could distinguish themselves. Individual portfolios were created to document meetings attended, committees joined and classes taken. The more non-nursing tasks documented, the further up the ladder you "climbed." Accordingly, your wages increased. Ironically, the further up the ladder you went, the further from direct patient care you were. There is no denying the benefits of continuing education. However, in our quest to be treated as professionals, we created an environment where a new generation of nurses run as fast as they can from direct patient care.

Now, they say the bigger problem is not enough teachers to teach nursing. My guess is the 64 who received their master's in nursing will teach. They have the right credentials. My question is, how will they teach without any experience? Here is my solution. Let nurses teach based on their years of experience, not just credentials. The nurses with 15- to 20-plus years of bedside experience, whose backs are killing them, may not want to write for nursing journals, but they do know how to take care of patients. So, who better to teach? Second, increase compensation to nurses who give direct patient care, twofold. Make good old-fashioned bedside nursing desirable to the next generation of nurses. Perhaps then, even more men will join us. Last, for the nurses calling the shots, but not giving the shots, build in a few clinical hours into their schedules. (Doctors do!) We must remove the focus of this hemorrhaging profession away from the credentialing scorecard that it's become, and return it back to the patient, where it belongs.

Kate Dunn Scott, RN, Portland

Copyright © 2007, The Hartford Courant

Mga Sirang Batayang Kagamitan: Prayoridad ba ng Administrasyon?

Sa paghahanda kaugnay sa Sentenaryo ng PGH, maraming mga kagamitang medikal ang nasa prayoridad sa pagpapatupad ng “modernization” subalit hindi maitatanggi na ang mga ilang batayang gamit ng ospital ay luma na at dapat mas nasa proyoridad ng pagkumpuni o pagbili ng bago tulad ng generator, elevator, chiller, autoclave, PABX at CBC machine

Ito ay ilan lamang sa nagiging paksa sa diyalogo noong ika-2 ng Hulyo 2007 sa pagitan ng Unyon at PGH Administration.

Dinala ng Unyon ang isyu kaugnay sa mga sirang batayang gamit dahil sa malaking implikasyon nito sa ating serbisyo sa mamamayan at sa ating kalagayan sa paggawa.

Ang ating dalawang pangunahing generator ay puro sira na at may pondo na para sa pagbili ng mga piyesa (ang iba ay bibilhin pa sa Singapore).

Ang mga sirang elevator naman sa Central Block Building ay may inilaan nang pondo para sa pagbili ng bago.

Ang mga chiller plant (3) naman sa DEMS ay puro sira kaya parang pugon sa init ang ER. Kagyat na pinapahanapan ng pondo sa Budget para sa pagkumpuni.

Ang autoclave sa CSR na puro sira din ay kinukumpuni na at may plano ang Administrasyon na ikabit sa CSR ang isang nakatiwangwang na Autoclave Machine na kasama pa sa DEMS Modernization Project, at bibili pa ng karagdagang unit, para pamalit sa madalas masirang unit.

Samantalang ang local telephone exchange system (PABX) natin ay sinabing may nakikita ng pagkukunan ng pondo para sa pagbili ng bago.

Inaasahan natin na ang diyalogong ito ay magpapabilis na maibalik sa normal na operasyon ang mga batayang gamit - para sa maayos na serbisyo sa mamamayan at upang magaan na magampanan ng ating mga kapwa kawani ang kani-kanilang mga tungkulin.

Sabi nga ng marami sa atin: “Anong silbi ng modern medical equipment tulad ng MRI kung ang mga batayang gamit sa ospital tulad ng standby generator, telepono, elevator, aircon at autoclave, kung hindi madalas masira ay di na talaga magamit?

Masusi nating susundan ang mga ipinangakong ito.

PGH: Hospital for the Poor No More: Employees, health groups oppose hospital fee increases

The management of the country's premier public hospital said that there is a need to increase fees to have funds for improving facilities and services. Various groups, however, argued that increasing fees will be done at the expense of the poor who are supposed to be the main beneficiaries of public health services.

BY AUBREY MAKILAN
Bulatlat

The University of the Philippines-Philippine General Hospital (UP-PGH) community and other health groups last week said that there is no reason for increasing fees of PGH's services, arguing that it is being done at the expense of poor patients.

Rate increases

In a Feb. 8 dialogue with PGH-based health groups, UP-Manila Chancellor Ramon Arcadio and PGH Director Carmelo Alfiler said that they will push through with the imposition of the operating room (OR) fee of P1,500 ($31.05) despite protests from various groups. In the past, the use of the OR was free.

Present in the dialogue included representatives of the UP Manila Coalition against PGH Rates Increases, All-UP Workers Union (AUPWU), All-UP Academic Employees Union and the associations of physicians, nurses, nursing attendants and utility workers.

In end-January, the planned rate increases for blue card acquisition and medical certificate releasing were deferred. The payment for the blue card 'which every patient should have to transact with PGH' was supposed to increase by 114% from P7 to P15 ($0.14 to $0.31). On the other hand, the "fast-lane" payment for getting a medical certificate was proposed to be increased by 400% from P20 to P100 ($0.41 to $2.07).

The UP-PGH's rate increase proposals were made immediately after the UP Board of Regents' (BOR) approval of the tuition increase for incoming freshmen students.

During the BOR's 1216^th meeting on Dec. 15, the highest policy-making body of the UP did not only approve a 233-percent hike in tuition and miscellaneous fees. The BOR also ruled that "tuition will be subsequently adjusted annually based on the national inflation rate."

At whose expense?

With the proposed P1,500 ($31.05) OR fee, the administration would not give up the projected annual income of about P16 million ($331,228.65), said Jossel Ebesate, president of AUPWU and secretary-general of the Alliance of Health Workers (AHW).

According to Ebesate, the administration claimed that the income will be allocated for the development efforts of the hospital.

"Profit at whose expense?" he asked. "Hindi tama na ang development efforts to improve facilities and services ay kukunin mo sa patients na dapat ay sineserbisyuhan mo." (It is not right that development efforts to improve facilities and services will be sourced from patients whom you are supposed to serve.)

PGH has 500 pay beds, 800 charity beds and 200 special beds or for the intensive care unit (ICU). PGH accommodates about 1,500 patients every day in the out-patient department (OPD) and 350 patients every day in the emergency room (ER). Most of these patients, Ebesate said, are charity patients.

At first, the PGH management claimed that only holders of the Philippine Health Insurance, Inc. (PhilHealth) card would be required to pay the OR fee. However, since 70 percent of patients undergoing surgical operations are not covered by PhilHealth, Ebesate said that everybody will now be affected by the imposition of the OR fee.

In case of non-PhilHealth coverage, patients will be assessed by the hospital's social service which will then find donors to help them. If no donor is found, Ebesate said that the OR fee would be waived. His group, however, doubt if this will be implemented.

In many cases, Ebesate said that nurses and physicians shoulder the charges passed on even to poorest-of-the-poor patients. "Wala pa nga 'yung OR fee, hindi na kaya ng mga pasyente 'yung mga (simpleng) bayarin. Paano pa kapag nagtaas na?" (Even now that there is no OR fee, patients cannot afford basic fees. What more if the fees increase?)

Wrong priority

Ebesate, chief nurse of the PGH nursing service, said that it is not true that there is no fund available for health services. "Mali lang ang priority," (The priority is wrong) he said, citing misappropriations in the national budget as a result of higher allocation for debt service and military expenditures.

Since 1983, Ebesate said that the PGH budget for personnel services (PS) and maintenance and other operating expenses (MOOE) has never reached P1 billion ($20.7 million). Their actual computations showed that they need about P2 billion ($41.4 million).

He said that the PGH has been generating income to augment the government's meager budgetary allocation. From three percent in the past, Ebesate said that PGH has been earning 30 percent of its total budget at present.

To show their firm opposition to the rate increases, Ebesate said that all groups of the UP-PGH plan to stage mass actions at the offices of concerned government agencies like the Departments of Budget and Management (DBM) and Finance (DOF). Bulatlat

(Computation of dollar equivalents based on an exchange rate of P48.305 per US dollar)

Reign of the Kleptocrats

by: Perry Diaz
PerryScope
January 19, 2007

The recent indictment of former Justice Secretary Hernando "Nani" Perez by the Sandiganbayan brings, once again, to the forefront of debate the issue of corruption in the top echelon of the government. Cabinet members, who are charged of implementing the policies and programs of the government, are supposed to represent the best and the brightest in government service. They are supposedly the models of good moral conduct to be emulated by their employees.

Those were days when government officials were the cream of the crop, and when government service had a mystical appeal to the idealists who truly wanted to make a difference. Indeed, what we used to know as "good governance" is now transformed into "kleptocracy." The public service-oriented government functionaries of yesteryears are gone. Although there are still those in government who are honest and incorruptible, what we have today is a breed of greedy opportunists who use their positions in government to enrich themselves. They are the "kleptocrats." Wikipedia defines "Kleptocracy" as a pejorative, informal term for a government that is primarily designed to sustain the personal wealth and political power of government officials and their cronies.

The Perez corruption case is one of the most despicable corruption cases because, as the chief guardian of the law, he brazenly broke the law that he swore to protect. He was responsible for the prosecution of law-breakers and now he is prosecuted for breaking the law. The Ombudsman, Merceditas Gutierrez, filed charges of graft, extortion and falsification of public documents against Perez -- her former boss -- in connection to the extortion charge of former Manila Congressman Mark Jimenez.

In 2003, Jimenez was extradited to the US where he was tried and convicted to 27 months in prison for tax evasion and conspiracy to defraud the US and commit election financing offenses. Upon his return to the Philippines after serving time in a US prison, Jimenez filed a complaint against Perez with the Ombudsman, claiming that Perez extorted $2 million from him in February 2001 in exchange for dropping him as co-accused in the plunder cased against deposed President Joseph Estrada.

The Jocelyn "Joc-Joc" Bolante case is another high-profile corruption case involving the fertilizer scam during the 2004 national elections. To avoid prosecution, Bolante disappeared for a while only to surface in the US in 2006. Upon his arrival in Los Angeles, he was arrested because of an expired visa. Bolante is now being held in a US jail while his case is pending in a court in Chicago. Coincident -- or was it? -- with the arrest of Bolante, President George Bush announced the escalation of the war on kleptocracy, denouncing "high-level corruption by senior officials, which is robbing the people of many poor nations of their future." Although he did not name the Philippines, he probably had the Philippines in mind when he said that.

In 2002, a report titled "The Eight-Point Comprehensive National Anti-Corruption Strategy" was released by then Ombudsman Aniano Desierto which stated that as of December 2001, "the high ranking officials with criminal charges filed in court included 62 armed forces and national police officials, 523 mayors, 18 governors, 6 congressmen, 2 ambassadors, 17 cabinet members, a former vice president, 2 former first ladies and a former president." I wonder if any of these high-ranking officials had been convicted?

In the same month, the report says, "the Office of the Ombudsman had a combined workload of 13,585 criminal and administrative cases. The number of cases disposed of totaled 9,324 out of which 1,374 was recommended for criminal prosecution, while administrative sanction was imposed on 390 cases." What is wrong with the picture? It's either the prosecution staff were incompetent or the accused were too smart for the prosecutors. Clearly, the wheel of justice is slow as a sloth.

In 2004, Transparency International released a list of "what is believed to be the ten most self-enriching leaders in recent years." In the order of the amount allegedly stolen in US dollars, they are: 1) former Indonesian President Suharto ($15 billion - $35 billion); 2) former Philippine President Ferdinand Marcos ($5 billion - $10 billion); 3) former Zairian President Mobutu Sese Seko ($5 billion); 4) former Nigerian President Sani Abacha ($2 billion - $5 billion); 5) former Yugoslav President Slobodan Milosevic ($1 billion); 6) former Haitian President Jean-Claude Duvalier ($300 million to $800 million); 7) former Peruvian President Alberto Fumitory ($600 million); 8) former Ukrainian Prime Minister Pavlo Lazaarenko ($114 million - $200 million); 9) former Nicaraguan President Arnoldo Aleman ($100 million); and 10) former Philippine President Joseph Estrada ($78 million - $80 million). It is interesting to note that the Philippines is the only country with two of its presidents -- Marcos and Estrada -- on the list.

There was a story during the Marcos years about how Marcos selected the Chief of Staff of the Armed Forces. There were two candidates who vied for the coveted position -- Gen. Fidel V. Ramos and Gen. Fabian Ver. Marcos interviewed Ramos first and at the end of the interview he asked Ramos, "What is ten divided by two?" Ramos quickly answered, "Five!" "Very good," Marcos said, "I'll let you know my decision tomorrow." Next, he interviewed Ver and asked the same question at the end of the interview, What is ten divided by two? Ver paused and scratched his head. Then he said, Five, sir! Five for you and five for me. Excellent, Marcos said, "the job is yours."

Today, the kleptocrats are having the grand "shopping spree" of their lives, filling their shopping carts as fast as they can because they don't know how long the "shopping spree" is going to last. It is sad that the "spirit of service" that predominated during commonwealth years and early period of the republic is gone. What we have today is kleptocratic governance which subordinates economic growth to the avaricious personal interests of the kleptocrats.

The Arroyo Gov't in ASEAN: More Deaths Than Health!

Health Alliance for Democracy (HEAD)
2/F Doñ a Rosita Bldg, E. Rodriguez Ave. , Quezon City
Email: headphil@gmail.com
Press Release
13 January 2007

Leaders of Health Alliance for Democracy (HEAD) and local representatives of health workers and health professionals joined mass actions being held in Cebu City today to protest Arroyo government's callousness and utter negligence of basic health services, while spending billions in hosting the Association of South East Asian Nations (ASEAN) summit.

"Again, the Arroyo regime is shamelessly promoting its mendicant agenda in the ASEAN while lying outright to the Filipino people." Decried Dr. Geneve E. Rivera, HEAD deputy secretary-general and leader of the health delegation. "Two of its principal agenda - the Mutual Recognition Agreement (MRA) and regional "anti-terrorism" - will cause more hardships for Filipinos in the long run."

According to HEAD, the MRA will open new doors for the overseas employment of licensed Filipino nurses by allowing them to work in other ASEAN countries without the need to acquire licenses from these countries. However, because the Arroyo government has done nothing to improve the status of Filipino nurses locally, the MRA will spur rather than stem the exodus of health professionals.

"Almost 90% of those who pass the Nursing Licensure Examination will seek employment abroad. That is roughly 30,000 nurses for 2006 alone." Stated Dr. Rivera. "With the MRA, Mrs. Arroyo is facilitating the exodus of Filipino nurses rather than offering viable alternatives for them to stay. Even if the MRA may provide some benefit for individual nurses, its negative impact on the Philippine health care delivery system is tremendous. And Mrs. Arroyo could hardly care less for as long as the remittances keep coming."

Also, the Arroyo regime wants to be at the forefront of the United States-led "War on Terror" in the region. Thus, it is pushing for regional "anti-terrorism", which is its favorite euphemism for its militarist and repressive programs that have led to the unabated killings and abductions of activists by its own armed security forces. Mrs. Arroyo has even allocated P10B for the so-called modernization of the Armed Forces of the Philippines (AFP).

But as Dr. Rivera pointed out, "That amount (P10B) is already the equivalent of the entire annual national health budget, which has not changed considerably over the last six years under the Arroyo regime. With Mrs. Arroyo, there is money for killing and harming Filipinos, but not for their health care and well-being!"

In fact, the spending on the ASEAN summit is about one-fourth of the entire Department of Health budget for 2006 and is even bigger than the entire budget allocated for parallel importation, the program meant to provide cheaper medicine for Filipinos. It is also bigger than the combined annual budget of the six biggest public hospitals under the DOH.

"What is obvious here is that the motive force behind Mrs. Arroyo's programs is not the welfare of the Filipino people but her own selfish needs as well as those of her neocolonial patron: US imperialism. Mrs. Arroyo wants to show to the Bush administration that contrary to their initial impression that she is an "unreliable ally", she will do everything to get their good graces." Concluded Dr. Rivera. "And everything means sacrificing the lives of Filipinos."

References: Dr. Geneve E. Rivera (Deputy Secretary-General – 0920 4603712)
Dr. Gene Alzona Nisperos (Secretary General - 0916 2145724)

6,000 Doctors Now Working Abroad as Nurses

By JENNY F. MANONGDO
Manila Bulletin
Wednesday, January 10, 2007

The number of doctors who left the country to become nurses abroad has reached 6,000 since year 2000 while 3,000 more are currently enrolled in nursing schools, latest estimates from Dr. Jimmy Galvez-Tan, former executive director of the University of the Philippines-National Institute of Health (UP-NIH) and professor of medicine in UP, revealed.

Dr. Galvez-Tan, who has monitored the trend of exodus among local health professionals, said that approximately 1,000 of them leave the country each year.

Mental health experts are also leaving.

Psychiatrists number only 400 across the country, yet some of them are also enticed to go abroad. Five of them have taken up nursing and one has left for abroad recently, the Philippine Psychiatric Association (PPA) said in a forum in Quezon City yesterday.

"The reality is, even the medical community does not put in that kind of importance. In the medical community, we have the specialty that is not very popular among medical students. Ob-Gyn, Surgery, Pediatrics is at par with us at some point. But how can you pit yourself against ob-gyn, surgery in practice, they earn very much," Dr. Lourdes Ladrido Ignacio, founding president of PPA, said.

"In Psychiatry, even if we spend that many hours, it’s not quite appreciated that every minute there is professional work. Every minute for a surgeon is professional work but it’s worth P20,000 right away," Dr. Ignacio added.

She said others have decided to leave due to economic reasons and many professional Filipinos go where their talents are also appreciated, she said.

Dr. Ignacio said psychiatrists are well-distributed in hospitals in Metro Manila but there is a shortage of psychiatrists in far-flung areas such as Cotabato and Surigao provinces.

At a separate forum earlier, child psychiatry experts revealed the same dilemma.

At present, only 41 child psychiatrists are active in their field supposedly catering to 36-million children below 19 years old that makes up 40 percent of the total population.

The Child and Adolescent Psychiatrists of the Philippines, Inc. (CAPPI) said there is one child psychiatrist in Cebu, and another in Bacolod and Iloilo. There are two child psychiatrists in Davao, one of whom is leaving for abroad soon.

PGH to Increase Rates Next Month

OR fee Union’s prime concern

By Christian V. Esguerra
Inquirer
Posted date: January 05, 2007

THE PHILIPPINE GENERAL HOSPITAL, the “teaching hospital” of the University of the Philippines system, is set to increase rates this year, raising concern from its own employees.

The PGH employees union said the planned increases, particularly those involving operating room and patient identification cards, could be too much for charity patients.

Union president Jossel Ebesate said a December announcement showed that the price of the “blue card,” a patient’s identification card, would rise from P7 to P15. Patients would also pay P1,500 in operating room (OR) fee, through the Philippine Health Insurance Corp. , the government health insurance program, said Ebesate, a nurse and the secretary general of the Alliance of Health Workers. He said the rate adjustment was scheduled to take effect next month.

Ebesate said the union was concerned primarily about the new fee for the operating room. Dr. Michael Tee, PGH spokesperson, said yesterday the adjustments were carefully studied by the hospital’s rates committee that included union members. The committee meets Jan. 9 to discuss the various concerns. “At the PGH, everything is democratic,” he added. Ebesate said even if the new OR fee was to be paid by Philhealth, many charity patients were not covered by it. This means they will have to pay the P1,500, “no small amount for indigent patients,” he said.

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