The nurse population in the Philippines is declining — and statistics point to low wages and intense overseas recruitment as potential culprits. 

Low pay and minimal benefits have driven Filipino nurses to speak out. In Metro Manila, private hospitals pay nurses as low as 12,000 pesos ($215) a month, according to a report by the Philippine Star. Nurses working in public hospitals make around ₱35,000 ($625). In comparison, nurses in the United States make an average of $77,000 a year, or $6,416 a month, according to the U.S. Bureau of Labor and Statistics.

“Aside from better compensation, better working conditions probably [is another reason why nurses work abroad]. Sadly, nurses here are overworked… overworked and underpaid,” Anika Agulan, a nurse in a large public hospital in Manila, wrote to the News.

She also noted limited opportunities for career growth in the Philippines. While other countries have specializations for nurses, such as becoming a nurse anaesthetist, they cannot pursue these roles in the Philippines, prompting them to go overseas in pursuit of greater opportunities. 

This intense overseas migration of nurses has posed various challenges for health care and medical institutions back home. Hospitals often find themselves understaffed, and the nurses who stay in the Philippines have to work longer hours for low pay. 

“In the treatment hub right now, I work alone,” Angelica Parabas, HIV Treatment Hub nurse working in a private tertiary hospital south of Manila, wrote to the News. “Though the workload is not that hard, it’s a lot for one person, thus requiring me to make some small sacrifices such as eating late, or not having anything at all. But there are better days.” 

She recounted attempting to quicken counseling for HIV-positive patients due to the large number of patients that needed to be seen, juggling her assignments with other logistical work, such as answering telephone inquiries from patients. This can affect the quality of the overall patient care. 

However, the loss of nurses abroad does not just affect nurses back home. It also impacts the hospital administration and doctors themselves who train new graduates only to have them leave. Due to less manpower, they are forced to support fewer patients.

“Administratively, our hospital finds itself constantly training new, fresh graduate nurses,” Nicole Alabado, Infectious Disease Consultant doctor, wrote to the News. “After training and nurturing our nurses’ development, we stand idly as more lucrative employment overseas swoops down and grabs our most proficient teammates, leaving us to train new recruits all over again.” 

Alabado also reported that hospitals have seen fewer admissions due to limited staff. Because hospitals do not want to compromise patient care and prioritize patient safety, they must keep an appropriate patient-nurse ratio. 

Alabado works closely with nurses every day; these nurses provide doctors with updates regarding patient status, administer proper doses of medicine and facilitate other orders doctors put on charts. 

“The management of each patient requires a team,” Alabado wrote. “The doctor, nurses, and other staff all play their respective roles. Nurses are vital cogs in this system where they carry out the doctor’s plans and orders.” 

Knowing that nurses play a vital role in patient care and public health, hospitals and doctors have been trying to find ways to encourage them to stay in the country.

Monique Reyes, another nurse in the Philippines who has worked in the Intensive Care and Medical Surgical Units, suggested that hospitals increase the monthly salary of the nurses. 

“This also comprises of the hazard pay that is very low in the hospitals — it doesn’t reach a thousand pesos per month,” Reyes said.”To think that our health is most at risk since we deal with patients 24/7, with a very intimate distance [from] say, infectious patients.”

In order to lessen the burden on nurses, whose duties include patient transport, Reyes noted the possibility of assigning the task to a nursing assistant.  As an alternative, she said that hospitals could assign a specific transport nurse for procedures before and after surgery. 

She also mentioned the addition of better healthcare benefits for the nurses’ immediate families as a way to keep them in the Philippines. These benefits should include full discounts for medical concerns and coverage for immediate family members, not just one eligible person, she said. 

Anika Agulan echoed the sentiment that better working conditions and right compensation would encourage nurses to stay in the country, especially since they would be able to stay with their families. 

Jonas Balneg, another nurse working in a public tertiary hospital in Manila, added that a higher respect for the profession would keep more nurses in the country. 

“It is a sad fact that many of our countrymen view nurses as maids. It is quite different from how developed countries treat nurses as professional partners in healthcare,” Balneg wrote. 

Alabado said that mass migration needs to be addressed on a larger scale. Even if the Philippines cannot give nurses a competitive salary as in other countries, smaller changes such as subsidized dental, medical and educational benefits could encourage nurses to stay in the country. 

“While it’s true that we cannot offer the same salaries as more affluent foreign economies, we have the advantage of being ‘home’ to our nurses,” she added. 

Though many nurses choose to go abroad, those who choose to stay cite family and challenges as an expatriate as the main reasons they prefer working at home.

“As the child of a nurse who went abroad, I have also seen the hardships an expatriate encounters while being abroad,” Jonas Balneg wrote. “Since I am comfortable with the compensation the government provides for me, I choose to stay here to be with my family.”

Previous initiatives have worked to implement change.  Republic Act No. 9173, also known as “The Philippine Nursing Act of 2002,” mandated that nurses in public hospitals be paid a minimum base salary of ₱35,000 ($625). While this law has been difficult to implement, especially in the provincial areas, it was a large step forward to providing a better and livable wage to nurses around the country. 

As more and more nurses choose to migrate abroad, hospitals in the Philippines have faced many challenges. By providing competitive salaries, greater benefits and other opportunities, it may be possible to keep this vital part of the healthcare system in the country. 

According to an article by TIME, an estimated 150,000 Filipino nurses have migrated to the U.S. alone over the past 60 years.