More Than 100 Nursing Schools Open (Part 1)

Despite government ban

By Andrew Jonathan Bagaoisan And Mark Angelo Ching Vera Files
Source: ManilaTimes.net

Nursing schools all over the country will be opening their doors this week to thousands of students with the great white cap dream—getting a nursing degree, working in a hospital abroad, and earning a comfortable living.

But not all these schools are qualified to offer the Bachelor of Science in Nursing program. In fact, some of them were supposed to have been shut down years ago for failing to meet the requirements of the Commission on Higher Education (CHED), while some new ones were not supposed to have opened at all.

The fact is, many students are spending their parents’ hard-earned money on substandard nursing education because the commission has been unable to weed out the poorly performing nursing schools.

In 2004, the commission declared a moratorium on the opening of more nursing schools after professional nurses complained that nursing schools were sprouting like mushrooms, even as more students were failing the nursing licensure exams. The problem reached tipping point in 2006 when news of a leakage in the exams made headlines.

But political and business pressures exerted on the commission have been preventing it from effectively regulating nursing schools and closing down those that perform badly.

Commission records show that from 2004 to 2007, more than 120 schools began offering nursing courses compared to only 98 new schools in the same time span before the moratorium. A total of 459 nursing schools operate in the country today.

The agency’s officials revealed that the Commission even allowed more schools to open by continually processing pending applications. As recent as August 2008, the agency exempted certain schools from the moratorium through a verbal agreement among the commissioners. The Commission did not make this agreement public. Even now, a number of schools are reportedly applying to open, one of them with up to 17 new campuses.

Special status

Nursing, along with maritime education, currently occupies a special status in the Commission’s system of granting applications to schools seeking either to start operations or offer new courses.

New nursing and maritime programs need direct approval from the Commission’s main office in Quezon City before they can take in students, unlike other courses which may be processed at one of the agency’s 16 regional offices.

The centralization of applications for nursing courses was enforced in 2004, near the time when the Commission issued Memorandum Order 27 freezing the opening of new programs, said William Malitao of the agency’s Office of Programs and Standards.

Approved in May but released in August that year, the moratorium was recommended by the Commission’s Technical Committee on Nursing Education. The committee cited as reasons the “proliferation” of institutions offering the course, the “marked deterioration” in quality of nursing graduates based on the declining board exam performances, and the lack of qualified faculty, deans and tertiary hospitals that would serve as partners to nursing schools in training the nursing students.

To open a nursing program, a school must meet four requirements: a dean with a master’s degree in nursing; faculty members with master’s degrees; facilities such as a library and a nursing skills laboratory; and its own or partner tertiary base hospital where students can be trained or have related learning experiences.

Most schools fail to comply with the requirement on tertiary hospitals, said Elsa Florendo, supervisor of the health sciences division under the Office of Programs and Standards. Tertiary hospitals offer the full range of medical services, from childbearing to surgery. Because not all nursing schools own tertiary hospitals, they go into partnerships with one or more hospitals.

In Metro Manila alone, close to 70 tertiary hospitals provide related learning experience for nearly 100 nursing schools. Usually, in the mad scramble for slots with the hospitals, some schools offer to pay more for the partnership.

Permit procedures

Schools that apply for the Commission on High Education’s recognition of their nursing program must also go through four stages of permits in four years. An initial permit is given on the first year when a school fulfills the initial requirements. Two preliminary permits are issued in the next two years, until the school is finally recognized on the fourth year.

Malitao said some contracts with hospitals expire just when the nursing schools were on their last stage of obtaining recognition from the Commission. The graduating batch of these schools therefore could not take the board exam until their schools have found another partner hospital.

The four-year application system did not always sit well with officials outside the Commission. Transcripts of congressional hearings in 2005 showed some lawmakers decrying what they called the agency’s “abuses” and “injustice” against nursing schools that were denied permits after a year of operation. One congressman from Central Visayas argued that this was unfair to the school owners who had already invested money in the enterprise.

Dr. Teresita Barcelo, barely warming her seat as president of the Philippine Nurses Association, also criticized the system of application and said this was too slow. By the time an application reaches the Commission’s central office, the new nursing school has already begun admitting students even without the initial permit. When the Commission notices such schools, the latter counters with the question: What would they do with the students?

Also, the Commission did not impose a limit on appeals from schools that lack one or more of the requirements. Requests for reconsideration therefore go on and on.

Dr. Fely Marilyn Lorenzo, who headed the agency’s Technical Committee on Nursing Education when the moratorium was issued in 2004, recalled that there were 25 schools with pending requests during her time.

But the Commission keeps confidential the schools whose requests were in the pipeline. This has led to the perception that the number of such schools may in fact be infinite.

Lack of transparency

Dr. Josefina Tuazon, dean of the University of the Philippines College of Nursing, said the secrecy has led to the suspicion “that the moratorium is not actually being fully implemented.”

Even the commissioners began to wonder about the pipeline’s extent. A commissioner who was appointed in 2005 proposed that the Commission stop considering the schools still applying since there appeared no sign that the list was ending. Nothing came out of the proposal.

Malitao denied that politics or business had anything to do with the apparent violation of the moratorium, but former Commission officials said otherwise.

“It’s not really easy. You’re subjected to all kinds of pressures,” said Carlito Puno, Commission chairman from 2005 to 2007. Now president and chief executive officer of United Coconut Chemicals Inc. or Cocochem, a position offered to him by President Gloria Arroyo after he was replaced by now Social Security System head Romulo Neri, Puno said he now lives a quieter life managing a company that has kept him out of the public eye.

At the Commission where Puno had served since 2001 initially as commissioner, he and other officials had to balance not just the interests of students, faculty and school administrators, but also those of politicians demanding certain benefits from the agency, such as the allocation of up to a hundred scholarships each for their constituents. For 2008 and this year, the Commission got funds for nearly 52,000 scholarships amounting to P851 million.

Puno said the national budget hearings were the frequent battleground for these clashing interests. The Commission, like other government agencies, gets its funds through the annual national budget approved by Congress. It is often in the hearings of the House Committee on Appropriations where lawmakers can assert their power over other government agencies.

Thus, legislators with an axe to grind with the Commission are able to get their point across to the commission. In the case of nursing schools, such members of Congress usually have financial stakes in them or have constituents or supporters who own these schools.

“If you don’t give in to them, at the next budget hearing you’re dead,” Puno said in Filipino. “They‘ll mock you, humiliate you, postpone the approval of your budget, schedule your hearing at 10 in the morning and call you about it at midnight.”

House records

Transcripts of the appropriations committee hearings during Puno’s term and earlier do not paint that exact picture. In the records, some lawmakers in fact chastised the Commssion for failing to act on the increasing number of nursing schools at that time. One other lawmaker from Central Visayas, for instance, demanded to know if all the new nursing schools in his province had permits from the Commission.

But Puno said many of the heavier demands were not made during the committee hearings but elsewhere. True enough, the transcripts showed congressmen repeatedly asking the Commission to address their parochial concerns before or beyond the hearings.

In a Commission committee hearing in 2004, Puno’s predecessor, Fr. Rolando de la Rosa, pleaded with congressmen to send the agency “consistent signals.” De la Rosa said politicians wanted the Commission to be strict with certain nursing schools but lenient with others.

Many in the Commission and outside agree that political pressure on nursing schools contributed to de la Rosa’s resignation, only months after his appointment. During his term, the Commission had ordered the closure of 23 nursing schools for not meeting its requirements. Many of them remain open.

The pressure was also too much for the technical committee headed by Lorenzo, who is also a professor at the University of the Philippines-Manila. She resigned months after de la Rosa did, citing “serious differences” with the Commission on High Education leadership under Puno.

Lorenzo said the technical committee eagerly pursued reforms in nursing education by keeping under tight watch the underperforming and substandard nursing schools. It also moved to extend the nursing curriculum to five years, which the commission opposed.

Lorenzo said while Puno assured the team that the Commission would support the cleanup that it would undertake, such support did not come when political and business pressures began. Frustrated that its attempts at reforms were getting nowhere, the technical committee resigned. A few months after, the scandal on the nursing exam leakage broke out.


Editor’s note: The authors are journalism graduates of the University of the Philippines. This two-part report is an abridged version of their thesis, which was done under the supervision of Yvonne Chua, a University of the Philippines journalism professor and VERA Files trustee.