By ANDREW JONATHAN BAGAOISAN and MARK ANGELO CHING
Note: This two‐part report was the output of my thesis with Mark Angelo Ching, which was supervised by Prof. Yvonne Chua and edited by Prof. Chit Estella. We chose to investigate the state of our nursing schools partly due to our concern with the increasing number of jobless nurses. We also saw that the media has not looked deeper into this issue since the 2006 exam leakage controversy. For our research, I took care of interviewing most sources and researching the Congress archives, while Mark compiled and analyzed nursing board exam performances of schools. Our work on this thesis familiarized us with the dealings of the Commission on Higher Education and the problems that still need to be addressed in nursing education. Vera Files (Part 1 & 2), The Manila Times, GMANews.tv (Part 1 & 2), and The Philippine Graphic magazine released the report.
First of two parts
(First published Monday, 15 June 2009)
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, 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 CHED has been unable to weed out the poorly performing nursing schools.
In 2004, CHED 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 CHED have been preventing it from effectively regulating nursing schools and closing down those that perform badly.
CHED 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.
CHED officials revealed that the commission even allowed more schools to open by continually processing pending applications. As recent as August 2008, CHED exempted certain schools from the moratorium through a verbal agreement among the commissioners. This agreement was not made public by CHED. Even now, a number of schools are reportedly applying to open, one of them with up to 17 new campuses.
Nursing, along with maritime education, currently occupies a special status in the CHED’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 CHED’s 16 regional offices.
The centralization of applications for nursing courses was enforced in 2004, near the time when the commission issued Memorandum Order No. 27 freezing the opening of new programs, said William Malitao of the CHED Office of Programs and Standards (OPS).
Approved in May but released in August that year, the moratorium was recommended by CHED’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 (RLEs).
Most schools fail to comply with the requirement on tertiary hospitals, said Elsa Florendo, supervisor of the health sciences division under the CHED OPS. 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 RLEs for nearly 100 nursing schools. Usually, in the mad scramble for slots with the hospitals, some schools offer to pay more for the partnership.
4-year application process
Schools that apply for CHED 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 are on their last stage of obtaining recognition from CHED. 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 CHED. Transcripts of congressional hearings in 2005 showed some lawmakers decrying what they called CHED’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 CHED central office, the new nursing school has already begun admitting students even without the initial permit. When the CHED notices such schools, the latter counters with the question: What would they do with the students?
Moreover, CHED 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 CHED Technical Committee on Nursing Education when the moratorium was issued in 2004, recalled that there were 25 schools with pending requests during her time.
CHED, however, 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.
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 CHED stop considering the schools still applying since there appeared no sign that the list was ending. Nothing came out of the proposal.
‘All kinds of pressure’
Malitao denies that politics or business had anything to do with the apparent violation of the moratorium, but former CHED officials say otherwise.
“It’s not really easy. You’re subjected to all kinds of pressures,” said Carlito Puno, CHED chairman from 2005 to 2007. Now president and CEO 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 CHED 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 CHED, such as the allocation of up to a hundred scholarships each for their constituents. For 2008 and this year, CHED 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. CHED, 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 CHED 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 ten in the morning and call you about it at midnight.”
Needed: ‘Consistent signals’
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 CHED 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 CHED.
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 CHED to address their parochial concerns before or beyond the hearings.
In a CHED committee hearing in 2004, Puno’s predecessor, Fr. Rolando de la Rosa, pleaded with congressmen to send CHED “consistent signals.” De la Rosa said politicians wanted CHED to be strict with certain nursing schools but lenient with others.
Many in the CHED and outside agree that political pressure on nursing schools contributed to De la Rosa’s resignation, only months after his appointment. During his term, CHED 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 UP Manila. She resigned months after De la Rosa did, citing “serious differences” with the CHED 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 CHED 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.