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Nurses serve a crucial role in meeting the healthcare needs of the Filipino people and to ensure that nurses are well-equipped to fulfill this role, the Philippine government passed laws over the years to keep Nursing Education in the country relevant and apace with the demands of global competitiveness (CHED,2001). Nursing Education in the Philippines has undergone a lot of changes starting from the early 1900s with the establishment of the first Nursing School (Iloilo Mission Hospital) by the Baptist Foreign Mission Society in 1906. At that time, there were no standard requirements but just willingness to work and the instruction includes reading, writing, arithmetic, and nursing (Giron-Tupas, 1952).
The outbreaks of epidemics in the country increased the need for more nurses to serve the public and opening government-sponsored nursing schools were seen as the solution to the problem. This time, those who want to study to become a nurse were required to complete 7th Grade and pass a comprehensive examination. Courses included Drugs & Solutions, Anatomy & Physiology, English, Spanish, Psychology, Dietetics, Hygiene and Sanitation, Materia-Medica, Bacteriology, Operating Room Nursing, Obstetrics Nursing, General Nursing, and Medical & Surgical Nursing. Lectures were given by foreign doctors & nurses and Filipino Nurses who have been to the United States. During these times, all nursing schools in the Philippines were diploma-granting programs and are all based in hospitals. That is until the Filipino Nurses Association passed a resolution in May 1946 for the establishment of a College of Nursing at the University of the Philippines, effectively establishing Nursing as part of university education. As the healthcare needs of the people continue to evolve so the Nursing Education in the country. With the state’s aim to provide the best healthcare services to the Filipinos and ensure the global competitiveness of Filipino Nurses, laws were passed to implement and monitor standards for Higher Education Institutions in educating Filipino Nurses. Curriculum and Instructions were continually adjusted to reflect the changing healthcare needs and technological advancement. This propelled the reputation of Filipino Nurses as one of the best in the field. As a result, the Philippines is considered the largest global provider of nurses, accounting for 25% of all overseas nurses and 85 percent of Filipino nurses employed serving in one of more than 50 countries worldwide, owing to the country’s well-established international nursing program. (Global Trade Magazine, 2020).
A search for journals related to Philippine Nursing Curriculum yielded very few published studies that discuss the curriculum itself. Most studies conducted focus on migration as one of the driving forces of the development of the country’s Nursing Curriculum. Ortiga (2014) argued that “teachers and school administrators face the task of producing nurse labor, not only for domestic health needs but employers beyond the national borders, and that Philippine Nursing Schools are embedded within a global nursing care chain.” Though the Philippine Nursing Curriculum focuses on adjusting to meet the global standards of care and has proven to be highly effective in top-notch nurses, it also presented wider issues such as the difficulty to bridge the gap in providing the highest possible care between the “ideal” situation and the “actual” situation that nursing students experiences in domestic clinical settings.
In 2018, James Ryan Reblando conducted a study to analyze a number of nursing curricula from different countries including their requirements, core competencies, and their contribution to the nursing profession as a whole. His study concluded that the strength of the Philippine Nursing Curriculum is its compliance with international standards, its teaching strategies, and the assessment methods implemented to determine its effectiveness. He also concluded that the current curriculum equips nurses with the basic skills needed to be successful nurses, as well as sufficient preparation to help them advance in their careers. Ramirez (2001) also concluded in his study that one of the strengths of the Philippine Nursing Curriculum is the inclusion of General Education Courses grounded in liberal arts which strengthens the character and values of the person as a caregiver. Ramirez also identified Research as part of the curriculum that needs to be updated. He suggested including a research practicum to provide nurses with needed skills for evidence-based research and advanced nursing practice.
The Philippine Nursing Curriculum
The Philippine Nursing Act of 2002, RA 9173, governs the practice of nursing in the country, stating that in order to become a registered nurse, one must complete a Bachelor of Science in Nursing (BSN) program and pass the Nurse Licensure Exam. The same legislation gave the Commission on Higher Education (CHED) the authority and duty to promulgate Nursing Education policies and standards, with the broad mandate that Nursing Education provides a solid general and technical basis for nursing practice. In 2017, CHED issued Memorandum Order No. 15, Series of 2017 establishing the policies, standards, and guidelines for the Bachelor of Science in Nursing (BSN) Program and to implement the “shift from competency-based standards to outcomes-based education. This memorandum order specified the National Core Competencies Standards of 2012 which allows nurses to function as nurse generalists assuming the roles of Client Care, Leadership and Management, and Research. Higher Education Institutions (HEIs) in the country have the academic freedom to adjust their Nursing Curriculum suited to their own contexts and missions but they must demonstrate that the same leads to the attainment of the required minimum professional nursing outcomes
The country’s nursing curriculum maintains a high standard of instruction utilizing appropriate and updated course syllabi/references and instructional methods and strategies. Professional nursing subjects are offered with the corresponding Related Learning Experience (RLEs) to provide students the opportunity to put their theoretical/didactic knowledge into practice either in a simulated environment or in any applicable actual healthcare setting. To ensure the best possible learning environment for students, a ratio of faculty to students is observed – 1:20 in a laboratory class and a range of 1:20-40 for regular classroom classes. The curriculum uses an outcomes-based education which is a student-centered method of the teaching-learning process that focuses on the achievement of the learning outcomes by nursing students as they progress on their level of nursing education.
| YEAR | EXPECTED OUTCOMES |
|---|---|
| 1 | At the end of the first year, given simulated situations in selected settings, the learners demonstrate basic nursing skills in rendering safe and appropriate nursing care utilizing the nursing process |
| 2 | At the end of the second year, given a normal and high-risk mother and newborn, child, family, communities, and population groups in any health care setting, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process |
| 3 | At the end of the third year, given individuals, families, population groups, and communities with physiologic and psychosocial health problems and maladaptive patterns of behavior in varied health settings, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process and applying research and evidence-based practice. |
| 4 | At the end of the fourth year, given groups of clients (individuals, families, population groups, and communities) with health problems and special needs, the learners demonstrate safe, appropriate, and holistic care utilizing the nursing process and can assume first level entry positions in any field of nursing. |
Salient Points from Existing Literature and Basis for the Formulation of Philippine Nursing Curriculum
I understand that the available research studies on Philippine Nursing Curriculum may not be enough to paint a detailed picture and they may also not be an absolute reflection of the subject. However, based on at least the studies I read, three main points always come out and these are (1) Philippine Nursing Curriculum utilizes Outcomes-Based Education, (2) Philippine Nursing Curriculum focuses on the global competitiveness of Filipino Nurses and (3) The ever-changing healthcare needs are the main basis of Philippine Curriculum and its further development.
1. Philippine Nursing Curriculum utilizes Outcomes-Based Education
CHED Memorandum Order No. 15, Series of 2017 implements the shift from competency-based standards to outcomes-based education in BS Nursing in the Philippines. This put the student nurses at the core of instruction and allowed nursing educators to continue to innovate ways to engage the learners in relevant and responsive instruction. With outcome-based standards, both nursing students and nurse educators are afforded the benefits of clarity. The nursing student has a clear understanding of what is expected of them at the end of the course. This also afforded educators the freedom to use various teaching methods and assessment techniques. One of the best benefits of the shift to outcomes-based education in nursing is the continuity of education standards. Though different HEIs have the academic freedom to adjust their curriculum based on their mission and use different teaching strategies, all nursing students on the same level in their education are expected to demonstrate the same outcome.
2. Philippine Nursing Curriculum focuses on the Global Competitiveness of Filipino Nurses
Most of the available literature on the subject talks about how the Philippine government and Education Regulatory Agencies create policies that are always aligned with the International Standards giving Filipino Nurses an edge over nurses from other countries. Topics that were relevant in the United States and other first-world countries were incorporated into the Philippine Nursing Curriculum (Eder, 2016) to be “consistent with the latest trends in higher education abroad” (Choy, 2003, p. 53). The Philippine Development Plan (PDP) for 2017-2022 sees investment in education as the key to strengthening human development outcomes and excelling in the global knowledge economy. Furthermore, they also see Internationalization as instrumental for improving the quality of education in the Philippines. The Commission on Higher Education (CHED) being the regulatory body, sets out the key policy for the internationalization of Philippine higher education, which is firmly placed against the backdrop of the ASEAN Economic Community and the country’s national plans (The Quality Assurance Agency for Higher Education, 2018).
Looking back at CHED’s Strategic Plans for 2011-2016, one of their mandates is to “promote relevant and quality higher education” by ensuring that “higher education institutions and programs are at par with international standards and graduates and professionals are highly competent and recognized in the international arena” (CHED, n.d., p. 1). Eder (2016) argued that from this statement, CHED clearly equated the quality and relevance of Philippine Higher Education Institutions (HEIs) and their programs to some measures defined by an external body and that CHED values the needs of the international industry just as much as the needs of the local industry. Though the Philippine government’s efforts to ensure that courses and programs including nursing offered by HEIs are at par with international standards have proven to be remarkably effective it also cannot be denied that it brought some issues. Battistella and Sun Liao (2014) argued that the deregulation of private post-secondary institutions and the underdevelopment of the domestic labor market perpetuates a condition of brain overflow or the spilling over of skilled workers into the global labor market. To put this into perspective, due to the high popularity of nursing among new college students, which is driven by the high possibility of working overseas and high earnings, the number of privately-run HEIs offering Nursing courses has grown exponentially. The disproportion between the number of new nurses and available jobs in the domestic labor market increased the number of nurses leaving the country to work overseas.
In pursuit of a “globally-competitive” curriculum, foreign hospital policies shaped the Philippine Nursing Curriculum (Ortiga, 2018). The curriculum was constantly revised in such a way that the competencies of Filipino nurses are not limited to the Philippine Healthcare system. This presented an “overloaded” nursing curriculum and there were also instances when the Philippine government enters into an agreement with another country that requires additional subjects that nurses must learn. One such instance is the requirement for Proficiency in Nihongo as part of the Memorandum of Order signed in 2009 by the Philippine and Japanese governments, which pertains to the recruitment and deployment of nurses and caregivers to Japan. Though the Philippine Nursing Association (PNA) has declined this agreement on grounds of discrimination and unrealistic demands, this still clearly shows the government’s willingness to adjust the country’s nursing curriculum to cater to the needs of other nations.
3. The Ever-changing Healthcare Needs is the Main Basis of Philippine Curriculum and its Further Development
The Philippine government recognizes the vital role of nurses in the country’s healthcare system. RA 7164 also known as the Philippine Nursing Act of 1991 is described as “an act regulating the practice of nursing in the Philippines.” The Philippine Nursing Act of 2002 (RA9173) which repealed RA 7164 is described as “an act providing for a more responsive nursing profession.” Senate Bill No. 916 introduced by Senator Paolo Benigno Aquino IV though it was rejected was described as “an act for a comprehensive nursing law towards a quality healthcare system, appropriating funds therefor.” These descriptions of legislation concerning nurses and the nursing profession in the country are clearly aimed at improving the nursing profession in response to changing healthcare needs in the country and guaranteeing the delivery of quality basic healthcare services. As new healthcare needs arise and recent studies are made, the Philippine Nursing Curriculum is constantly evaluated and revised to include outcomes that will address new healthcare needs and/or update new treatment modalities.
The Effectiveness of the Philippine Nursing Curriculum in Attaining the Over-all Goals of Nurse Education and Status of Nursing Graduates
The aim of the BSN Program is to develop a professional nurse who is able to assume entry positions in healthcare facilities or community settings. CHED Memorandum Order No. 15, Series of 2017 further defined a professional nurse as who is capable of providing safe, humane, quality and holistic care to individuals in varying age, gender, and health-illness status; healthy or at-risk families; population groups; and community; singly or in collaboration with other health care providers to promote health, prevent illness, restore health, alleviate suffering and provide the end-of-life care. Drawing from these, we can then conclude that the Philippine Nursing Curriculum is aimed at producing clinically-competent nurses equipped with the needed knowledge, skills, and attitude to provide safe and quality nursing care.
To determine the effectiveness of the Philippine Nursing Curriculum, we must study the nursing graduate’s readiness to assume entry-level positions in healthcare facilities and communities. The Philippines, the same as many other countries traditionally use the passing rate in the Licensure Examination to assess the quality of nursing education (Cabanda, 2017). The Board of Nursing takes into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related areas of disciplines and competencies when determining the subjects and the scope of the Nurse Licensure Exam in the country making it one of the best methods to measure the effectiveness of the curriculum.
| YEAR | EXAMINEES | PASSERS | PASSING RATE |
|---|---|---|---|
| 2018 | 21,906 | 9,137 | 41.71% |
| 2017 | 24,045 | 9,757 | 40.58% |
| 2016 | 28,506 | 13,019 | 45.67% |
| 2015 | 36,391 | 18,821 | 51.72% |
| 2014 | 55,878 | 26,517 | 47.46% |
*Figures are from NLE conducted within the Philippines. Special Examination conducted outside the country is not included in the above figures
The above table shows the pass rate at Nurse Licensure Examination held inside the Philippines from 2014 to 2018. Drawing from these figures, almost half of those who took the licensing examination successfully demonstrated the necessary competencies needed to provide safe and quality nursing care in an entry-level position in healthcare settings. Since HEIs in the country are given the academic freedom to create their own nursing curriculum as long as it leads to the same outcomes expected from every level of nursing education, looking at the overall Nurse Licensure Exam (NLE) Pass Rates will only show the effectiveness of the curriculum in the country as a whole. A smarter strategy would be to look at the NLE Results of every school. This can be better shown with the comparison of the number of passers of the Nurse Licensure Exam (NLE) and the number of nursing graduates – sorted by the year they graduated.
The Nurse Licensure Examination has though proven to be useful in determining the effectiveness of the curriculum in producing nurses equipped with competencies required to provide safe and effective nursing care a new way of determining how the beginner nurse will put his/her competencies, knowledge, skills, and attitude into practice. Since the goal of the BSN program is to develop a professional nurse who is able to assume an entry-level position, the effectiveness of the nurse in assuming his/her role in the healthcare setting should also be measured to fully determine the effectiveness of the curriculum
Discussion
The review of literature related to the Philippine Nursing Curriculum has revealed that the ever-changing healthcare needs of the people and the quest for the global competitiveness of Filipino Nurses are the main drivers of curriculum planning and development in the country. Most of the available studies on the subject pertain to the reasons behind the creation of the curriculum and its implementation. I believe nurses and those we serve will benefit more from more studies on the effectiveness of the Philippine Curriculum. The performance of nursing graduates on the Nurse Licensure Examination (NLE) has proven to be effective in determining the effectiveness of the curriculum, but I believe is not enough as a measure.
Statistical data on nurses who landed a job in any healthcare setting after passing the NLE will not accurately measure the aim of the BSN program which is to develop a professional nurse who is able to assume entry-level positions in healthcare facilities or community settings due to the disproportion on the number of registered nurses and available job opportunities. I believe a more in-depth study on how entry-level nurses effectively perform their duties in their first year on the job will be a more accurate way of evaluating the effectiveness of the curriculum. I also believe that such a study will help bridge identify factors that will help bridge the gap between theoretical and practical knowledge and skills of nurses and will also ensure that the curriculum will remain effective in domestic settings while also ensuring the global competitiveness of Filipino Nurses.
References
• Appiah, S. (2020). Quality of nursing education programme in the Philippines: faculty members perspectives. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-00508-9
• Cabanda E. Higher education, migration and policy design of the Philippine nursing act of 2002. Higher Education Policy. 2017;30(4):555–75.
• Choy, C.C. (2003). Empire of care: Nursing and migration in the Filipino American history. Durham, NC: Duke University Press.
• Commission on Higher Education. (n.d.). Strategic Plan for 2011-2016. [Archive]. Retrieved from http://www.ched.gov.ph/index.php/budgets-targets/plans-targets/ched-strategic-plan/
• Eder, R. (2016). I Am Where I Think I Will Work: Higher Education and Labor Migration Regime in the Philippines. Educational Studies, 52(5), 452–468. https://doi.org/10.1080/00131946.2016.1214913
• Giron-Tupas,A. (1952) History of Nursing in the Philippines, Star Publications
• Global Trade Magazine. (2020, May 5). Developed countries are the largest importers of healthcare professionals. Global Trade Magazine.
• Ortiga, Y. Y. (2014). Professional problems: The burden of producing the “global” Filipino nurse. Social science & medicine, 115, 64-71.
• Reblando, J. (2018). A comparative analysis of the philippine nursing curriculum from other countries. International Journal of Advanced Research, 6(7), 526–532.
• The Quality Assurance Agency for Higher Education. (2018). Country Report: The Republic of the Philippines. qaa.ac.uk