It’s More Than Just the Money, Why Filipino Nurses Are Leaving

Carmina Giezzele G. Mones

It’s More Than Just the Money, Why Filipino Nurses Are Leaving

It all starts with a dream, as it so often does with any ordinary Filipino thinking of providing their family with more than just the necessities – owning a home, buying a car, taking a vacation now and then, and maybe even saving up for a rainy day. 
But in a country like the Philippines, where poverty and corruption are the norms, Filipinos are not just being robbed of the chance to earn a decent wage to live a decent life, but more so, they are being devoid of the right to dream. 

Losing the dream

Nursing wasn’t Jett’s dream job, but he joined the healthcare industry in search of a better life he couldn't afford to have in the Philippines.

“I didn’t want to become a nurse. But it came to a point where my parents were already fighting over my future. My mom supports my dream of becoming an engineer, while my dad was adamant that I take up nursing. I wanted the fight to end so I gave in and took up nursing,” said Jett, 26, a travel nurse working in Virginia, USA.  

Thousands of miles away from the US, Kim, another Filipino nurse working abroad, has a story all too familiar on how and why she became a nurse – her mom wanted her to become one. “I didn’t want it to the point that I was crying because I was dreading the idea of becoming a nurse.”  

Kim’s mom was a doctor, and according to Kim, she saw the practicality of a job in the medical profession. Kim originally wanted to become an architect or a dentist, but with her mom’s persistence and after many of her friends chose the same path, she begrudgingly obeyed. She thought maybe it wasn’t so bad after all.  

It’s a story common to many Filipino nurses. Children grow up wanting to become flight attendants, engineers, dentists, or architects, but end up working as nurses after their parents or relatives would push them to take up nursing for a higher chance to go abroad and improve their future.  

Jett and Kim are just two of the thousands of Filipino nurses currently working abroad. In December 2021, the Philippine Nurses Association (PNA) and the Department of Health (DOH) recorded 316,405 healthcare workers living and working abroad. Just this year, the Philippine Overseas Employment Association (POEA) recorded another 2,000 healthcare workers leaving the country to try their luck abroad.

Jett (rightmost) with his classmates from nursing school/ Kim (third, standing from the left), with her classmates

A mass exodus of nurses

Since the 1970s, Filipinos have started leaving their country in droves to work abroad. Locally,they are called Overseas Filipino Workers or OFW. According to experts, from a high demand for workers in the Middle East, the tide slowly turned to a demand for domestic helpers,caregivers, and nurses.

Since then, the Philippines continues to champion the idea of migration to their own people.National agencies and priority lanes were set up left and right to ease the burden of Filipino workers moving out of the country. Just this year (2022), former President Duterte enacted into law Republic Act No. 11641 or the creation of the Department of Migrant Workers (DMW). TheDMW is tasked with protecting the rights and promoting the welfare of OFWs.

The government created a system to cater to other countries’ needs to fill in vacancies that it feels like they are creating a product called “Bagong Bayani” (Filipino word for modern-day heroes) and they come in different variants. “Oh, you need a domestic helper? An engineer? A driver or a nurse? Come here, we’ve got it all for you.”

According to International Labor Organization (ILO), more than 10 million Filipinos live outside the country, and about 1 million Filipinos depart yearly. Last year, the country deployed 8,307 nurses to different countries, a huge chunk of them went to the Middle East.

One might ask what does the Philippines get from this? Well, just around $34.88 billion every year from remittances, that’s what. This accounts for 10 percent of the country’s gross domestic product. And for a developing country like the Philippines, this helps in keeping the economy afloat, especially amid a global pandemic.

But what happens when hundreds of thousands of healthcare workers leave the country just when more of them are needed to care for their fellow Filipinos?

“It was a traumatic experience”

After graduation, Kim started working in a tertiary government hospital in La Union as a staff nurse.

“The competition was tight. The only reason I got in was because of my mom’s connections. You know, you know somebody who knows somebody who can get you in,” said Kim, who felt lucky at that time to even land a job just a few months after graduation.

Working in the government hospital was not a piece of cake. She recalled how she would come into her shift at seven in the morning and only be able to have her first meal at 5:00 PM, two hours after her shift should have ended. She’s still in the hospital by then, preparing to hand off her patients to the next batch of nurses.

At that time, Kim’s department would be in charge of 60 patients a day. With only 4-5 nurses per shift, each nurse needs to take on 15-20 patients daily. “Staffing is bad. Imagine having to assist in delivering 15 babies every day in your first year,” said Kim. Because they are understaffed, nurses are pushed to work more hours and take more patients much more than they are required to by law.

Nurses also often feel guilty if they get sick. “If you get sick, you’d feel like it’s your fault. Many nurses only take a sick leave if they can’t physically push themselves anymore because you know that the other nurses will take the brunt of covering your shift,” Kim relayed. All that for a measly 10,000 pesos ($180) every month.

In the Philippines, where there’s a surplus of nurses who graduate every year because of the promise of earning more if you become a nurse, the competition in getting a job is tough. One would think that a country that encourages its people to take up nursing would have more than enough job opportunities for its people, but that’s not the case here. In 2021, the Department of Health said that there are currently 600,000 nurses in the Philippines, but only 300,000 jobs available for them.

To address the growing number of unemployed nurses in the Philippines and the need to provide quality healthcare to rural communities, the DOH launched the Registered Nurses for Health Enhancement and Local Service (RN HEALS) Program in 2011. Nurses are deployed for six months in the community, and another six months to a hospital. In Kim’s case, she was deployed to the pediatric unit, and later on to the labor and delivery unit.

The working environment pushed Kim to her limits. “I was always so anxious, so afraid to be assigned to doctors who talk down and embarrass the nurses in front of patients, and I think that affected my mental health. I feel like I will never be good enough.”

“I felt like I was in jail”

It took 3 years, a pandemic, and her kid’s life on the line for Quinn to finally leave the Philippines and start a new life in California with her growing family. An ICU nurse for three years in one of the biggest and most expensive private hospitals in the Philippines, Quinn looks back on her experiences during her first few months working in a hospital.  
“I’ve always thought of hospitals as my own personal jail. Once I entered the ICU, I couldn’t leave until the end of my shift. I couldn’t even go out to catch my breath, or even to pee. I go to work crying, and I go home crying.”
Quinn during her 3-year stint at St. Luke’s Medical Center in Philippines

Her usual shift of 12-14 hours per day would even extend to 16 hours per day. A mom of two, Quinn complained about how her off days were spent sleeping and resting instead of spending quality time with her family. Even on her off days, the hospital will still call her for the most mundane reasons.

Quinn also recalled one of the most absurd requests from a patient, “a VIP patient asked me to floss his teeth for him even if he can do it on his own. I couldn’t complain because what if he also files a complaint against me?”

Quinn’s final straw to work abroad was when her kid who was 1 month old then caught pneumonia. Despite working as a healthcare worker, she still needs to pay fifty percent of her child’s hospitalization because she still wasn’t a regular employee then. “We were scared. My baby needs immediate care but I don’t have the money. If I stay here, how can I raise two kids and save up with our meager salary? So I told my husband, ‘We need to leave. We will die here.’”

Things turned for the worst after the pandemic hit. Because of the lockdown and the fear of bringing the carrier of the virus to her kids, Quinn decided to stay in the hospital for two months. “It was hard, not being able to see your kids. But I did it anyway because they gave us an additional 1,000 pesos (18 dollars) if you’re assigned to the COVID ward. In my head, I took the risk because I want to save up for the money that I will be using to go to the US.”

Asked if the extra pay was worth risking her life for, Quinn laughed and said, “I just needed to do it so I can leave right away.”
According to the Philippine Nurses Association, the starting salary in private hospitals range between 9,000 to 14,000 pesos ($155 to 240 dollars). In 2018, the National Migration Survey (NMS) said that this wage level means nurses are living just above the poverty line for a family of five. With this, the government raised the salary of nurses to an average of 32,000 - 40,000 ($550 to 700 dollars) every month.
But still, the Philippine Nurses Association is pushing to close the disparity in the wide gap in wages between the private and government sector in the hopes of preventing the nurses from leaving the Philippines.

According to the Philippine Nurses Association, the starting salary in private hospitals range between 9,000 to 14,000 pesos ($155 to 240 dollars). In 2018, the National Migration Survey (NMS) said that this wage level means nurses are living just above the poverty line for a family of five. With this, the government raised the salary of nurses to an average of 32,000 - 40,000 ($550 to 700 dollars) every month.   

But still, the Philippine Nurses Association is pushing to close the disparity in the wide gap in wages between the private and government sector in the hopes of preventing the nurses from leaving the Philippines.   

Burned out

Mary Rose, 29, is one of the 75,000 nurses currently working in the Philippines amid the pandemic in a public hospital in the nation’s capital. During the surge of COVID-19 cases, Mary Rose said she wasn’t able to see her family for three months. She worked in the COVID ward for seven months straight wherein she would work for 14-16 hours every shift.

Pre-pandemic, Mary Rose enjoyed being a nurse and takes pride in taking care of her fellow Filipinos despite it being a very demanding job, but things took a one-eighty after the pandemic hit. Patients started filling up the hospital and the hospital had to put up makeshift tents as holding areas donated by the private sector. The holding area and the COVID ward also reached full capacity and at times, exceeded the capacity. These weren’t ideal, but they made do with what they had.
“I liked working in the ER pre-pandemic because that’s where the action is. I see about 20 patients in my 8-hr shift.” Mary Rose said there was a lot of pressure because that’s 20 lives under her care, but it became more toxic during COVID season. Patients died under her watch. “I began to ask why this keeps happening to me even after doing everything we can for the patient.”

Aside from the mounting death toll, healthcare workers were all physically, mentally, and emotionally exhausted from the situation. “There were times when I didn’t want to go to work. Just thinking about going to work exhausts me. But I have to show up because I’m needed.”

Things got worse for her when the news of her uncle’s passing due to COVID reached her. “It pained me that I wasn’t there for my family. I questioned everything, I told myself that I was very kind and compassionate to the patients, but why did this happen to me? I felt guilty then that those thoughts crossed my mind, but I guess that’s life,” Mary Rose shared crying. His uncle died due to a lack of equipment at the hospital where he was brought due to the high volume of COVID patients.
Mary Rose in one of her COVID ward shifts

“I liked working in the ER pre-pandemic because that’s where the action is. I see about 20 patients in my 8-hr shift.” Mary Rose said there was a lot of pressure because that’s 20 lives under her care, but it became more toxic during COVID season. Patients died under her watch. “I began to ask why this keeps happening to me even after doing everything we can for the patient.”

Aside from the mounting death toll, healthcare workers were all physically, mentally, and emotionally exhausted from the situation. “There were times when I didn’t want to go to work. Just thinking about going to work exhausts me. But I have to show up because I’m needed.”   

Things got worse for her when the news of her uncle’s passing due to COVID reached her. “It pained me that I wasn’t there for my family. I questioned everything, I told myself that I was very kind and compassionate to the patients, but why did this happen to me? I felt guilty then that those thoughts crossed my mind, but I guess that’s life,” Mary Rose shared crying. His uncle died due to a lack of equipment at the hospital where he was brought due to the high volume of COVID patients.
Emergency Response Team at Tondo Medical Center

Nurse deployment ban

It was in 2017 when Kim, who earlier said she will never leave the country for a job, explored the idea of working in the United Kingdom. At that time, her mom was already sick, and she didn’t want to worry about money should her father falls ill as well. That’s when she snapped and told herself to think about the future.
She was already in her last few steps of processing her documents and completing requirements when the pandemic hit. By then, COVID-19 cases were at their peak, and the national government through the POEA and the Department of Labor and Employment implemented the restriction of nurses from leaving the country at the onset of the pandemic. The government has set a 5,000 annual deployment cap which was later on raised to 6,500 newly hired healthcare workers.

The nurse deployment ban was enacted even after then Labor Secretary Silvestre Bello III said in 2021 that there is an “oversupply” of nurses in the country, which makes the ban unnecessary. Former senator Richard Gordon also reiterates that this restriction violates the rights of the nurses.

“I was scared that my IELTS and all other certifications will expire. I felt defeated, what’s the point? They wouldn’t let me go anyway. We’re expendables, like a commodity to them.” Despite this, Kim also felt guilty about having to leave the country at a time when it needs more nurses to care for Filipinos. But at that point, she decided to choose her future and her family.

Life abroad

It may have been easy for Jett to leave the country, but he was later slapped with the harsh realization that finding a job in the US – the promised country for nurses - is not a walk in the park as people and the government make it seem to be. It took him five months before landing a job in New Mexico.  
“It was so frustrating. I remember sending out resumes to so many hospitals and attending interviews almost every day, but to no avail,” said Jett, who is now in his fifth year working as a nurse in the US. Since he did not have any hospital experience, he was considered a “no skill” nurse. But Filipino nurses helped him learn the ropes. “You know there’s an unwritten ‘Filipino standard’ here where nurses have to be the best in what we do.”  
Jett said he rarely experienced feeling discriminated against or having racist comments thrown at him while working as a nurse. While he recalled a certain time when a patient’s entitled wife did not trust him because he was not white, he had the chance to prove himself after saving her husband from bradycardia (slow heart rate). “They were really thankful for me after that and I gained their trust.”  
But not everyone is as lucky as Jett, a US citizen, who was able to pack his bags and leave his home country, no-frills and all.  
For many Filipino nurses, relying on agencies to get the chance to work abroad is the norm. Jeannette, 31, recalled her experience when she started applying back in 2011. “I was doing door-to-door in Ermita (Manila). I’d knock on every agency’s door and my spiel would be, ‘Hello, do you accept 21-year-old nurses?’” Jeannette shared laughing, who said it seemed like she was ‘pimping’ herself to agencies back then. She tried her luck after realizing that working as a nurse in the Philippines would get her nowhere.  
“There are no work opportunities here if you do not know anyone who can get you in. I applied to so many hospitals,” she said. “It’s either they’re not hiring, or they’re only looking for volunteer nurses.” 
Jeannette worked as a volunteer nurse for six months after college before applying abroad. She said that companies do not consider volunteer work as work experience, so the agency she applied for had to fake her certificate of employment then. “I just realized now that that was so scary.”
Jeannette went on to work for a two-year contract in Saudi Arabia. “I was 21, earning P20,000 ($370) so I thought that’s more than triple the nurses’ salary here,” she said. In 2011, the wages of a nurse averaged P6,000 ($110) per month. In Saudi, she also received benefits like free housing, transportation, and health benefits where she worked as a nurse at a dental clinic.
Life in Saudi Arabia wasn’t all peachy. Jeannette had to learn everything from scratch since dentistry wasn’t part of her background. She also experienced getting locked up in their dorms with other female nurses at night so no one could leave or enter their house. It lasted for three months, the company only stopped doing it after they complained to authorities.

After her contract lapsed, she applied as a nurse in a government hospital in Saudi. Aside from enjoying a higher salary, she also got better benefits - groceries, free accommodation, transportation, skincare items, laundry, and 45 days of vacation leave every year. These benefits are not given in the Philippines.

“We were also given free training if you want to become a trainer or transfer to another department. In the Philippines, you pay for your training if you want to upskill,” she said.

According to studies, the high nurse-to-patient ratio and extremely low wages were among the top reasons for the mass exodus of Filipino nurses. This further exacerbates the working condition of the nurses who remain in the Philippines and the pandemic even worsened them.

Jeannette (middle) as a nursing student with her classmates  / Jeannette (right most), with her co-workers in Saudi Arabia

Modern-day heroes

While the late dictator and president, Ferdinand Marcos, was the one who initiated the labor export program for Filipinos in the 1970s, it was his successor, President Cory Aquino, who coined the term “bagong bayani” (modern-day heroes) for Filipino economic migrants.

Simply put, “bagong bayani” becomes the tag and the dominant narrative attached to workers who sacrificed being away from their loved ones in the Philippines to provide for their families. Consequently, these remittances have allowed the Philippine economy to survive even in turbulent times.

In the 2021 data released by the Central Bank of the Philippines, cash remittances sent home by OFWs reached a new high, amounting to $31.418 billion, which is around 8.9 percent of the country’s gross domestic product (GDP). This gave the country’s economic recovery a much-needed boost.

Today, this term is a popular term to pertain to Filipino migrant workers, but the real meaning of the term may have lost its meaning.

“That term does not apply to me. I left the Philippines for very selfish reasons. My goal is to leave the Philippines because I didn’t see a future there,” said Quinn. “Even if you work yourself to death, you will not be able to get out of poverty.”

Jeannette winced after hearing the term “bagong bayani.” “I get annoyed whenever I hear that term because I don’t think that’s true. The government just says that so you feel good about your contributions to the country.”

Jett paused and concurred, “In a way, it’s true and it’s not. They call us that because of the remittances. It’s like they’re just milking you for the money. On the other hand, yes, all the sacrifices you do abroad to provide for your family makes you a modern-day hero.”

Meanwhile, Kim ponders on the term “bagong bayani.” “If you leave your country in the middle of a pandemic when they needed you the most, are you still a hero?” she stated. “How do you define it, really? A hero for whom? My family? In my country who benefits from pounds? I wouldn’t tag myself as such.”

But in the time of pandemic, Filipino nurses truly lived up to that moniker, and it’s not because of their monetary contributions to their home country, but because of their selfless act in saving people’s lives, albeit a big chunk of them had to pay an even bigger price.

In a study done by the National Nurses United (NNU), it revealed that out of all the registered nurses who succumbed from COVID, 21% accounted for Filipino nurses, despite them only making up 4% of the nurses in the US.

Zenei Cortez, the NNU president, says that this is still underreported. She also relates that this could be related to Filipinos’ innate trait to care for the welfare of other people, one of the reasons why Filipino nurses are well-loved, even if it means putting themselves in the face of danger.

Quinn and Jett echoed this sentiment. Quinn shared, “the level of care our nurses give to their patients are on a different level. When I first came here, I noticed that they would always go and check the patients.”

Living the dream

It all starts with a dream, as it so often does with any ordinary Filipino thinking of providing their family with more than just the necessities – owning a home, buying a car, taking a vacation now and then, and maybe even saving up for a rainy day.   
But in a country like the Philippines, where poverty and corruption are the norms, Filipinos are not just being robbed of the chance to earn a decent wage to live a decent life, but more so, they are being devoid of the right to dream.   
But as I talked to these nurses, I learned that while they were forced by their parents into an industry that they didn’t want in the first place, in one way or another, they were still able to make lemonades out of the lemons thrown their way, and to dream again.  
Being a nurse in the Philippines may have made them hate the profession, but experiencing the way they should be treated - with recognition and reverence - allowed them to fall in love with the profession, value their self-worth, and grow as a person.  
“You have the chance to elevate your life here, you can’t do that in the Philippines. If only they (the government) give us opportunities, I’d never leave the Philippines,” said Quin. She said it’s sad that healthcare workers are leaving, but they too deserve to live decent lives. “How will we feed our families? Imagine you’re a nurse yourself, but if and when your loved one gets sick, you can’t afford to send them to a hospital.”  
Quinn said she misses the comfort of being with her family, but being in the US allowed her to mature. “I didn’t grow there because my family always has our back. Here, you pay for your apartment, you take care of your children, everything. My husband and I don’t have anyone to rely on but ourselves. You will be forced to be responsible for your own life. I only learned how to cook and drive here,” said Quinn, who just learned how to cook and drive after arriving in the US. She is now starting to realize her dream of becoming her own person, empowered that she, her husband, and two kids are in a good place for a fresh start. 
Quinn recalled the time when she was still struggling in the Philippines, unable to buy her kids expensive shoes. “That’s one of the first things I bought for them. Now, I can buy them Crocs!,” said Quinn, who feels at ease she can now buy stuff for her kids she used to think was expensive.
Jett echoed Quinn’s realizations. “You and other Filipino nurses will help each other out, but at the end of the day, you are on your own,” he said. Though he jokes that he still sometimes tells his mom he needs him whenever he’s tired. “I have become independent.”
“I was 21 when I first left. There are a lot of firsts for me when I left - cooking, doing my laundry, doing household chores. If I don’t cook, I won’t eat. I didn’t even know then how to use the washing machine. There were no ‘free trials,’ you have to take it head-on,” said Jeannette, the family’s youngest child who used to be sheltered and pampered, but grew as a person after leaving her parents’ nest.
As for Mary Rose, she’s waiting for her loyalty award, an award given to workers who have dedicated at least 10 years of their lives to government service. “It’s funny, that I can’t leave because of this plaque, but I want something that will remind me of the service I rendered.”
She hopes to migrate to Canada with her relatives and bring her parents with her. “It seems like people who live in Canada live long, I’m doing it for them,” she said.
Kim, who admitted that her first year in the hospital traumatized her, said that she realized that her anxiety was triggered by her managers then and with a better working relationship with doctors, she rarely questions her abilities anymore and is even thinking about how can she upskill. 
“Nursing is a very noble job,” said Kim, who now sees its value and why her late mom sees it as such. “It’s very heartwarming when patients say “thank you,” when you help people. I hope it can once again be viewed as a very noble job that nurses can go into the industry with the intent to help people, not because it’s a ticket out of the country.”
“It’s sad that I fall in love with it again here because I’d want to feel that in my own country. I’d want to use my skills there. But my sacrifices will be for naught. It’s so hard to love the Philippines.” Today, Kim is reunited with her longtime boyfriend and is now building a future together.
Quinn working as nurse in the US  / Kim, who is now thriving as a nurse in United Kingdom

Carmina Giezzele G. Mones

Writer
From writing for her school paper to her personal blog, and later on for television, Carmina Giezzele Mones believes in the power of stories and how they can connect and move people to work together and transform the world. She has a diverse background in broadcast media and is currently working as an information officer and is pursuing her Master of Development Communication at the University of the Philippines Open University.