Filipino Nursing: A conversation with the dean

An hour long Grab car ride (the company that bought out Uber in South East Asia) outside the Makati business district of Manila took us to the De La Salle Health Sciences Institute (DLSHSI) campus. Its nursing school jockeys for the number one spot in the country each year. Over the last decade, students at DLSHSI have passed their Nursing Licensure Exam boards with a 96-98% passing rate and an 100% rate in 2016 and 2017, and they always have one of the top 6 nursing students in the country based on these scores.

We had the privilege of talking to the dean and some of her staff, and beyond their friendly demeanor, were impressed by their commentary on nursing in the Asia Pacific region, strategy for nursing education excellence, and the evolution of the archetypal student over the past three decades.

19,000 nurses leave the Philippines each year to work abroad, and despite the fact that the country is the number one exporter of nurses across the globe, the country does not face a nursing shortage itself. While the Philippines has historically tailored curriculum to US standards, with increasing nursing shortages in most developed countries, the country has begun updating curriculum to ensure cross-competency in the UK, Australia, and parts of the Far East like Japan and South Korea. However, these jobs create a “brain drain” of sorts on home soil, as greater financial incentives, better growth trajectory, and greater ability to specialize keep many overseas.

A lull in the growth of global demand on the heels of the financial crisis led to an overabundance of nurses domestically and a crack down on sub-par nursing programs in 2011. New regulation now requires that schools have sufficient training laboratories, faculty with robust teaching credentials, the availability of a base hospital for clinicals, and a certain percentage of students to pass board exams. Just in the region around DLSHSI, 16 nursing schools have been closed as a result.

At De La Salle, all classes are taught in English, and some of their students come from abroad.  90% of the faculty have or are completing PhD degrees, and the school has a simulation laboratory more well equipped than many in the United States.

“The most valuable lesson students learn at De La Salle [however] is discipline.”

-Says a graduate who is now head nurse at a unit in New York City.

Outside global demand trends, the biggest changes nursing school administrators have seen has been with the students themselves. A member of the academic administration noted that during her 27 years of teaching at De La Salle she has seen less confidence and willingness to learn new skills and work hard, and more “attitude” than when she first started. She noted other millennial characteristics: more emotional instability, less respect, and more “gadget distraction.” Another difference she noted are the prevalence in mental health conditions. While there may have been 1 student out of 160 with an identifiable mental health condition at the start of her tenure, there are now several out of a class of 40 diagnosed with depression, bipolar disease, or ADHD. All of these combined factors have led to a more challenging teaching climate as instructors wear more hats: a teacher, a parent, a friend, a mental health counselor, and, for students who have been shielded from disappointment by their parents, a disciplinarian. In response, nursing schools like De La Salle then have opted to take a more individualized approach to cater to these changing student demographics.

As Philippines is the number one exporter of nurses in the world, it is crucial that nursing institutes throughout the world create solutions together to prepare for changing healthcare ecosystems, a rise in digitization, and new generations of global student leaders.