Wanted: Another 40,000 Nurses!; Thailand Health Crisis

[webfact]

HEALTH CRISIS

WANTED: Another 40,000 nurses!

By Pongphon Sarnsamak

The Nation

Large incentives being offered as state hospitals fighting for graduates

State-run hospitals across the country are competing strongly to grab newly graduated nurses because of a severe shortage blamed on government inattention over the past few years.

Khon Kaen Hospital director Dr Peeraphan Suwanchaimart said even though his hospital had 800 nurses, it was not enough because of the National Health Security Office's policy to extend medical services under the universal healthcare scheme.

The hospital also had to provide medical treatment for patients transferred from other hospitals, especially from rural facilities.

Currently, the hospital has to provide medical services to about 3,000 outpatients and 300 emergency patients a day. The hospital also has to treat about 900 in-patients.

But nurses could no longer shoulder the heavy workload, as many were getting older. So, the hospital had to recruit younger nurses to keep up its treatment standards.

However, the hospital now faced challenges from other centres with staff shortages.

"We have to compete with other hospitals for nursing students and provide scholarships or grants, otherwise they will sign long-term contracts to work at other hospitals," Peeraphan said.

The hospital had been forced to provide Bt60,000 scholarships to attract new graduate nurses and asked them to sign a contact to work for two years to resolve the nursing shortage.

During the past few years, there had been intensive rivalry among state hospitals for nursing graduates.

"We had to step back [in the race for] nursing students, as some hospitals had offered over Bt150,000 to them. We could not offer so much money," he said.

At Khon Kaen Hospital about 300 of the 800 nurses are employed as temporary workers. But such employees have been resigning due to the heavy workload, and going to work at private hospitals.

Chon Buri Hospital is another that has faced a severe shortage of nurses. Director Dr Chatri Tantiyawarong said the hospital needed over 900 nurses to work there but now had only 500.

"Even though the hospital has tried to recruit newly graduated nurses, no one has walked in and submitted a job application," he said.

To resolve the problem, Chon Buri set up a booth at the local university to recruit nurses. The hospital offers scholarships and a monthly salary, together with Bt13,500 when graduates sign a contract. New recruits also get benefits such as over-time and special allowances.

"Only 10 newly graduated nurses a year come to talk with us and want to work at the hospital," he said. "Some just work for a few months and then resign due to the workload."

The hospital now has teamed up with a local university and other educational institutes to train its "own" nurses, by supporting them with Bt30,000 scholarships.

According to a recent survey conducted by the Thailand Nursing Midwifery Council, Thailand needs about 180,435 nurses in the health system but has only 138,710.

Human Resources for Health Research and Development Office (HRDO) manager Nongluck Pakraiya, who conducted a study, said many general and provincial hospitals, especially in the Northeast, had to resolve the problem by themselves.

They offer student nurses grants of Bt60,000 up to Bt160,000 and other benefits while in their first year of university. Nursing students were also asked to sign deals so they stayed with the hospital for four years.

The high demand for new nurses or nursing students at state hospitals has been caused by many senior nurses leaving over the past few years. Many experienced nurses could no longer bear the heavy workload, she said.

Another problem is most new nurses don't want to work at health ministry hospitals, as they are designated as temporary employees - not civil servants. They prefer to work at private hospitals instead, where they get higher wages for less work.

A 23-year-old nurse, who did not want to be named, who works at a state-run teaching hospital with a university, said she was offered a Bt150,000 scholarship by a state hospital while doing her first year at nursing school.

She had to sign a contract with the hospital and promised to work there for four years. Failing to complete the contract would have meant having to pay Bt300,000 back to the hospital in compensation.

She could get over Bt20,000 a month in salary to lift her quality of life but had to face a heavy workload everyday in the emergency department.

"Even though I face heavy workloads I will continue to work at this hospital as I can get an opportunity to improve my life," she said.

-- The Nation 2011-06-14

[zakk9]

With private hospitals offering higher salaries for less work and selling health services to foreigners and wealthy Thais, this is not going to improve soon. The best graduates go where they can get the best working conditions and salaries. To make things worse, there aren't teaching facilities or teachers enough to increase the number of nursing students overnight.

Those who suffer are the less qualified nurses who have to work more for less money, and the patients that can't afford to go to private hospitals.

No extra points for guessing which political party will get additional votes as a result of this. Then, there will be another military coup, then, the reds will take to the streets again, then, people will get killed... back to square one.

[whybother]

With private hospitals offering higher salaries for less work and selling health services to foreigners and wealthy Thais, this is not going to improve soon. The best graduates go where they can get the best working conditions and salaries. To make things worse, there aren't teaching facilities or teachers enough to increase the number of nursing students overnight.

Those who suffer are the less qualified nurses who have to work more for less money, and the patients that can't afford to go to private hospitals.

No extra points for guessing which political party will get additional votes as a result of this. Then, there will be another military coup, then, the reds will take to the streets again, then, people will get killed... back to square one.

Why would any party get additional votes over this? None of them have done anything for a few years, and none of them have policies to do anything.

[anterian]

One perennial problem in Thailand is language, Britain has a nursing shortage, we recruit qualified Filipinos, as do many other countries. Indeed the Philippines is increasingly geared towards exporting trained nurses, care givers and English language teachers. However, a nurse to be 100% effective needs to be able to talk with the patient.

[Berkshire]

One perennial problem in Thailand is language, Britain has a nursing shortage, we recruit qualified Filipinos, as do many other countries. Indeed the Philippines is increasingly geared towards exporting trained nurses, care givers and English language teachers. However, a nurse to be 100% effective needs to be able to talk with the patient.

Problem? Do you see the irony in your comments? If Thai nurses were more proficient in English, the nursing shortage in Thailand would be much, MUCH worse, as said nurses would be scampering to the west, just like the Filipinos. The nursing shortage in the PI is much worse than Thailand for precisely this reason.

[anterian]

One perennial problem in Thailand is language, Britain has a nursing shortage, we recruit qualified Filipinos, as do many other countries. Indeed the Philippines is increasingly geared towards exporting trained nurses, care givers and English language teachers. However, a nurse to be 100% effective needs to be able to talk with the patient.

Problem? Do you see the irony in your comments? If Thai nurses were more proficient in English, the nursing shortage in Thailand would be much, MUCH worse, as said nurses would be scampering to the west, just like the Filipinos. The nursing shortage in the PI is much worse than Thailand for precisely this reason.

Yes I am aware of the irony, but not quite as you suggest. The nursing shortage in Phil is due to the lack of funds to employ them. As Filipinos, particularly Pinays, are extremely supportive of their extended families, this drives them to seek work overseas. Whenever you see a shortage of nurses, always look to their salaries for the real reason.

[818mike]

Neither Thailand or Phil can compete with the nursing wages offered abroad in US, UK etc. If the Thai nurses spoke English as well as the PI ones, the US would gladly take them. It is even a stereotype for PI women in the US.

My ex-wife was born in PI and many of her family members are nurses.

[pisico]

<br />Neither Thailand or Phil can compete with the nursing wages offered abroad in US, UK etc. If the Thai nurses spoke English as well as the PI ones, the US would gladly take them. It is even a stereotype for PI women in the US. <br /><br />My ex-wife was born in PI and many of her family members are nurses.<br />

<br /><br /><br />

Just go to Yanhee and Bumrungrad hospitals and you will easily see th[r]ongs of Filipino nurses, males and females, working full time and with work permit for two reasons: 1: their schooling resembles pretty much the USA standards. 2- their fluency in English.

Thais are not taught in a dynamic environment anywhere and English proficiency is given marginal attention as part of the curriculum. My ex is also a nurse and she is Thai and is about to finish her Master's Degree. Her thesis of choice was the incidence of Cancer of the Cervix in Thailand and Cambodia and the causes, among them, cultural. She was forced to change it to a social issue thesis regarding women's rights in the Western Society. Her English was a tad better than the norm of Thais who have knowledge of the language. Her writing atrocious and spoken word clear but haltingly, much like my dismal Thai.

Who can expect such an educational system devoted to a large degree to perfunctory attendance and ceremonial and ritual activities, that have nothing to do with science, to produce excellence in their graduates, much less in large numbers due to the salaries constraints? Additionally, private hospitals are opting out increasingly from the socialized medical system in the country thus, compounding the problem: fewer hospitals participating, a greater load on the ones still in the Universal health care scheme. That was a headline in The Nation and TV not long ago. This is Thailand.

Edited June 14, 2011 by soundman
Corrected throngs.

[Bagwan]

My experience over the years has been that in the private hospitals Thai custom is followed and that overmanning seems to be chronic. It is by no means unusual for me to see 3 or 4 nurses standing around chatting. In the State hospitals I rarely see a nurse standing still at all. They must be totally knackered at the end of their shifts. When visiting family members or friends in a State hospital I always take a large box of chocolates for the overworked and underpaid nurses.

In a perfect world the O and M people could move into the private hospitals, and the numbers who are moved on offered positions in the public service. Alas, this is not a perfect world and this or any Thai Government will provide sensible levels of funding to bring this about.

[exbelg]

why don't they go find some girls in india? they only cost lost of money there to the family

[ginjag]

My experience over the years has been that in the private hospitals Thai custom is followed and that overmanning seems to be chronic. It is by no means unusual for me to see 3 or 4 nurses standing around chatting. In the State hospitals I rarely see a nurse standing still at all. They must be totally knackered at the end of their shifts. When visiting family members or friends in a State hospital I always take a large box of chocolates for the overworked and underpaid nurses.

In a perfect world the O and M people could move into the private hospitals, and the numbers who are moved on offered positions in the public service. Alas, this is not a perfect world and this or any Thai Government will provide sensible levels of funding to bring this about.

Agree with you, one thing that has not been commented on is prevention is better than cure---stop the people going to the hospitals so often !!!! Khon Khen Hospital had 300 emergencies in a single day, police and law enforcement, would stop 50% of AEU.............When I visit my local it's full of Thai's who are bored-with little wrong with them they go to hospital with a cough!! taking up so much time. A pity they cannot have a local state doctor as the west-to visit if a problem. NOT involve the hospital. It's all iffs-and easy to speak . The admittances locally include drink related-- road accidents--abuse--dirty food--and child related to parental care(neglect). Maybe correcting these issues they would have to lay-off nurses rather than recruit :whistling:

[Amras]

Hmm. Very very interesting. Shortages all over the world for nurses yet, most aren't paid relative to the work they do.

Anyone actually know the monthly salary of a graduate nurse? My girlfriend recently asked about nursing school/college (vocational one) and it gives nearly the equivalent of a university degree (almost). When we asked what the starting salary was, she was told 6,000 baht per month.

I knew it wouldn't be big, but this seemed a little low? Anyone know from direct experience? Maybe it's different up north in Chiang Mai?

If it is this low, then understandable, why would you study for 3+ years to be paid the same as a waitress.

[MaiChai]

Cost of healthcare in Thailand is rocketing; to the point where people are dieing because they cannot afford it. While all these parties are bandying around their populist policies to get votes, whoever gets into power is going to have to get a grip with this health problem. Otherwise it becomes something only rich people can afford and alot of people are going to die. Basically what happens is if you need emergency surgery, they won't operate until you make a sizable advanced payment. If you don't pay, they will nurse you until you die.

[webfact]

SHORTAGE OF NURSES

Govt urged to change stance on recruitment

By PONGPHON SARNSAMAK,

DUANGKAMON SAJIRAWATTANAKUL

THE NATION

Medical staff seek job security otherwise more could migrate to private hospitals, experts warn

The Thailand Nursing and Midwifery Council has called on the government to provide more civil service positions for newly graduated nurses and to reduce the heavy workload for ageing nurses at state-run hos?pitals.

Its aim is to cut the chronic problem of shortage of nurses and retain nurse staffing levels in public hospitals, especially in rural areas.

"They want job security for their working lives," the coun?cil's second vice-president, Dr Krissada Sawaengdee said.

The move follows a nation?wide shortage of nurses since the government implemented a policy to cut the public serv?ice, affecting medical services at state-run hospitals.

Krissada said during the past few years, the Public Health Ministry has been unable to retain either newly graduated or experienced nurses in state-run hospitals which has become a big issue.

About 20 per cent of nurses resign their positions at state-run hospitals within five years of being recruited.

"Once upon a time, they wanted to be nurses because they loved it and wanted to help patients but times have changed. They want to be nurs?es because they want job secu?rity," she said.

As a result, the Public Health Ministry and the government should adjust their attitudes towards nursing as a career - not ask them to sacrifice them?selves and demonstrate a vol?unteer mindset, Krissada sug?gested.

The ministry had not han?dled this problem well, nor does it understand the nursing shortage situation. In fact, its policies have worsened the situation, Krissada added.

Since the economic crisis in 1997, the government has implemented a policy to limit civil service growth and also cancelled its programme compelling newly graduated nurses to work at state-hospitals for four years before any change in career.

" This policy had left nurses to freely choose their careers," she said.

Moreover, the medical hub policy to attract foreign tourists to receive medication in Thailand was another key factor that has attracted nurses away from public hospitals.

" We found that during 2005 - 2006 about 23 per cent of newly graduated nurses decided not to work in public institutions," she added.

Private hospitals need about 20,000 nurses but now have only some 12,000 - meaning more will be persuaded to move out of the public sector.

To find a resolution to the nursing shortage, Krissada and her research team are now conducting a study to follow up on the quality of health and the working life of nurses for the next 20 years.

The study was supported by the Health System Research Institute and Human Resources for Health Research and Development Office.

Preliminary results of Krissada's study found large numbers of nurses aged under 30 resigning their jobs after working for only three to four years for state hospitals.

"The ministry will [continue to lose] younger nurses working at state-run hospitals if there are no measures to retain them for at least five years," Krissada said.

Her study also found the average age of nurses working at general provincial hospitals and central hospitals was over 40 years; while the average age of nurses at district hospitals was about 37.

About 30 to 40 per cent of nurses aged over 45 years had to regularly work the night shift.

"The poor quality of [working] life of nurses will finally affect medical services provided to patients," she said.

Meanwhile, the Public Health Ministry's deputy permanent-secretary, Dr Narong Sahamethapat, said the ministry is now trying to solve the nursing shortage problem.

It has asked the government to create 20,000 civil service positions for the ministry, about 10,000 of which will be allocated to nurses.

The government has set up a subcommittee to study the medical personnel shortage and estimate the future demand for nurses. Narong said most hospitals had solved the problem by shouldering the financial burden, using their own budget to hire nurses as temporary employees.

"We have to work together to seek the way out," he said, adding, "We should work either as a bureaucratic system or we should work as a public organisation to deal with this on-going situation."

-- The Nation 2011-06-15