Nurses To Rally At Thai Govt House; Demanding Permanent Contracts, Less Workload

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SPECIAL REPORT

Critical condition

Chularat Saengpassa,

Pongphon Sarnsamak

The Nation

Thousands of nurses to rally at Govt House tomorrow; demanding permanent contracts, less workload

BANGKOK: -- Each year, hundreds of nurses at state hospitals have left their jobs due to hard work conditions and poor welfare. The staff exodus has forced some public hospitals to shut down wards.

Thailand's public health service, already plagued with a shortage of physicians and other problems, may face a worse state, as 17,000 nurses nationwide are threatening to quit unless the government improves job conditions.

Failure to properly resolve this long-running problem could hit state hospitals severely, as the ratio of nurses in Thailand is already lower than neighbours like Singapore and Malaysia.

In Thailand, there are just 1.5 nurses for every 1,000 people, compared to 5.9 in Singapore and 2.3 in Malaysia. In Norway, the country rated by the World Health Organisation to have the best medical care, the ratio is 31.9.

According to a survey by The Nation, many hospitals have to shut down wards - especially pediatric and surgical ones, because they don't have enough nurses to provide appropriate care to patients.

Rajavithi - a leading hospital and one of the country's biggest- has faced a shortage of nurses for more than 20 years. Due to this chronic problem, which has never been resolved, the hospital has had to close surgical rooms, as it hasn't enough nurses, who are the backbone of surgical teams.

"Shutting down surgical wards has made patients wait for so long and put them at risk of severe conditions," the hospital's director Dr Varunee Jinarat said in an exclusive interview.

The hospital has 36 surgical rooms but two have already been closed due to the lack of nurses.

"We cannot undertake surgery on [all] patients because we don't have enough surgical nurses to provide special care for patients even though we have many surgeons," she said.

The hospital needs at least 50-60 surgical nurses. It also needs more nurse anaesthetists to help doctors undertake surgery, Varunee said.

"We have to hire surgical nurses and nurse anaesthetists from private hospitals as a part-time job to help us undertake surgery and look after our patients," she said.

"We have to ask our nurses to use their connections - to invite their friends, who are nurses working at private hospitals, to work with us on a part-time basis. And we pay good money for them."

But it was tough to get nurses from private hospitals to do part-time work, as Rajavithi couldn't afford to pay rates over what they get at a private hospital.

At present, the hospital has 904 nurses and nursing assistants to look after patients. Some 881 of them are professional nurses and the rest nursing assistants. To reach top medical standards, the hospital should have 1,200 nurses to proving care, as it has about 1,200 beds for in-patients, Varunee said.

The hospital has to treat at least 4,500 patients a day at its outpatient department and nearly 1,200 a day at its in-patients department.

"The hospital's executives have been discussing the nursing shortage problem and finding a way out every week. We must to update the number of nurses working with the hospital every day," she said.

The shortage of nurses occurs not only in big hospitals in Bangkok like Rajavithi, but rural hospitals such as Chaibadarn Hospital in Lop Buri.

"We have to work around the clock, [with] no time for us to take a rest," Kanniga Panya-Amornwat, chief of nursing at Chaibadarn, said.

The Lop Buri hospital has only 90 nurses to care for 150 - 200 patients a day. And nearby hospitals also refer patients because it is the main facility in the district thanks to its specialist physicians in fields like obstetrics, pediatrics, and medicine.

Patient numbers at Chaibadarn have risen drastically in recent years. But due to the nurse shortage, some have to sleep in the corridor and can't get fast service.

This hospital should have 140 nurses to provide quality care to patients but only has 90 nurses, Kanniga said.

While Rajavithi Hospital had to close two wards, the severe lack of staff has prompted Chaibadarn to merge its pediatric and adult intensive care unit into the same room, so nurses can care for both young and adult patients.

At Bang Pa Han Hospital in Ayutthaya, they have the same problem. Two temporarily employed nurses resigned recently to get better pay at other hospitals.

Upcountry, at Maharat Nakhon Ratchasima Hospital, they also have a severe nurse shortage. Even though the hospital has enough money to offer nurses more than some other state facilities, recruitment ads win few applicants. Currently, nurses have to serve 12 patients in a day.

The nurse shortage at state hospitals across the country is caused by tough work conditions and poor job security. Some are hired on just temporary contracts, which must be renewed every year.

But those working for private hospitals can earn Bt30,000 a month, excluding average overtime expenses of Bt187.5 per hour, while auxiliary nurses earn Bt15,000 a month and Bt62.5 per hour. These high rates encourage "temps" to seek higher-pay positions at private hospitals. And nurses who can also speak English are now being lured by foreign hospitals, particularly in Singapore, which is competing with Thailand to become the region's top medical hub.

"What will happen to them if some day the hospitals have no money and cancel their contracts? We have found some that have worked for six months without any pay," Krisada Sawaengdee, the second vice-president of Thailand's Nursing and Midwifery Council, said.

About 150,000 professional nurses aged up to 60 have registered for licences with the council but only 130,000 of them work at hospitals across the country. Some 17,000 have been hired as temporary nurses at state hospitals. But about 300 to 400 resigned from state hospitals every year.

The council estimates Thailand will need 50,000 nurses to work at both state and private hospitals by 2017 to care for the population, expected to be about 70 million then.

Tomorrow, about 3,000 temporary nurses plan to gather in front of Government House to call for a change in their job conditions. They want greater job security - for the government to offer permanent contracts and cut their workload.

Kanniga, a committee member of the Nursing and Midwifery Council, said about 17,000 temporary nurses were threatening to resign from state hospitals, if their demands are not met within three months.

-- The Nation 2012-10-15

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Nurses have their say

The Nation

LOP BURI: -- Juthamart Baipokthong a professional nurse working in the emergency department of Lop Buri's Chaibadarn Hospital

"When I decided to study nursing, I was convinced I was going to have a secure job. But things haven't turned out the way I expected...I have been working as an employee for years, never knowing when my employment contract will be terminated. I don't want to give up, though. I want to be recruited as a civil servant one day. Of course, as a nurse, I want to help patients. But I also hope I can enjoy a secure job too".

Yupin Ketdee a professional nurse at an inpatient ward of Lop Buri's Chaibadarn Hospital

"I have been working really hard because the ward has about 49 inpatients to tend to... Competition for civil-servant nursing spots is so high. There were only eight seats available the last time the exam was held.

"I am now preparing myself for the next exam…But if I really can't enter the civil services, I may consider starting a small business."

Oratai Tumnok, a professional nurse at the intensive-care unit of Lop Buri's Chaibadarn Hospital

"I have been working at state hospitals for seven years, but still have not been recruited as a civil servant…Sometimes, I think I should apply for a job at a [different] hospital instead. But my parents really hope to see their daughter become a civil servant. I have thus decided to stay put."

Nitipong Puangmalai, a professional nurse in the male inpatient department of Lop Buri's Chaibadarn hospital "I have been working here since May. The workload is huge. In the morning shift, we have five nurses for 34 patients in beds. The number of nurses falls to three in the afternoon shift, and just two during the night shift. I want to work for people. So, I have decided to work at a state hospital. But I can't say whether I will switch to a private hospital in the future."

-- The Nation 2012-10-15

[ScouseTommy]

The Government needs to pull its thumb out. Nurses deserve proper pay, and the working hours over here make the NHS look like a model of Healthcare!!!

[jerrysteve]

Based on the wage and over time charts the government's pay is way substandard, based on the work I have seen nurses do, they do work extremely hard, and no doubt take a lot of guff from the doctors too.

Edited October 15, 2012 by Scott
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[jerrysteve]

Unlike the Philippines which has an exchange program for Nurses with the U.S.A. It is too bad many of them do not speak English or there would perhaps be many higher paying jobs out side of Thailand.

Edited October 15, 2012 by Scott
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[bushwacker]

This article is all over the map. Sounds like nurses are doing the right thing by working for private hospitals. No need to work for the government if the pay or security is not there. By refusing to work part time at a government hospital they are only helping the cause of all nurses and the right thing to do.

The numbers sure seem a bit off. On the second slide/pic of the nurse.... It says the number of nurses to people in Thailand is 600 and then immediately says in Thailand it is 1:400. So which is it .... makes the entire article suspect ... back to my coffee.

[ttelise]

Problem of affordable health care . . . Not enough dough left over to staff properly.

[moe666]

Unlike the Philippines which has an exchange program for Nurses with the U.S.A. It is too

bad many of them do not speak English or there would perhaps be many higher paying jobs out side of Thailand.

Not a exchange program they have to apply and go thru a very rigorus program before they are hired, it can take a year or more to get excepted. Many are opting for England, UAE and this area as it is easier to get hired. I currently see a nurseing student in the Philippines and the program is very rigorus for them. One of my friends friends was kicked out of the nurseing program at there school with only 6 months to go as she didn't make the grade.

[Theboy]

And there are foreigners who depend on Government hospitals

[asiawatcher]

In stead of pissing billions of baht up against walls by bureaucrats lining their own pockets, increase pay rates for nurses and they will attracts full employment and relieve the work load, but that would be logical. Some things are not as important as others...

[Pib]

And there are foreigners who depend on Government hospitals

I expect so. While I don't, government hospitals will indeed treat foreigners just like private hospitals and the cost will be significantly less....you just gotta have money to pay the bill. And the doctor and nurse(s) that take care of you in a hospital on Tuesday could very well be working in a private hospital on Wednesday as it common for doctors and numbers to work at multiple hospitals....and then also work in private clinics. I personally know several situations like this and one of my inlaws is a nurse who works in a both a governement and private hospitals.

[carra]

My wife is a registered nurse at a Private hospital in Bangkok, the hours they work are clearly too much for too little pay, on the upside we get heavily discounted treatment there, we don't pay drs fees etc.

[Robby nz]

Me I use an army hospital, no problems, seem to be plenty of nurses and Drs.

[jaltsc]

And TAT is envisioning Thailand as being a Medical Tourist Destination

[geriatrickid]

The problem is acute outside of the major cities.

For those that left the west, know what? Thailand has the same problem as small town Australia Canada, USA.

[jerrysteve]

The Government Nurses should all walk out at once...Coz I don't think the Government gets the message!!

Perhaps if the government Nurses walk out, the government might shake out a much better wage, than throwing it away on useless programs.

The burden of work would shift to the Doctors, but they are certainly capable of handing the over load; that you can be sure of.

[jerrysteve]

moe666: you are right, but the opportunity presents itself...and thats the important thing.

[zakk9]

The biggest problem is not the pay, but the fact that there are not enough nurses. Teaching them English will only make it more tempting to work abroad, making the problem worse. Unfortunately, there doesn't seem to be any plan to increase education capacity. There's also a shortage of teachers.

[chiangmaikelly]

Unlike the Philippines which has an exchange program for Nurses with the U.S.A. It is too

bad many of them do not speak English or there would perhaps be many higher paying jobs out side of Thailand.

Ya that would be great for Thailand.

[chiangmaikelly]

And there are foreigners who depend on Government hospitals

What is funny about that?

[hellodolly]

The biggest problem is not the pay, but the fact that there are not enough nurses. Teaching them English will only make it more tempting to work abroad, making the problem worse. Unfortunately, there doesn't seem to be any plan to increase education capacity. There's also a shortage of teachers.

It dosen't seem to matter who is is power health and education are a low priority with the Government. Not to bring up old differences but it would seem that the Dems were never really given a chance to work on these two problems. The current Government under one guise or another has had 8 to 9 of the last 12 years to work on this and we are no farther along after 12 years. With no viable plans to solve the problems.

It would be nice to see an election run based on what the party is going to do for the benefit of the population rather than fancy promises to get in to office and then be cut way back or ignored all together.

[cup-O-coffee]

There are plenty of good models around the world to copy.

1. Raise the standards and the wages and benefits that go with.
   
2. Decide how many heads are needed to fill the shifts and their requirements.
   
3. Put out the job vacancies and hire those qualified.
   
4. Patients are cared for the way they should be
   
5. Everyone is happy
   
6. Life goes on
   

This ensures that the job applicants come to the table qualified, and the employers are able to fulfill the requirements they advertise as being able to meet.

Seems simple enough to me.

Oh, I forgot; this is Thailand. Face does not permit quality of life outside of self and how one feels about something.

[drdoom6996]

A Medical Treatment HUB? What will you call the hub without employee's. If I knew that their salary was that low I would have tried to get a nurse as my daughters nanny while I am at work overseas. Not quite a days pay at my day rate. How ridicules.

[hellodolly]

There are plenty of good models around the world to copy.

1. Raise the standards and the wages and benefits that go with.
   
2. Decide how many heads are needed to fill the shifts and their requirements.
   
3. Put out the job vacancies and hire those qualified.
   
4. Patients are cared for the way they should be
   
5. Everyone is happy
   
6. Life goes on
   

This ensures that the job applicants come to the table qualified, and the employers are able to fulfill the requirements they advertise as being able to meet.

Seems simple enough to me.

Oh, I forgot; this is Thailand. Face does not permit quality of life outside of self and how one feels about something.

Actually I think lack of qualified Nurses is a world wide problem.

All the baby boomers retiring are creating a demand that the schools are not capable of turning out.

[carib102]

The nursing shortage in the US is no longer as bad as it once was some 20 years ago. Many hospitals have either recruited from overseas (maybe not an option in Thailand), or put together alliances with nursing schools whereby the nurses tuition was paid for by the hospital in exchange for a contract to work a set number of years (typically 3-5) for said hospital after graduation (certainly possible in Thailand). Of course, it hasn't hurt that nurses wages have risen by over 36% from 1986-2005. My wife made 4x as much as a nurse in the U.S. versus what she could make working as a nurse in Thailand (before OT). She was also paid a fair overtime wage and not subject to all the other bullshit that Thai employers seem to put their employees through.

Simple solution to the problem:

1. Offer full time jobs rather than temp contracts

2. Raise the wages of nurses to remain competitive with private hospitals

3. Staff hospitals appropriately to avoid nurse burnout

4. Offer tuition reimbursement to students to fill projected vacancies in a proactive manner

[ttelise]

The problem is acute outside of the major cities.

For those that left the west, know what? Thailand has the same problem as small town Australia Canada, USA.

What problem is acute? I represent a lot of hospitals and nursing homes in rural areas and generally find these well staffed with a much higher quality of staff.

Not directed at you, but I disagree about the issue being one of supply. Low supply typically leads to higher wages. The problem, as stated above, is inherent to the low cost affordable health care model. Thai's are sufficiently intelligent to utilize accounting practices to determine profitability of hospitals.

Adequate staffing is a huge expense and is much easier to cut back on than fixed expenditures that can not be manipulated so easily. The solutions are two fold: (1) Be willing to operate in the red to provide affordable health care; or (2) raise costs of health care to provide appropriate staffing ratios. I have these very discussions with my clients frequently during peer review/quality assurance meetings.

There are also a whole lot of US nurses without employment. The job market is very soft for nurses with 0 to 3 years experience and temporary services can fill small scheduling gaps cheaper. Experienced nurses, especially in specialized fields, are and will always be in demand. Unfortunately, that does little to help the recent nursing grads seeking employment.

Edited October 15, 2012 by ttelise

[waza]

Nursing has come a long way from when they were recruited from work houses and institutions and paid in rum, but not far enough. The nursing shortage is a world wide problem, after all who wants to study for years just to work flat out wiping bums for a minimum wage. In Australia its the lowest paying profession, so they import nurses from all around the world. However, these nurses are not as well trained and are train in a different nursing philosophy, this has led to an overall deskilling of nurses working in Australian and adverse outcomes for patients. Hopefully the Thai government will come to it senses and increase Thai nurses wages to better reflect the work they do and legislated a realistic nurse to patient ratio.

Edited October 15, 2012 by Scott
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[ttelise]

Nursing has come a long way from when they were recruited from work houses and institutions and paid in rum, but not far enough. The nursing shortage is a world wide problem, after all who wants to study for years just to work flat out wiping bums for a minimum wage. In Australia its the lowest paying profession, so they import nurses from all around the world. However, these nurses are not as well trained and are train in a different nursing philosophy, this has led to an overall deskilling of nurses working in Australian and adverse outcomes for patients. Hopefully the Thai government will come to it senses and increase Thai nurses wages to better reflect the work they do and legislated a realistic nurse to patient ratio.

Registered Nurses in US hospitals assigned to floors work about 32 to 36 hours a week and earn in mid 50s to 60s. CNAs do dirty work or wipe bums.

[atyclb]

And TAT is envisioning Thailand as being a Medical Tourist Destination

That description justifies lots of taxpayer money that somehow evaporates along the trail.

[jellykookabanj]

And there are foreigners who depend on Government hospitals

What is funny about that?

Me too, I have no idea why this is considered funny. I had two strokes and was very well cared for by doctors in a govt hospital and would probably have died if not cared for speedily and well. So NOT funny comment at all.

Perhbaps the original poster has a mental illness which make him think illogically.