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The nursing profession requires urgent care

The SARS outbreak sweeping across Taiwan has seriously damaged the nation's nursing profession, which was already weak in nature. Apart from triggering an outflow of some of the profession's elite members, the epidemic has highlighted other problems -- including the steady erosion in quality in the profession, the shaky professional ethics of our nurses and the poor recruitment of nursing schools.

Ever since the Bureau of National Health Insurance began to implement its "global budget" system a few years ago, medical institutions have become budget-oriented as they strive hard to control their labor costs and promote a flat-personnel structure. As a result, their personnel departments usually do not recruit new employees when a post is left vacant, or they hire temporary or part-time nurses.

The monthly salary for a temporary nurse is slightly over NT$20,000 and he or she enjoys neither welfare nor retirement benefits. Meanwhile, the starting monthly salary for an officially employed nurse is slightly over NT$30,000. Can we really attract high-quality personnel with such low pay? It's predictable that more medical and nursing disputes may occur in the near future.

In the face of the SARS epidemic, many medical institutions accepted SARS patients, thereby reducing the volume of both their outpatient and inpatient services, since people tried to avoid going to a facility known to have SARS patients. Since the hospital's profits were reduced, the first thing they did was to launch a wage cut for their medical and nursing workers.

Many of these workers were asked to take wage cuts of 10 percent to 20 percent, or even take a leave without pay. This created great unrest among nursing personnel and complaints. Is this kind of working environment able to keep our nursing elite? Will it hurt their morale, or directly affect the quality of health care in this country? The answers are self-evident.

Today, many medical centers in the US and the UK are recruiting Taiwanese nurses and offering them very high starting salaries because of nursing shortages in those countries. Some US hospitals are even willing to provide green cards to attract top nurses. This will significantly affect the development of this nation's nursing profession, while causing a tremendous impact on out ageing society.

How can we resolve these predicaments? In terms of nursing professionalism, I hope that the Department of Health can set up a specific unit responsible for nursing affairs right away, in order to enhance nurses' job stability and loyalty, as well as the quality of health care.

For medical institutions and professional nursing groups, they should buy casualty and medical insurance for nurses on the frontline of epidemics. In terms of the categories paid by the Bureau of National Health Insurance's global budget system, the budgets for nursing affairs should be separated from the budgets for ward management, since these are frequently compressed or eliminated.

Nurses should also be offered psychological counseling, when necessary, to help them to relieve their emotional tensions. In addition, the professional ethics of the nation's medical and nursing teams -- both at universities and colleges and in the workplace -- have to be rebuilt with a humanitarian and respectful attitude.

After the SARS epidemic is over, the nursing profession will need the government's help. Otherwise, it will not be an easy task for this profession to restore its vitality as quickly as needed.

Lee Sheuan is the president of the Taiwan Nurses Association and the dean of the School of Nursing at Chung Shan Medical University.

TRANSLATED BY EDDY CHANG
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