Tue, Nov 26, 2019 - Page 13 News List

Plight of Taiwan’s ‘nightingales’

Neurosurgeon Tim Yang hopes to garner more respect and better working conditions for nurses through his documentary ‘A Bittersweet Dilemma,’ which was selected as one of four winning features at last Thursday’s Labor Gold Awards

By Han Cheung  /  Staff reporter

An illustration created for the documentary, A Bittersweet Dilemma.

Photo courtesy of Tim Yang

In A Bittersweet Dilemma (南丁格爾), a man is seen screaming angrily at a nurse who has just told him she can’t change his father’s diapers because there’s another patient who needs critical care.

“We are paying customers! My father is human too,” he exclaims when the nurse suggests that a family member perform the task. When her supervisor appears, however, the nurse is found to be at fault.

While this scene is a simulation, documentary director Tim Yang (楊朝鈞) has seen his fair share of similar incidents since his days as an intern. The neurosurgeon at Chang Gung Hospital took up the camera three years ago to examine why Taiwan has a relatively high nurse-to-patient ratio, but A Bittersweet Dilemma grew into a multi-angled exploration of why only about 60 percent of certified nurses still work in the field. Many leave within five or six years for completely unrelated professions, he says.

“Nurses aren’t respected,” Yang says. “If they were, the system wouldn’t be like this. People wouldn’t treat them this way. They spend just as much time training as doctors. It’s just the job description that’s different.”

“Taiwanese nurses are like nameless housewives and mothers, silently helping doctors serve patients,” says Yang Wan-ping (楊婉萍), assistant professor of nursing at Fooyin University (輔英大學). “Over time, people start taking their care for granted. If a patient recovers, credit goes to the doctors, the patient’s constitution and devoted family members. People forget that nurses take care of many details and provide considerable professional assistance.”

On Thursday last week, the documentary won an award of excellence at the Labor Gold Awards (勞動金像獎), hosted by the Taipei City Government’s Department of Labor. It was screened at the Taiwan International Labor Film Festival last month and Yang is looking for more opportunities to bring attention to the issue.


During his medical internship, Yang wanted to do something about the hardships he saw in the nursing industry. He was a photography enthusiast in college, and after taking a few classes in documentary filmmaking during his time off, he launched A Bittersweet Dilemma as a one-person project.

At first, Yang thought that the problems simply stemmed from the nurse-to-patient ratios in Taiwan, which result in long work hours with little time to even eat or use the restroom. Regulations passed in May of last year require a ratio of at least 1:9 for medical centers, 1:12 for regional hospitals and 1:15 for district hospitals. By comparison, the maximum ratio allowed in California is 1:5 depending on the assigned unit, while in September, a Florida intensive care unit nurse spoke out against her hospital’s 1:8 ratio to the New York Times.

“With every patient over four assigned to one nurse in a medical surgical unit, there’s an increase in mortality of 7 percent per patient,” the article states.

But when Yang started interviewing nurses, he discovered a different problem.

“Some told me that they didn’t mind taking care of many patients as long as the patients treated them with respect. I soon realized that I wanted to focus on the relationship between nurses and patients,” Yang says.

“There has already been plenty of coverage about the problems with the law and the system.”

In a restaurant, for example, customers are happy to be there and willing to spend money. The staff is hired specifically to serve their needs. But that isn’t the case for hospitals, Yang says, which can often lead to the kinds of conflicts he portrays in the film. In addition to the simulated scenes, several professionals address the issue as well.

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