The challenges for Taiwan’s nursing workforce lies not only in staffing shortages, but also in the broader, structural crisis of how the medical care system operates. Minister of Health and Welfare Shih Chung-liang (石崇良) has proposed three major directions for reform, saying that of the National Health Insurance budget’s near NT$600 billion (US$19 billion) increase from last year, pay rises for nurses are a priority.
However, ensuring reasonable salaries, retirement and worker protections for nurses should be an integral part of broader reform policies for the institution as a whole, not just an add-on for when the budget increases.
For years, nurses have been dealing with low pay, insufficient ratios to patients and poor working environments.
So far, at the cost of nursing standards and patient welfare, policy has failed to address these issues.
To begin, unfair compensation is the primary factor behind poor retention of nurses.
Because of the limited point values used to calculate pay rates in the public hospital system, nurses’ salaries are not adjusted according to hospital profits.
In addition, labor laws require nurses to retire early at the age of 55, further limiting worker stability. If these regulatory mechanisms cannot be overcome to retain workers for longer, it would be difficult to fully overcome the present systemic staffing shortages.
Institutional reform, then, is the necessary key to overcoming these challenges and offering reasonable salaries and retirement plans.
Second is low nurse-to-patient ratios and the burdens these entail.
Out of more than 3 million licensed nurses in Taiwan, only about 60 percent are actively practicing — testament to the profession’s workload and physical and psychological tolls.
The government’s plan to expand the Inpatient Integrated Care Program by increasing the number of beds it staffs from 5,000 to 30,000 is certainly a welcome reprieve, but even this risks becoming a surface level reform without thorough institutional implementation.
The three-shift nurse-patient ratio system, which sets minimum ratios for day, evening and night shifts, must be codified in law to guarantee adequate staffing levels and protect patient safety. This is a bottom line that cannot be avoided.
Finally, work culture and mental health support for nurses has long been overlooked. Although some hospitals offer mentorships, counselling, programs for new nurses and part-time scheduling around workplace training, disjointed and individual measures such as these cannot treat a nationwide issue.
Token measures in the name of employee well-being might temporarily relieve some stress, but do little to retain workers in the long run.
Nurses are the backbone of the medical care system, and their pay, patient ratios and well-being are of indispensable importance. To create a truly sustainable and positive nursing environment, the government and hospital administrators must each recognize the value of nurses, and implement compensation and workplace protection systems which reflect this.
Yeh Yu-cheng is a secretary at the Pingtung County Public Health Bureau.
Translated by Gilda Knox Streader
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