Tuesday, February 27, 2007

The Nursing Exam June 2006 Saga

Headline: Gov't to make nursing exam passers retake tainted tests. The Philippine Star 02/17/2007 http://www.philstar.com/philstar/NEWS200702170418.htm

In brief, the blazing news declared that "The government will accede to the request of the Commission on Graduates of Foreign Nursing Schools (CGFNS) to let the passers of the June 2006 leakage-tainted licensure examination retake the test so they can obtain visas to the United States, President Arroyo said yesterday."

In an earlier post I covered the Nursing exam leak scandal, saying:

…"Medicine means many things to society. It means the treatment of illness or injury

using drugs, it means the drug or substance used for treating illness or it means the

profession of treating illness as a doctor. The profession of treating illness itself has

ramifications and branches that are classified as conventional (doctors, surgeons,

dentists, psychiatrists, gynecologists, proctologists, nurses and many medical

specialists) or informal or alternative practitioners(midwives, chiropractors, acupuncturists, reflexologists, herbalists, aromatherapists and a slew of other psychic or shaman healers.)

The two classes of healers differ radically in methods and practices, but have one common bond between patient and healer: trust. Although trust is not uncommon in most human interaction --- a friend trusts his friend to pay back the money he borrowed, a client trusts his lawyer to handle his case with diligence, a depositor entrusts his money with his bank, citizens trust their officials to spend their tax money for the common weal --- it is in the realm of health and wellness that the trust link is extraordinary --- and vital.

It is in the trust aspect that the wide-ranging and destructive tremor … rocking Pinoy society caused by the alleged cheating in the Nursing exams held by the Professional Regulatory Commission. First, it confirms the existence of cheaters and validates Pareto's Law (the 20-80 rule stating that 20 percent of the examinees create 80% of the problem) that temporarily denies honest passers from anointment and consequently eagerly desired employment. Second, it injects some doubt and mistrust in the minds of prospective employers and patients about the honesty and reliability of Pinoy nurses, including those now employed. Third, the impact of potential loss of high-income jobs to the nation's economy. Fourth, the wound of cheating still festering in the nation's body politic is reopened and reinforces an image of charlatans rampaging in the country …

… Adverts, a powerful modern marketing tool, also benefits the consumer by offering purchasing choices. However, whenever buyers are in the market, whether wet, dry, mall, or Net, it would be wise to beware of "truth in advertising" and trust must be guarded by the economic jargon "Caveat Emptor", Latin for buyer beware.

The nursing exam cheating erupted initially as an ethics and morality issue but is now settling into a market economics issue. The nurses (the sellers) offering their services must convince the American hospitals (the buyers) that their goods (nursing healthcare) are trustworthy. Having learned of alleged dishonesty in the nursing tests, the buyers have assumed a heightened beware mood and consequently would demand proof that the goods offered are not tainted. To remove the stigma, this might entail a painful decision to invalidate parts or all of the previous tests. If so, the real problem of the government is not the search for wrong doing or wrong doers, but how to alleviate the pain."

A CGFNS fact-finding team came to Manila in September last year to assess the effects of the nursing exam leakage scandal. In their decision, CGFNS said the June 2006 passers can still qualify for a Visa Screen Certificate by taking the equivalent of Tests 3 and 5 on a future examination administered by Philippine regulatory authorities and obtaining a passing score. The CGFNS insisted that passers retake Tests 3 and 5, where the answers were leaked: "The integrity of foreign licensing systems ultimately affects the health and safety of patients in the United States, a primary consideration of CGFNS in its role in evaluating candidates under US immigration law."

The news shocked officialdom who blustered with the usual bravado to the effect that no foreign country can dictate to us. That is nationalistic pride speaking, and we know what consequences pride can lead to. However, exercising sobriety, a virtue still possessed by a few Filipinos in authority, the Labor Secretary fully recognizes that the issue is beyond resolve by legal fiat or diplomatic gobbledygook in dealing with the CGFNS (the pitbull-like guardian of entry by alien nurses.) and bows to the U.S. decision. In the face of market forces, even sovereign governments must give in, or else. The law of supply and demand is inexorable and unforgiving, and not repealable.

The CGFNS offered a means to salvage battered pride (loss of trustworthiness) by allowing a partial retake by the June 2006 oath takers to redeem their lost trust. Passing the test would restore competency and thus acceptability for employment in the U.S.

The reaction of the Philippine government from the top downwards went the entire gamut, from silly or ludicrous to sensible and sober. Ate Glue at first flip wanted a retake, but later flopped, mounting the political patronage high horse and ordered her Labor Secretary to appeal the CGFNS decision, obviously to appease 17,000 nurses (plus their parents and relatives). Senator Richard Gordon said the government's plan to appeal the decision of the Commission on Graduates of Foreign Nursing Schools (CGFNS) requiring nurses who passed the June 2006 board examination to retake two leak-tainted tests if they want to acquire US visas is useless,. Rene Tadle of the University of Sto. Tomas' College of Nursing Faculty, who spearheaded the filing of a court case seeking a retake of the June licensure exam, agreed with Gordon. Both asked the PRC to work for the retake instead of appealing the CGFNS decision

Rosero is set to leave for the United States to ask the CGFNS to reconsider its decision not to give VisaScreen certificates to the 17,000 or so nurses. Rosero added that she would head the delegation, which the PRC chief said was independent of the group directed by President Gloria Macapagal-Arroyo last week to appeal for reconsideration of the CGFNS decision. "We would show the CGFNS officials how the examination results were computed, together with the decision of the Court of Appeals and Supreme Court on the issue," Rosero said. The members of the task force would leave for Philadelphia, where the CGFNS is based, on February 26. Dr. Remigia Nathanielz, president of the Association of Deans of Philippine Colleges of Nursing, and the PNA president, Dr. Leah Primitiva Samaco-Paquiz would form part of the task force. The sobriquet “task force” could convey an intimidating authoritative sense (deliberately or inadvertently), the phrase originating from military jargon meaning a naval force formed temporarily to accomplish a specific mission. Perhaps task group or delegation would be less militant sounding and more civil. Moreover, will the local agents of CFGNS take the slap with equanimity?

The Supreme Court dismissed the petition for certiorari the motion filed by the University of Santo Tomas (UST) College of Nursing Faculty Association asking the government to administer new tests to all the nursing graduates who passed the nursing board examinations last June 2006.

The PRC head apparently balks at the idea of preparing a retake test and clearly defying her boss the Labor Secretary (who declines to be drawn into a squabble with his subordinate.). The Department of Labor and Employment (DOLE) will conduct a retake of the leakage-tainted June 2006 licensure examination especially for Filipino nurses who want to work in the United States. Labor Secretary Arturo Brion said DOLE has recommended to MalacaƱang a voluntary retake of the compromised test to resolve questions on the eligibility of those who passed the 2006 board examination. "Our alternative plan is for the Department of Labor, through the Board of Nursing (BON), to administer the re-examination of Tests 3 and 5," he said. Brion said the BON will prepare and do the corrections of the special tests to be held simultaneously with the scheduled nursing licensure examinations in June and December this year.

It seems Labor Secretary Briones never wavered in his stand that a voluntary retake would satisfy both official positions, leaving those nurses that spurn a retake to realize that a U.S. job is closed to them, since the VisaScreen Certificate is required for all persons applying for work in America.

I surmise the concise standards set by the CGFNS are merely a reflection of the collective standards of the medical institutions they represent, which are not just medical in nature but also economic, in view of the terribly high litigation rate of medical malpractice in the U.S.

The appeal-to-CGFNS-decision drama ended in a crescendo when the CEO of CGFNS Barbara Nichols declared in an unequivocal statement that any effort to appeal the decision of the US Commission on Graduates of Foreign Nursing Schools (CGFNS) will be futile. This was conveyed to Philippine Regulatory Commission (PRC) Chairperson Leonor Tripon-Rosero, in their phone conversation on Saturday, 24 February. The CEO added that the decision was final, and no useful purpose would be served by Rosero coming to the United States to make an ‘appeal’ of that decision. This decision was made by its Board of Trustees, the highest authority of that corporation, There is no process or provision for an appeal or reconsideration of a Board decision. There is no higher authority than the Board of Trustees," Nichols told Rosero.

Moreover, Nichols pointed out that the board's decision on the issue was unanimous. "This decision of the CGFNS Board is final; the matter is settled."

A news report said Rosero declined to comment whether the task force would still leave for Philadelphia to appeal the decision in light of the CGFNS statement., and was quoted as saying she preferred “that we issue a collective statement.” Of course, in all fairness the shame and blame must be shared, but proceeding to Philly in the face of the rejection would be a grave abuse of discretion if tax money is used.

It was, after all the mayhem, a matter of trust on caregivers that could save or snuff a life.

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