Filipino nurses are highly trained and recruited overseas, but this exodus is straining hospitals at home. In the first of a four-part series, CNA looks at the global nursing shortage and how countries are holding on to their healthcare staff.
For 18 years, nurse Ralph Ching has worked at the Dr Jose N Rodriguez Memorial Hospital and Sanitarium, a public facility in Caloocan City, Metro Manila.
But the 39-year-old will soon leave the Philippines, in search of a healthier work-life balance.
He applied for a job in the United States through an agency that specialises in recruiting nurses. It did not take him long to find one.
“They were hiring so fast. I was fortunate enough to find an employer willing to finance (my move). They financed everything – from review to registration, including the visa processing,” he told CNA.
Ching’s story is not unusual. Across the Philippines, both veterans like him and newly licensed nurses are weighing their options.
For many, the profession is still a noble calling – but it is also seen as a ticket to a better life abroad.
PAIN POINTS AT HOME
The pressures Filipino nurses face at home are well known: modest pay, long hours, heavy workloads and uncertain job stability.
Entry-level nurses in public hospitals earn around 40,000 pesos (US$700) a month, while overseas positions can offer several times that figure – a temptation that many say is hard to ignore.
In public hospitals, permanent government positions – known as plantilla posts and highly sought after – are limited and tied to budget allocations.
Hospitals often hire nurses on contract arrangements to fill immediate gaps. These roles may provide an income, but do not always come with the same long-term security or benefits as plantilla posts.
Last year, Ralph Garcia, 24, passed the Philippine Nurse Licensure Examination, the national nursing board exam, and is well aware of the profession’s demands.
He is not planning to build his career at home.
“The quality of life that I could have abroad is going to be better than staying here in the Philippines,” he said.
Educators said this mindset is common among nursing students.
“Times have changed. When I interview students, ‘What is your primary motivation? Why do you want to take up nursing?’
“They usually say they want to help their family, and helping their family means they have to leave the country,” said John Lorena, dean of St Luke’s College of Nursing at Trinity University of Asia in Quezon City.
“I cannot do anything about it because that’s the sad reality.”
A GLOBAL EXPORT
The Philippines has supplied nurses to the world for decades.
Today, about 300,000 to 350,000 Filipino nurses are working overseas, according to the Department of Health, but the country is short of about 160,000 nurses.
Health Secretary Teodoro Herbosa says the country did not arrive at this point overnight.
Large numbers began going to the US in the 1960s, particularly after changes in US immigration laws increased demand for foreign-trained healthcare workers.
In the decades that followed, recruitment expanded to the Middle East, Singapore and other English-speaking countries, Herbosa noted.
Today, demand has widened. “Even non-English speaking countries want our nurses,” he said.
Herbosa attributes that demand to the Philippines’ decades-old nursing education system, taught in English and shaped by American healthcare standards – a combination that makes Filipino nurses readily deployable overseas.
“Our nurses are globally accepted, and it seems that most countries that are developing health systems try to hire Filipino nurses … I now consider it not a problem, but our soft power,” he added.
That global demand has translated into significant economic flows for the country.
In 2024, Filipinos abroad sent home a record US$38.34 billion in personal remittances, according to central bank data.
There is no official breakdown for healthcare workers, but groups such as Filipino Nurses United estimate that nurses contribute around US$8 billion annually.
THE COST AT HOME
While remittances strengthen the economy, the outflow of trained nurses has strained the country’s health system, where staffing levels at some hospitals are stretched far beyond recommended nurse-to-patient ratios.
“One nurse would be dealing with 25 patients, 50 patients, when in fact it’s recommended that there should be one nurse to three patients,” said Jacquelyn Galler-Nicolas, programme head and dean of the College of Nursing at Our Lady of Fatima University in Valenzuela City.
At Dr Jose N Rodriguez Memorial Hospital, nurse supervisor Liza Policarpio says the strain is constant.
“It’s what we say when we’re joking around – one nurse is to one ward. For 100 patients, sometimes you only have two nurses. So, of course, that results in burnout for our nurses.”
The pressure affects not only patient care but also morale within the system.
“Our nurses are really displaced. In our current system, that’s what happens because the programmes we have are unclear about the welfare and the future of our nurses,” said the hospital’s chief nurse, Samuel Sumilang.
Over time, the workload takes an emotional toll.
“Nursing is a very stressful profession. You go to bedside, you are dealing with death, you are dealing with sadness, you are dealing with grief, you are dealing with irate patients and irate family. It’s like going to the battlefield every day,” Galler-Nicolas said.
Yet the government does not plan to stop nurses from leaving.
“Why will I ban people from getting a better life elsewhere? If there are nurses and there are better offers for their jobs, that is their personal choice. This is a democratic country, so if you want to leave, it is up to you,” Herbosa said.
OFFERING INCENTIVES TO REMAIN
Instead, the health secretary said the focus is on making local nursing jobs more attractive.
“We’re trying to be competitive with our salaries. We’ve started to increase the government salaries for nurses, which are much higher than that of the private sector,” he said.
As salaries increased, Herbosa added, some private hospitals began adjusting their own pay to remain competitive.
The government is also working on improving benefits beyond pay, including housing and car loans, as well as health insurance coverage, so that (nurses) will be discouraged to leave the country and stay with their families.
Another strategy is supporting career growth. Scholarships are being offered for master’s and doctoral degrees in nursing, allowing nurses to advance professionally and earn higher salaries, Herbosa said.
He added that the government is trying to reduce what he described as arrangements where private recruitment agencies “pirate” nurses from the country. Instead, he prefers government-to-government agreements that set clear terms.
Under this approach, nurses could be deployed abroad for a fixed period – for example, six months to a year – before returning to the Philippines. The aim is to make the arrangement more of an exchange than a one-way loss of talent.
The Philippines has also signed agreements with countries such as Germany and Austria, linking nurse deployment with grants, scholarships or equipment support.
“It must be equally beneficial. It cannot be one way in which the rich countries just get our nurses that we train. They’ve got to have some conscience to also help develop the health system that they’re pirating the nurses from.”
BOOSTING THE DOMESTIC HEALTHCARE SECTOR
At the same time, Herbosa said the country must expand its nursing workforce.
A moratorium on opening new nursing schools – first imposed in 2011 over concerns about oversupply and declining training standards – was lifted in 2022 following a review during the COVID-19 pandemic, when both domestic and global demand for nurses surged.
The effort to train more nurses is backed by stronger public financing, he added, noting that healthcare is now among the top three spending priorities of the government.
In 2024, healthcare expenditure accounted for about 5.9 per cent of gross domestic product, according to data from the Philippine Statistics Authority.
Revenue from tobacco and alcohol taxes, introduced under reforms passed in 2012, has helped strengthen health financing over the past decade, Herbosa added, supporting hospital upgrades and health worker benefits, including during the pandemic.
These workforce measures sit alongside broader structural reforms.
In 2019, the country passed the Universal Health Care (UHC) Act, which aims to automatically enrol Filipinos in the national health insurance system and strengthen access to care nationwide.
But expanding coverage also requires enough trained health workers to deliver services, particularly in rural and underserved areas, Herbosa noted.
Under the National Health Workforce Support System, mandated by the UHC law, the Department of Health deploys nurses and other health workers to local government units that lack sufficient staff.
“We give them higher pay and some incentives, like a scholarship for master’s (degrees) and then other perks to attend conferences. And they actually prefer staying as what we call rural health nurses,” Herbosa added.
He said some nurses prefer working in such community-based settings rather than large urban hospitals, which are often busier. That preference is one reason some government hospital positions remain vacant, he said.
The nursing curriculum is also being adjusted to align with the country’s shift toward primary care and community-based services.
“Previously, the curriculum was hospital-based, so it was easy for (nurses) to transfer to hospitals that were built abroad. So today, we’re trying to address the gaps in the healthcare system by tweaking the curriculum slightly,” he added.