Position Paper 2012 by CBMS | 1 INTRODUCTION The Philippine Nursing Licensure Exam(NLE) is a 500-item multiple choice exam to test

basic nursing level competency which considers the objectives of the nursing curriculum, the broad areas of nursing and other related disciplines and competencies. It is held every June and December annually in various public schools throughout the Philippines. According to R.A. 9173, Article IV, Section 14, the scope of this examination for the practice of nursing in the Philippines is determined by the Board. The board shall take into consideration the objectives on the nursing curriculum, the broad areas of nursing and other related disciplines and competencies in determining the subjects of examinations. These subjects included in the scope of board exam were taught or were tackled during the 4-year stay in the colleges while taking Bachelor of Science in Nursing. Thus, the scope of the exam was already encountered by the examinee who is expected to be competent in finishing the exam and passing the exam. According to R.A. 9173, Article IV, Section 15: In order to pass the examination, an examinee must obtain a general average of at least seventy five percent (75%) with a rating of not below sixty percent (60%) in any of five test subjects. This implies that NLE is not just a joke but it measures how much knowledge you gained and on whether or not you deserve to have license and practice the nursing profession. Considering the number career opportunities available for registered nurses in the Philippines as follows: You can work as a staff nurse for both private and public hospitals. You can work as a company nurse for business establishments Work as a school nurse in private schools. Nurses may also work under Local Government Units as Rural Health Nurses. These are not enough to compensate the increasing population of nurses. An issue as to how to limit the increasing numbers arises, as well as choosing qualified nurses. The Philippines produces over 200,000 nursing graduates annually as per the Department of Labor and Employment (DOLE). There are approximately 450 Nursing Schools in the Philippines and each is manned and regulated by the Commission on Higher Education (CHED) to monitor and evaluate the quality of nursing graduates that these schools produce each year. Out of these nursing schools, around 150 were warned to improve their board exam passing rate in November 2009 to avoid closure. CHED has the ability to close or phase out nursing schools that failed to meet the standards in the licensure examination. In an article entitled CHED Proposal: Limit Number Of Times One Can Take Nursing Board Exam, it was stated that taking into account the low percentage of nursing graduates who passes the board exam, the Commission on Higher Education (CHEd) in Western Visayas

Position Paper 2012 by CBMS | 2 said that nurses should not be allowed to take the nursing licensure exam for as long as they like. They suggested that a limit should be set on the number of times the exam can be taken. The Assistant Regional Director of CHED, Dr. Rex Casiple blamed the repeaters for the very low passing percentage of some nursing schools in Western Visayas. He said sixteen nursing schools that got a good passing rate in the 2009 board exam for nurses registered a low passing mark this year because of the number of repeaters that comes from the said schools (Robles, 2010). This alarmed the nursing world and provided a lot or reaction, opinions and ideas from different people to different parts of the Philippines which makes it a nursing issue.

DISCUSSION Statistics on unemployment of Filipino (Pinoy) nurses hit a whooping 150,000 (estimated count). According to government sources, this figure is actually lower than the previous estimate of 400,000 unemployed (and underemployed) nurses in the Philippines but still confirms that there really exists an oversupply of nurses in the country (Simbulan, 2012). This huge number of nurses is hard to regulate. Thus, a limit in the retaking on NLE will help in preventing increase of unemployed Filipino nurses in some ways. In an article entitled US market shut for Filipino nurses, it was stated that from 1995 to 2011, a total of 145,081 Filipino nurses sought to practice their profession in America by taking the US licensure exam, or NCLEX, for the first time (excluding repeaters). However, from 2006 to 2011 alone, a total of 938,552 US nursing graduates also took the NCLEX for the first time. Ty has been pushing for new legislation that would establish a special local jobs plan for idle Filipino nurses, now estimated at more than 300,000. As proposed by him in House Bill No. 4582, the plan would be an expanded version of the Nurses Assigned in Rural Service, the short-lived Philippine government project that enlisted nurses to improve healthcare in povertystricken towns. Tys Special Program for the Employment of Nurses in Urban and Rural Services (NURSE) would mobilize a total of 10,000 practitioners every year. Meanwhile, Sen. Edgardo Angara expressed his support for the Registered Nurses for Health Enhancement and Local Services (RN HEALS) program, which is set to launch next week and deploy 243 nurses to 28 municipalities in Cagayan de Oro and Misamis Oriental. Angara has been meeting with leaders of the nursing profession to find a solution for the lack of job opportunities for nurses in the Philippines and the apparent deterioration in the quality of nursing education, and recently filed a bill in the Senate that will develop community health delivery and health team placement for rural area(Jottings, 2010). It was observed that the search for the greener pasture motivated students to take up nursing and this led to the increasing number of Filipino Nurses. Unfortunately, the need for nurses in the US suddenly

Position Paper 2012 by CBMS | 3 declined and there is now overpopulation of unemployed nurses in our country. A way to end this is limiting the retaking chances for repeaters in the NLE. In the article entitled CHEd asked to regulate nursing test of repeaters, Dr. Rex Casiple said that the CHEd and PRC must formulate a policy to regulate the taking by repeaters of the board examination or require them to take refresher subjects or lessons. Aside from the significant number of repeaters who took the examination, Casiple said the performance of nursing schools was affected by the lack of school-owned hospitals and lack of qualified faculty. He said most of the nursing schools in Western Visayas lacked hospitals to accommodate the training of students with only six of the 21 nursing schools in the region owning a hospital. The huge number of nursing students also require more faculty to accommodate the students. Casiple said many of the nursing graduates have taken up nursing as a second course because of the demand for nurses abroad. Many of them were not fully trained as a nurse because some of the subjects taken in their first course were credited to nursing subject requirements (Burgos, 2010). Similar to the law, in state RN board examination in Indiana, the examinee must wait between 45 to 50 days before retaking the NCLEX exam. If you fail the NCLEX exam three times, you must take a remedial training course consisting of classroom and clinical work before being allowed to retest. This means that this is practiced in other countries. Reasons mentioned were: To provide safe and quality care. If a nurse who retook the board exam for 3 or more times works in a hospital and practices nursing profession in that institution, there is a high risk of errors due to the level of knowledge the person has. Because at some point, retakers are seen smarter due to refreshment classes they took only and not merely by the capital they earned while they were a regular college student taking up BSN. To increase level of competency a nurse must exude. The nurse must not only exude knowledge but skills as well. In board exams, most questions are application which reflects an examiners knowledge on the application of care/nursing profession exactly in the hospital area. The failed NLE result of an examiner reflects how he/she performs in the area. The competency of the examiner is seen on how he/she uses critical thinking on situations given. Now, how can we increase the level of nurses competency if NLE is not limited to 3 takes only? Right then and there, a nurse must exude high level of competence prove how much he/she have gained experience. In a position paper entitled Continuing Competence in Nursing, it states that patients, families and communities have a right to receive competent nursing care; and, the public has a right to expect registered nurses will demonstrate professional competence throughout their careers (Washington State Nurses Association, 2010).

Position Paper 2012 by CBMS | 4 In another supporting article entitled 152 Nursing Schools Face Closure for Poor Board Performance, it was stated there that a total of 152 nursing schools face closure for registering poor passing percentages in the nursing licensure examinations over the past five years. Among the 152 schools, nine had already stopped offering their nursingcourse, and five schools had stopped operation altogether, Angeles said. Next year, CHED will enforce a rule that schools whose performance in licensure examinations is below five percent for three consecutive years would have their permits revoked and their concerned program phased out (Philippine Star, 2009). With this move, we are helping not only the parents and students to carefully choose the nursing schools they go to, but we are helping our economy by minimizing frustrations and wastage among our nursing graduates when they take the licensure exams and make sure that they only get quality education from schools that prioritize quality by adhering to world class standards that we are now imposing. stated by Emmanuel Angeles, Commission on Higher Education (CHED) chairman This is a wake-up call to our nursing schools to shape up or phase out. They are challenged to improve their quality. On the contrary, one of the comments I read in the blog was that limiting the retaking of NLE would provide shortage of exported Filipino nurses. Another comment implies that, retaking means that a person is eager to learn and practice nursing as much as possible thats why they retake the NLE until they can. Some says that repeaters are facing circumstances that affected their failure in the NLE. Circumstances mentioned includes the following: lack of preparedness, financial problems that prevented them to undergo review, typographical or technical errors during the board exam (Philippine Nurse Blogspot, 2011). I totally disagree with this because an effective nurse must be flexible, able to adapt to any circumstances, if by just merely taking the board exam and an examinee is easily affected by these external factors, then what more if he/she is in the clinical setting. Another is that financial constraints to take or enrol in a review center is not considered a hindrance. A review is defined as a program or course of study that is intended to refresh and enhance the knowledge or competencies and skills of reviewees obtained in the formal school setting in preparation for the licensure examinations according to EO 566. We are not even required to enrol a review because undergoing a refreshment program is not compulsory unless the law requires like for 3-time retaker of NLE. Contradicting the limitation of nurses in retakes of 3 is the increasing demand on countries like Australia, Canada, and countries in the Middle East. In an article entitled Kuwait to hire 660 nurses from PH, it was mentioned that hundreds of Filipino nurses are needed to fill in the vacancies in the public and private medical facilities in Kuwait (Santiago, 2011). This implies the urgent need for nurses to pass the board exam in order to have work experience. Also, RN HEALS are now available in the Philippines that provides job availability in our country for unemployed nurses. If NLE is limited to 3 takes then there will be a decrease in the supply

Position Paper 2012 by CBMS | 5 of nurses in our country since they woul now prefer going to the said countries in the beginning of this paragraph.

CONCLUSION: From the above statements, RRLs, opinions, and sets of ideas, I therefore conclude that I agree in pursuing the limitation of NLE for only 3 times. If an examinee failed for 3 times or more, a refreshment must be taken or he/she must enrol 4th year of the degree course. As a Louisian, as part of the 4 core values of a Louisian, I strongly believe that competence is definable, measurable and can be evaluated. This may be in the form of written exam like the Nursing Licensure Exam which is the key step of becoming a registered nurse. If by this examination you failed then by the time you are working, the confidence you exude is deteriorating. Regulatory committees must do something to address the increasing population of unemployed and underemployed nurses. Preventing an unsafe and ineffective health environment through proper screening is a way to resolve this problem. Hence, leading to the screening incoming nurses in order to give them the license. I also believe that no single evaluation method or tool can guarantee competence. While several states have mandated continuing education as a measure of competency, research shows that continuing education alone is not sufficient to ensure competency. Competence is situational, dynamic, and is both an outcomes as well as ongoing process. Context determines what competencies are necessary (ANA, 2010). REFERENCES: Burgos, 2010, CHEd asked to regulate nursing test of repeaters, retrieved from http://newsinfo.inquirer.net/inquirerheadlines/regions/view/20100207-251819/CHEdasked-to-regulate-nursing-test-of-repeaters Jottings, 2010, US market shut for Filipino nurses, retrieved from http://www.manilatimes.net/index.php/business/business-columnist/22207us-market-shut-for-filipino- nurses Philippine Nurse Blog spot, 2011, Comments and Blogs, retrieved from http://philippinenurse.blogspot.com/2011/11/december-2011-nurses-licensure.htm Robles, 2010, CHED Proposal: Limit Number Of Times One Can Take Nursing Board Exam, retrieved from http://www.nursingguide.ph/article_item591/CHED_Proposal__Limit_Number_Of_Times _One_Can_Take_Nursing_Board_Exam.html#ixzz24GsuOST6 Santiago, 2011, entitled Kuwait to hire 660 nurses from PH, retrieved from http://www.abs-cbnnews.com/global-filipino/09/16/11/kuwait-hire-660-nurses-ph

Position Paper 2012 by CBMS | 6 Simbulan, 2012, Oversupply of Nurses in the Philippines Confirmed: 150K Unemployed Filipino Nurses, retrieved from http://www.jpsimbulan.com/2008/09/05/oversupply-ofnurses-in-the-philippines-confirmed-150k-unemployed-filipino-nurses/ Washington State Nurses Association, 2010, Continuing Competence in Nursing, retrieved from http://www.wsna.org/Practice/Publications/documents/pp.continuingcompetence.pdf