Monday, April 9, 2007

The Nursing Scandal

Starting this week some 10,000 Philippine nurses who passed the tainted June 2006 Philippine nursing board exams will be taking review classes, paid for by the Philippine government, to retake two sections of the nursing exams they already passed – a requirement imposed by the United States’ Commission on Graduates of Foreign Nursing Schools (CGFNS) for Philippine nurses who wish to work in the US.

The retaking the 2006 exams may not end the controversy which has damaged the reputation of Filipino nurses throughout the world. "The outcome of the ongoing scandal on the alleged leakage in the June 2006 Nursing Board Examination could make or break the future of Filipino nurses who intend to work abroad," the Philippine Daily Inquirer noted,

The controversy began with the discovery of a “leakage” of exam questions disseminated by two nurses review centers to their examinees in Baguio City and perhaps other locales. The examinees were provided with a list of 500 questions and answers in two of the exam’s five subjects (Tests III and V).

After the board exams were conducted, test-takers in Baguio City who heard about the leakage protested, claiming the leaks “tainted the results of the test, bringing to question the qualifications of all who passed.”

The Professional Regulations Commission (PRC) which administers the nursing exams with the Philippine Board of Nursing (BoN) conducted an investigation and learned that two BoN members were responsible for the leakage. According to one of the two members who were removed for “negligence,” she just inadvertently left copies in a Baguio copy shop where she was “xeroxing” her 500 questions. Others charged that the BoN members were bribed by the review centers to provide them with copies of their questions and answers.

According to Business World columnist Greg Macabenta, however, the leakage did not affect the outcome of the exam.

Macabenta’s analysis is based on the fact that there are five subjects in the examination: Nursing Practice I to V. Five BoN nursing examiners are asked to provide a list of 500 questions from each of their particular subjects of expertise, a total of 2,500 questions in all. From this batch of 2,500 questions, computers arbitrarily extract 500 total questions, 100 from each subject. This computer extraction of the 500 questions is done shortly before the exams are given to allow time only for the printing of hard copies.

Of the raw “un-extracted” test questions, Tests III and V were “compromised,” in the sense that 20 questions for Test III and 90 questions for Test V were in the list of 500 questions in the final exam.

The PRC decided to invalidate the 20 questions in Test III, recomputed the scores on Test V, and re-averaged the results before announcing the list of the 17,781 who passed the exam out of the 42,000 nursing graduates who took it.

Even assuming that all 2,500 questions were leaked to all the nursing examinees, instead of just 1,000 questions to those who attended the two review centers who obtained the leaked questions, the examinees would not have known which of the questions would be computer extracted for the final exam.

It’s as though I leaked to you the 100 questions and answers that I guarantee you will be asked in a US naturalization exam (which anyone can obtain from the immigration website, by the way), except that I can't provide you with the 10 particular questions that will be asked. I can similarly provide you with the list of all the questions and answers in a California Department of Motor Vehicles (DMV) exam without knowing precisely which questions will be asked.

The examinees who attended the Gapuz review center and the INRESS review classes of George Cordero apparently obtained advanced access to 500 questions in Tests III and V that will in a pool from which the questions would be selected. But they didn’t know which particular 100 questions from each subject
would be asked.

Interestingly enough, of all the test centers in the Philippines which conducted the nursing exams, Baguio City, where the leakage originated, reported a 36-percent passing rate, the lowest among the 11 national test centers.

But the damage was done. Before the exams, the Philippines was lobbying the US-based National Council Licensure Examination (NCLEX) to include Manila as a NCLEX exam site to ease the financial burden on Filipino nurses having to travel to Singapore or Kuala Lumpur just to take the exams. After news of the 2006 leaking scandal broke, Manila was removed from any such consideration.

The Philippine Overseas Employment Administration reported that 7,768 nurses went to work abroad in 2005, down from 12,822 in 2001. There are 450 nursing schools in the Philippines, 50 of which the PRC would like to close down as nothing more than diploma mills.

The nurses also face stiff competition from Philippine doctors, 6000 of whom, according to The Asian Pacific Post, are studying to become nurses so they can find higher-paying jobs abroad. A physician employed in a Philippine government hospital earns only about 25,000 pesos (446 dollars) a month. A doctor could earn around 8,000 dollars a month while working as a nurse overseas.

On February 15, 2007, the CGFNS announced in its website ( that it would not issue VisaScreen certificates to passers of the “compromised” Philippine nursing licensure exam of June 2006. The organization urged the Philippine government to “provide an opportunity for retake” of the compromised test parts so the affected board passers may qualify for the VisaScreen.

“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 commission stated.

The New York Times reported on August 21, 2006 that the Philippine nursing scandal threatens the country’s status as the world’s top producer of nurses, regularly supplying US, Canadian, UK and Saudi hospitals with several thousand RNs a year. This number was likely to increase in the US with the lifting of the cap on the number of foreign nurses that US hospitals can hire.

Already, Philippine officials reported, American recruiters are turning away nurses who took the tainted board exams, while those who remain in the Philippines are having difficulty finding jobs. Questions also have been raised about the integrity of previous nursing board exams.

Meanwhile India is rapidly producing more nurses to fill the nursing void in the US and other countries, threatening to surpass the Philippines in that category.

But it is in the category of cheating in elections and in the rigging of government contracts that the Philippines has been unsurpassed in Asia. It is this widespread perception that has fueled the nursing scandal even where, ironically enough, the attempt at cheating did not actually affect the results.

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