Nursing News and Articles

[-JaJa-]

Nursing shortage prompts creative efforts to fill nursing jobs

By Katy Schiel

Plentiful nursing jobs in the Canadian province of Saskatchewan are soon going to be filled by unlikely candidates if local health care professionals get their way. In March, a delegation of health care professionals and hospital administrators are traveling to the Philippines in hopes of recruiting up to 300 nurses to fill the gap in local nursing jobs and to relieve the nurses who are currently working many hours of overtime.

Saskatchewan, like much of North America, is facing a huge nursing shortage. The Saskatchewan Union of Nurses estimates that there are between 800 and 1,000 open nursing jobs in the province. And the problem is only going to get worse, with more than 1,400 practicing nurses eligible for retirement in 2010.

The Philippines is an attractive destination for recruiting nurses because it trains more nurses than it needs. According to James Winkel, the spokesperson for the Saskatoon Health Region, the province would not be "poaching" nurses to fill their nursing jobs, since there are over 400 nursing schools there. "They have a huge surplus of nurses graduating and not enough openings," Winkel said. "There's just too many nursing grads." Despite the frigid temperatures in Saskatchewan, finding Filipino recruits to fill open nursing jobs is relatively easy since the pay is substantially higher. Nursing jobs in the Philippines only pay between $125 and $150 per month.

All candidates are required to take an English test, and officials will check their credentials to ensure that they meet all the requirements of the specific nursing jobs they are being recruited for.

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[-JaJa-]

Hospitals go overseas for nurses
by Julie Bryant

Faced with a crippling nursing shortage, U.S. hospitals are increasingly recruiting nurses from Canada and England and as far away as the Philippines. By the end of the year, Tenet Healthcare Corp. hopes to recruit at least 100 registered nurses from Northern Ireland to hospitals in the Southeast through a special visa program passed last year by Congress.

But foreign countries such as Ireland and Canada are dealing with their own spiraling health-care labor shortages. Global talent pools that were once plentiful are now drying up, strained by high demand, immigration issues and spreading competition.

Some health-care officials, meanwhile, say foreign recruiting is a deceptive quick fix and could actually detract from solving the real problem: an overwhelming lack of decent wages for nurses and a startling dip in the number of students choosing nursing as a profession worldwide.

"It's really a short-term focus that may not benefit us in the long run," said Debbie Hatmaker, president of the Georgia Nurses Association. Recruiting foreign nurses may be creating problems for other countries and worsening the shortage overall, she said.

Last month, Canada sponsored a job fair in Texas, hoping to lure back some of the nurses it lost to the United States during health-care cutbacks leaders in Canada levied during the 1990s. That's a far cry from a few years ago, when Canadian job fairs were mostly set up for nurses who were being recruited to the United States, said Sandee Phillips, president of Global Nurse Force, an Atlanta-based international nurse recruiting agency.

Canada was a hot spot for recruiting. Now they have closed their job fairs and have begun looking at foreign recruiting themselves, Phillips said.
Other countries, such as England and Ireland, are jumping on the bandwagon with their own new efforts to shore up nursing shortages, shelling out better pay and providing more educational opportunities for nurses they hope will stay.
Fifteen years ago, Ireland was inviting U.S. hospitals over, setting up job fairs for their abundant pool of nurses, said Lorna Martin, vice president of nursing for Piedmont Hospital. Now they are competing for business.

Canada, while it lobbies for a loosening of nurse migration restrictions, also is raising ethical concerns about recruiting in impoverished nations such as South Africa, where medical personnel are desperately needed. Buckling under a massive HIV/AIDS epidemic, the country is desperate to retain nurses and doctors that are easily seduced by the promise of better pay and better living and working conditions.

Worldwide problem

Several countries are scheduled to meet through the World Health Organization to discuss the state of nursing resources and the gaps that have been identified across the globe, said Lucille Auffrey, executive director of the Canadian Nurses Association. "The shortage of nurses, the manpower issues are universal," Auffrey said. "They are not limited to the United States or Canada."
It has gotten so bad that hospitals in England and Ireland are recruiting from South Africa and South Africa is going to Jamaica and the Caribbean to find nurses, said Piedmont's Martin. "Everybody is kind of taking from each other," she said.

But nurses can't be blamed, say officials. In Third World countries, nurses are paid peanuts and working conditions can be deplorable. In Canada, cutbacks have sent most nurses into part-time positions. "We went from about 75 percent to 80 percent of nurses working full time to 50 percent of nurses working part time," Auffrey said.

As in the United States, the number of nursing students also has dropped dramatically. In 1980 Canada was graduating 10,000 nurses a year, today that number has dropped to 4,000, she said. So Canada, like the United States, has turned to foreign recruiting.

So have England, Ireland and even Saudi Arabia, which now gets most of its nurses from the Philippines -- the very same place where most countries, including the United States, now are doing the majority of their recruiting.
In the last few years, the Philippines has become the global hot spot for recruiting, a seemingly bottomless well of talent. Nurses there are actually groomed to migrate, said Phillips of Global Nurse Force, which has an office in the Philippines and does most of its recruiting there.

Almost all of the graduating nurses in the Philippines want to move to foreign countries, especially the United States, said Anabelle Espinoza, a registered nurse who was recruited from the Philippines to Piedmont Hospital 13 years ago. "Money is the No. 1 reason," Espinoza said. "It means something to be in the United States."

Last year, Promina Health System sponsored a trip to the Philippines for recruiters from DeKalb Medical Center who would also be recruiting for Piedmont Hospital. From that trip the hospitals actually only have gotten five or six new nurses so far, Martin said.

The immigration process for foreign nurses can take months, even years. Hospitals, hoping to ease immigration restrictions, are lobbying Congress to increase the number of health-care professionals that can be recruited into the United States each year. Canada is lobbying for similar immigration concessions for their own hospitals.

Win-win or short-sighted?

This year, Tenet is one of the first U.S. hospital systems to take advantage of the Walsh Visa Program, sponsored by U.S. Rep. James Walsh and passed last year by Congress. The program allows 4,000 residents from Northern Ireland between the ages of 18 and 35 to enter the United States each year to work for up to three years.

It is a win-win situation for both countries, said veteran nurse Diane Kriegal, a director of services development for Tenet who is helping with the Irish nurse recruiting efforts. "This program allows nurses to come over here and upgrade their skills so when they come home they are better educated and more skilled nurses," Kriegal said. Tenet probably will only be able to take about 100 nurses a year from Ireland because of their shortage, she added.

Growing competition for the world's available nurses could eventually jack up the costs of foreign recruiting. A shrinking pool of talent also may force countries, such as Canada, to more adequately deal with the root cause of their shortage, Auffrey said. "Foreign recruitment is short-sighted. That kind of thinking is going out with the aardvark," she said. Georgia's Hatmaker agrees. Hospitals need to focus on retention as well as recruiting, she said.

The Canadian Nurses Association is working to compile a national report that will show exactly how many nurses Canada needs versus how many they have, she said. Similarly, U.S. Institute of Medicine President Kenneth Shine, who spoke recently at Emory University, said the institute plans to tackle the nursing shortage issue, particularly how quality of care has been affected.

The Georgia Hospital Association is supporting federal legislation that would provide more dollars for nursing education and make it easier for nurses to pay back school loans, said Karen Waters, the hospital association's vice president of professional services. This year the hospital association lobbied successfully for more state dollars for its nurse scholarship program and is upping its efforts to get more nurses through school.

This nursing shortage isn't going away, Phillips said. "In the past, [nursing] shortages have been cyclical," she said. "They would end and the labor pool would build back up, but this time there are a lot of reasons why this one will continue far into the future."

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[AngelGorgz]

American Nephrology Nurses' Association Releases New Editions Of Certification Review Guide And Core Curriculum

The American Nephrology Nurses' Association (ANNA) has released new editions of two popular publications - the Nephrology Nursing Certification Review Guide and the Core Curriculum for Nephrology Nursing.

The Certification Review Guide, a highly anticipated resource 10 years in the making, uses case studies to present the concepts of renal failure, hemodialysis, peritoneal dialysis, pediatric nephrology and transplant. Each section includes practice questions to test the readers' knowledge.

In addition to updated clinical content and blueprints for the Certified Nephrology Nurse (CNN) and Certified Dialysis Nurse (CDN) exams, the Certification Review Guide also includes a bonus section on critical thinking related to test taking.

According to Norma J. Gomez, MBA, BSN, RN, CNN, who served as editor and project director, nurses have noted the Certification Review Guide helped boost their confidence and was a key resource for passing the exam.

ANNA has also just released the Core Curriculum for Nephrology Nursing, 5th edition. This revised and expanded edition was written by top experts and contains 18 sections and more than 70 chapters spanning the nephrology nursing specialty.

The Core Curriculum covers core modalities, disease processes and professional issues, including chronic kidney disease, acute care, transplantation, hemodialysis, vascular access, peritoneal dialysis, pediatrics, nutrition, pharmacology, infection control, evidence-based practice, the role of the advanced practice nurse, health policy, emergency and disaster preparedness, and more. Each section offers self-assessment questions and continuing nursing education (CNE) credit opportunities.

Editor Caroline S. Counts, MSN, RN, CNN, believes this expanded resource is an important contribution to nephrology nursing and health care literature and a good foundation for nephrology nursing knowledge.

"Both of these publications were highly anticipated, and both the Certification Review Guide and the Core Curriculum are packed with the latest information," said ANNA President Sue Cary, MN, APRN, NP, CNN. "Nephrology nurses can use these resources and feel confident they are drawing from a strong, solid study base."

The Certification Review Guide and the Core Curriculum can be used as study resources in conjunction with other ANNA publications, including Contemporary Nephrology Nursing: Principles and Practice, 2nd edition.


Source

[AngelGorgz]

Long-Term Care Nursing Directors Juggle Multiple Responsibilities

by Marcia Frellick

Directors of nursing (DONs) in long-term care do everything from shouldering accountability for the facility,s quality of care to finding Grampa,s missing dentures. The chance to work more independently than they would in a hospital, and the satisfaction of working with the elderly are big reasons many are lured to the job. But the frustrations and fears that go with the sweeping job description also are reasons many DONs in long-term care aren,t successful in their positions or burn out.

The DON turnover rate was 49.7% in a 2002 American Health Care Association survey of U.S. nursing homes, up 3.1% from the previous year.

“What happens often is that someone who is just getting comfortable as a floor nurse is pulled to be the DON,” says Sherrie Dornberger, RNC, CDONA, FACDONA, of Mullica Hill, N.J., president of NADONA/LTC (The National Association Directors of Nursing Administration in Long Term Care). “Until recently it was the belief of most administrators that you learned what you needed to know to be a DON in nursing school. That,s just not true.”

Robin Arnicar, president of Maryland,s NADONA branch, has seen nursing home care change from more custodial to more subacute. “Patients go from the hospital to the nursing home for skilled rehab,” Arnicar says. “They once got that rehab in the hospital. The [types of patients] we once took care of are now going into assisted living programs..”

New DONs quickly find that direct care can take a back seat to fulfilling increasing bureaucratic and legal demands. Whereas hospital nurses have easy access to doctors, labs, and consultants, DONs in long-term care have to make decisions quickly and independently. That challenge appealed to Christine Mueller, RN, PhD, BC, CNAA, associate professor at the University of Minnesota in Minneapolis.

“I liked the independence in my clinical decision-making,” she says. “I also liked the relationship you have with the residents and families.”

But evolving pressures are pulling long-term care DONs further from patient interaction. The DON model hasn,t changed much, even as the role has become more complex. Patients are living longer, hospital stays are shorter, litigation in the healthcare setting is soaring, and federal regulations are multiplying. But there is no requirement for more than one DON no matter what the size of the facility. And there is no requirement that the DON have more than an associate,s degree in nursing.

“I would like to see different models,” said Mueller. “Maybe two RNs — one DON and another gerontological clinical nurse specialist. That might work well for a place that has 150 or more beds.”

Aging baby boomers, combined with longer life expectancy and accompanying chronic illnesses, will further strain nursing home resources and put pressure on DONs.

Dornberger says addressing training and recruitment problems and mentoring those already in the job are NADONA,s priorities. “When a typical patient gets sepsis, you would think from nursing school that you should be looking for a fever,” she says. “But in a geriatric patient with sepsis, the temperature goes down. Also, when a resident gets combative and has a change in mental status, a geriatrically trained nurse would know to check for a urinary-tract infection.”

Dornberger says demanding a higher level of education can,t come without first addressing the critical shortage of instructors and available classes.

Kathryn Anderson, RN, PhD, director of clinical services at Providence Mount St. Vincent, a living care community for older adults in Seattle, in many ways represents the model of the future. Her role is atypical in that she has accountability for quality of care at the 215-bed facility but direct supervision lies elsewhere. Separate professional staffs supervise “neighborhoods” or clusters of rooms. The community has become a national model for culture changes in nursing homes that make them more compassionate and more like residents, former homes.

Anderson also represents the future model in that she has a doctorate. She advocates higher levels of education for long-term care DONs and cites more funding as a critical need. Unlike hospitals, nursing homes rely on out-of-pocket pay from families, long-term care insurance policies, or Medicaid, which can,t cover the true cost of care.

“We need nurses with bachelor,s degrees and leadership with master,s degrees,” she says. “Without the higher education, you don,t know what you don,t know.”


Source

[AngelGorgz]

Cheering on Patients

DC/Baltimore nurses use motivational interviewing to encourage change

by Catherine Spader, RN

You might not be able to teach an old dog new tricks, but nurses can partner with patients to help them change long-standing behaviors that negatively impact their health. Using a technique called motivational interviewing, nurses can employ a counseling approach to transform the toughest behavioral issues, such as smoking and overeating, and help patients better adhere to treatment recommendations.

"Knowledge alone does not lead to behavior change," says Joan E. Kub, RN, PhD, APRN, BC, associate professor at the Johns Hopkins University School of Nursing in Baltimore. "Change is affected more by motivation than by information."

Motivational interviewing is a non-confrontational tool that encourages patients to explore and resolve emotionally charged feelings of ambivalence toward change and enhance an intrinsic desire to alter behavior. The crux of motivational interviewing for nurses and their patients is to learn how to roll with, not be frustrated by, a patient's ambivalence toward changing behavior and attitudes.

"We all know what we're supposed to do – be healthy – but trying to do that is another matter," says Susan E. Appling, RN, MS, CRNP, a nurse practitioner in the Prevention & Research Center at Mercy Medical Center, Baltimore. "One day we're up for change, and the next day, not so much. Dealing with this ambivalence is a chronic issue for most people."

Picture what life could be

Motivational interviewing was developed in 1991 by clinical psychologists William Miller, PhD, and Stephen Rollnick, PhD, for use in the addiction treatment field. The technique has since been applied to encourage healthy behaviors for a wide variety of patients, including those with cardiac disease, stroke, diabetes, and obesity. It is also used to help patients quit smoking and with medication adherence.

"Motivational interviewing can be employed for any health behavior that requires long-term commitment to change," says Appling. "Even if someone is not at the point where they are thinking about making a change, such as with court-ordered substance abuse treatment, motivational interviewing can help [patients] to begin to see what their life would be like if they choose to make a change."

Research demonstrating the wide potential of motivational interviewing is mounting. One study, published in the January-February 2008 issue of the Journal of Cardiopulmonary Rehabilitation and Prevention, concluded a nurse-delivered motivational interviewing technique holds significant promise in the cardiac rehabilitation setting.

A study in the May 2007 Archives of Pediatrics and Adolescent Medicine concludes motivational interviewing shows promise as an office-based strategy for preventing childhood obesity.

In a nutshell

Motivational interviewing helps patients who are moving along the continuum of change and employs the same interpersonal skills nurses learn in nursing school, Appling says.

With obesity secondary to a sedentary lifestyle as an example, the basic stages of motivational interviewing are as follows.

Express empathy to help build a relationship: Encourage patients to express feelings and beliefs about their conditions, and use empathy and a warm approach to show concern and acceptance.

"It's really tough to get regular exercise when you have a family and a job that keep you so busy."

Develop discrepancy: This involves helping patients understand the gap between current behavior and lifestyle choices and the healthy ideal for their conditions.

"What concerns you most about your weight? What do you think will happen if you do not lose the excess weight?"

Roll with resistance: Resistance is an inevitable part of the change process. The ability to "roll with" patient resistance without becoming confrontational or attempting to "build a better case" for adopting change is key. Show acceptance while reflecting on goals and shifting the focus to encourage patient control of change.

Patient: "I hate going to the health club and exercising. The classes are too hard and it's embarrassing."

Nurse: "Health clubs definitely are not for everyone. There are plenty of ways to increase your fitness level without strenuous exercise. What types of activities really interest you?"

Patient: "I do enjoy gardening."

Nurse: "Gardening is a great way to be active! You might consider increasing your activity level by doing something you really love, such as planting a new flower bed, instead of fretting over a visit to the health club."

Support self-efficacy: Developing confidence is vital to self-efficacy, and nurses can help in this process by supporting patients as they use their own ideas to create realistic goals for change.

Kub recommends nurses use a tool, such as a 0-10 scale similar to the pain scale, to assess confidence in making a change and help patients measure where they are in the change process.

Nurse:"On a scale from 0-10, how confident are you that you can increase your activity level by gardening?"

Once nurses have an idea where their patients are, they can work with a patient's own ideas to identify realistic strategies that can be successful and build confidence.

Nurse: "You say that your confidence level is at a four. What are some simple things you can do to increase your activity level with gardening?"

Patient: "I could organize my tools so it's easier to grab what I need and get going. I could use the baby monitor so that I can be in the garden while the baby naps."

"If nurses can help improve patients' confidence in making a change, then we can help them move along toward their goal," says Kub.

[-JaJa-]

Court Grants No TRO on Nursing Classes

A new memorandum by the Commission on Higher Education (CHED) imposed additional subjects in the nursing curriculum and increase practicum hours for nursing students. The government agency made this move to ensure the quality of Filipino nurses making them more competitive to the global arena.
 

The new nursing curriculum has an additional 28 units and three summer classes. Required hours in the hospital increased from 2,142 to 2,703. The move was met with criticisms and disapproval by various groups such as the Coordinating Council of Private Educational Associations (Cocopea), Philippine Nursing Association (PNA), Association of Deans of the Colleges of Nursing of the Philippines and Association of Private Hospitals in the Philippines.
 

The Cocopea filed a petition to suspend the implementation of this memorandum on the ground that CHED did not conduct a public hearing. According to Cocopea chairman and president of the Catholic Educational Association of the Philippines, Fr. Rod Salazar Jr., SVD, the additional units is not practical and helpful as it would make the nursing course more expensive and there would not be enough hospitals that will be available for all students to have their practicum. 


In spite of the above reasons, the group failed to be granted a temporary restraining order against the new memorandum. Judge Esperanza Fabon-Victorino of the Pasig City Regional Trial Court denied a petition.

The CHED defends the petition by saying that they followed procedures and complied with the requirements of the Technical Committee on Nursing Education. Lawyer Carmelita Yadao-Sison, Director III, CHED Legal Service said, “[The memorandum] was a result of a series of TCNE meetings, workshops, and public zonal consultations held in Tagaytay, Baguio, Cebu and Davao City on June 21, July 5, July 19 and Aug. 2, respectively and were participated by deans, faculty members, chief nurses, clinical coordinators, CHED regional directors and supervisors and some school presidents,”   



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[-JaJa-]

Limited Work Visas Curb Deployment of RP Nurses to US

The United States of America continues to lead the current NursingGuide.ph survey regarding the best country for a nurse to practice his/her profession. Most nurses aspire to work inAmerica because of the attractive benefits like high salary, migration opportunities, better work environment, and many others.


The good thing is that America is also in dire need of nurses forcing them to deploy nurses from other countries like the Philippines. The shortage of nurses is caused by various factors; one of them is the retirement of the baby boom generation.  America has high demand for Filipino nurses and RP nurses are very much willing to go there.


It must have been a prefect scenario except that the number of work visas allowed by US is not enough to employ all foreign workers needed. Applicants need to wait for years before they are given a wok visa. This shows that the immigration policy of America needs to be amended. To address the problem, a bill that would allow more work visas for foreign nurses is currently pending in US congress. 



However, Gregory Siskind, an immigration attorney from Memphis said that it is improbable for the bill to be passed before the year ends. Siskind also said that while more lenient immigration policies may bring temporary and instant relief to nursing shortage, it will not solve the problem in the long run.


Siskind said, “Currently, the easiest way for nurses to come is to apply for a green card, which offers wide freedom to work within the United States. But there are only 140,000 green cards in the employment category issued per year for immigrants around the world, and only a small sliver of those go to nurses from the Philippines.”,


A nursing expert at Vanderbilt University, Peter I. Buerhaus predicts the nursing job vacancies to reach 285, 000 by 2020. Buerhaus said, “Hospitals are hiring more foreign nurses and they now make up 14 percent of the 2.4 million nurses nationwide. They hail from the Philippines, as well as Canada and Ireland.

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http://nursingguide.ph/article_item-403/Limited_Work_Visas_Curb_Deployment_of_RP_Nurses_to_US.html

[-JaJa-]

As RNs Retire, Drain on Intellectual Knowledge Looms

Nursing professionals have talked a lot about the aging nursing workforce and the looming catastrophic shortage of nurses that will emerge as more baby boomers retire. At a New Jersey Association of Healthcare Recruiters (NJAHR) Executive Leadership Conference, on April 18 in Princeton, N.J., attendees learned the impending nursing shortage brings other equally critical concerns.

Speaker Terri Gaffney, RN, MPA, vice president of consulting services for Gannett Healthcare Group, warned attendees that an issue perhaps even more critical than the lack of nurses is the intellectual knowledge drain that will occur when these seasoned nurses leave or retire.

Costly losses

Many of the nurses who will soon be retiring hold key positions in hospitals and healthcare facilities and retain a body of knowledge critical to the operation of the facility and to the delivery of quality patient care. Gaffney notes that many institutions have failed to document this critical intellectual knowledge and pass it on to others. The results can be costly in both dollars and patient outcomes.

It is not uncommon, she says, that "a loss of this intellectual knowledge trickles down to the bottom line and has an impact on quality. Hospitals often spend tens of thousands of unnecessary dollars to replace knowledge that could have been preserved with some forethought."

What are the effects of this lost knowledge? In many cases, Gaffney says, the speed at which decisions are made is decreased because less experienced nurses might not have the ability to recognize potential problems. Also, there is often a reduction in the organization's ability to innovate for business growth, improve efficiency, and question established policies and procedures. There is also a loss of mentoring ability and perhaps even the denigration of the sense of "team."

Solving the problem

A recent "State of the Workforce" study of New Jersey nurses found that 36.4 percent report that their caseloads caused them to miss important changes in their patients' medical conditions. Gaffney asked participants to consider what this number would be if New Jersey nurses were polled 10 years from now. Without aggressive action on the part of nursing administrators to maintain adequate staff and retain key knowledge, the figure would be far worse, she says.

Gaffney outlined several steps that all healthcare facilities can take to address the problem. These include the following:

• Identify key employees who hold critical knowledge

• Transfer that knowledge to at least one other person

• Institute a retirement planning system by asking employees when they plan to retire

• Identify alternative jobs or activities that might entice key employees to stay

• Consider a phased retirement plan whereby employees can work reduced hours in lieu of leaving

• Look at rehire programs for recently retired nurses

• Implement a storytelling program to pass on critical knowledge through clinical narratives

• Incorporate critical knowledge into the mentoring programs

• Debrief employees when they leave about the knowledge they hold

Gaffney concluded with a warning that the threat is looming, and she encouraged healthcare facilities to implement action plans now.


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[-JaJa-]

The demand for Filipino nurses in the United States and other key labor markets is falling, thus swelling the ranks of jobless Filipino nurses, the Philippine Nurses Association (PNA) said Tuesday.

“In the past two years alone, with domestic demand not increasing and global demand decreasing, many nurses are now waiting to be employed,” said Philippine Nurses Association (PNA) President Leah Primitiva Samaco-Paquiz, in a press conference Tuesday at the PNA office in Malate, Manila.

“There is already a decrease in demand for nurses, and that's the trend for now. Mahirap po ngayong makahanap ng trabaho kahit qualified ka. Matagal. (It's hard to find a job now, even if you're qualified. It takes a long time.),” said Dr. Fely Marlyn Lorenzo of the National Institutes of Health, a research institute of the University of the Philippines Manila.

Lorenzo said the nursing job market slowdown began in 2006 when the demand for Philippine nurses plateaued due to a shrinking US market for nurses and a change in policy of the United Kingdom on hiring of foreign nurses.

Since the domestic market for nurses is oversaturated, nursing pools of qualified nurses in major Philippine hospitals are as high as 1,500, and employment waiting time ranges from six to 12 months.

The PNA explained that the high unemployment and underemployment of Filipino nurses is due not only to lower demand but also overproduction of nurses by Philippine nursing schools.

The nursing licensure examinations produced 37,030 nurses in 2006 and 31,275 nurses in 2007. In 2007, there were about 65,000 newly-registered nurses.


CONTINUATION

[Irene]

Yan din sabi ng mamy ko, na dahil sa oversupply ng nurses, konti na lang ang nakakahanap ng trabaho.