"Not deskilling us at all"

29 May 2017

In this opinion piece JED MONTAYRE responds to comments in a recent Nursing Review article: Filipino Nurses: our fastest growing nursing workforce. In the article some Manila-based Philippine nursing leaders questioned whether Filipino nurses risk being deskilled by being pigeon-holed into working in the aged care sector in New Zealand.

I enjoyed reading the latest Nursing Review edition on Filipino nursing. Indeed for us Filipino nurses, it is a great acknowledgment of the Filipino nursing workforce growth in New Zealand. However, I personally do not agree with the comments on Philippine-trained nurses being 'deskilled' just because they end up working in aged care.

I am aware that many of my Filipino registered nurse colleagues working in the aged care sector here have enjoyed and done remarkably well with their nursing roles – which absolutely contradicts the idea of them being deskilled. I believe that the statements made around deskilling my fellow Filipino nurses, appear – though maybe not intentionally - to be short-sighted and don't reflect the New Zealand healthcare system and areas of nursing practice here, particularly gerontology nursing.

Aged care nursing is specialty practice, but it is not a common career pathway for Filipino nurses nursing in the Philippines. Although, gerontology is integrated into the Philippines' nursing curriculum, post-registration nursing experience in the Philippines focusses on acute care provision in hospital settings.

Gerontology nursing is uncommon in the Philippines for cultural and economic reasons. Philippine families primarily look after their elders in their homes and, apart from that, there are more acute and pressing health issues on the country’s healthcare agenda resulting in a different healthcare delivery focus.

My response to the 'deskilling' comments are based both on my actual nursing experience and accounts from fellow Filipino nurses working in the aged care sector. I did not feel deskilled when I first started working in aged care back in 2011, instead I felt challenged by the complexity of this care environment which taught me to regularly carry out comprehensive nursing assessments so I could make the sound nursing care decisions that were critical to the care I provided. I indeed got to apply the skills I had gained from my acute care and emergency nursing background.

There is huge nursing autonomy in aged care and that professional responsibility is underpinned by good nursing knowledge, skills and attitude. My Filipino nursing colleagues working in aged care have progressed to senior nursing positions, and some hold managerial roles in aged care at a national level, a clear skill progression from novice to expert status. And they have a professional status that is far from being deskilled.

While I acknowledge that every Filipino RN has different experiences of working here in New Zealand, that is not a reason to devalue skills applied in one nursing practice setting or specialty when compared to another. I am also aware that some Philippine registered nurses work as healthcare assistants (HCA) here in New Zealand, however this is not issue of being deskilled but a separate, socio-political circumstance brought about by factors like awaiting nursing registration or complying to state registration requirements. Also, based on conversations I've had, working as an HCA is not viewed as a deskilling process at all. When talking to Philippine RNs working as HCAs in aged care I've asked them where they want to work after registration and they all want to come back as an RN in aged care.

Perhaps it is a matter of career choice, however the issue of being deskilled is not an issue at all. Yes there are issues in aged care, like pay and tough work conditions, but these are not new or unknown to other nursing work environments around the world.

However I believe that nursing skills and education are best judged, not by where a nurse practises, but by how they apply their previous nursing knowledge and background to their current practice setting and their ability to provide professional and safe nursing care.

Author: Dr Jed Montayre is a nursing lecturer at AUT University who came to New Zealand from the Philippines in 2011 and started his New Zealand nursing career in the residential aged care sector.

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