Q: Every year Taiwan has 13,000 graduates of nursing programs, but only 60% of those graduates actually enter the profession. With regard to nursing manpower, what supply and demand problems is Taiwan facing?

A: Aside from those nursing graduates continuing their studies in order to acquire additional skills or to attain a master’s or doctorate, an estimated 7,000 graduates find work at hospitals every year.

In recent years 60% of sitters have passed the exam for certification as a nurse, but next year the system is being overhauled. There will be a new test for certification as a registered nurse, and only 30% will succeed. We can thus anticipate that the nursing shortage will only grow worse.

The DOH is considering extending the time that graduates can serve at hospitals during their internships in order to help make up the shortfall. It is also suggesting that the Ministry of Examination and the Ministry of Education put an emphasis on reviewing nursing education, so as to resolve long-standing problems such as a lack of clinical experience among nursing instructors and a gap between the book knowledge tested on certification exams and the reality in hospitals. The goal is to “harmonize teaching, exams and practice.”

“Bring the angels back!” Teng Sue-wen of the DOH’s Bureau of Nursing and Health Services Development has come up with 10 strategies for retaining more nurses and convincing those who have left the profession to return.

Q: With regard to the strategy of increasing NHI funding for nurses, the Taiwan Radical Nurses Union is concerned about whether the nurses will actually receive the benefits. How is the DOH handling the implementation?

A: These concerns stem from the fact that the “Project for Improving Hospital Care under National Health Insurance” didn’t specify how funds were to be used in 2009 and 2010. Since 2011, the Bureau of National Health Insurance has been required to use that funding for bolstering nursing personnel and nurses’ salaries.

By the end of March this year, participating hospitals had used those funds to hire 1,709 people. A total of 41.6% (NT$770 million) has been used for bonuses, 22.7% (NT$420 million) to raise salaries, 21.8% (NT$400 million) to hire more nurses, and 4.5% (NT$85 million) to raise night-shift pay. This year total funding for nurses has increased from NT$1 billion to NT$2 billion, and all of that must go to personnel. The increase in funding has been of great help in increasing nursing manpower.

Q: The nursing shortage has caused working nurses to break down from overwork. Is the DOH examining the nurse-to-patient ratio?

A: Regulations are but fingers plugging holes in a leaky dam. Only if people really want to enter the profession will the load be lightened.

Every year Taiwan has 7,000 new nursing graduates entering the profession. And there are another 100,000 who have nursing licenses but aren’t practicing. The fact is that Taiwan has enough nurses. The problem is getting them to want to return to nursing.

Increasing incentives is now the top priority. Quite a few hospitals have discovered that higher salaries are enticing nurses to return to the profession.

What’s more, nurses are mostly women, and three-shift scheduling can have a big effect on how nurses can care for their families. In the future, we’ll be pushing reforms that promote greater shift flexibility, facilitate part-time work, and increase pay on night shifts so as to retain nurses who have families.

Q: What is the purpose of extending the maximum time allowed for nursing graduates to obtain certification from 15 months to four years after graduation? What effect will this have on the shortage of nurses?

A: There are a lot of misunderstandings about this reform, with many believing that hospitals want to employ nurses at lower wages. In fact, when uncertified nurses are being trained and assessed, they cannot be counted toward the required nurse-patient ratios.

Consider that every year there are about 10,000 graduates of nursing programs who cannot attain certification in their first year but who can work with nurses performing lots of tasks that caregivers can’t do, such as giving enemas and clearing mucus from the respiratory tract. Those graduates represent an important human resource. They can be put to good use before they acquire certification.

The truth is that all other medical professionals have specified maximum time periods for obtaining certification. For instance, it’s five years for doctors, five years for nutritionists, and three years for psychologists. Nurses were the exception in not having a specified internship period under the Nurses Act. The DOH originally intended to introduce revisions that would allow the maximum duration of nursing internships to be increased from 15 months to four years. But because nurses’ unions didn’t have a full understanding of the proposal, the DOH decided to postpone making the change.