Nurses unable to nurse enthusiasm for stressful, underpaid job

The Cardiac Surgical Resuscitation Department at a leading public general hospital in HCMC is functioning with just 13 nurses, less than half the number it used to have.

Over the past two years, nurses have left the department for better paying private clinics or even quit the healthcare sector altogether and switched to other jobs.

Most of those who left the hospital said they could no longer work in a stressful environment, having to deal directly with issues of life and death, get exposed to infectious diseases on a regular basis and work frequent night shifts – all this for just VND7-9 million ($295-380) per month.

“We used to have five nurses per shift but now we have just three. Those who stay have to do more of the work and in the long run, it would be hard for them to keep going,” said the head of the department, who wanted to remain anonymous.

“The current inadequacies, if not promptly resolved, can easily lead to a healthcare crisis,” he added.

A nurse takes care of a patient in the ICU of a hospital in HCMC. Photo by VnExpress/Quynh Tran

At a meeting in late August, HCMC Health Department director Tang Chi Thuong said: “Lately I have had to sign decisions to let medical workers quit jobs in public facilities every single day.”

Most of them are people who have worked many years in the field, he said.

Thuong said every hospital in the city was complaining about difficulties in recruiting nurses.

“Doctors can earn extra by opening their own clinic at home but nurses have to rely completely on state salaries,” he said.

In the first six months of this year, 874 medical workers quit their jobs in HCMC, including 199 doctors and 391 nurses. This compares to 1,154 people resigning in all of 2021.

Nationwide, 9,680 medical workers quit public healthcare facilities in 2021 and the first half of this year, including 2,874 nurses.

The ratio of nurses to population in Vietnam is among the lowest in the world, at 11.4 per 10,000 people, the Ministry of Health has said.

According to the World Bank, Vietnam had 1.4 nurses per 1,000 people back in 2016. The World Health Organization recommends three per 1,000 population.

The rate of nurses to doctors in Vietnam, according to the health ministry, is also among the lowest in the world, at less than two compared to the global average ratio of 3-4.

Treat them better

Pham Duc Muc, chairman of the Vietnam Nurses Association, said 60-70% of work at hospitals is taken care of by nurses.

They are the first and the last hospital staff that patients meet when they enter and leave the facility, and it is they who take care of patients the most.

“Given their important role, nurses in Vietnam have not been treated the way they deserve. Despite their efforts, nurses are not highly appreciated – they are poorly paid and do not have many opportunities to develop their career.”

Mai, a nurse at a hospital for HIV patients in HCMC, said she has to care for hundreds of patients every day and face high risks of getting infected, especially when taking care of patients in their last stage as they have suffered from opportunistic infections and have sores all over their bodies, or when getting blood samples or injecting patients with medicine or when cleaning up medical waste.

She and her colleagues also have to take care of the patient’s mental health because in several cases, they do not have any family member by their side. It is when the addict patients get angry and violent as their cravings increase that it gets most challenging for the nurse, she added.

Son, a nurse at the intensive care unit (ICU) of a major general hospital in Hanoi, said he has to take night shifts two-three times per week. During those shifts, he and his colleagues barely get any sleep and have to work almost nonstop.

A nurse sets up a food tube on a patient at a hospital in Hanoi. Photo by VnExpress/Giang Huy

However, the highest income he can get, including extra allowances, is VND9 million per month.

“More and more people have quit the job while the newly-recruited ones need a lot of time to learn it as ICU nurses must have the skills to use various types of equipment and machinery,” Son said.

He added that the ICU receives 200-250 patients every day and 70% of them are in critical condition, but there are only 20 doctors and 80 nurses to care for them.

“And the actual number of staff would be even lower when doctors and nurses take sick leave and go on vacation or business trips,” he said.

Actually, there’re nurses aplenty

Pham Van Tac, head of the Health Ministry’s Administration of Science Technology and Training, said Vietnam has 43 universities and more than 150 colleges training 50,000 nurses every year.

Therefore Vietnam should not lack nurses but instead be able to supply staff for the global market, he said.

However, he acknowledged: “There are now many issues that need to be solved to increase the ratio of nurses to doctors.”

The health ministry has proposed an increase in benefits for health workers to the government with the hope that it can contribute to tackling the ongoing nurse shortage.

Healthcare workers who stay put in their stressful job say their main motivation is the love for their jobs and the reward of saving lives.

“I’ve never thought that I work for money. I live on my own and spend most of my time at the hospital. My income is just enough to cover my daily meals,” said nurse Son in Hanoi.

He said it was the joy of saving the lives of patients that makes him stay.

Recently during one of his night shifts, the ICU received a 32-year-old patient who’d lost her heartbeat by the time she had reached the hospital.

The heart paddles, however, did not work.

Given the emergency situation, one nurse in the team got on the stretcher to perform chest compression manually as he and two other nurses continued to carry the stretcher to the ICU.

That presence of mind and effort made the difference between life and death. The patient survived.

“It is this that motivates and keeps us moving forward.”