Dutch losing trust in RI's nurses

Dutch losing trust in RI's nurses

By Solita Sarwono

WASENAAR, The Netherlands (JP): Last month a controversy
regarding Indonesian nurses fired by a hospital in The Hague,
brewed in the Dutch media. They had failed a three-month
probationary term and most of them have sued the hospital.

This case highlights the high demand for nurses in the
Netherlands, which has led to unscrupulous agencies taking
advantage of the situation.

The worst impact now is the diminished trust of Indonesian
nurses among the public, particularly healthcare institutions,
thanks to the malpractice of some individuals.

One hospital has declared that it is no longer recruiting
nurses from Indonesia -- despite the shortage this year of 7,000
nurses.

Rehabilitation of the Indonesian nurses' image will be a long
and difficult process, which can only be achieved with strict
regulations and control over the selection, training and sending
of nurses.

The nurses had failed their three-month probation in The Hague
because of their poor command of the Dutch language.

They were unable to work independently and needed constant
supervision and guidance in undertaking their duties.

The hospital, which had invested a huge sum in recruiting and
training the nurses, had to use extra manpower, time and money to
guide them, meaning an extra burden for the already overburdened
paramedics working there.

The nine nurses had been offered two options.

First, they could continue working and improve their language
skills for another month, after which they could take another
Dutch language test. Those who passed could sign a working
contract of one or two years; the present Dutch law does not
permit a working contract longer than two years for foreign
workers.

Those who failed the test were told they had to return to
Indonesia.

The second option was a return ticket to Indonesia, three
months' salary, amounting to approximately 7,500 gilders or
almost Rp 30 million, and exemption from paying back a debt of
12,000 gilders owed to the employment agency.

This sum reportedly covered selection costs, language training
and an air ticket. The hospital has already paid this amount in
advance to the agency, which was to be deducted from the nurses'
monthly salary.

Only one nurse took the option of returning. The rest decided
to sue the hospital for having breached their two-year contract.

The hospital insisted that a contract is only signed when
recruits have passed their probation. Reports suggest that the
two-year contract was promised by the agency manager, a Dutch
citizen of Indonesian origin.

The court ruled that the hospital did not need to extend the
employment term of the nurses who did not meet the required
performance standards. Besides, the hospital had met its
obligation by paying the agency an additional sum of 5,000
gilders as a mediation fee.

The Dutch labor inspector has stated that the employment
agency, which had recruited 64 nurses from Indonesia in 1999 and
2000, would be investigated. The Ministry of Social Affairs and
Labor said it suspected that the agency, which was planning to
import another 60 nurses, did not have the necessary permits.

This is the second time that Indonesian nurses working in the
Netherlands have become the center of controversy, even
attracting discussion in parliament.

The first time related to an uproar about the huge amount of
money which had to be paid to the same employment agency by
hospitals, nursing homes and the nurses. In the Netherlands it is
illegal for an employer to deduct money from an employee's salary
to pay a debt.

Besides, a 500-gilder deduction from a gross salary of 2,500
to 3,000 gilders (exclusive of 38 percent tax) per month is
extortionate.

The Dutch public and politicians were upset, especially
because the victims of the malpractice were young people from
developing countries who were supposed to benefit professionally
and economically from working in the Netherlands.

Over the past decade the need for nurses in the Netherlands
has rapidly increased as a consequence of population growth, an
aging population and decreasing interest in the profession.

In the coming five years there may be around 40,000 vacancies.

The Dutch government has campaigned strongly to attract the
young to join the profession with little success. Nursing is very
hard work, yet attracts insufficient financial, social and
psychological compensation.

Career development in nursing is limited; salaries are no
higher than hospital administrative personnel, who are free from
night shifts; nurses are the front line recipients of complaints
from patients and doctors; and their social status is lower than
others in the medical profession.

In the past few years hundreds of thousands of gilders have
been spent on campaigns promoting the nursing profession among
the young.

The campaigns have also been directed at people with nursing
diplomas who left the profession for various reasons, including
child raising and family care. There are an estimated 160,000
people with nursing diplomas in the Netherlands who do not work
as a nurse.

Long shifts, sometimes up to 24 hours, are among the main
factors turning people away from nursing.

The Ministry of Health still tries hard to persuade these
former nurses back and is prepared to make the working conditions
for those who return more flexible.

The Ministry hopes to get 12,000 returnees this year to meet
the cries for help from the healthcare sector.

However, despite all the promotional efforts, the domestic
supply of nurses will not catch up with the rapidly increasing
demand.

This has forced the government to open its doors to aspiring
nurses from neighboring and more distant continents.

Migrant nurses have flown in from Eastern Europe, the
Philippines, Indonesia and South Africa.

To ensure professionalism, quality of care and to avoid
illegal migration, special regulations have been developed to
support this policy.

Various problems have arisen in the implementation of this new
policy. Employment agencies in the Netherlands and overseas see
this policy as a golden business opportunity.

Some dubious agencies, in the search for maximum profit, have
ignored the quality and competence of the personnel they supply,
as indicated by the situation above.

A group of nurses from the Philippines have become victims of
similar suspected malpractice. Yet healthcare institutions have
been so desperate for nurses that recruiting has not been as
strict as it should be.

The nurses themselves often have problems adjusting to the
culture, health system, working habit, lifestyle and climate of
their host country.

Many South African nurses had to go home after three months,
mainly because of reported failure to adapt to working and living
conditions.

Although many people here speak English, this is no comfort
for nurses. Skills in Dutch are a prerequisite to enable the best
communication possible between nurses and patients, who, being
ill, would prefer to speak in their mother tongue.

Writing medical reports is, therefore, also an essential
skill. Nurses are expected to be able to explain the state of the
illness to the patients and give them soothing and comforting
words. Moreover, nurses must be able to correctly understand
doctors' instructions to avoid fatal mistakes.

They also need to work with other professionals in caring for
their patients.

Poor command of the Dutch language results in further drops in
status and salary. The nurses are not likely to be given more
responsibility and are assigned to merely washing and dressing
patients, changing sheets and cleaning bathrooms.

With poor language skills they are not assigned to work the
night shifts either, which pay higher, for fear of more potential
problems.

Most of the two groups of Indonesian nurses sent by the agency
involved in recruiting personnel at the above hospital, were
assigned to the "low care" jobs, despite having graduated from a
good nursing school in Jakarta, whose standards of
professionalism are well recognized by the Dutch government.

According to the experience of an organization which teaches
Dutch and adjustment courses for migrants seeking jobs here, it
takes at least a whole year for foreigners to be able to think in
Dutch and to understand the working system.

Having ex-nurses return is taking much time while new ones
also need time to be able to meet required standards. Given the
desperate need for nurses, aspirants and potential employers
should look out for possibilities of malpractice by unscrupulous
agencies, which are hard to prevent and control.

There are agencies who have even reportedly "sold" nurses who
failed the Dutch language test.

These agencies do not care whether clients, such as hospitals,
are satisfied, whether nurses are extorted, have low social
status, or even if these young women end up finding a partner and
staying in the Netherlands as a housewife.

To prevent this problem, the Dutch government, together with
the private healthcare sector and the unions, are preparing a
code of conduct for agencies dealing in the "import and export"
of nurses.

Unlike the "export" of domestic workers, standards for the
nursing profession are of course much higher.

The urgency for quality control from the Indonesian side
arises, given the many, inexperienced, employment agencies
fighting to get a piece of this delicious cake.

The writer is a psychologist, public health educator and
sociologist residing in the Netherlands.