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Elizabeth Cheung

Filipino domestic helper Lorna Sianen Pagaduan is keeping her fingers crossed that a recent Hong Kong policy change to tackle a chronic shortage of healthcare workers will let her practise nursing again.
She obtained her degree in the Philippines and worked as a registered nurse in a hospital there for two years. Just as she was preparing to go overseas to start working as a private nurse, her new employer died.
In a twist of fate and desperate to support her family, she ended up working as a domestic helper in Hong Kong.
After 27 years in the city, Pagaduan, 49, said the new rules offered hope that people like her might be able to take up nursing jobs.
Despite working as a helper, she has been president of the Filipino Nurses Association Hong Kong since 2006.
She set up the association to support other women like her and said some of its 150 members were qualified nurses or nursing graduates working as helpers.

Hong Kong changed the law in July to create new opportunities for nurses trained elsewhere to work in the city.
Among other things, those who qualify would not need to sit the city’s licensing exam if they join public hospitals, clinics and care homes.
Those with three years’ working experience may apply for special registration, allowing them to apply for full registration after working in specific institutions for five years.
Those with at least a year’s working experience may be given limited registration to work in Hong Kong, but that will not lead to full registration.
Nurses are among the healthcare professionals Hong Kong has long needed more of, with one government projection estimating a shortage of 9,500 nurses next year.
While the situation is projected to ease gradually, the city is still expected to be short of thousands of nurses by 2045.
From 2014 to 2023, the number of non-locally trained nurses who managed to pass the city’s licensing exam and obtain full registration was only between two and 26 each year.
With the recent changes, Hong Kong will be competing with developed countries such as Canada, Germany and others also facing shortages and hiring foreign-trained nurses.


Aside from the competitive pay in Hong Kong, Asian nurses are expected to be drawn to the city because it is closer to their homes.
But two issues could put off potential applicants: the language barrier for foreign nurses who do not speak Cantonese and the notoriously heavy workload in public hospitals.
So far the response has been positive to the Hospital Authority’s recruitment drive in Singapore, Malaysia, Macau and mainland China from July to September. Online job talks were also held for nurses in Britain, the United States, Canada and Australia.
Authority chairman Henry Fan Hung-ling said on Friday that around 600 applicants “had potential”, and interviews were being arranged for shortlisted candidates. So far, the authority has already hired 70 of these nurses.
The authority earlier said nurses’ professional qualifications, clinical experience, personal character and language proficiency would be considered, and being able to speak Cantonese was a plus.
A source said nurses from the mainland and Southeast Asian countries were among those who had applied to work in public hospitals.
The Nursing Council said in a reply to the Post that it was processing applications for special or limited registration first filed in late September.
‘Pay, proximity are a big pull’
Indonesian nurse Matilda*, 25, wished she knew of the city’s new rules before accepting a job she will start in Europe in the new year for better pay and work-life balance.
A private home care nurse to the elderly in Jakarta, she declined to reveal the country she was moving to, but said she was learning two European languages.
She thought other Indonesian nurses would find working in Hong Kong attractive, not only for the higher pay but also the proximity to home.


Registered nurses in Hong Kong public hospitals receive a starting monthly pay of HK$37,590 (US$4,830). That is higher than the pay of around €3,000 (US$3,155) Matilda will receive in Europe, which is several times more than what she is earning currently.
Nurses in Jakarta are generally paid about HK$1,780 to HK$2,500 a month, while those in other parts of the country receive even less.
Matilda, who has been preparing for almost a year to work in Europe, said she might have changed her plans if she had known sooner about the changes in Hong Kong.
“I would have chosen Hong Kong because it’s so much closer and I’ll be able to go home when I have some days off,” she said.
‘Nurses need to speak Cantonese’
Tse Kin-keung, chairman of the Association of Hong Kong Nursing Staff, did not expect the qualifications of foreign nurses to be an issue because the Nursing Council would ensure that applicants met the required standards.
He was more concerned about bringing in those who could not speak Cantonese.
“Many patients in public hospitals speak Cantonese. If there are any issues in communication, there could be problems,” he said.
And if the foreign nurses needed interpreters to understand patients, it would be an extra burden, he added.
Tse also wondered if the foreign hires would be able to cope with the heavy workload.
“Hong Kong has lots of patients but there aren’t enough nurses, and they also need to perform lots of steps in carrying out care procedures,” he said.
The workload was also a concern for Filipino nurses’ association chief Pagaduan.
She said that in the Philippines, family members were allowed to stay in the ward to help take care of patients, easing the load on nurses.
This was not allowed in Hong Kong, except for critically ill patients.

The Indonesian National Nurses Association, which oversees nursing education and services in the country, shared the concern about language proficiency.
Agung Waluyo, head of its collaboration division, said Indonesian nurses faced difficulty speaking Cantonese and English.
A professor of nursing at the University of Indonesia, he said nurses fluent in English usually did not look for a job in Asia but preferred working in Europe, North America or Australia.
Although thousands of Indonesian women already worked in the city as domestic helpers and many could speak Cantonese, the language demands in a healthcare setting were much higher, as miscommunication could lead to a patient’s death, Waluyo said.
He said Indonesian nurses, especially those who worked in major hospitals, were used to the workload and long hours.
In August, Indonesia’s consul general in Hong Kong, Yul Edison, told the Post that his country could provide nurses to help address the city’s shortage.
Public hospital nurse Tracy Chan*, who works in an emergency medicine ward, said she usually handled more than 10 patients on her own in a shift.
But at night, with fewer staff, a nurse might end up caring for more than 20 patients and the ward could descend into chaos if several needed attention at the same time.
“Some elderly patients who are quite confused will yell or leave their beds,” Chan said. “There was a patient who burned his clothes with a lighter.”
She said non-locally trained nurses would be useful in helping relieve the workload if they were familiar with medical English for written records and could perform common nursing procedures, such as inserting urinary catheters and feeding tubes.
Care homes hope to benefit too
The changes for recruiting non-locally trained nurses also cover Hong Kong’s residential care homes, which likewise face a shortage of manpower.
Grace Li Fai, who runs nine care homes for the elderly, said it had been hard for facilities such as hers to hire nurses because most preferred working in hospitals.
All her homes were short of nurses, she said. A home that needed 14 nurses, for example, would usually be short of three to four and she would have to find part-time nurses to meet the facility’s licensing requirements.
“I believe every care home in Hong Kong is facing the same problem,” said Li, an honorary chairwoman of the Elderly Services Association of Hong Kong.
She hoped the changes would help her engage nurses trained overseas with a higher proficiency in English, which was needed to check medical records and medication.
As for mainland-trained nurses, she said there should be no issue with their abilities, but she expected they would need time to develop a relationship with elderly residents of the homes.
Li said it had been hard for the care homes to find the people they needed from outside the city so far.
“We don’t know where to look for these people. We just rely on referrals from friends and relatives,” she said.
The changes to allow non-locally trained nurses offered them more options.
Instead of posting job advertisements and waiting for applications, Li hoped to collaborate with some mainland nursing schools to recruit their graduates, ensuring a stable supply of staff.

In the long run, she hoped there would be programmes between governments to provide a reliable stream of professionals.
“There should be higher-level discussions between governments on ways to help companies look for this kind of talent, instead of leaving us to look for people, which is like finding a needle in a haystack,” she said.
Germany, one country with a similar shortage, has rolled out a government-backed programme to ensure sustainable recruitment of nurses from other countries.
The programme began in 2013 and partnered with the Philippines, Indonesia, Tunisia, Jordan, Bosnia and Herzegovina and the Indian states of Kerala and Telangana, all which were said to have a surplus of qualified nurses.
It was named “Triple Win” because it increased the supply of nurses to Germany, eased the pressure for jobs in the source countries, and the remittances of salaries helped the nurses’ countries too.
Language training was a feature of the programme. Nurses selected to work in Germany began learning German before they left home to start their new jobs.
The Hospital Authority said it would provide training for the non-locally trained nurses, including basic Cantonese, to help them adapt and integrate.
Li and Waluyo agreed authorities should provide Cantonese-language lessons to overseas nurses recruited to work in the city.
“If your government would like to help us in preparing language training, that would be very helpful for us to send the best Indonesian nurses to Hong Kong,” Waluyo said.
* Names changed at interviewees’ request


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News

Hong Kong

Health & Environment

Worries persist despite rule change to open door to professionals trained elsewhere, as city set to be short of thousands of nurses by 2045


Worries persist despite rule change to open door to professionals trained elsewhere, as city set to be short of thousands of nurses by 2045.
