The image of a nurse conjures the stereotype of a benevolent, compassionate individual who provides both physical and emotional support to the ill and dying. An expectation taken verbatim by a notable anchor, columnist, and a well-known name in politics in the Philippines in recent days has sparked public attention. For Filipinos, nursing is more than an occupation; it is a vocation rooted in profound cultural ideals of compassion, care, familial ties, and community relationships. Filipino nurses have a well-deserved global reputation for their commitment and gentle touch, as well as for being able to nurse both the physical and emotional needs of their patients. But what happens when too much is expected of them? When do patients expect more than what is due? When does goodwill turn into cruelty? How far does a nurse go before self-care becomes necessary? This article seeks to answer several questions regarding the nature of caring for Filipino nurses, the parameters of their responsibilities, as well as the limits of caring and compassion even the most affectionate hearts should exercise.
The Heart of a Filipino Nurse: An Identity Beyond Mere Vocation
Nursing, like other professions, has its calling and guiding principles. Caring is the essence of Filipino nursing, and unlike other disciplines, it is culturally instilled; it is taught in schools, memorialized in traditions, and upheld in hospitals, homes, and even on the battlefield. Filipino nurses, unlike machines that perform tasks, integrate their entire selves into their work. They soothe crying patients, listen to their narratives, and at times, are the family that the patients never had. Such concerns stem from the Filipino value of “malasakit”, an ethnocentric notion that lacks an English equivalent. It refers to caring with empathy, concern, and selfless sacrifice. A nurse with “malasakit” goes beyond the requirements of the job and takes ownership in ensuring the patient’s welfare. “One of our foremost nurses and leaders in the Philippines explains that caring is not simply doing things for the patients. It is about being there, giving attention, showing empathy, and treating each person with dignity” (Garcia Lorenzo, 2021).
A Nurse’s Oath: The Duty to Care
In the Philippines, nurses take a solemn oath upon receiving their professional license. This oath commits them to the welfare of those entrusted to them, alongside promises to preserve life, relieve suffering, and protect the dignity of patients.
This duty, when taken, provides a sense of mission and purpose in the profession. It is something that many nurses cherish deep in their hearts. But it also brings a considerable burden. For example, nurses need to maintain a cheerful demeanor during and after long shifts. They also have to maintain professionalism when dealing with demanding or hospital patients. Regardless of the circumstances,a bare minimum paycheck, an understaffed hospital, or low morale, nurses need to serve. During the COVID-19 pandemic, many nurses surpassed boundaries of selflessness by working overtime in full PPE. Thousands put their lives on the line to care for their patients. While some grew ill, others had to isolate themselves from their families for months.
Challenges in the Workplace: The Reality Behind the Smile
The day-to-day experiences of Filipino nurses tell a different story from the narrative presented by the media. Many government hospitals lack the resources to provide high-quality services. In dire circumstances, nurses must manage 20 to 30 patients simultaneously, instead of the recommended 4 to 5 patients per nurse (Department of Health, 2022). Some hospitals even lack essential supplies such as gloves, syringes, and oxygen tanks. Patients and their families add to the emotional burden of waiting by making unrealistic demands. They expect dedicated service around the clock and often believe they are entitled to abuse the staff if their needs are not met. While most patients are understanding, a small yet significant portion of them are rude and entitled. Nurses have faced verbal and physical abuse for simply doing their job. Due to inadequate compensation, many nurses are facing an economic burden. Entry-level positions in private clinics and hospitals pay around PHP 10,000 a month (approximately USD 180), which is significantly lower than the living wage (Philippine Nurses Association, 2021).
Kindness or Burnout? Understanding Limits at Work
Calling exhaustion ‘understanding the problem’ is very common in the nursing profession, especially among nurses who feel unwarranted fatigue and appreciation shortages. When do we go over the line of kindness to excess self-sacrifice? How much caring becomes too much? Being overly friendly or caring towards the patient can lead to mistakes, such as taking critical shortcuts, which puts both the nurse and the patient’s health in peril; as such, excessive care can sometimes be reckless. For instance, for a nurse who has been on double shifts, their attempts to care during the next shift can lead to “mistakes” at best, or giving the wrong medicine or skipping essential steps at worst. In this scenario, attempting kindness without concern for limits becomes unsafe for everyone involved. A nurse ethicist reported in 2022 that compassion fatigue affects a nurse’s ability to care safely, describing a nurse leaving feeling empty, unfulfilled, and burned out. “A nurse’s first duty is not to harm, not only to the patient but also to themselves.” Over-demanding. Set boundaries like saying “NO”. Refusing unreasonable demands and politely saying ‘no’ displays responsibility and obligation, a nurse’s duty. Nurses cannot be expected to work under these conditions – no entitled breaks, no answering personal calls post duty hours, no verbal abuse to be endured from patients or family members. These actions breach respectable professional lines, as well as fundamental human sanity and dignity.
The Power of Saying No, Kindly
In Filipino culture, saying “no” is often avoided, as it may be perceived as disrespectful. However, within the field of nursing, ‘no’ can and should be uttered in a considerate manner, especially when rational explanations are provided. For example, a patient may ask a nurse to administer medications beyond the prescribed limits, and the nurse is required to say, “I’m sorry, but I cannot do that.” It is necessary to step in and kindly yet assertively state the reasoning behind such requests. At this moment, the nurse can demonstrate empathy alongside professionalism. A nurse can say: “I know you’re in pain and genuinely wish to help you, but I must take care of you, and for that, I have to follow the rules in place.” This demonstrates that the nurse does care but is ultimately protecting both their career and the patient’s safety.
Beyond the Call of Duty: Real-Life Stories
Consider that of Nurse Angel, who is 28 years old and employed at a public hospital in Manila. During the pandemic, she was assigned to the COVID ward and thus stayed in the hospital for 30 days straight. She has provided emotional and physical support to patients through numerous stages in their lives, from holding dying patients to singing lullabies to terrified children. “I did it because I couldn’t bear to see them alone.” She continues, “That’s what a nurse does. We don’t just give medicine, we give love” . Additionally, she explained that she had to report a patient’s relative for attempting to bribe her for preferential treatment. “It was hard, but I had to draw the line. Being kind doesn’t mean you allow abuse.” Her account reflects a larger problem. Some nurses sacrifice their last ration of food for patients, purchase supplies out of pocket, or offer desperate prayers when all hope seems lost. These demonstrations are striking. However, these acts of extraordinary compassion also highlight a troubling reality: to what extent is the nursing profession obligated to compensate for the failures of an inefficient healthcare system?
Striking the Balance: A New Kind of Caring
In the context of our rapidly evolving world, what does it mean to be a caring nurse? A caring nurse is skilled, considerate, wise, and courageous. A caring nurse stands by the patients during their most vulnerable times but also advocates for their entitlements. A caring nurse understands that genuine caring is not the act of giving until depletion; rather, it necessitates the ability to strike a balance between assisting others while tending to oneself. Caring encompasses self-care, professionalism, and maintaining ethical boundaries. Nursing schools in the Philippines are incorporating instruction on mental health, stress, and ethical decision-making into their curricula. Additionally, mentorship programs and support groups are emerging, along with advocacy for equitable compensation.
Compassion with Courage
Filipino nurses embody the very soul of the healthcare system. Their “malasakit” driven spirit has provided healing not only in the country but across the globe. Yet caring does not mean suffering in silence. Caring means suffering with a courageous love, wise enough to protect that love from being misused. As we celebrate the contributions of nurses, let us also extend our unwavering support. Let us construct systems and institutions that honor and protect their invaluable contributions, corporeal presence, and life. Let us educate society that kindness does not equate to weakness, and that selflessness, while admirable, has boundaries, which nurses are not to be bound by. To every nurse who has gone above and beyond, and who continues to go above and beyond by extending their hours, gently holding the hands of those who are no longer able to hold on, enduring, and defiantly persisting in the face of unjust demands, thank you. You are the ones who make this world worth living in.
References
Del Rosario, E. (2020). Filipino nurses at the frontlines of COVID-19. *Philippine Daily Inquirer*. Retrieved from [https://newsinfo.inquirer.net](https://newsinfo.inquirer.net)
Department of Health. (2022). *Nurse-to-patient ratio policy brief*. Government of the Philippines. Retrieved from [https://www.doh.gov.ph](https://www.doh.gov.ph)
Garcia-Lorenzo, M. F. (2021). The ethics of caring in filipino nursing. *Journal of Philippine Nursing*, 16(2), 45–53.
Philippine Nurses Association. (2021). *State of the Filipino Nursing Workforce Report*. Retrieved from [https://www.pna.org.ph](https://www.pna.org.ph)
Ramos, M. (2022). Nursing ethics in the age of burnout. *Asian Nursing Ethics Journal*, 7(1), 12–20.
