If You’re Crying at 2AM…Burnout, the Bar, and Believing in Yourself

Every year, thousands of bar examinees walk the tightrope between determination and burnout. This piece was born not just from memory, but from a recent conversation — a mentee quietly broke down, and I remembered that night I did too. This isn’t a lecture. It’s a companion. A mirror. A warm hand on the back at 2AM, telling you: you’re not alone.

Anxiety is like a thief that arrives without a warning

I didn’t fret during the review. I was feeling positive about everything. Month after month, I was landing high in the mock bar rankings. On paper, I was peaking. Friends said I looked calm. I believed I was perfectly fine.

Then one night — out of nowhere — it hit me. Like a sweep of sudden dread. An inconsolable feeling of doom. No trigger, no warning. My heart started pounding, my chest tightened, and I couldn’t sleep. Thoughts were racing in my head, a flood of tears suddenly came rushing, and a sense of impending doom overtook my body at 2:00 A.M.

I cried — not because of a codal provision I forgot, but because anxiety arrived like a thief in the night, stealing away my sense of control. And that loss of control? That frightened me more than any question the exam could throw my way.

How did I survive that night? Still, I do not know.

But living to see the light of day the following morning taught me something that codals never did: Bar review isn’t just a test of mastery. It’s a test of self-mastery.

Have you had your 2 A.M. moment yet? The one that makes you doubt everything — even yourself? If you haven’t, it might come.

And if it does, remember this: You’re not breaking down. You’re breaking open.

Maybe you’re counting down too by now. But this is more than a countdown to test day; it’s a rehearsal for something bigger. You memorize the law. You outline jurisprudence. But no one teaches you what to do when anxiety wraps around your chest at midnight and won’t let go. If you’ve ever felt that way — like you’re doing everything right and still falling apart inside — this is for you.

What does anxiety feel like?

It’s not always what you expect. Sometimes it’s subtle. Sometimes it’s physical. Here are some signs to watch out for:

• A pounding heart, even while doing nothing

• Shortness of breath, or feeling like your chest is tight

• Restlessness — the inability to sit, focus, or relax

• Sweaty palms or cold hands

• Nausea or stomach discomfort

• Racing thoughts or mental fog

• Feeling detached from your surroundings (a sense of unreality)

These are symptoms of your fight-or-flight system being activated. It's your body reacting as if there’s danger — when really, you're just alone with a reviewer in your room.

It sneaks in — when you're brushing your teeth, or lying in bed, or after acing a mock bar.

You think, “This shouldn’t be happening to me.” But it does. It did.

In my case, the anxiety was sudden, sharp, and overwhelming. The kind that shortens your breath. I didn’t know where it came from — there was no specific trigger. That made it scarier.

What helped was learning to catch it. Naming it. Breathing through it. Anxiety loses power when you don’t fight it — when you observe it.

You are not your anxiety. It’s a signal, not a sentence. Let it pass through, not take over.

Mind the Mind Spiral

Bar review glorifies discipline — and rightly so. But somewhere along the way, we started worshipping the myth of the machine: the bar taker who studies 12 hours a day, eats stress for breakfast, and operates without emotion or error.

What we don’t talk about enough is the quiet unraveling beneath the surface — the tears that don’t make it to social media, the panic that doesn’t fit into planner checklists, the self-doubt that creeps in even when your scores say you’re doing well. You are not a machine. You are a whole person. And success at the bar doesn't require perfection — it requires preservation.

Before your thoughts drag you into a “what if I fail?” spiral, pause, and reframe.

Bar exam anxiety isn’t just emotional. It’s neurological. Every time you mentally rehearse worst-case scenarios, you’re building neural pathways that make those fears more dominant. That’s where neurolinguistic programming (NLP) comes in — it’s about becoming conscious of your internal scripts and changing how your brain processes fear.

Reset your mind frame

What the mind conceives, the body achieves. Your words become your reality. It is important to control the narrative early on by:

1. Noticing the pattern. Catch spiraling moments (e.g., “I haven’t studied enough”, “I’m not good enough”, “I’m not as good as my classmate”).

2. Name it without judgment. “I’m telling myself I’m behind. That’s just a story. Not a fact.”

3. Replace it with an anchored phrase. Create a phrase that calms and grounds you.:

   • “I am not in the bar exam yet. I am in a study session. And I’ve survived harder days than this.”

   • “This is just a mock bar. I can still improve.”

   • “I have been preparing for this my whole life.”

4. Use physical anchors. Tap your wrist or place your hand on your chest while saying the phrase. Over time, the gesture becomes a physical cue for calm.

Know When to Step Back

Sometimes the bravest thing you can do is close the book.

““You don’t want to burn out before the real test begins.”

— Atty. Edwin Sandoval

You think you’re falling behind. But your brain isn’t a machine — it needs space to breathe, reset, and remember. De-escalating doesn’t mean giving up. It means protecting your mental clarity. Walk. Nap. Water your plants. Pause the war. You’re not wasting time. You’re making time work for you.

Atty. Edwin Sandoval once reminded me earlier during the review not to push to the point of collapse. “Rest,” he said. “You don’t want to burn out before the real test begins.”

Sing. Watch. Be Silly.

Joy is not a distraction. It’s a cognitive reset.

In the thick of bar review, I once sang karaoke in my room — just one song, out of tune, at full volume. I also watched a dumb romantic comedy I had already seen five times. For a moment, I wasn’t a bar review machine. I was just… me again.

And here’s the surprise: I didn’t forget Civil Law because of it. If anything, I remembered better the next day.

Why? Because your brain retains more when it’s not drowning in cortisol. Laughter oxygenates your mind. Music regulates your heartbeat. A 20-minute comedy break is not a waste of time: it’s recovery. So don’t feel guilty for singing your heart out to Queen or SB19, watching your favorite Netflix series, dancing on TikTok to recharge, or eating out with friends.

Even the late criminal law luminary Judge Oscar Pimentel said in our first-year class: “If you want to memorize your codals — sing the provision.”

If your joy feels like rebellion — good. You are rebelling against the lie that suffering is the only way to succeed. You are allowed to feel good, even while preparing for something hard. Learning from the readings in political law on the right to privacy, “life is not only meant to be endured, but enjoyed.”

If you were to take the bar exam once, why not enjoy it. You will never pass this way again. Whatever it is, the way you tell your story online can make all the difference.

Honor Your Rhythm — Sleep Included

Bar review is a marathon. The only way to last is to know your rhythm and protect it. I used productivity tools like the Pomodoro Technique, a time management method that breaks work into focused intervals, traditionally 25 minutes long, called “Pomodoros,” followed by a 5-minute break. After completing four Pomodoros, you take a longer break of 15 to 30 minutes. The method uses a timer to instill urgency, enhance focus, and reduce burnout—making it especially useful during intense study periods like bar exam prep.

Sleep isn’t a luxury. It’s a core part of cognitive function. You can’t retain what your brain didn’t get a chance to consolidate. Neuroscientists confirm REM sleep strengthens memory, and naps boost learning.

Build a routine

In my case, I built a routine comprising of:

• 5:00 AM — Wake and first read

• 7:00 AM — Breakfast and self-care

• 9:00 AM — Focused study

• 12:00 PM — Lunch

• 1–2 PM — Nap

• 2–6 PM — Review

• 6 PM — Dinner

• 8–10 PM — Final review

• And by 10:00 PM — I stopped.

Naps are not laziness. They’re mini-reboots. Routine is not rigidity. It’s safety.

Protect Your Peace

Mute the chat group. Curate your feed. Stop comparing reviewer stacks or practice scores. You don’t need permission to log off.

But protecting your peace isn’t just digital — it’s spiritual and environmental too.

Build inner stillness however you can. That could mean:

• Saying a short prayer before opening your codal

• Taking 3 deep breaths at the start and end of each review session

• Trying guided meditation or soundscapes to fall asleep

• Creating a ritual: light a candle, play focus music, tidy your desk — a signal to your mind that you are safe to focus

Adjust your surroundings. If your space is noisy, wear earplugs. If it’s messy, clear just one corner. Small shifts create mental clarity.

And then, this: Stay away from people who bring chaos. Bar season is not the time to fix everyone’s life. Avoid drama. Exit the group chat with obnoxious arguments. Limit contact with those who drain you. Be kind, but firm.

Trust me. During the bar exams, your emotions will peak. And when that happens, you’ll need all the calm you’ve saved. So you need to conquer your tendency to panic, before panic conquers you.

Your peace is your fuel. Guard it like it’s part of your reviewer.

The late Dean Willard Riano also shared a lesson I’ve held close: “Be proud of who you are and what you can be.” It’s a reminder that self-trust is as essential as study, and its starts by being at peace with yourself.

Seriously Mind Your Posture

Sit up. Support your spine. Stretch your neck.

During bar review, I ignored the small body signs — until they weren’t small anymore. I wish I had paid attention.

Now in my late thirties, I feel the consequences. So I’ll say this loud: Take care of your back. Your body is carrying your dreams.

Good posture isn’t just about avoiding back pain. It’s a signal — to your brain and to the world — that you are alert, grounded, and in control.

Physically, proper posture ensures that oxygen flows more freely throughout your body. When you’re slouched or hunched over your desk for hours, your lungs compress, making breathing shallow. This reduces your energy, weakens focus, and contributes to fatigue. Sitting upright with your spine aligned improves circulation and helps keep your brain awake.

Mentally, posture can influence how you feel about yourself. According to social psychologist Amy Cuddy, who is widely known for her research on "power posing", an upright posture is linked with increased confidence and lower cortisol (stress hormone) levels. Thus, simply adjusting your body can change how your mind performs.

Cognitively, your brain responds to posture as a feedback loop. Slouching often mirrors defeat or exhaustion — and your brain picks up on that signal. Standing or sitting tall, on the other hand, reinforces a mindset of capability and readiness.

In moments of stress, like cramming for the bar or reviewing difficult cases, try this simple shift: uncross your legs, plant your feet flat on the floor, roll your shoulders back, take a deep breath and look up, not down. This posture doesn’t just feel better — it tells your body, “I’m not overwhelmed. I’m here. I’ve got this.”

Final Words

 I was inspired to write this because one of the bar takers I am mentoring recently opened up about the pressure and anxiety they were feeling. It reminded me of my own story — that night I broke down with no warning, and still made it through. This post is for them, and maybe, for you too. If it helps even one person feel less alone — then it’s done its job.

You’ve probably heard it a hundred times: “Just trust the process.”

But the truth is, the process can feel terrifying. And lonely. And heavy. And sometimes, like you’re not enough.

That’s why you need to bring all of you — not just your brain, but your heart, your humor, your breath, your body. Because the bar isn’t just a test of what you know — it’s a test of who you are when no one’s watching.

And if you ever find yourself crying at 2AM, it doesn’t mean you’re weak. It means you’re already braver than most — because you showed up.

Self-mastery is part of bar mastery. The big day won’t just test your memory — it will test your mind, your rhythm, your peace.

So breathe. Stand tall. Study hard, but rest harder.

You’re not behind. You’re becoming.

If you’re feeling overwhelmed, exhausted, or isolated, this is for you—a safe space where your challenges are seen and your courage is honored. Together, we’ll walk through the darkness toward the light at the end of this difficult road. Because no one should have to face the bar alone. Let’s face it, and rise beyond it—side by side. #

Statutes of limitation for medical malpractice in the Philippines

The law sets time limits for filing court cases called statutes of limitations. Prescriptive periods also apply to medical malpractice cases. How long can someone sue for medical malpractice before it's too late?

Such quandary was answered in De Jesus v. Dr. Uyloang, Asian Hospital and Medical Center, and Dr. John Francois Ojeda (G.R. No. 234851, February 15, 2022).

The case involved a failed surgery by Drs. Uyloang and Ojeda on De Jesus for gallstones. De Jesus later had abdominal pains and bile leakage, which Dr. Uyloang said was normal.De Jesus sought a second opinion, confirming the wrong duct was clipped, leading to bile leakage. Another surgery was needed on November 19, 2010.

On November 10, 2015, after five years, De Jesus lodged a medical malpractice case against Dr. Uyloan, Asian Hospital and Medical Center and Dr. Ojeda. All of them moved for the case’s dismissal invoking that the time to file the action already prescribed.

Now, the crux of the controversy: did the action grounded on medical malpractice already prescribe?

De Jesus argued that, since the action was based on a contract between the defendant doctors and hospital, the action prescribes in six or ten years under Article 1145 and 1144 of the Civil Code, respectively.

To determine whether the De Jesus’ medical malpractice suit was barred by the statutes of limitation, the Philippine Supreme Court had to define the nature of a medical malpractice suit.

Medical Malpractice defined: contract or quasi-delict?
While jurisprudence is clear as to the requisites of establishing a physician-patient relationship, there appears to be a lacunae in what the nature of the relationship is. Does it constitute a contract?

As defined in the earlier Casumpang v. Cortejo (G.R. No. 171127, March 11, 2015), “a physician-patient relationship is created when a patient engages the services of a physician, and the latter accepts or agrees to provide care to the patient. The establishment of this relationship is consensual, and the acceptance by the physician essential.” It can be gleaned from this jurisprudential definition that the first requisite of a contract — consent — is satisfied. Does this mean that this meeting the minds between a physician and patient ourightly establishes a contractual relationship between them?

After all, contracts are born with concurrence of three : (a) consent of the contracting parties; (b) object certain which is the subject matter of the contract; and (c) cause of the obligation which is established (Art. 1318, Civil Code).

The Philippine Supreme Court held that a physician-patient relationship is not contractual. It explained:

The fact that the physician-patient relationship is consensual does not necessarily mean it is a contractual relation, in the sense in which petitioner employs this term by equating it with any other transaction involving exchange of money for services. Indeed, the medical profession is affected with public interest. Once a physician-patient relationship is established, the legal duty of care follows. The doctor accordingly becomes duty-bound to use at least the same standard of care that a reasonably competent doctor would use to treat a medical condition under similar circumstances. Breach of duty occurs when the doctor fails to comply with, or improperly performs his duties under professional standards. This determination is both factual and legal, and is specific to each individual case. If the patient, as a result of the breach of duty, is injured in body or in health, actionable malpractice is committed, entitling the patient to damages. (De Jesus v. Dr. Uyloang, et. al, supra.)

Does this pronouncement therefore foreclose any contractual relationship between a physician and a patient? Interestingly, the Philippine Supreme Court hinted that it was also possible that an action for medical malpractice can be based on contract, specifically when the plaintiff “allege[s] an express promise to provide treatment or achieve a specific result.”

Citing a textbook on American malpractice jurisprudence, “The Preparation and Trial of Medical Malpractice Cases[,]” the Philippine Supreme Court expounded that:

Absent an express contract, a physician does not impliedly warrant the success of his or her treatment but only that he or she will adhere to the applicable standard of care. Thus, there is no cause of action for breach of implied contract or implied warranty arising from an alleged failure to provide adequate medical treatment. This allegation clearly sounds in tort, not in contract; therefore, the plaintiff's remedy is an action for malpractice, not breach of contract. A breach of contract complaint fails to state a cause of action if there is no allegation of any express promise to cure or to achieve a specific result. A physician's statements of opinion regarding the likely result of a medical procedure are insufficient to impose contractual liability, even if they ultimately prove incorrect. (Shandell and Smith, 2006)

Following this logic, we can draw this conclusion: absent any specific promise to cure or achieve a definite result, no contractual relationship between them arises notwithstanding the physician’s acceptance of the patient’s engagement. Supporting this conclusion are rulings of the Philippine Supreme Court in earlier cases which recognizes that physicians are not insurers of life (Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999) and good result of treatment (Lucas v. Dr. Tuaño, G.R. No. 178763, April 21, 2009). 

Verily, that physicians cannot and do not guarantee that a patient will be cured is already well-entrenched in Philippine jurisprudence. Seemingly, this jurisprudential trend will not favor award of damages based on contract liability theory in medical malpractice suits, notwithstanding the the settled doctrine that liability for quasi-delict may co-exist in the presence of contractual relations.

The inescapable conclusion then is the period of prescription for quasi-delict applies in medical malpractice cases. 

Nature of medical malpractice cases

American legal system classifies medical malpractice or medical negligence as a form of “tort.” The Philippines, however, does not have “tort” imbedded in its legal system. Instead, the Civil Code of the Philippines provides for a system of quasi-delict. Chief Justice Alexander Gesmundo speaking in De Jesus eruditely explains:

For lack of a specific law geared towards the type of negligence committed by members of the medical profession in this jurisdiction, such claim for damages is almost always anchored on the alleged violation of Art. 2176 of the Civil Code, which states that:

ART. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties, is called a quasi-delict and is governed by the provisions of this Chapter.

Medical malpractice is a particular form of negligence which consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. In order to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed to do something which a reasonably prudent physician or surgeon would have done, or that he or she did something that a reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient. There are thus four elements involved in medical negligence cases, namely: duty, breach, injury, and proximate causation. (De Jesus v. Dr. Uyloang, et. al, supra.)

While the contract theory of medical malpractice cases was debunked, it does not mean that victim of medical malpractice or medical negligence are without recourse. The Philippine Supreme Court’s pronouncement in De Jesus only indicates that medical malpractice victims may vindicate their rights by filing an action for damages based on quasi-delict. Parenthetically, they can also file a case for criminal negligence under Article 365 of the Revised Penal Code (on Quasi-Crimes). 

Drawing lessons from the De Jesus case, victims of medical malpractice should ever be mindful of the prescriptive period in filing the suit within the prescriptive period. Simply put, as in any case, time is of the essence.

Revisiting statute of limitations in civil cases

Generally, statutes of limitation are provided for in specific laws. In so far as civil cases are concerned, absent specific prescriptive period under special law, the Civil Code applies. Determinative in the case of De Jesus are Articles 1144, 1145 and 1146 of the Civil Code, to wit:

ARTICLE 1144. The following actions must be brought within ten years from the time the right of action accrues:

(1) Upon a written contract;

(2) Upon an obligation created by law;

(3) Upon a judgment.

ARTICLE 1145. The following actions must be commenced within six years:

(1) Upon an oral contract;

(2) Upon a quasi-contract.

ARTICLE 1146. The following actions must be instituted within four years:

(1) Upon an injury to the rights of the plaintiff;

(2) Upon a quasi-delict;

However, when the action arises from or out of any act, activity, or conduct of any public officer involving the exercise of powers or authority arising from Martial Law including the arrest, detention and/or trial of the plaintiff, the same must be brought within one (1) year.

Falling under the broad concept of quasi-delict, medical malpractice cases prescribe within four-years from the commission of such wrongful act or omission. Clearly, De Jesus’ medical malpractice suit came one year too late. It took him five years to pursue his claim against Drs. Uyloang and Ojeda, as well as Asian Hospital and Medical Center. As to why he waited for time to slip away, we could only surmise. This curious case serves as a reminder and a caveat what tons of law books have been saying all along: “the law helps the vigilant but not those who sleep on their rights.” Vigilantibus, sed non dormientibus jura subverniunt.

Filipino nurses: Too many, but never enough

Healthcare workers in government, including nurses, cheered on when it was announced on July 9, 2024 that the Department of Health will release around P27.4 billion health emergency allowance for health workers who served during the height of the COVID-19. Will this be enough to keep them from fleeing the country to search for greener pastures? Only time will tell.

For a country that prides itself as one of the world’s largest producers of nurses, the Philippines is faced with the paradox of having a surplus of nurses yet still never enough to sustain its much-needed army of nurses during the battle against COVID-19. Overseas migration was not the only factor affecting deficient supply of nurses in the Philippines. The lack of stable jobs and dismal wages also factored in. (Ortiga & Rivero, 2019). Inadequate state funding to hire more nurses worsened this existing crisis in nursing supply. (Perrin, Hagopian, Sales, & Huang, 2007)

The International Centre on Nurse Migration reports close to six million shortfalls of nurses even prior to the outbreak of the COVID-19 pandemic. (Buchanan, Catton & Shaffer, 2022) retaining nurses and maintaining adequate supply of nursing workforce challenged many countries. It compelled nations to implement drastic and "emergency" policy actions to keep a sufficient regiment of nurses. The Philippines is no exception.

In 2020, the Philippine Overseas Employment Administration (POEA) through Governing Board Resolution No. 9, 2020 banned the deployment of health workers abroad. The deployment ban was due to a reported shortage of 290,000 health workers in the country. (Governing Board Resolution No. 9, 2020) The shortfall in health workers was aggravated by an average annual migration of 13,000 health care professionals that aggravated the deficiency in national supply of health human resource, majority of whom are nurses. (Ibid.)

After a huge public backlash, the POEA Governing Board issued Governing Board Resolution No. 17 which temporarily lifted the ban but imposed an annual overseas deployment cap of 5,000 new hire healthcare workers starting January 1, 2021. (Governing Board Resolution No. 17, 2020)

During the pandemic, nurses were seen as “heroes” of the war against COVID-19. However, Rowalt Alibudbud (2022) argues that it’s not enough to honor nurses during the Covid-19 crisis. (Alibubud, 2022) Honor sans just proper wages, adequate staffing and livable conditions will not sustain the Philippines’ Covid-19 response. He observed, “hospitals in the country began downsizing operations, not because of lack of facilities, but rather because of lack of health care workers.” (Alibubud, 2022)

Agence France-Presse (2021) reports the alarming plight of nurses experiencing burn out in the midst of the unprecedented rise COVID-19 cases in 2021, which ultimately led most of them to quit nursing. The article notes that the nursing service in most hospitals were already “dangerously understaffed even before the pandemic.” (Agence France-Presse, 2021)

Filipino Nurses United President, Maristela Abenojar, attributes such “chronic understaffing” to inadequate salaries of Filipino nurses. On paper, an entry-level nurse in a private hospital is entitled to earn Salary Grade 15, which is roughly Php 33,575.00 (US$ 670.00) per month. However, according to Abenojar, in reality, there are still nurses in the public hospitals who are employed on short-term contracts, earning Php 22,000.00 per month with no benefits such as statutorily-mandated hazard pay. (Agence France-Presse, 2021)

During the COVID-19 pandemic, overseas recruitment of nurse became widespread and aggressive. While reforms in the nursing policies are seen in increments, the circumstances beg the question whether our government has done enough to retain our pool of nurses and instill in them a sense of nationalism that would make them stay.

The twenty year saga for nurse’s equitable wages

We cannot blame Filipino nurses if they have their a strong desire to migrate. Afterall, they have been fighting for 20 years for government to hear their call to implement the statutory wage under Republic Act (RA) No. 9173.

In order to enhance the general welfare, commitment to service and professionalism of nurses, the minimum base pay of nurses working in the public health institutions shall not be lower than salary grade (SG) 15 prescribed under Republic Act No. 6758, otherwise known as the “Compensation and Classification Act of 1989”: Provided, That for nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said law.

This provision on minimum base pay of entry level nurse in public health institutions incorporated the prevailing Compensation and Classification Act of 1989 or RA 6758. Under Section 9,in relation to Section 7 of RA 6758, the minimum base pay of nurses was classified as SG 10 or Php 3,102.00 (1st Step) to Php 3,325.00 (8th Step) prior to the effectivity of RA 9173.

Section 32 of RA 9173, thus, upgraded the salary grade for entry level nurses in public health institutions for SG 10 to SG 15 (Php 4,418.00 to Php 4,737). On 28 July 2008, the Congress approved Joint Resolution (JR)No. 4 (Salary Standardization Law III) authorizing the President to Modify the Compensation and Position Classification System of Civilian Personnel and Base Pay Schedule of Military and Uniformed Personnel in the Government, and For Other Purposes.” Under Section Item 3 (a) of JR No. 4, SG 15 was equivalent to Php 24,887 to Php 26,868. However, JR No. 4 expressly repealed RA 9173.

On 17 June 2009, President Macapagal-Arroyo approved JR No. 4 and issued Executive Order (EO) No. 811 implementing JR No. 4. Section 6 of Executive Order No. 811, downgraded the SG assignment for entry level nurses from SG 15 as provided under Section 32 of RA 9173 to SG 11 (Php 18,549.00 to Php 19,887.00).

On 8 October 2019, the Supreme Court step its foot against the downgrading of the pay grade of entry level nurses in public health institutions from SG 15 to SG 11 through a mere Joint Resolution and Executive Order implementing the same in the case of Ang Nars Party-List v. Executive Secretary, G.R. No. 215746, October 8, 2019.

In this case, the Supreme Court clarified that a JR is not a law or a statute, thus, it was held that it cannot repeal the provision of RA 9173:

Under Section 26 (2), Article VI of the 1987 Constitution, only a bill can be enacted into law after following certain requirements expressly prescribed under the Constitution. A joint resolution is not a bill, and its passage does not enact the joint resolution into a law even if it follows the requirements expressly prescribed in the Constitution for enacting a bill into a law.

xxx xxx xxx

A bill is, of course, vastly different form a joint resolution. First, a bill to be approved by Congress must pass three (3) readings on separate days. The can be no deviation from this requirement, unless the President certifies that the bull as urgent. In contrast, Congress can approve a joint resolution in one, two or three readings, on the same day or on separate days, depending on the rules of procedure that the Senate or the House may, at their sole discretion, adopt.

Second, the Constitution requires that before a bill is approved, printed copies of the bill in its final form must be distributed to the Members of the Senate and House three days before its passage. There can be no deviation from this requirement, unless the President certifies the bill as urgent. In contrast, a joint resolution can be approved on the same day, or several days after, the final printed copies are distributed to the Members of the Senate and the House, depending on the rules of procedure that the Senate or the House may, at their sole discretion, adopt.

Third, a bill approved by Congress must be presented to the President for his signature or veto. There can be no deviation from this. In contrast, a joint resolution approved by Congress does not require the President’s signature or veto, unless the Senate or the House, in their respective rules of procedure, at their sole discretion, requires such presentation to the President.

Fourth, upon the last reading of a bill, no amendment is allowed, and voting on the bill shall immediately be taken. There can be no deviation from this requirement. In contrast, there is no such requirement in approving a joint resolution, unless the Senate and the House, at their sole discretion, adopt such requirement.

Fifth, the procedure in enacting a bill into law is permanently fixed as prescribed by the Constitution and cannot be amended by any act of Congress. In contrast, the procedure for passing a joint resolution is adopted separately by the Senate or the House, respectively.

xxx xxx xxx

Again, this amendment or repeal cannot be affected through a mere joint resolution. Moreover, EO No. 811, not being a law, cannot also amend or repeal Section 32 of RA 9173. There can be no dispute whatsoever that EO No. 811, a mere presidential issuance, cannot amend or repeal a prior law.

Notwithstanding this pronouncement on the rightful salary of government nurses, the Philippine Supreme Court said that it did not have the mandate to compel the DOH and Department of Budget and Management (DBM) to implement Section 32 of RA No. 9173 due to the following reasons:

Despite the continued existence and validity of Section 32 of RA No. 9173, the Supreme Court cannot grant petitioner’s prayer to compel respondents to implement Section 32 of RA No. 9173, an implementation that requires the appropriation of public funds through a law. The power of the purse belongs exclusively to Congress under Sections 24 and 25, Article VI of the 1987 Constitution.

Section 29(1), Article VI of the 1987 Constitution mandates: “No money shall be paid out of the Treasury except in pursuance of an appropriation made by law.” The power to appropriate public funds can only be made through law, and the power to enact a law is a purely legislative power. The court cannot compel Congress to fund Section 32 of RA 9173 as the power to appropriate makes the necessary appropriation through a law, Section 32 of RA 9173 will remain an unfunded law, a situation that applies to other laws.

Petitioner may lobby with the Congress to fund through a law the implementation of Section 32 of RA 9173. Congress may also review RA No. 6758 and pass amendatory laws to reconcile the distortions in the salary grades of all government employees. The Supreme Court, however, cannot dictate upon Congress which, under the separation of powers, has the sole Constitutional power of the purse – the exclusive power to appropriate public funds.

Factors for Filipino Nurses’ strong intention to migrate

Many developing countries grapple with migration of nursing work force. (Zolot, 2019) Buchan & Calman (2004) attribute the spike interest international nurse migration due to shortfall in the nursing workforce worldwide. While the World Health Organization (WHO, 2020) notes as marginal increase in the global nursing workforce from 2013 to 2018 by 4.7 Million, such increase fails to keep up with population increase, demands of universal healthcare and sustainable development goals. (Elmaco, 2022)

Researchers from the Institute for Immigration Research of George Mason University, noting that 13 to 15 percent of working nurses in the United States are foreign-born, place emphasis on the crucial role of immigrant nurses in supplying adequate nursing workforce to keep a stable healthcare delivery system. (Hohn, Lowry, Fernández-Pena & Witte 2016)

The trend in recruitment of nurse continues to rise. Years prior to the COVID-19 pandemic, Hohn, Lowry, Fernández-Pena & Witte (2016) already predicted a shortfall of more than a million new and replacement nurse by 2022. According to the US Bureau of Labor Statistics, the US healthcare market will need around 372,000 additional registered nurses by 2028. (Smiley, 2020).

In her Empire of Care: Nursing and Migration in Filipino American History, Dr. Catherine Choy traced the migration of Filipino nurses in the US which led to the Philippines being dubbed as “the leading exporter of nurses in the world.” The 1907, when the Philippines was still annexed to the US, saw the growth spurt of nursing schools under Americanized medical training curriculum aiming to employ Filipino nurses for the US market. (Choy, 2003) A century hence later, the Philippines remain its standing as the “the leading exporter of nurses in the world” (Lorenzo, Galvez-Tan, Icamina, & Javier, 2007).

The Philippine Statistics Authority records that 70,000 Filipinos were employed abroad from 2008 to 2012 (McLaughlin, 2020). According to the Washington-based Migration Policy Institute, there were 145,800 Filipino registered nurses employed in the US. (Batalova, 2020)

Meanwhile, on the other end of the Atlantic ocean, UK National Health Service employed roughly 18,500 Filipinos in 2020. In the Asian hemisphere, Japan had been actively recruiting Filipino nurses to care in for its elderly (Elmaco, 2022) On the other, in the middle east, there is a huge population of Filipino nurses recruited to man its healthcare system. (McLaughlin, 2020). Spain, the Philippine’s first and longest colonizer, fast-tracked the hiring of Filipino nurses to assuage its strained healthcare system especially during the COVID-19 pandemic. (Aboy, 2020).

The promise of the “opportunity to change their lives for the better and to secure the quality of life they aspire” in a more advance society drives many nurses. (Xu and Zhang, 2005) This explains why many nurses consider moving and working overseas as one of their future goals. (Elmaco, 2022)

Prior to the COVID-19 pandemic, the emigration of Filipino nurse burgeoned to at least 71 percent from 2012 to 2016. (Elmaco, 2002; citing Lopez and Jiao, 2020) As shown in the estimates of the Philippine Overseas Employment Administration (POEA) and the Commission on Higher Education (CHED), the Philippines is produces around 26,000 licensed nurses annually from 2012 to 2016, however, an estimated 18,500 emigrated annually. (Lopez and Jiao, 2020)

Elmaco (2022) cautioned that these figures may be inaccurate as may Filipino licensed nurses leave the Philippines unofficially owing to the practice of direct recruitment and departure on the basis immigrant visas which are not reflected in the Philippines’ international employment estimates. Pang, Lansang and Haines (2002) opined that mobility estimates of the Philippine government ought to be treated with caution.

The Philippines produced 20,000 graduates per year since 1999 under 233 nursing schools. (Corcega et al., 2002) However, retention and integration of this nurses in the country’s healthcare system appears to be the government’s least concern. Corcega et al (2002) noted that the Philippines’ strategy for healthcare migration involved actively training a surplus of registered nurses that cannot be absorbed by the local market for the international market. Building a nursing workforce for export to boost the country’s economy through foreign remittances remained a predominant government policy strategy. (Ortiga, 2017) Clearly, as in other countries that supply nursing workforce to the world, the Philippine government support the migration of its nursing workforce is a widely accepted policy. (Dussault, Buchan and Craveiro, 2016).

For a country that boast itself as one of the world’s largest producers of nurses, the Philippine’s nurse staffing ratio, however, is inadequate to support the needs of its burgeoning population. (UPPI and DRDF, 2020) The Private Hospitals Association of the Philippines reported a shortfall of around 23,000 nurses (Maru, 2020).

WHO’s Global Code of Practice on the International Recruitment of Health Personnel looks down on the recruitment of health personnel from countries that experience shortage (WHO, 2010) However, recruitment of Filipino nurses for overseas employment became more rampant amidst the pandemic. From personal experience, the proponent of this study saw offers of foreign recruiters that are irresistible.

According to a study, the Philippines is “ill-placed to encourage” deployment of Filipino nurses. (Elmaco, 2022) The International Council of Nurses, in a study, concluded that the “the local health system in the Philippines needs to support the growth of nursing as a profession and to address the dilemmas present with regard to work environments and pay.” (Buchan, 2020). However, the economic realities confronting Filipino nurses in the Philippines cannot stop them from migrating for greener pastures.

The study of Elmaco (2022) makes a strong argument that the Philippines’s nursing migration experience are affected by push and pull factor. The ‘push’ factors that encourage nurses to leave their home countries, according to the International Centre on Nurse Migration, including limited access to educational and career opportunities, low pay, a lack of resources, limited social benefits, political instability and the absence of safe and secure conditions. (Li, Li and Nie, 2014).

Meanwhile, the ‘pull’ factors that gravitate nurse to developed countries include better “working conditions, job security and advancement, avenues to improve skills, and travel opportunities.” (Aiken et al., 2004).

In the three decades, Philippine society saw the saga of Filipino nursing working public hospitals and government office fighting for a decent wage. It took decade from 1991 for Filipino nurses in the public sector to secure a statutory minimum wage of Salary Grade 15 through the enactment of RA 9173 in 2002. This was however a phyrric victory as it took the government 20 years to implement through the Supreme Court’s Ang Nars ruling. The legal battle for this right to be recognized and finally implemented was uphill and full of heartbreaks. “Filipino nurses public hospitals and government offices had to campaign for almost two decades before they secured a pay increase required by law.” (de Vera, 2020)

Perhaps the pandemic’s silver lining for Filipino nurses is that during the height of the pandemic Budget Circular No. 2020-4 (Department of Budget and Management, 2020) was released to enforce Section 32 of RA 9173 only in July 2020. Nurses finally enjoyed a monthly salary equivalent to t PHP 28,890 (USD 580) to PHP 33,423 (around USD 671) in state-run health institutions.

Will the enforcement Section 32 of RA 9173 keep our Filipino nurses from migrating? With the rising trend of overseas recruitment, Philippine government needs to act fast to prevent the pool of its talented nurses from hemorrhaging.