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Philippines to train 1k nurses from PunjabNaqvi expresses gratitude for 3,000 Filipinos providing valuable services in P...
15/12/2023

Philippines to train 1k nurses from Punjab

Naqvi expresses gratitude for 3,000 Filipinos
providing valuable services in Pakistan, including over 700 in Lahore.

The Philippines will train 1,000 female nursing students from Punjab.

An understanding was reached in this regard as the Ambassador of the Philippines, Maria Agnes M Cervantes, met Caretaker Chief Minister Mohsin Naqvi with the discussion focusing on enhancing cooperation in the fields of nursing, pharmaceuticals and medicine.

Acknowledging global acclaim for nursing professionalism of the Philippines during the pandemic, Naqvi expressed gratitude for the 3,000 Filipinos providing valuable services in Pakistan, including over 700 in Lahore.

Highlighting the persistent need for nursing professionals in Punjab, he welcomed collaboration with institutions from the Philippines.

He endorsed a proposal of mutual admissions for students from universities in Punjab and the Philippines.

Potential exchange of professional skills between the police of Punjab and the Philippines was also discussed.

Naqvi invited the to the ambassador to visit the police and Safe City Authority headquarters.

He emphasised the potential for broader partnerships in hotel management, hospitality and other sectors.

Ambassador Cervantes noted scholarship opportunities for Pakistani students in Philippine higher education institutions.

The meeting was attended by Honorary Consul of the Philippines Fahad Sheikh, Caretaker Provincial Minister Amir Mir, the additional chief secretary and other officials.

NMC guidance clarifies nurses’ freedom to express beliefsThe Nursing and Midwifery Council (NMC) has published new guida...
13/12/2023

NMC guidance clarifies nurses’ freedom to express beliefs

The Nursing and Midwifery Council (NMC) has published new guidance aiming to clarify the boundaries of nurses’ freedom of expression.

The NMC said the guidance – headed ‘Freedom of expression and Fitness to Practise’ – is aimed primarily at decision makers in its fitness to practise process but ‘also provides clarity to nurses, midwives and nursing associates, to support them to express their beliefs appropriately’.

While the guidance reaffirms that ‘everyone enjoys the right to freedom of thought, conscience and religion and freedom of expression’, it warns that the NMC may need to take action if the way someone expresses their belief means there is a risk to the public; public confidence in the profession; or proper professional standards and conduct.

According to the guidance, nurses, midwives and nursing associates are free to express themselves and their legally protected beliefs (religious, political and philosophical) outside of work.

However, if they were to use racist, homophobic, sexist or other discriminatory language; target people using health and care services; or suggest that they would discriminate against others as a result of these views – especially in a professional context – then their fitness to practise ‘could be impaired’.

The NMC said the guidance was developed following engagement with ‘key partners’ and includes examples to help decision makers approach cases ‘in a consistent way that is rooted in the law’.

One of these examples describes a midwife discussing their work with friends in a restaurant and expressing ‘very vocal’ support for a specific political party and claiming that the government is ‘destroying the service and profession they work in’.

In the example, the midwife goes on to criticise their line manager, saying they are ‘part of the problem’.

According to the guidance, regulatory action is unlikely to be taken in this scenario because registered professionals are entitled to hold and express opinions about their work and politics.

However, if the midwife had described their manager using a racial slur or indicated that their patients would be treated differently based on their political views or other characteristics, then action would be likely.

In another example where action would likely be taken, a nurse on duty tries to persuade parents to remove their consent to have their child vaccinated because child vaccination runs contrary to the nurse’s ethical beliefs.

Even though the nurse’s beliefs are protected, by ‘seeking to actively interfere with treatment on that basis’, they would be acting contrary to the NMC’s code and undermining confidence in the profession.

Matthew McClelland, executive director of strategy and insight at the NMC, said: ‘We firmly believe that everyone has the right to freedom of expression. Our code requires nurses, midwives, and nursing associates to put the people in their care first.

’That means treating people with kindness and respect and not expressing their personal beliefs in an inappropriate way.’

Mr McClelland added: ‘Occasionally, concerns are raised about the way in which someone on our register has expressed themselves so it’s important our decision makers in fitness to practise are clear on the right way to reach swift and safe decisions that are rooted in law.’

Of course the Tories will do anything to stop migrants. You know the ones: students, carers, nurses …Notwithstanding the...
10/12/2023

Of course the Tories will do anything to stop migrants. You know the ones: students, carers, nurses …

Notwithstanding the sound and fury of the Conservative party descending into more mayhem, pledging to cut immigration will not be its saviour. If the Tories think it’s an ejector seat from their political nosedive, that’s a forlorn hope. The cost of living tops voters’ concerns, so distracting them with immigration noise hardly looks like a winner: even on immigration, as on every issue but defence, Labour leads in the polls.

Having already morphed into Ukip, the Conservatives now lean to Reform. Brexit won the election for them last time; couldn’t an immigration scare win now? After all, Brexit and immigration became political conjoined twins. But they forget who has overseen net migration figures reaching 672,000 in the UK in the year to June 2023. Though 60% of those polled by YouGov say immigration is too high, its salience in terms of what matters most to voters has fallen steeply since Brexit.

Passions on immigration are intense among the mere 9% who see it as a top priority. But back in 2015, for 44% of voters it was their greatest concern, according to an Institute for Public Policy Research report co-written by Robert Ford, a professor of political science. Attitudes have changed, with young people most positive towards immigration and not becoming more anti-migrant as they age. The UK is more positive about migration than many of its European neighbours. Who cares about it most? The hardest core Tory vote that Labour needs not try to pe*****te.

Ask what kind of migrants people don’t want and the answer barely relates to the real figures, which are dominated by students and those on work visas. Do people object to foreign students and their dependants? They bring treasure chests to universities and university towns, paying fees of up to £38,000 a year and up to £1,400 a month in living costs – and almost all of them go home. No, it’s not them.

What of those invited on work visas? The vast majority of them work in health and social care: almost half the promised extra nurses recruited last year were trained overseas. No, don’t stop them.

One-off flows of 80,000 people came from Ukraine and Hong Kong in 2022, but they arrived with strong public support.

Among skilled workers, the new salary threshold of £38,000 will hit hospitality and catering staff most. Do people want them exiled?

Did Brexiters mean a drop of 70% in EU workers should be replaced with many more from around the world, swapping near neighbours for those from further afield? Possibly not.

What people worry about is that sense of uncontrolled borders, those small boats arriving randomly, unchecked. But Suella Braverman, Robert Jenrick, Nigel Farage and the rest conflate the total number of migrants issued with visas with the relatively small number (29,090 since 1 January 2023) who arrived here in boats. A few hundred people sent to Rwanda would barely touch the totals, yet the Conservatives eviscerate themselves over the details. The ambitious Tories hoping Rwanda is their springboard to success are diving headfirst into an empty pool of a policy fiasco.

While the Braverman ranters shout for cutting numbers at any cost regardless, Labour wisely refuses to set an “arbitrary target” on cutting net migration. Look what that failure did to every Tory leader. The shadow home secretary, Yvette Cooper, rightly focuses on the failure to deal with the boat arrivals, which accounted for 45% of all asylum claims in 2022. In total, more than 75% of asylum claims were granted refugee status or humanitarian protection at the initial decision stage in the year to September 2023, but the asylum backlog now stands at more than 175,000 people waiting in limbo, unable to work, when they could be in jobs tomorrow if they had been processed quicker. No, they wouldn’t be taking other people’s jobs in this hungry labour market. Nor taking homes: it’s the acute lack of construction workers that is holding back building. As for taking NHS appointments, as noted earlier, health and social care is the sector that most migrants work in.

That’s where this week’s panicky new immigration rules – especially barring carers from bringing families from spring next year – will do most damage. By chance, that blow fell just in time for a long-arranged conference of senior NHS and social care people at the King’s Fund on Wednesday, where they discussed the urgent need to recruit and retain staff. Here on display was this government’s perpetual state of cognitive dissonance. How do you recruit and retain staff and at the same time deter and prevent them from coming here to take those 264,000 vacancies in the NHS and social care? There was despair at the effect of banning carers from bringing their families: those in the room reckoned carers would choose welcoming countries elsewhere that pay them more.

Angriest and most outspoken was Steve Brine, the Tory chair of the Commons’ health and social care select committee. “They should show me the evidence that people will still come without their families,” he told me. “There isn’t any. Care England says it was never consulted on this. The government expects enough homegrown people to work in care instead? I’ve talked to schools: young people won’t take these bottom-wiping jobs.” Besides, failure to bring in promised social care reform keeps pay abysmal. “Immigration is the price we have to pay willingly, not begrudgingly,” Brine said. As he’s standing down at the next election, he’s free to speak his indignation at a doomed policy made for all the wrong reasons.

Immigration tears apart parties around the world, terrifying some politicians as they watch others stir venomous xenophobia and race resentments. But in the UK, Brexit may have helped increase the appetite for such extremism among some voters. While there is 47% public support for the Rwanda policy, according to some polls, there’s no wish to turn the UK into an international pariah, with only 22% public support for leaving the European convention on human rights and 57% against. Opinion on immigration has softened.

Spineless Rishi Sunak should have told some home truths about migration. He should have reminded his party and the public that we need lucrative foreign students and useful workers invited here with visas. Immigration is not out of control, even if boats are hard to stop. But he lives in fear of the monsters in his party that he was always too weak to confront.

Cost of living drives London nurses away and temp costs up - RCNLondon hospitals are spending hundreds of thousands of p...
08/12/2023

Cost of living drives London nurses away and temp costs up - RCN

London hospitals are spending hundreds of thousands of pounds on temporary nursing staff to cover vacancies created by the high cost of living and inadequate wages, the Royal College of Nursing (RCN) claims.

The analysis is based on information from NHS trusts across England between 2020 and 2022.

The NHS in London spent more than £630m on staff, the RCN said.

But the government said the Covid pandemic affected the statistics.

In 2020, RCN London said 57% of the city's nurses said they were "likely" to leave the capital within five years.

They cited the expense of living and working in the city as a factor - which the RCN said bodes ill for the future.

RCN London said the continuing cost of living crisis in the capital, especially the impact of hikes in interest rates, rents and travel costs means the risk of more nursing staff leaving has "spiralled".

"Long before 2020, NHS leaders were grappling with the challenge of recruiting and retaining enough nursing staff in the capital," a RCN spokesperson said.

"Nurse vacancy rates in London have been consistently higher than any other part of the country for several years. Currently, London's NHS has over 10,000 vacant nurse posts.

"At the same time, the health system is desperately trying to get to grips with high waiting times while being told to be more productive and make cost efficiency savings."

RCN chief nurse Prof Nicola Ranger, said: "Ministers have got their priorities wrong - forcing trusts to squander billions on agency staff while they provide miserly funding for fair pay and nurse education.

"With cuts to nurse education and maintaining unfair pay levels, ministers are choosing to spend the money on much higher private agency bills instead, this is yet another false economy when it comes to NHS spending.

"This should act as a wake-up call. The government must give nursing staff and patients the investment and respect they deserve."

A Department of Health and Social Care spokesperson said: "These statistics cover the Covid pandemic when the NHS was under huge additional pressure and staff sickness rates were exceptionally high.

"While temporary staffing allows the NHS to meet fluctuations in demand, we are controlling spending by capping hourly pay and prioritising NHS staff when shifts need filling.

"The long term workforce plan is ensuring the NHS has the staff it needs over the next 15 years so that patients continue to receive the best possible care."

Hospitals in England splurge more than £3bn on agency nursesHOSPITALS in England have splurged more than £3 billion on a...
06/12/2023

Hospitals in England splurge more than £3bn on agency nurses

HOSPITALS in England have splurged more than £3 billion on agency nurses in the last few years, according to new data.

The Royal College of Nursing (RCN) gathered figures under the Freedom of Information Act from 182 NHS trusts on spending on agency nurses plus nursing staff such as assistants and support workers.

The union said every region has spent millions of pounds, which it suggested could have paid the salaries of almost 31,000 full-time nurses or trained more than 86,000 new ones.

In total, NHS trusts spent £3.2bn between 2020 and 2022, with the London region spending the most at almost £630.5m, followed by the south-east at £582m.

Hospitals use doctors and nurses as temporary agency staff to fill gaps in rotas.

NHS England data shows that one in 10 — 42,306 — registered nursing posts stood vacant at the end of September.

RCN chief nurse Professor Nicola Ranger said: “Ministers have got their priorities wrong, forcing trusts to squander billions on agency staff while they provide miserly funding for fair pay and nurse education.

“With cuts to nurse education and maintaining unfair pay levels, ministers are choosing to spend the money on much higher private agency bills instead.

“This is yet another false economy when it comes to NHS spending.

“This should act as a wake-up call. The government must give nursing staff and patients the investment and respect they deserve.

“Not acting now will mean even more patients on waiting lists and the crisis in the nursing workforce deepening further.”

The Department for Health and Social Care said: “These statistics cover the Covid pandemic when the NHS was under huge additional pressure and staff sickness rates were exceptionally high.

“While temporary staffing allows the NHS to meet fluctuations in demand, we are controlling spending by capping hourly pay and prioritising NHS staff when shifts need filling."

Government pledge to recruit 50,000 nurses a ‘pipe dream’, RCN saysNURSING leaders have ridiculed a government claim tha...
04/12/2023

Government pledge to recruit 50,000 nurses a ‘pipe dream’, RCN says

NURSING leaders have ridiculed a government claim that it has honoured an election pledge to recruit 50,000 new nurses to the NHS.

The Royal College of Nursing (RCN) said the commitment, which was made in the Conservatives’ 2019 general election manifesto, “remains a pipe dream.”

The Department of Health and Social Care claimed this week that it had reached its recruitment target of 50,000.

It said in a statement: “Data published today by NHS England shows there were 51,245 additional nurses in September 2023 compared to 2019.

“This means the number of nurses have increased from 300,904 in 2019 to over 352,000 — hitting the government’s manifesto commitment to recruit an additional 50,000 nurses six months early.”

But RCN chief nurse Professor Nicola Ranger said: “Nursing staff will reject government claims that it is
‘mission accomplished’ on nurse recruitment.

“This political target had no basis in the reality of demands on health care. There are still tens of thousands of nursing vacancies in the NHS.

“On every shift nursing staff are caring for too many patients. They’re spread perilously thin leaving patients waiting longer and unable to provide the outstanding care that they want to.

“The ambitious workforce plan will remain a pipe dream without proper investment and critical detail on how it will be achieved.

“Nursing staff won’t tolerate a status quo of low pay and endlessly increasing demands.”

An increase in registered nurses has also come amid a rise in the number of people joining the register from so-called “red list” countries.

These countries have their own health and care workforce-related problems and under ethical recruiting guidance the NHS is told not to actively recruit workers from these places.

Nursing numbers rise but ‘red list’ recruitment sparks fresh concernThere are a record 808,488 nurses, midwives and nurs...
01/12/2023

Nursing numbers rise but ‘red list’ recruitment sparks fresh concern

There are a record 808,488 nurses, midwives and nursing associates eligible to practise in the UK, according to new data released by the Nursing and Midwifery Council (NMC).

The number on the register represents a record, according to NMC, with a rise of more than 19,857 (2.5%) from the figure six months ago, and 114,874 (16.6%) over a five-year period.

However, concerns have been raised over data showing an upward trend in joiners from the so-called ‘red list’ countries, where active recruitment is prohibited by the UK Government’s code of practice.

The NMC register mid-year update shows there were 30,103 new joiners in the six months to September 2023 – 27.7% more than in the same period in 2022 (23,565), and more than twice as many as in the corresponding period five years ago (14,311).

Just over half (15,067) of these new joiners were educated in the UK, representing the highest number of domestic joiners ever in the first half of a financial year, and nearly 25% higher than in the same period last year (12,104).

However, it is understood that the rise in UK educated joiners is partly because, since 2020, the NMC has clarified for education institutions that newly qualified professionals can join the register once they have finished their programmes – for example, after three academic years rather than waiting until the end of three calendar years.

The number of international joiners was almost identical to UK joiners, at 15,036. India moved further ahead as the biggest single source of international recruitment, with 7,223 joiners in the last six months, compared to 4,849 between April and September last year – a 49% rise.

However, the NMC said the rise in the number of people joining the register from red list countries was ‘concerning’. This included joiners from Nigeria (1,536), Ghana (886), Zimbabwe (283), Zambia (189) and Pakistan (110) over the last six months.

It should be noted, however, that while Department of Health and Social Care (DHSC) and Scottish Government codes of practice prohibit active recruitment from nations on the red list, they do not prevent individual health workers from those countries seeking employment independently.

The concerns over red list recruitment follow the uncovering of evidence of ‘widespread fraudulent activity’ at a testing site in Nigeria used by some internationally educated nurses before joining the Nursing and Midwifery Council (NMC) register.

Reacting to the figures, Professor Nicola Ranger, chief nurse from the Royal College of Nursing (RCN) said: ‘The government’s over-reliance on unethical international recruitment from red-list countries has become the norm and cannot continue. It’s a false economy.’

Professor Ranger also expressed the view that the headline figures from NMC ‘don’t reflect what nurses are seeing on the NHS frontline’.

She added: ‘Since 2019, the NHS waiting list has grown four times faster than the nurse workforce, meaning there aren’t enough staff to provide the outstanding care patients deserve.’

NHS Providers also expressed concern over the rise in joiners from red list countries, as well as disparities in supply and demand.

‘International recruitment must be done ethically, in line with the DHSC’s code of practice,’ said Miriam Deakin, NHS Providers’ director of policy and strategy.

‘The NHS Long Term Workforce Plan aims to drive domestic training alongside international recruitment. For this to be realised, the plan must be adequately funded by the government,’ she added.

Ms Deakin welcomed the overall rise in nurses, midwives and nursing associates, describing it as a ‘welcome boost for a depleted workforce’, but also observed that demand on healthcare services has risen since the pandemic, maintaining a ‘mismatch’ between demand and capacity.

‘Recruiting more staff only goes so far to address this,’ she said. ‘We also need to focus on retaining staff by continuing to improve workplace culture, which includes stamping out racism and discrimination.’

Meanwhile, chief executive of the International Council of Nurses Howard Catton, added: ‘Around the world demand for healthcare is outstripping the supply of nurses and as a result we have seen a relatively small number of richer countries, including the UK, at the forefront of a significant increase in international recruitment.’

He noted that at a recent meeting of nursing associations, nurse leaders told of ‘deep unease and concern about the impact of recruitment activity that was further weakening already vulnerable health systems and also resulting in poor and exploitative recruitment practices’.

The register shows a steady retention rate, with a total of 13,308 professionals having left since April – equivalent to 1.7% of the total. In the same period last year, 13,164 people left, representing the same percentage.

The NMC noted that the ethnic profile of the register continues to change, with more international professionals joining the register and UK joiners becoming more ethnically diverse – a quarter of the UK joiners since April are from Black and minority ethnic backgrounds.

The proportion of all registered professionals from Black and minority ethnic backgrounds now stands at 29.1%, compared with 27.7% in April and 19.1% in 2018.

The figures also show ‘a slow but steady change’ in the age profile of the register. The total proportion of professionals aged 21 to 40 is now 43.5%, compared to 42.7% six months ago, and 37.7% in September 2018.

Commenting on the latest data, Andrea Sutcliffe, NMC chief executive and registrar, said the headline figure was ‘very encouraging given the well-publicised pressure on health and care services at a time of rising demand for care’.

While insisting that all of the professionals on the register make a ‘vital and welcome contribution to people’s health and wellbeing’, Ms Sutcliffe emphasised that it was important that employers continue to be mindful of the government’s ethical recruitment code regarding countries on the red list.

‘People from across the world want to come and work in the UK. However, employers must not undermine health systems in countries with the most pressing workforce challenges through active recruitment,’ she said.

A Department of Health and Social Care spokesperson said: ‘There were a record number of homegrown nurses joining the NHS in the first half of this year and that number is increasing.

‘There are now over 17,600 more NHS nurses working than this time last year, and we are on track to deliver 50,000 more compared with September 2019.’

They said the NHS Long Term Workforce Plan would also ‘deliver around 24,000 more nurse and midwife training places a year by 2031’.

‘Our published Code of Practice is clear that whilst recognising an individual’s right to migrate, organisations should not actively recruit from WHO red list countries,’ they added.

I have reached 5K followers! Thank you for your continued support. I could not have done it without each of you. 🙏🤗🎉
01/12/2023

I have reached 5K followers! Thank you for your continued support. I could not have done it without each of you. 🙏🤗🎉

24/09/2023

Up coming Senior career Orientation in Hong Kong
This coming 8 of October 2023

Nurses recruited from overseas offered free housing and transportSupport package is designed to ease foreign nurses’ tra...
03/07/2023

Nurses recruited from overseas offered free housing and transport

Support package is designed to ease foreign nurses’ transition to working and living in the UK as NHS continues to depend on international recruitment

Nurses newly recruited from overseas are benefitting from financial advice plus a month’s free travel and accommodation thanks to an employers’ partnership.

Under the scheme, the nurses get a month’s free bus travel, 30 days’ accommodation and money advice through a collaboration between their trusts, a major bank, a bus company and a housing provider.

Support took away the stress I could have felt doing this on my own’

The nurses have been recruited by Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust from countries including Nigeria, Kenya, Ghana and the Philippines.

Staff nurse Virginia Enyidede, who came from Nigeria to work at Walsall Healthcare, said: ‘Settling in was very easy for me, right from when I entered the country till now, I never felt left out,’ she said.

‘The accommodation was comfortable, the bus pass helped me in navigating my way around and the account-opening session all contributed to making me feel at home.’

Fellow staff nurse Patience Ekuna, from Ghana, added: ‘It took away a lot of the stress and frustration that I could have felt doing all this on my own.’

International recruitment of nurses surging

Many trusts have ramped up international recruitment as part of efforts to fill widespread nursing vacancies. Latest NMC data show a surge in the number of overseas-educated recruits joining the register, with more than 25,000 arriving in the year up to March 2023.

Alongside recruitment drives, trusts are developing bespoke support programmes to help international nurses familiarise themselves with NHS systems and life in the UK.

Support for international nurses at Wolverhampton and Walsall is co-ordinated by a specialist recruitment team that recently achieved an NHS Pastoral Care Quality Award, which recognises good practice in supporting internationally recruited nurses and midwives.

The team oversees a structured training programme and offers practical advice for international recruits, who are also assigned a ‘buddy’, generally a fellow nurse from overseas who has been in the UK for at least six months.

Out of nearly a million registered nurses in the Philippines, one third work abroadAfter an excellent training, most nur...
15/06/2023

Out of nearly a million registered nurses in the Philippines, one third work abroad

After an excellent training, most nurses prefer to move abroad because of the low wages at home. Last year, President Ferdinand Marcos Jr. set a ceiling of 7,000 going overseas. Filling staff shortages in Philippine hospitals would take at least 12 years.

Manila (AsiaNews) – According to the Philippine Health Secretary Teodoro Herbosa, the country's registered nurses (RNs) are "the best in the world”. Yet, a good number work abroad because of very low wages and heavy workload at home, this according to the Inquirer.net news website.

The Professional Regulation Commission puts the number of Philippine RNs at 951,105. about 75 per cent women, but only 509,297 are considered “active.” Another 316,415 have left, most notably for Austria, Canada, Germany, Japan, Saudi Arabia, Singapore, and the United States.

Last year, President Ferdinand Marcos Jr. set a ceiling of 7,000 overseas nurses per year.

The reasons why Filipino nurses are so in demand abroad is because of their excellent training.

“Filipino nurses are competent and very caring at the same time,” said Jocelyn Andamo, general secretary of the Filipino Nurses United (FNU). And “We are proficient in English, too.” In fact, the Philippines ranks 22nd out of 111 countries on the English Proficiency Index.

What is more, Philippine nurses have a “very positive work attitude,” Andamo notes, pointing out that they have good personal relations and show compassion, qualities that are not, however, rewarded at home.

At present, Department of Health data suggest that the country needs an additional 127,000 to provide optimal health care. At the current rate of graduation, it would take 12 years to close the gap.

According to the FNU, the only way to keep Philippine nurses in the country is to increase their salary; in the public sector, the entry-level salary is 32,097 pesos (US$ 575) per month; however, many government nurses are contractual and get much less than what is provided by law.

Compared to the entry-level pay in the United States (US$ 3,800) and the United Kingdom (£ 1,662, US$ 2,116), the choice is obvious for some Philippine nurses.

According to the FNU, the only way to make nurses stay in the Philippines is to regularise contractual nurses, increase the entry-level salary to 50,000 pesos (US$ 895) in government and private hospitals, and ensure a safe nurse-patient ratio to address the problem of severe and chronic understaffing, a situation that was all too obvious during the COVID-19 pandemic.

The FNU notes that the ideal nurse-patient ratio in hospitals is 1:12, while some nurses presently can take care of 20 to 50 patients every shift.

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