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From left to right: Emma Estandian, RN, Minda Alonso, RN, clinical manager 3W/3s (intermediate care units), Shirley Landrito, RN, Carmencita Bieber, RN, and Luz Yumang, RN, from University Medical Center, Las Vegas.

Elvie Magsarili, RN, will never forget the first time she came to the United States in the 1960s. Magsarili, who had earned her bachelor of science in nursing degree from Manila Central University, had never been outside the Philippines, and her port of entry that October — Alaska. Nothing had prepared her for the icy weather. Fortunately, she had thought to wear a wool cape. “If I didn’t have that,” she says, “I would’ve died.”

Today, Magsarili still lives in the U.S. The San Diego-area resident considers the U.S. her home and doesn’t plan on moving back to the Philippines.

Magsarili, who came to the U.S. on an H-1, or temporary work, visa, is part of the migration of Filipino nurses to the U.S. The Philippines, which is the world leader in nurse emigration, played a key role in helping the U.S. fill its nursing shortages over the last 55 years.

During the last four years, more than 50,000 Filipino nurses have found work in the U.S., according to an October 2004 study by the University of the Philippines National Institutes of Health. In The New Asian Immigration in Los Angeles and Global Restructuring, Paul Ong and Tania Azores estimate that at least 25,000 Filipino nurses migrated to the U.S. between 1966 and 1985.

Colonial link

This migration to the U.S. is linked to early twentieth-century U.S. colonialism in the Philippines, Catherine Ceniza Choy asserts in her 2003 book Empire of Care: Nursing and Migration in Filipino American History. Choy says U.S. colonialism in the early 1900s led to the creation of a Filipino labor force in the late twentieth century with the requisite skills, professional credentials, and knowledge of the English language to work in U.S. hospitals, as well as a labor force accustomed to the U.S. hospital work culture, due to the Americanized professional nursing training.

Nursing comes to the Philippines

Americans began training the first Filipino nursing students in 1907. Nursing students in the Philippines studied many of the same subjects as nursing students in the U.S. However, Choy says, the curriculum in the Philippines “was never a mirror-image reproduction of the American nursing curriculum” and involved more than a simple transfer of knowledge from American nurses to Filipino nurses. The first Filipino nursing students also studied subjects that were more relevant to their patients, such as “the nursing of tropical diseases” and “industrial and living conditions in the islands,” as described by Lavinia L. Dock’s 1912 book A History of Nursing: From the Earliest Times to the Present Day with Special Reference to the Work of the Past Thirty Years.

In addition, Filipino nursing students studied English; today, the Philippines is the third-largest English-speaking country in the world. However, Choy notes, Filipino nursing students didn’t lose their native language; Philippine schools of nursing believed the best way to promote physical health was to have a select few medical professionals spread their knowledge “in the dialects of their own people,” as described in the Philippine General Hospital School of Nursing Ninth Annual Announcement and Catalogue, 1915-1916.

Through the 1930s, Philippine schools of nursing continued to adopt those aspects of American professional nursing they deemed relevant and appropriate, such as higher admission standards and the specialization of public health nursing.

Training and practice at the hospital schools of nursing in Manila was “violently disrupted” when the Japanese occupied the Philippines in 1942, Choy says. However, U.S. colonial patterns in Philippine nursing education soon returned after the U.S. reclaimed the country in 1945 and even after the Philippines gained independence from the U.S. July 4, 1946.

Although American philanthropic organizations sponsored Filipino nursing graduates to study abroad in the 1940s, the Filipino nurses who traveled to the U.S. continued to be few in number, according to Choy.

First wave

That changed with the establishment of the U.S. Exchange Visitor Program in 1948. The goal of the program was to fill a post-World War II labor shortage, as well as promote a better understanding of the U.S. in other countries to combat the “hostile propaganda campaigns directed against democracy, human welfare, freedom, truth, and the United States, spearheaded by the Government of the Soviet Union and the Communist Parties throughout the world,” as Choy quotes from Senate reports.

The EVP contributed to the first wave of migration of Filipino nurses, with more than 11,000 Filipino nurses participating in the program between 1956 and 1969.

The 1965 Immigration Act included new occupational preferences, which enabled Filipino nurses to settle as permanent residents. By 1967, the Philippines had replaced European and North American countries as the world’s biggest exporter of nurses to the U.S., which was experiencing a nursing shortage of 125,000 vacant positions. With the passage of a U.S. public law in 1970, fewer exchange visitors had to meet a two-year foreign residency requirement to become permanent residents. Between 1966 and 1978, 7,495 Filipino exchange visitors amended their status to become U.S. permanent residents.

The Philippines also led other countries in the number of H-1 visa nurses entering the U.S.; between 1972 and 1978, 60% of H-1 visa nurses were from the Philippines.