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But the U.S. immigration laws don’t tell the whole story. Choy also attributes the 1960s and 1970s migration of Filipino nurses to their desire for travel and adventure, low nursing wages and poor working conditions in the Philippines, heavy recruitment by U.S. hospitals and travel agencies, and the Marcos government’s shift to an export-oriented economy, among other things. The Philippine government exported laborers in an attempt to revitalize the Philippines’ economy in the hope that the laborers would deposit their earnings in Philippine banks.

A good fit

Magsarili, now a member of the San Diego County chapter of the Philippine Nurses Association of America, Inc., who owns a residential facility for adults with developmental disabilities, says it was “so easy” for her to adjust to working in an American hospital. Not only do Philippine students begin learning English at the kindergarten level, but the mode of instruction in Philippine nursing schools is the same as in nursing schools in the U.S.

The main difference is that Philippine nursing schools place more emphasis on bedside nursing and clinical training, while American nursing schools, particularly baccalaureate programs, seem to focus more on leadership and critical thinking.

Students in the Philippines complete more clinical hours than American students and receive year-round clinical exposure, with more concentration on areas like medical/surgical, OR, obstetrics, and labor and delivery, says Nelly Peterson, RN, MNEd, president of the Arizona chapter of the PNA. Peterson, a nursing faculty member at Phoenix College, received her BSN from the University of Santo Tomas in Manila in 1977.

Students have even delivered babies. When Gemma Rama-Banaag, RN, MSN, MBA, a member of the PNA San Diego, was attending what is now Adventist University of the Philippines in Cavite, she spent summers working in the obstetrics area so that she could complete the required 35 deliveries. Rama-Banaag, who graduated in 1987, was part of the last class in the five-year BSN program; after that, all BSN programs in the Philippines were cut to four years.

Peterson spent five weeks in L&D caring for patients for about 20 to 24 hours a week, while her students in the U.S. now spend 16 hours a week.

Marlon Saria, RN, MSN, OCN, an oncology clinical nurse specialist at University of California, San Diego Medical Center who graduated from the University of the Philippines Manila in 1998, says nursing students had to participate in a community health program that involved living with local families and working in a rural area for about two months without pay.

Saria, a member of the PNASD, says all of his textbooks in school were in English except his Tagalog, history, and civics textbooks. Students weren’t allowed to speak Tagalog, Rama-Banaag says, unless it was a Philippine subject.

Rama-Banaag’s mother even instituted “English Day”; each Thursday, Rama-Banaag and her cousins weren’t allowed to speak any Tagalog. The children would carry English dictionaries, hoping to catch one of the others using an English word incorrectly; if they did, they could fine the offender, on top of handing off a household chore.

In general, Filipino families value education, and parents begin saving money for their children’s education as soon as they’re born, say members of the PNASD. It is common for family members to provide financial support for each other’s education.

The educational attainment of Filipino-born Americans is generally higher than that of native-born RNs in the U.S., with 71.1% of the Filipino-born earning BSN degrees, compared with 30.7% of the native-born, according to Daisy Rodriguez, RN, MN, MPA, co-author of “Demographic Survey of Filipino American Nurses,” which appears in a 2004 edition of Nursing Administration Quarterly. In the Philippines, there is no associate nursing degree; the bachelor’s degree is the entry-level degree.

Opportunity to grow

Rama-Banaag, a clinical manager involved in business development at Paradise Valley Hospital in San Diego, came to the U.S. because there were more opportunities for nurses in administration and management. There were few management roles in the Philippines, where the highest position a nurse could achieve was director of nursing and nurse practitioners and case management didn’t exist, she says.

Rama-Banaag also saw how successful her two cousins were as nurses in Michigan and heard their stories of America. She says that in the Philippines, it’s common for family members to choose the same career.