A Proud Nursing Heritage
Focus on the Philippines
(South Central Edition)
By Scott Williams
April 11, 2005
Merlita Velasquez, RN, BSN, a Houston nurse who owns two nursing-related companies, is like a lot of Filipino nurses who come to the U.S. to work. She wanted to to help support her family in the Philippines by working at a job earning 10 to 20 times more than what she would have been paid back home.
She lasted only a year and a half. It wasn’t that she couldn’t keep up with American-trained nurses or that patients didn’t like having a Filipino nurse. Quite the contrary. Velasquez returned to the Philippines because she had left her husband and three children behind, including an infant who was only six months old when she left.
That any mother would leave her children behind, especially at such young ages, points to how troubled the Philippine
economy is and how desperate Filipinos are to give their families a better life.
Pool of eager talent
It also points to an eager source of well-trained nurses who could help alleviate the nursing shortage, provided the U.S. health care industry, politicians, and the general public are willing to accept them.
Velasquez’s 18-month stint in the 1960s wasn’t her last in the U.S. She worked here a second time between 1975 and 1977 before returning for good in 1982 — this time with her entire family — to California. She now lives in Houston, where she owns and operates a nursing home and a home health business.
“It’s a better program, a better life, than staying in the Philippines,” says Velasquez, explaining her family’s desire to move to the U.S. It’s also a good way to help one’s family in the Philippines, which has a long history of relying on remittances from relatives working in other countries.
Remittances — the term for sending money back to one’s home country — represent about 11% of the Philippines’ gross domestic product. Filipino nursing schools have, in the past at least, graduated more nurses than the country can use and countries with nursing shortages have turned to the Philippines for decades for help in meeting their staffing needs.
Eileen DeCesare, RN, MS, CNAA, LNC, president and owner of Professional Healthcare Resources International, an Annandale, Va., company that recruits foreign nurses, says Filipino nurses have been coming to the U.S. since the 1950s. U.S. hospitals, she says, have welcomed them for a variety of reasons.
The most important is that the nursing curriculum taught in the Philippines most closely resembles that taught in the U.S., she says, adding that books used in Filipino nursing schools are the same ones used in U.S. nursing schools.
Another factor in Filipinos’ favor is the fact that they speak English, which is taught in the Philippines from an early age. That gives them a distinct advantage over nurses from other countries known to send nurses to the U.S. — Japan, Korea and India.
“The training and experience we have in the Philippines are very marketable in the U.S.,” says DeCesare, who also owns four home health companies and employs 500 people.
Getting savvy with equipment
The only area in which nurses from the Philippines fall short, she says, is familiarity with equipment used in the U.S. At least one U.S. university is helping address that shortcoming.
Nashville, Tenn.’s Vanderbilt University is collaborating with MedLink International, an international health care recruiting and placement firm that specializes in RNs, to provide curriculum content for a training program taken by nurses in the Philippines that MedLink has recruited to work in the U.S. The Vanderbilt course curriculum provides instruction on current U.S. nursing practice to prepare Philippine nurses for the National Council Licensure Examination for Registered Nurses (NCLEX-RN), the licensing exam developed by the National Council of State Boards of Nursing. The Vanderbilt curriculum includes instruction on how to use equipment commonly found in U.S. hospitals with the ultimate goal of improving skills and ensuring patient safety.
Linda Norman, RN, DSN, senior associate dean for academics at Vanderbilt’s School of Nursing, says the training program is given to nurses before their arrival in the U.S. using CDs, other media, and facilitators.
She emphasizes that Vanderbilt is not involved in recruiting foreign nurses and that nurses who complete the MedLink program receive no academic credit from the university. Norman says the university has been approached in the past by recruiting companies asking them to provide the NCLEX-RN exam to recruits. Vanderbilt declined, she says, because it does not get involved in recruiting foreign nurses. The difference in the MedLink proposal, she says, is that it’s designed to help Filipino nurses make a better transition to the U.S. health care system, which ultimately benefits nursing care and patient safety.
High-quality nursing
Norman says she worked with several Filipino nurses after she graduated from the University of Virginia School of Nursing in 1969. “I have to say I learned a tremendous amount from them,” she says, describing their attention to detail in patient care as amazing. “They were excellent nurses.”
Although Norman has worked in academia since 1977, her work has taken her to clinical settings throughout that time. That and discussions with nurses who work more often in clinical settings leads her to believe that nurses from the Philippines continue to enjoy a stellar reputation.
“The thing I have understood is the quality that I saw as a nurse is one that has continued,” Norman says. “Filipino nursing schools are very high-quality schools, and the students there graduate with a great deal of nursing experience.”
Norman says that, contrary to what some may believe, Filipino nurses do not work for less than American ones. That’s because, in order to work in the U.S., Filipino nurses must meet the same education and licensure requirements. And it’s illegal to pay someone less, based on ethnicity. “So I think it would be difficult for them to be paid less than what anybody else would be paid,” she says.
Pete-Reuben Calixto, RN, BSN, CNN, a Filipino nurse who works in the kidney, pancreas, and liver transplant unit at the University of California, San Francisco Medical Center, says Filipino nurses are better-prepared in some ways than were Filipino nurses who came to the U.S. when he did in 1979.
He says that they’re much more computer literate and that their English skills are better thanks, at least in part, to the ubiquitous presence of Cable News Network, which broadcasts in 150 countries, including the Philippines.
Different cultures, different views
Calixto says the hardest professional adjustment he had to make involves the different communication styles in the U.S. and the Philippines. In the states, people expect you to look them in the eyes when you speak to them, while in the Philippines, that is considered rude. Calixto felt so uncomfortable with eye-to-eye contact that at first he would move away from people while they were still talking, leading one colleague to wonder whether he was deaf.
Velasquez says that she felt she had to prove herself to American-trained nurses by matching or exceeding their level of expertise. She says because she went out of her way to prove her worth, American nurses always treated her well.
“I think I had to prove myself to be treated well,” she says. She did such a good job of proving herself, Velasquez says, that she was promoted to a management position and later worked as a supervisor at another hospital.
Norman says a recent speaking engagement before a Filipino nurses alumni association exposed her to an impressive number of Filipino nurses who had become professors, managers, executives, and entrepreneurs.
“Many of the people who attended were in the U.S. and were in high-level leadership positions,” she says.
DeCesare, whose company recruits between 150 and 200 foreign nurses on behalf of U.S. hospitals each year, would naturally like to see more Filipino nurses come to the U.S. to work. The problem is that not everyone believes recruiting more foreign nurses is such a great idea, and immigration limits are making it more difficult.
“I think one of the problems we encounter now, as we lobby the House and Senate, is lack of education of the politicians,” she says. “They think this recruitment is designed to take jobs from American nurses.”
That’s not true, says DeCesare. Instead, it’s one method for dealing with the U.S. nursing shortage, which is expected to peak in 2010 despite increased enrollment in U.S. nursing schools.
“This is when I think they really need to look at what can we do if we are not able to produce enough nurses to offset the deficit,” she says.
Norman says the International Council of Nursing, a federation of more than 120 nurses associations, has studied the issue and wants to protect the rights of nurses to work wherever they want. But the council also believes each country should be responsible for educating enough nurses to meet its needs and not rely on luring nurses away from other countries.
“I would hope that we get to where there isn’t as much dependence on
foreign-educated nurses in places like the European countries and the U.S.,” she says.
A drain on Philippines’ nurses
The conventional wisdom, as previously mentioned, in regard to the Philippines is that it produces more nurses than it can use. At least one recent news report questioned that assumption. National Public Radio reported in February that the exportation of 15,000 nurses each year to developed nations like the U.S. poses a serious long-term threat to the Philippines’ health system. The report noted that Filipino physicians, realizing they can make more as nurses in America, are enrolling in nursing school with the intention of immigrating to the U.S. to work.
In previous decades, nurses wishing to immigrate to the U.S. could do so in as little as six months. In recent years, however, that process has become longer and more complicated. Foreign nurses not only must meet nursing standards, but also must meet immigration requirements.
Filipino nurses must first graduate from an accredited school of nursing in the Philippines. They then must work with the Commission on Graduates of Foreign Nursing Schools and the International Commission on Healthcare Professions (CGFNS/ICHP), an immigration-neutral, nonprofit organization that ensures that nurses educated abroad are eligible and qualified to work as nurses in the U.S.
The CGFNS/ICHP offers nurses educated in foreign countries the opportunity to take qualifying exams in their own country before coming to the U..S. Applicants may also use a service that evaluates education and licensing obtained outside the U.S. to make sure they meet American standards. Some recruiting companies, like International MedLink, offer training courses to help foreign nurses make the transition to the U.S. health care system.
Filipino and other foreign nurses must pass English-proficiency tests. Texas requires foreign nurses to pass such an exam before taking the NCLEX-RN. In Texas and other states, nurses must also pass a criminal background check that requires them to submit a fingerprint card.
Besides using programs offered by CGFNS, foreign nurses can obtain a license to work in Texas through an endorsement process. A nurse who obtains a license in another jurisdiction can have that license certified as giving them the necessary education and training to work as a nurse in Texas. Other states have similar requirements.
DeCesare says nurses in the 1990s were allowed to work in the U.S. using an H1-A temporary work permit, which allowed nurses to emigrate in only six months. The law that allowed that expired in 1995, forcing foreign nurses to apply for admittance to the U.S. under an EB-3 permit, an employment-based permit that falls under the permanent visa category.
The EB-3 process normally takes 18 months to two years, but a recent change in the way the U.S. government handles certain visa applications means foreign nurses would have to wait as long as three years to work here.
That may convince some Filipino nurses to give up on the idea of coming to the U.S. But as long as the nursing shortage continues and Filipino nurses can earn many times more here than at home, nursing professionals say, Filipino nurses will continue to play an important role in meeting U.S. health care needs.
Scott Williams is a freelance writer.