At the beginning of the war, rural China had very few hospitals, medical supplies, equipment or trained personnel. Malnutrition, lack of basic sanitation, overwork and disease were commonplace, making the provision of health care very challenging. Rural people usually relied on traditional Chinese medicine and practitioners. The Chinese Army Medical Corps was unprepared to care for hundreds of thousands of ill and injured soldiers, much less help a large civilian population. Some Western-trained Chinese physicians, along with European and North American doctors practicing in China, had founded the CRCMRC early in the twentieth century. The organization was invaluable in free China during World War II by supplying medical personnel, training and equipment (Mamlok, 2018). Seetoo was familiar with their work and had spearheaded financial collections for the CRCMRC while she was a student nurse. The lack of adequate supplies is illustrated by this recollection of Seetoo’s time with the CRCMRC:
“When I was at the Chinese Red Cross in Guiyang I saw how they were very economical in using their materials, like the dressings … the very soiled dressings would be thrown out, but there was a great big vat or a pond they had that was full of bleach and whatever, that they throw some of the … not-so-soiled [dressings] … to kind of bleach them clean, and after they were clean they would autoclave them and reuse those dressings again …” (Trojanowski, 2005).
Her work with the CRCMRC did not last long. She explained:
“My schoolmate, whose sister had been at Women’s College [of the University of North Carolina] … had gone up to Yenan back in 1938, and Yenan was where the Chinese Communists had holed out during Chiang Kai-shek’s time … she had finished high school and she wanted to join them, because she thought … they were doing the job of fighting the Japanese better than the Nationalists … because I knew the family, before I left Hong Kong to come inland I had gone to see the mother, and the mother said, “When you have a chance once you get inland, will you please write my daughter to tell her that we’re safe.” So that was all I did. But then the Chinese Nationalists have a way of censoring all the mail, opening all the mail that goes up there, or at least they take note of it, and the next thing I know they got hold of the nursing superintendent … my supervisor at the Chinese Red Cross, and asked about me … But, you know, the Chinese Nationalists were very—even during my high school years I hear all kinds of stories about people disappearing. So, when there was an opportunity to volunteer to go to India, I volunteered … But after I went over to India and then came back to Kunming, they lost my trail. That was the end of it.” (Trojanowski, 2005).
Seetoo spent the months from late December 1942 until the monsoons began in June 1943 at Camp Ramgarh, India, training Chinese Army medics in first aid and rudimentary medical procedures. She said this about her time in India, “For several months we lived kind of the Boy Scout, Girl Scout type of a camping life. I enjoyed it as long as I didn’t have to cook.” (Trojanowski, 2005).
US citizenship: lost and regained
The CRCMRC trainers shared space at Camp Ramgarh with the US Army 95th Station Hospital. In the summer of 1943, the two groups left India together for Kunming. After returning to Kunming the CRCMRC training unit was disbanded, and Seetoo applied to work at the 95th Station Hospital as a member of the US Army Nurse Corps. She was turned down because she had “performed military service for another country” and thus, unbeknownst to her, lost her US citizenship. She later recalled:
“They [US Army] considered that because of my being in the medical service training unit, it was part of the Chinese army … to regain my U.S. citizenship I had to take the oath of allegiance again, and oath of renunciation and allegiance, which I did.” (Trojanowski, 2005)
Now she was a US citizen both by birth and by naturalization. A year passed between the time it took for her to apply to the Army Nurse Corps, learn she was rejected due to her lost citizenship, regain her US citizenship, and apply again. She was accepted and on June 17, 1944, she became the first Chinese American nurse to serve in the US Army Nurse Corps. She entered at the rank of First Lieutenant. Although she did not serve near the ground war, her hospital was attacked repeatedly by the Japanese Air Force. “The planes came over to drop their bombs. The Japanese would penetrate [the defensive perimeter of the hospital] and we would hear the sirens and run for cover” (Lee, 2019).
The 95th Station Hospital’s official Army history notes the hospital was:
” … Reached by plane over the Himalayan mountain range-one of the most picturesque, albeit dangerous, flights in the world … having weathered monsoons, air raids, and indoctrination in the treatment and prevention of various tropical diseases …. It functioned as a station hospital to care for battle casualties from the various fronts in China … Officers, nurses and enlisted men were required to learn and carry out duties in addition to those for which they were trained. Long hours of work, doubling-up on duties and diligent application to new tasks were the rule rather than the exception.” (History of the 95th, 1951)
She was the only nurse with the unit fluent in both English and Chinese and was highly valued for both her nursing and her language skills. Seetoo spent the last months of her military duty, after the war, with the 172nd General Hospital in Shanghai and was discharged to the United States in the spring of 1946.
Years later, Seetoo reflected on her time in China:
“I had spent a total of fifteen years in China. I had had a huge opportunity to dig deeper into my roots and learn more about my Chinese heritage, its history, geography, and traditions. The war years gave me the opportunity to sample places I knew in earlier times only through a geography book, and met people from diverse backgrounds and walks of life. I was able to personally taste Guangxi’s famous pomelos, admire Guilin’s landscapes, read the couplets framing the temple by Kunming Lake, felt the dusty loess blow against my face in northwest China, heard the drum roll from towers over city gates, and see the flickering ghost fires dance outside city walls. It was truly, to quote Dickens, ‘the worst of times and the best of times,’ and on touching U.S. soil I felt I was really straddling two cultures.” (Trojanowski, 2005)
After visiting her family in Stockton, Seetoo visited friends on the east coast. In Washington, DC she met Joe Yuen, who worked on electrical systems for satellites at the Naval Research Laboratory. They had a whirlwind courtship and married after six weeks. When Seetoo met Yuen, she was already admitted into the new Bachelor of Science in Nursing degree program at Women’s College of North Carolina (now the University of North Carolina at Greensboro). Using veteran’s benefits to pay for college, from 1946-1948, she took classes during the week in Greensboro and commuted to Washington to see her new husband on weekends and during school breaks (.
After graduation she moved permanently to the Washington, DC area and spent the next 15 years focused on caring for her husband and their four children. During this time, Seetoo became a freelance translator of English/Chinese medical literature for a company in Washington. Perhaps her best-known translation is the Chinese paramedic text, “A Barefoot Doctor’s Manual.” In the 1970s she worked as a technical publication writer and editor at the Naval Medical Center and the National Institutes of Health (Moy, 2014).
Receiving the Congressional Gold Medal
On December 20, 2018, President Trump signed the Chinese American World War II Veteran Congressional Gold Medal Act, which had passed Congress unanimously. Soon after, on January 29, 2019, Seetoo was selected to receive the Congressional Gold Medal, the highest civilian honor awarded by Congress, on behalf of all Chinese American World War II veterans. Several high-ranking elected officials and officers of all the military branches expressed their gratitude to these veterans (U.S. Department, 2019). During the ceremony, Seetoo said:
“We have waited a long time for this moment. I am deeply honored to receive this Congressional Gold Medal on behalf of my sisters and brothers. I hope our perseverance, commitment, and hard work will further inspire our young people to serve this wonderful country.” (Eng, 2020)
Today, at 102, Seetoo is living outside Washington DC enjoying her friends and family.
When Elsie Chin Yuen Seetoo was born on September 14, 1918, in Stockton, California, no one could imagine that by the time she was 30 she would work in a hospital under attack by the Japanese Army; escape occupied Hong Kong disguised as a Chinese servant; travel by boat, truck and foot across 700 miles of war-torn China; become the first Chinese-American nurse to join the US Army Nurse Corps; and then graduate from Women’s College in Greensboro, North Carolina, with a Bachelor of Science in Nursing degree. Her unique and harrowing tale begins decades before her birth.
Seetoo’s father, along with thousands of other Chinese men, came to California seeking jobs and opportunities unavailable to them in their homeland. When he arrived, Mr. Chin first worked as a laborer and then as a cook for a private family. He saved enough money to open an import-export grocery store business in Stockton. He became a merchant because it provided the legal status he needed in order to bring his Chinese wife and son to the United States. After settling in Stockton as a family, the Chins had two daughters. Although she was the only Chinese student in her public-school classroom. she remembers her childhood fondly. The Chin children attended Chinese school from 5-9 pm, in Stockton’s small Chinatown, here they learned to read and write Chinese characters. In addition to her schooling, she was an active Camp Fire Girl (Lee, 2019)
In 1930 the United States was in the middle of the Great Depression. The family business was failing, so the Chins decided to return to China. Because Seetoo and her younger sister were born in California, they were United States citizens. After completing high school in China, she wanted to further her education. However, in the 1930s, Japan invaded China and controlled most of coastal and eastern China where the major cities and universities were located. Many Chinese universities closed during the Japanese invasion and occupation. In any event, the Chin family did not have enough money to help Seetoo with college expenses. So, in October 1938 she began her studies at the English language Queen Mary Hospital School of Nursing in the British Colony of Hong Kong (Moy, 2014).
Student Nurse Days
On December 7, 1941, the Japanese attacked Pearl Harbor, bringing the United States into World War II. That same day Japan also attacked the Philippines, Hong Kong, Burma and other Asian countries. Seetoo recalled:
“… it was the morning of December the eighth, when we were greeted by Japanese bombs and shelling. Of course, we were placed on a wartime footing right away … All patients that could go home were sent home, and then we were taking in battle casualties that very first morning … after two weeks Hong Kong surrendered … we knew after that the Japanese are going to want the hospitals … the British sisters [nursing faculty] had the foresight to know that they were going to be interned, so they gave us our temporary certificates, RN certificates. (Trojanowski, 2005).”
On December 10, 1941 during the Battle of Hong Kong, nursing school administrators issued each third-year student a Certificate of Training from the Medical Department of the Government of Hong Kong. These certificates were on par with diplomas and conferred the title Registered Nurse (Chung, Ching & Wong, 2011). Chinese, British, Indian and Canadian forces defended Hong Kong during two weeks of fierce fighting. Facing overwhelming Japanese forces, the allies surrendered on Christmas Day, 1941. By then, Queen Mary Hospital was full of casualties. Seetoo, alongside hospital staff and fellow student nurses, worked tirelessly caring for the wounded soldiers. On December 26, 1941, Japanese Army troops entered the hospital, interned the foreign patients and staff, and turned the hospital into a Japanese Military Hospital (Copp, 2001). Seetoo was 23 years old, a Registered Nurse and living under Japanese rule in occupied Hong Kong. In an oral history interview she remembered:
“A few days after the surrender we saw some Japanese officers come to inspect the hospital … as soon as we saw them, we were kind of on edge, because you’d hear all these stories about rape, and rape of Nanking, and the Japanese had been very bad about commandeering women to be part of their—they called it comfort women, which is actually making sex slaves of them. Anyway, we had heard stories of that, so naturally we were very, very concerned.” (Trojanowski, 2005).
Rita Wong, one of Seetoo’s classmates, remembered the early days after the Japanese invasion,
“All foreigners working at the hospital were sent to a concentration camp, and the Chinese were gathered at a hospital where they had nothing to do but wait for their meager food rations. The Japanese made it a rule that no doctors or nurses were to leave Hong Kong, and those who were caught doing so would be killed.” (Macfie, 2007, p.1)
Escaping Hong Kong
Despite this Japanese edict, Seetoo and several of her Chinese classmates, including Rita Wong, Rebecca Chan Chung, Daisy Pui-Ying Chan, Cynthia Chan and Irene Yu, were determined to help their country and its American and British allies. They knew they had to make their way to Free China, which was in southwestern China and unoccupied by the Japanese. Individually and in small groups, these nurses disguised themselves as peasants and slipped past Japanese guards as they escaped from Hong Kong, making the 700-mile journey inland towards Kunming, the capital of Free China (Chung, Chung & Wong, 2012).
Seetoo, her brother and three of her classmates began the journey together. They traveled to Macao by boat, then hitched a ride with a truck driver to the Chin family home in Xinhui. After a short visit, the group walked four hours to Shuiko where they boarded a ferry. On the ferry was a classmate of Seetoo’s brother, Mr. Liao. She recalled their encounter:
“[Mr. Liao said] I’m going to write a letter to the pastor of the Baptist Church at your next stop, Gaoyao, and ask him to let you folks sleep in the church sanctuary – and to provide whatever assistance you need. And when you leave for the next stop, ask him to write a letter to the Baptist preacher there in Wuzhou asking for the same favor … That was how we finally got to Guiyang – by stopping at various churches along the way.” (Trojanowski, 2005).
In April 1942 they reached Guiyang, headquarters of the Chinese Red Cross Medical Relief Corps (CRCMRC). There she met Dr. Robert Lim, the director of the organization, who offered her a position in the operating room of the Red Cross sponsored hospital in the city. Seetoo accepted the offer and went to work.
Nursing diversity and inclusion have become a top priority for healthcare organizations. To provide the best possible care for your patients, ideally, nurses would come from all walks of life and represent the communities they serve.
The Benefits of Nursing Diversity for Organizations
Nursing diversity and inclusion can benefit your healthcare organization in several ways. Having a diverse and inclusive nursing staff can help improve patient care, communication and collaboration. In addition, organizations that embrace diversity and inclusion are more likely to attract top talent and be viewed as attractive places to work. By understanding the benefits of diversity and inclusion, healthcare recruiting can help better attract nurses from diverse backgrounds. Nurse leaders can also create a more welcoming environment for all nurses in their organization. Finally, nurses can also play an active role in promoting diversity and inclusion in the nursing profession and nursing jobs.
Recruitment Tips for Successful Nursing Diversity and Inclusion
As the nursing profession becomes increasingly diverse, recruiters can take steps to ensure they are making hires that reflect this diversity. Here are some tips that can increase nurse recruiting from a variety of backgrounds:
Make sure your job descriptions and advertisements are inclusive and welcoming to all potential candidates.
Utilize social media and other online platforms to reach out to potential candidates from underrepresented groups.
Attend career fairs and events that focus on diversity in nursing.
Develop relationships with nursing schools and programs that strongly focus on diversity.
Be conscious of any personal biases and make an effort to put all candidates on an equal footing when conducting interviews.
Nursing is a field that is rich in diversity. Nurses come from all walks of life, with different backgrounds and experiences. However, this diversity can also be a challenge, as nurses may face more significant difficulties adapting to new environments and cultures. As a result, it is essential to consider how you can best support nurses from diverse backgrounds to assure their retention in the profession. Following these recruiting tips could help the nursing staff to be as diverse and inclusive as possible, which, in turn, can produce improved patient outcomes.
Strategies to Improve Nurse Retention Among Diverse Nurses
Nursing is a demanding and challenging profession. Nurses are often the front line of care in many healthcare settings, and they play a vital role in patient care and outcomes. Nursing is also a diverse profession, with nurses coming from various backgrounds and cultures. As the healthcare landscape evolves, hospitals and other healthcare employers will need to focus on strategies to improve nurse retention among diverse nurses.
One way you may improve nurse retention among diverse nurses is to create a supportive and inclusive work environment. This practice can help ensure career development and growth opportunities and implement policies and approaches that foster a sense of belonging.
Fostering a Welcoming and Diverse Environment for All Nurses
Studies have shown that healthcare organizations are at the most significant risk of employees leaving if they do not perceive the workplace as diverse and equal. Additionally, many employees and leaders who are disabled choose not to share their disability in the workplace. Furthermore, roughly three-quarters feel the need to mask their differences while working.
Nurse leaders can create a more welcoming environment for all nurses when they understand the benefits of diversity and inclusion. Healthcare recruiters can also attract top talent when they promote diversity and inclusion in their organizations. Helping healthcare professionals for over 70 years, Springer Publishing understands the importance of nursing diversity. Learn more about our award-winning resources written by noted scholars and practitioners, which span over 20 nursing subject areas to support every facet of the profession.
Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.
Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.
First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.
Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.
Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.
Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.
In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?
When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.
Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.
Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.
Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.
Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.
Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.
Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.
Nurses Are Uniquely Positioned to Champion DEI
Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.
One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.
When he is not treating kids as a pediatric Transitional Care Unit (TCU) nurse at VCU Health in Richmond, VA, Ren Capucao, MSN traces the rich heritage of Filipino nurses in the US.
As a nurse historian (Capucao’s first article was published in 2019 in the Nursing History Review), he focuses on studying the fascinating story of Filipino American nurses. Capucao is working toward a PhD at the University of Virginia School of Nursing, and his scholarship has shown so much promise that he has been named a Fulbright Scholar for 2022-23 and will be a Fellow at the University of the Philippines, Manila.
“Seeing through my mother’s lens as a nurse,” Capucao says, brought home to him “the sacrifices she made to care for her loved ones. For all the trailblazing nurses that immigrated to the U.S., I can only imagine the struggles they faced on top of caring for patients often culturally dissimilar, so I am humbled to have these nurses invite me into their homes and openly share their memories.”
Capucao will use the Fulbright grant to travel to the Philippines during the 2022-23 academic year to continue his investigations into Filipino nurses’ histories, conducting interviews, collecting oral histories, and diving into historical archives. He is also an editor for the nursing and medical history blog Nursing Clio, and his dissertation study “Pressed into Starched Whites: Nursing Identity in Filipino American History” has already earned him grants and accolades from the Virginia Humanities, the Philippine Nurses Association of America, the Bjoring Center for Nursing Historical Inquiry and the Barbara Bates Center for the Studying of the History of Nursing.
In this video, “A Culture to Care,” Ren shares some background on the history of Filipino nurses in the US and his own very personal links to nursing and the tradition of nursing among Filipinos.
Nurses inevitably encounter situations that cause moral distress. At the height of the Covid-19 pandemic, though—when there was no vaccine, and it was still assumed that for at least two years there would be no protection beyond masking and social distancing—moral distress became a daily ordeal for many frontline nurses.
Among those hardest hit by moral distress were the nurses of color working through a pandemic that exacted a disproportionate toll on Black, Filipino, Latino, and Native American minorities. Their experiences during the early days of Covid are at the core of a new study from researchers at DePaul University’s School of Nursing. In interviews with a diverse group of nurses located across the US, investigators found that moral distress was an almost inevitable affliction when lack of support made it impossible for nurses to provide high-quality care based on their training.
Nurses on the frontlines faced unrivaled psychological and physical demands during the pandemic, noted researchers. Voices of nurses from this moment in history could help inform policies and laws to improve retention and reduce burnout among nurses in the U.S. “People need to listen to nurses more, and nurses need to feel empowered to share their experiences at every level of leadership,” said principal investigator Shannon Simonovich, PhD, RN, an assistant professor of nursing at DePaul.
“Diverse nurses caring for a diverse patient population”
In 2020, many news stories about health care heroes featured white, female nurses, Simonovich said. In reality, nurses from many personal, ethnic and geographic backgrounds with a varying levels of education were caring for COVID-19 patients.
Simonovich recruited a diverse group of DePaul nurse researchers to conduct the study, which in turn helped recruit a diverse group of 100 nurses to be interviewed, according to assistant professor and coauthor Kashica Webber-Ritchey. “We captured the voices of diverse nurses caring for a diverse patient population that was being disproportionately impacted by COVID-19,” Webber-Ritchey said. In the DePaul sample, 65% of the nurses identified as a member of a racial, ethnic, or gender minority group.
Many nurses from these represented populations have lost their lives to COVID-19. Researchers at DePaul cite a tally that more than 3,300 U.S. nurses, doctors, social workers and physical therapists died of COVID-19 between February 2020 and February 2021.
DePaul researchers conducted interviews between May and September 2020, asking nurses to describe their emotions. Nurses reported moral distress related to knowing how to treat patients and protect themselves, but not having the staff, equipment or information they needed. As a result, they reported feeling fear, frustration, powerlessness and guilt.
The toll of frustration, stress, and guilt
This qualitative study is believed to be the largest of its kind from this period—a time of great uncertainty about the virus that causes COVID-19 before the development of vaccines. Highlights include:
Study participants described many forms of frustration while providing patient care, including frustration with healthcare leadership being out of touch with those on the frontlines.
Nurses felt powerless to protect themselves and others from contracting COVID-19.
Nurses described being placed in difficult patient care experiences that resulted in guilt around letting down patients and their families, as well as fellow members of the healthcare team.
““We are a largely female profession, and we don’t complain enough when things are tough.”
The burden nurses have shouldered during the COVID-19 global pandemic calls for research that describes and examines the emotional well-being of nurses during this unprecedented time in contemporary history, write the researchers. As the media coverage of nurse heroes fades, the narratives in this study should be a call to action, says Kim Amer, an associate professor with 40 years of nursing experience.
“Nurses need to come together as a profession and make our standards and our demands clear,” Amer said. “We are a largely female profession, and we don’t complain enough when things are tough. As a faculty member, we teach students that it’s OK to refuse an assignment if it’s not safe. We need to stand by that.”
The DePaul research team calls for clear, safe standards for nurses that will be legally binding and hold hospitals and health care agencies accountable. “We go into nursing with the intention of saving lives and helping people to be healthy,” said Simonovich. “Ultimately, nurses want to feel good about the work they do for individuals, families and communities.”
Investments by healthcare organizations and policymakers in mental health resources could help promote psychological resilience in nurses, noted Webber-Ritchey. “Taking time to speak to nurses to understand their needs and provide support would help with addressing moral distress,” she said.