Editor’s Note: This is the first in a series of articles examining leadership development initiatives at minority nursing associations.

Although she seems to juggle her dual roles with expert finesse, Susan Castor, MSN, RN, CCRN, president of the New Jersey chapter of the Philippine Nurses Association of America (PNAA) and director of patient care services for a post-coronary care unit at Community Medical Center in Toms River, N.J., remembers a time when she actually felt somewhat timid in a leadership position. Castor attributes her newfound assertiveness in part to skills she learned at the PNAA’s Chapter Leadership Institute.

“The Institute gave me the opportunity to meet and work with other nursing leaders from across the country, which was an empowering experience,” she says.


This summer will mark the fourth year the PNAA will hold the Institute (formerly known as the Chapter Leadership Development Workshop) as part of its annual national convention. The 2007 Institute, to be held on July 11 in Anaheim, Calif., is open to the presidents and presidents-elect of each of the association’s 37 local chapters. The PNAA currently boasts approximately 4,000 members nationwide.

“We wanted to offer our chapter presidents an orientation tailored to our organization’s mission and vision,” says Reynaldo (Rey) Rivera, MA, EdM, RN, CCRN, CNAA, BC, ANP, former co-chair of the PNAA’s Education Committee and director of nursing and special programs at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City.

Rivera, who is an accredited trainer in Stephen Covey’s “Seven Habits of Highly Effective People,” based the PNAA program on concepts he learned as a chapter advisor for the American Association of Critical-Care Nurses.

“Our Institute offers training in skills that benefit our chapter leaders both personally and professionally,” he explains. “In addition to learning how to recruit and retain new members, we teach [leadership skills such as] empathetic listening and relationship building.”

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Expanding the Focus

After gathering feedback from past participants, the PNAA recently decided to expand its leadership training initiative. This year, the newly renamed Chapter Leadership Institute will cover five critical areas: communication, member retention/ recruitment, education, accreditation and clinical issues. Perry Francisco, RN, MSA, PNAA Education Committee chair and manager of physician education for Sentara Healthcare in Norfolk, Va., will coordinate and direct the 2007 Institute, whose theme is “Back to Basics for a Stronger Foundation.”

“We developed a curriculum that we believe will be helpful to leaders who have undergone the training in past years as well as those who are taking it for the first time,” Francisco says. “Part of the training includes a discussion of best practices. Our leaders also have the opportunity to meet with their peers and discuss how they oversee activities in their respective chapters.” PNAA national president Rosario-May Mayor, RN, MA, director of performance improvement at the James J. Peters VA Medical Center in Bronx, N.Y., says the Institute helps PNAA chapter presidents build skills that aren’t typically taught in nursing school.

“Our chapter presidents come from a variety of clinical backgrounds,” she notes. “Some are staff nurses, others are supervisors. While many have undergone leadership training, others have not.” Mayor has noticed that the PNAA chapters operate more consistently since the leadership training was first offered four years ago. She credits this to workshops on topics like developing bylaws and reviewing rules of the organization.

“The Institute offers a terrific opportunity for our chapter presidents to hone their leadership skills while also brainstorming ideas on topics such as fundraising, recruitment and retention,” she says.

“We are particularly excited about one of our presenters this year,” Mayor adds. “Sumi Haru, a former officer of the Screen Actors Guild, will present the communication piece. She will focus on the art of public speaking and presenting oneself in public—how to articulate well and engage the audience.”

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Cultivating Future Leaders

Mayor is one of thousands of nurses from the Philippines who migrated to the United States in the 1960s and ‘70s. Today, in response to the current nursing shortage, U.S. medical facilities are continuing to recruit large numbers of nurses from the Philippines to fill staffing gaps.M

Today’s new immigrant nurses face a more complex health care system and stricter immigration rules than their counterparts of 30 or 40 years ago. The PNAA chapters strive to help this new wave of nurses arriving from the Philippines and provide support as they adjust to life in a new country. “The goal of PNAA is to meet the professional and personal needs of Filipino nurses across the United States and to provide mentoring activities for migrating nurses from the Philippines as well as new nursing graduates,” Mayor says.

While the PNAA is working to establish a formalized national mentoring program, many of the association’s chapters currently offer informal mentoring activities and acculturation classes to help recent immigrant nurses make a smooth transition into their new lives and jobs.

Even seasoned nurses like Susan Castor have reaped the benefits of having mentors within the PNAA organization. “Going back to school and achieving my master’s degree was one of my biggest accomplishments,” she says. “I hadn’t considered the possibility of attaining my master’s in nursing until I spoke with some of my PNAA colleagues. Their support and encouragement was invaluable.” In turn, Castor now makes it a priority to reach out to other Filipino nurses about the many benefits of PNAA membership. “Recruiting new members to PNAA is a way to secure future nursing leaders,” she says. “PNAA has not only allowed me to foster many new connections but to also reconnect with several of my former nursing school classmates [from the Philippines].”

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Mayor says part of the PNAA’s mission is to emphasize the need to orient foreign-born nurses to the American health care system as well as the need to help America’s majority population increase its understanding of ethnic minority groups in today’s increasingly multicultural nursing workplace. “It’s important to dispel myths,” she emphasizes. “For example, many nurses don’t realize that a large number of Filipino nurses are U.S. citizens. We see part of our role at PNAA as promoting positive images of Filipino-American nurses.”

PNAA Celebrates Decision to Bring NCLEX® Testing to the Philippines

The Philippine Nurses Association of America (PNAA) serves as a bridge between Filipino nurses in the United States and their colleagues in the Philippines. “We promote a culture of excellence and education in our activities,” says PNAA president Rosario-May Mayor, RN, MA. “We work with the motherland on a variety of initiatives.”

This year, PNAA leaders are rejoicing in the news that thousands of nurses in the Philippines who hope to work in America will no longer have to travel abroad to take their U.S. licensing exams. On February 9, the National Council of State Boards of Nursing (NCSBN) announced that it had selected Manila, the capital city of the Philippines, as a new international site for administration of the National Council Licensure Examination (NCLEX). The test center in Manila—the first of its kind in the Philippines—is expected to open in mid 2007.

“This is excellent news for Filipino nurses and the nursing profession as a whole,” says Mayor.

Passing the NCLEX is essential for obtaining a nursing job in the United States. Up until now, due to the lack of a test site in the Philippines, Filipino nurses had to go to places like Hong Kong, Seoul or Saipan (one of the Northern Mariana Islands) to take the exam, paying hundreds of dollars in travel costs out of pocket. And that was in addition to paying the required exam registration fee.

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“When Philippine nurses travel to Hong Kong or Saipan to sit for the NCLEX exam, their dollar layout may be anywhere from $1,200 to $1,500,” Mayor explains. “In addition to the $350 registration fee, examinees have to pay $500-$600 for airfare, plus pay for a hotel room, food, etc. And if the nurse fails the exam—which is a distinct possibility—he or she has to travel back there again in six months to retake it.”

PNAA leaders were actively involved in helping to make the idea of a NCLEX testing center in the Philippines a reality. Their advocacy efforts began five years ago, at a time when the NCSBN was looking into the possibility of offering the licensing exam outside the U.S. and its territories for the first time. (The NCLEX has been offered internationally since January 2005.)

“In 2002, the PNAA first approached the NCSBN with the idea of offering the NCLEX in Manila,” Mayor says. “It seemed logical that Manila [should] be among one of the pilot areas outside of the U.S. to offer the exam, since Filipino nurses make up between 50% to 60% of examinees worldwide.”

According to the NCSBN, approximately 25,518 Filipino nurses holding combined immigrant visas and work permits traveled to the U.S. to work between 1988 and May 2006. Mayor says the number of Filipino nurses taking the NCLEX-RN® was over 9,000 (35% of total examinees) in the 1990s, and more than 15,000 (60%) in 2006.

Initially, the NCSBN had some serious concerns about Manila’s suitability as a test site. There were worries about political instability, exam security issues (software piracy is a major problem in the Philippines) and the recent proliferation of inferior-quality “diploma mill” nursing schools that were churning out thousands of poorly prepared graduates to meet the huge demand for Filipino nurses in the United States.

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PNAA leaders—including Mayor, past president Filipinas Lowery and president-elect Leo-Felix Jurado—worked as part of a coalition of U.S. and Philippine organizations that helped address these concerns. Some of the other groups involved in these efforts were the Philippine Nurses Association (PNA)—the PNAA’s counterpart in the homeland—and the Manila-based Commission on Filipinos Overseas, which has been working with the Philippine government to improve some of the conditions that had originally raised red flags.

The PNAA, too, is working to help ensure the continued flow of only qualified and well-trained nurses from the Philippines into the American health care system. In a recent interview with the Philippine News, Mayor expressed her disappointment about the controversial results of last summer’s Philippine nursing board exams , where it was discovered that test questions were leaked to some students prior to their taking the exam. She is also concerned that the passing rate for the Philippine board exam is still alarmingly low—only 42%.

“It is an embarrassing percentage and tends to mirror the deteriorating quality of nursing education in the Philippines,” Mayor says.

While she believes the test question leakage was an isolated case, Mayor attributes the low scores to the ongoing diploma mill problem. Some nursing schools in the Philippines have increased their enrollment beyond what their capacities and resources can handle, she explains. Because of their student overflow, these schools resort to hiring new graduates as teachers, effectively removing the clinical experience requirement that is essential to being a nursing instructor.

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