Giving Voice to the “Invisible Minority”

Compared to other RNs of color practicing in the U.S. nursing work force, Filipino nurses are something of a “hidden minority.” Most of the statistical information available about them is lumped into the general category of “Asian nurses.” For example, the Health Resources & Services Administration’s National Sample Survey of Registered Nurses—the profession’s most frequently consulted source of statistics on nursing’s racial and ethnic demographics—does not give Filipino RNs a separate grouping.

Yet Filipino and Filipino-American nurses have their own unique ethnic identity and a rich cultural heritage. As the number of Filipino nurses working in the U.S. continues to increase, this group is quickly becoming an important part of our nation’s health care system.

Formally known as the Republic of the Philippines, this small island nation became independent from the United States on July 4, 1946. However, the Philippines retain close ties with America. English is taught in Filipino schools, including nursing programs, and widely spoken throughout the country. In recent years, large numbers of nurses trained in the Philippines have immigrated to America in search of better career opportunities. In turn, U.S. health organizations continue to actively recruit nurses from the Philippines, a practice that has increased in recent years as a result of the current nursing shortage.

“Since the 1960s, there has been an exodus of nurses and physical therapists from the Philippines,” comments Hilda Sadio, RN, BSN, OCN, RNC, a nursing case manager for Covenant Health System in Lubbock, Texas. “They come to America because there are not enough jobs for them in the Philippines.”

After receiving her nursing diploma from a school in Dagupan City, Pangasinan, Philippines, Sadio completed her bachelor’s degree in nursing at Manila’s Far Eastern University in 1969. Three years later she came to the United States, where she has worked in a wide variety of different nursing units within the hospital setting. She spent 17 years in oncology nursing, first as a nurse manager and then as a coordinator.

Sadio’s extensive experience enables her to mentor newly immigrated Filipino nurses and help orient them to an unfamiliar cultural environment—both professional and social. Learning to bridge the cultural gaps, she believes, is vital to these nurses’ success.

Life in America

Learning about a new culture can be a challenging, exciting experience, but it can also be a frustrating one. When Filipino nurses move to the United States, they not only have to learn about American customs and lifestyles but also about this country’s nursing practices.

“Nurses who have recently come here from the Philippines need to learn new technologies, like computerized charting and reading vital signs via monitors,” explains Magdalena A. Mateo, RN, PhD, FAAN, associate professor in the School of Nursing at the Bouvé College of Health Sciences, Northeastern University, Boston. “They also need to have a firm grasp of the language and understand the need to obtain licensure as an RN. They need to learn about visa status, employment contracts, salaries and benefits.” Mateo speaks from experience: She is a Filipino nurse who has lived in the U.S. for 25 years.

Bringing newly arrived Filipino nurses up to speed about American culture and the work environment takes time and effort on the part of both the nurse and the employer. Many large health care organizations in the U.S. that recruit nurses from the Philippines provide on-the-job training as well as orientation programs focusing on what to expect in America.

“The process of acculturation does not happen overnight,” comments Marie F. Santiago, RNC, EdD, associate professor of community/public health nursing at The College of New Rochelle School of Nursing in New Rochelle, N.Y., and founder of the Philippine Nurses’ Network.

“In the Philippines, we have different value systems,” adds Santiago, who has lived in the U.S. since 1967. “It took me a while to become comfortable in this country. For instance, when I first started to work here as a nurse, the tone of voice some Americans used wasn’t what I was used to. But once I became acculturated, I was fine.”

After new arrivals from the Philippines have adjusted to the logistics of their nursing jobs and received training in new technologies, the next hurdle is gaining an understanding of the American social structure and the priorities of American employers.

“Filipinos are very laid-back, easy-going, serene people,” Santiago explains. “The U.S. workplace is very competitive, but we’re not aggressive people. Sometimes that quality can be a hindrance to Filipino nurses’ career advancement.”

Another problem is that some Filipino cultural characteristics and beliefs may be misinterpreted in this country. For example, in the Philippines people show deference for their elders and for people who outrank them in terms of experience or position level. Sadio says she has overheard physicians say of Filipino RNs, “They are very good, hard-working nurses and you can rely on them, but they are very timid.”

The reality, Sadio argues, is more complex. What may seem like diffidence stems from the fact that Filipino nurses’ cultural and religious beliefs have taught them to persevere and not complain. Because they come from a Third World country, she continues, these nurses view the opportunity to work in the U.S. as a chance to prove themselves and to achieve a better life for themselves and their families. Therefore, they tend to work very hard without complaining. Often they take more than one job so they can send money back to their families in the Philippines.

Even after nurses from the Philippines have found their bearings in America, there is still the issue of whether they will want to stay in this country. Family loyalty often causes them to want to return to their homeland. Sadio believes that strong professional support networks can play a key role in determining whether or not Filipino nurses choose to remain on American soil.

“Right now, I have four Filipino nurses living with me until they find a place of their own,” she says. “It’s important for us to support each other and help each other make the cultural adjustments.”

Bringing Cultural Gifts

One of the most valuable qualities Filipino and Filipino-American nurses bring to America’s health care table is their unique understanding of Filipino languages and culture, enabling them to provide culturally sensitive and linguistically competent care to patients who share their ethnic heritage.

“Back when I was a young nurse working in the ICU, a nurse colleague asked me to help her put restraints on a patient because he was confused,” recalls Katherine Abriam-Yago, RN, EdD, associate professor at San Jose State University School of Nursing in California. “As I entered the patient’s room, I realized he was a Filipino man who was speaking in Ilocano, a Filipino dialect, and that he was in pain. I explained this to the nurse and told her that she did not have to restrain him. The patient had received pain medication, but it was not working. I told the nurse to call the doctor and ask for another pain medication order. Restraining the patient would have been an inappropriate intervention.”

Adds Mateo, “Filipino nurses, including those who are born in the U.S., are familiar and adept with Filipino culture and traditions. Filipino-American nurses who were born here learn Filipino customs and traditions through their parents or grandparents. When they are growing up, they are encouraged to participate in cultural and religious activities where they socialize with other Filipino-American children.”

This strong cultural grounding makes Filipino nurses highly attuned not only to Filipino patients’ needs but to those of the patients’ families as well. “Family values are an important part of Filipino culture, resulting in unique health care issues and beliefs,” Mateo says. “For example, Filipino children traditionally care for elderly and sick family members. This custom could be challenging when a patient has a communicable disease. Filipino nurses can play an important patient-education role by addressing ways of preventing the spread of a disease among family members.”

While many Americans openly express their emotions, particularly regarding pain, Filipinos tend to be less vocal about discomfort, Santiago explains. Therefore, Filipino patients’ expressions of pain are often muted or stoic. Nurses who are familiar with this cultural characteristic are more likely to realize that even if the patient doesn’t complain or appear to be in pain, he or she may still need medication or some other treatment.

“Often these patients will suffer in silence and will try to bear the pain as much as they can,” says Sadio. “Many Filipinos are Catholic and are taught to sacrifice and suffer. We rely heavily on spiritual healing; religion is very important to us.”

Another area in which Filipino nurses can make a vital cultural contribution is nutrition, Santiago notes. The traditional Filipino diet is high in red meat and fried, high-fat, salty foods, all of which contribute to coronary artery disease and hypertension, as well as ailments such as gout. Because Filipino patients already understand the diet of their people, they have an edge in communicating with these patients about the connection between diet and health.

Back to School—American-Style

The typical educational level of nurses who emigrate to the U.S. from the Philippines is a bachelor’s degree in nursing. Once they arrive in this country, they often quickly realize that continuing their professional education is important to their careers. While some of these nurses rely on self-education, such as reading or taking a few classes, many begin pursuing advanced degrees or training as nurse specialists at U.S. colleges of nursing.

However, some Filipino nurses working in America encounter obstacles that make it difficult for them to return to school. Nursing education in the Philippines involves extensive clinical experience, making Filipino nurses especially well prepared for jobs requiring direct patient contact. Therefore, because of the urgent nursing shortage in the U.S., many Filipino nurses may remain in these positions for years. Abriam-Yago is concerned that this prevents Filipino nurses from moving up into management roles, nursing education and research.

In addition, strong family ties and the need to send money home to their families in the Philippines can also prevent these nurses from advancing in their careers. Some Filipino nurses work more than one job in order to make enough money to support themselves and their loved ones. As a result, they may not have time to further their nursing education.

Nevertheless, graduate programs at American nursing schools are making an active effort to recruit and retain Filipino nurses. Abriam-Yago says that her academic role at San Jose State University includes advising new Filipino nursing students.

She recalls an experience when a Filipino graduate student told her that she came to San Jose State University specifically because of all the support she would receive there. “She reviewed different types of nursing programs, but they did not offer the support she needed to be successful. We offer a comprehensive student retention program with tutoring, peer and professional mentoring, membership to ethnic nursing students’ associations and financial support.

“I was the founder of San Jose State’s Filipino Nursing Students Association, which was formed in 1998 with support from the Philippine Nurses Association of Northern California,” Abriam-Yago continues. “In 1999, we established the first Philippine Nursing Students Association of America and held our first annual national conference in February 2000.”

With so much to offer, both to their patients and their profession, Filipino and Filipino- American nurses deserve to be recognized as unique and significant contributors to the American health care system. As the number of nurses who come to this country from the Philippines continues to grow, so do opportunities to learn from them and ensure that Filipino patients and their families are provided with culturally and linguistically sensitive care.

You’re Not Alone: Professional and Networking Resources for Filipino Nurses

Philippine Nurses Association of America
Contact: Rosario May Mayor, President
[email protected]