When my son Ziyad was three, he began to regress in his development. He lost his ability to communicate and socialize. My little boy had stopped talking and had started to act socially detached. First, Ziyad walked on his tiptoes and swayed back and forth while staring out into space. Then he became obsessed with his toy trains. For hours he would line them up in circular and linear patterns.
I am a Filipino American who is married to a Jordanian American. When I began to notice the change in Ziyad’s behavior, many of my husband’s Jordanian family members told me, “He’s fine. Boys develop slower than girls.” My own Filipino family and I knew something was wrong. But the word for autism doesn’t even exist in either of our cultures.
Cultural traditions, values and beliefs affect how people deal with difficult situations. In our family’s struggle to deal with our son’s disorder, my husband and I have learned firsthand that culture affects the way people think about, cope with and adapt to autism.
The American Psychiatric Association defines autism as a developmental disorder that severely affects the development of a child’s social interaction and communication skills. The child has a limited range of interest and insists on sameness and repetitive, nonfunctional routines and behaviors. Symptoms of autism are usually not noticed at birth but eventually become obvious, usually during the first three years of life, when some aspect of communication development is delayed. Autism is one of the most prevalent disorders in the U.S., affecting approximately one in 150 individuals. It occurs in people of all cultures, races, religions and social classes and is more common in males than in females.
Two Different Views
The way people view autism varies from culture to culture, and even within cultures, as my husband and I discovered. In the Filipino culture, having a child with a disability is viewed in a positive way. As a Filipina mother, I accept my son as a blessing or gift from God and I am grateful that I have been found worthy of this child. My spiritual and religious beliefs strongly affect my personal view of Ziyad’s autism. I see my child as normal and a valued member of the community, regardless of his disabilities. In the Filipino culture in general, we all share a common concern for the well-being of each individual.
Some older-generation Middle Easterners, even if they now live in the United States, believe that a disability is a form of punishment for sins or perhaps the result of a curse. They often feel ashamed and embarrassed to have a child with a disability in the family. Because my husband is from the younger generation of Jordanian Americans, he understands and accepts autism as a medical disorder that affects our son. My husband’s parents and their generation are more acculturated to the U.S. than the Jordanian elders who adhere more to traditional cultural values, but they still share some of the same beliefs.
Before Ziyad was diagnosed with autism, my husband’s family demonstrated a cultural attitude that a three-year-old male who is not yet verbal may be considered normal, since boys often develop language skills later than girls. Some older-generation Jordanians may be more willing to overlook developmental differences in their children because they may be trying to avoid the stigma of autism, in which the child is perceived as imperfect or needing to be fixed. Unfortunately, this often causes delay in diagnosis until the child is of school age, preventing early intervention which is crucial to the treatment of developmental disorders.
It was difficult to make my husband’s family understand the meaning of autism. In their culture, they believe that Ziyad will eventually talk “normal,” that he will “grow out of it.” But with the help of family discussions and autism awareness campaigns in the media, they now have a better understanding of our son’s disorder. They are very supportive in his care and follow Ziyad’s structured behavior and educational plan prescribed by his child study team and pediatric developmentalist.
Cultural beliefs about family roles also play an important part in how families cope with and adapt to autism. Once Ziyad was diagnosed, I received strong support from my extended family, because the Filipino American family is built on cooperation and allegiance. We believe that individual desires are sacrificed for the benefit of the family. My family guided me to the appropriate medical and organizational resources. When difficulties arose, we pulled together and tried to work things out in a way that would benefit everyone.
Most Filipinos believe that providing care to a dependent family member is a responsibility to be shared among siblings and extended family. A child or other family member with a disability is often cared for in the family home setting instead of being sent to an institution.
Stress and Support
Regardless of one’s culture, autism causes stress to families. But here too, culture can affect the way they deal with the stress, how they view it, their ability to use problem-solving and coping skills, and their willingness to seek support from sources outside the family. Relying on their culture can either help families cope with and adapt to autism or create even more stress.
Middle Eastern families in the U.S. who experience high levels of stress in raising a child with a developmental disability may seek and need more social and organizational support to adapt to their situation. However, those Middle Easterners who believe there is a stigma attached to autism tend to access services provided by professional organizations less frequently. They are more likely to rely mainly on family, friends and religious support.
In the Filipino culture, reliance on organizational support varies according to many factors, including the amount of family support received. Filipino families may take upon themselves the responsibility of raising their autistic child with little professional support.
Our own family’s experience with autism has been a multicultural journey. With both sides of our family now having knowledge of what autism is all about, we are all working together to raise Ziyad to develop his full potential. With family cooperation and the willingness to adapt to having a child with a developmental disability as part of the family, I know Ziyad will exceed all of our expectations.
For more than 60 years, nurses from the Philippines have been immigrating to the U.S. in search of higher-paying jobs, opportunities for professional growth and the hope of a better life for themselves and their children. In the late 1940s and again in the 1960s, two successive generations of Filipino nurses migrated here in large numbers. While many of the nurses in this second wave of migration succeeded in finding the American dream, others encountered obstacles of discrimination, economic hardship and exploitation, with no one they could turn to for help.
But today, Philippine immigrant nurses do have a resource they can turn to: the Philippine Nurses Association of America (PNAA), an organization that provides a strong, unified voice to support and advocate for all Filipino nurses in their quest to provide compassionate nursing care in the United States.
This past July, PNAA celebrated its 30th anniversary at its 2009 national convention, held in Baltimore. In her keynote address, Clarita Miraflor, PhD, RN, CHCQM, the PNAA’s first president, recalled the association’s beginnings, when local groups of Filipino American nurses representing New Jersey, New York, Michigan, Illinois and California met in New Jersey at the invitation of Phoebe Andes, MA, RN, to form a national organization, then known as the National Federation of Philippine Nurses Associations in the U.S.
Since its inception on April 21, 1979, PNAA has grown to encompass four U.S. regions, 37 local chapters, 13 subchapters and more than 4,600 members. It has become a charter member of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA). The PNAA Foundation, the association’s non-profit charitable arm founded in 2002 by Andes, a PNAA past president, provides opportunities for philanthropy to support the professional advancement of Philippine American nurses and the promotion of health through nursing care, education, scholarships, management and research.
Taking a Stand
The need for an organization like PNAA arose from a variety of problems immigrant nurses from the Philippines were experiencing in the 1970s, Miraflor explains. These included exploitation by recruitment agencies and employers; high failure rates on RN licensing exams due to insufficient test-taking skills; discriminatory hiring practices; unfair staff scheduling that placed Filipino nurses on evening or night shifts; difficulties in adapting to American culture, and inability to communicate effectively with employers and patients.
“The price of silence is high,” says Miraflor. “[As Filipino nurses ourselves,] we couldn’t turn our heads the other way. We had to direct our destiny.”
One particularly troubling incident that directly contributed to the formation of PNAA was the legal case involving two Philippine nurses, Leonora Perez and Filipinas Narciso, who were accused of causing the deaths of 11 patients at the Veterans Administration Hospital in Ann Arbor, Mich., in 1976, says PNAA past president Remedios Solarte, MSN, NP, RN.
Despite the lack of evidence against Narciso and Perez, the backdrop of racial tension in the 1970s due to the increased numbers of Asian immigrants to the U.S. set the stage for the nurses’ conviction. Although the verdict was eventually overturned, the nurses suffered adverse affects from the lengthy trial. The case made international news that bonded Filipino nurses and their countrymen.
Since then, PNAA has continually been in the forefront of advocacy efforts to ensure fair treatment for Filipino nurses in the U.S. In 1989, for example, the association rallied around the dilemma of Philippine nurses who faced deportation because they were nearing the expiration of their five-year H-1 visa limit. Under the leadership of its fifth president, the late Filipinas Lowery, MA, RN, CNOR, the PNAA and its chapters engaged in several months of concerted lobbying, in collaboration with other national nursing and hospital organizations. As a result of this campaign, the federal government enacted the Nursing Relief Act of 1989, which provided for the adjustment to permanent resident status for H-1 RNs who entered the U.S. prior to September 1, 1989.
“PNAA had to articulate the vital role of Filipino nurses in alleviating the acute nursing shortage and the [negative] impact their departure would have had on health care [in America],” says Solarte, who is writing the association’s history with two other founders, past president Lolita Compas, MA, RN, CEN, and past executive director Ampy de la Paz, MS, RN.
Presidential Visions
Current PNAA president Leo-Felix Jurado, PhD(c), NE-BC, APRN, credits the association’s founders as visionaries who have made PNAA the strong and successful organization it is today. “[Over the years,] 14 presidents have left a legacy that impacts PNAA as it continues to champion the welfare and advancement of Filipino American nurses in the U.S.,” he says.
For example, Solarte’s theme as sixth PNAA president (1990-1992) was “Visibility, Viability and Vitality.” “In a spirit of teamwork, we advanced the organization by making it visible to nurses in the U.S. and the Philippines, by strengthening its viability through increasing membership, and renewing its vitality [by establishing our] first Nurse Excellence Awards program for members,” she explains.
Jurado’s own presidential theme, “the PRISM of PNAA,” is based on his conceptualization of a framework that the national organization, its chapters and subchapters can use to work in unison for the association’s advancement. PRISM, he says, is an acronym that stands for:
Professional linkages with likeminded organizations and agencies.
Regulatory and legislative agenda initiation and support of those favorable to PNAA’s goals and objectives.
Interagency collaboration with the communities PNAA serves in the U.S. and abroad, and with other ethnic associations.
Service and program development that drives PNAA’s membership growth.
Managing organizational resources.
Meanwhile, president-elect Reynaldo Rivera, DNP, RN, CCRN, NEA-BC, ANP, who takes office in 2010, is already constructing the framework for his presidency, “Engage and Make a Difference.” Building on a strong leadership foundation, he envisions three pillars—membership development, community partnerships, and financial and operational strength— that will enable members to become role models and make a difference in the lives of those they serve.
“We are studying what makes nurses engage and have that passion for nursing,” Rivera says. “We plan to invite RNs to join [the association] and [we hope to] inspire and motivate them to continue their journey with the PNAA.”
On the World Stage
As PNAA has grown in size and scope, it has also emerged as an internationally recognized voice. One of the association’s most exciting international achievements was its work with the National Council of State Boards of Nursing (NCSBN), along with a coalition of other U.S. and Philippine organizations, to establish the firstever NCLEX® testing center in the Philippines. Following five years of advocacy efforts spanning the three PNAA presidential administrations of Anunciacion (Seny) Lipat, MA, RN (2002-2004), Mila Velasquez, MN, RN, CS, ANP, CCRN (2004-2006) and Rosario-May Mayor, MSN, RN (2006- 2008), and led by the dedicated work of PNAA NCLEX Task Force chair Filipinas Lowery, the NCSBN awarded international NCLEX test site status to Manila in February 2007.
“No longer would nurses from the Philippines, who supply the largest percentage of foreign-educated nurses to the world, have to make a journey from their native country to take the RN licensing exam,” says Mayor.
During her presidency, Mayor represented PNAA at three major international conferences: the World Health Organization (WHO) Global Advisory Group on Nursing and Midwifery conference; the Call to Action: Ensuring Global Human Resources for Health conference, sponsored by WHO, the American Hospital Association and the Bill & Melinda Gates Foundation; and the Global Forum on Migration and Development, an annual forum sponsored by Migrants Rights International and other international civil society organizations (CSOs).
“[Our representation] at these conferences was a major breakthrough that [positioned] the PNAA as a player on the international health care stage,” says Mayor.
Championing Nurses’ Rights
Working conditions for Philippine nurses in the U.S. have come a long way over the last 30 years, thanks in large part to PNAA’s efforts on their behalf. “When comparing the early days to now, Filipino nurses are better positioned to advocate for other nurses and speak out for human rights,” Mayor believes.
Rosario-May Mayor, MSN, RN, immediate past president
“Advocacy has always been at the core of the PNAA’s activities, even from its beginnings as the umbrella organization for PNAA chapters in 1979,” adds Mary Joy Garcia-Dia, MA, RN, chair of the association’s Human Rights Committee. Initially, PNAA’s advocacy work focused on assisting the transition of immigrant Philippine nurses to the U.S., providing safety nets and support through networking, mentorship and education, she explains.
An increase in unscrupulous recruitment practices in the early 1980s triggered an expansion of PNAA’s involvement with nurses’ rights issues, both at the national and local chapter levels—a mission that has continued into the 21st century. “PNAA has been monitoring these cases based on anecdotal stories and direct referrals,” Garcia-Dia says.
During Garcia-Dia’s term as PNAA New York Chapter president (2006- 2008), the PNAA Human Rights Committee strengthened alliances with community-based and professional organizations to fight for the cause of nurses’ rights. For example, the chapter joined with the New York State Nurses Association (NYSNA) and other organizations to support a group of health care workers from the Philippines—26 nurses and one physical therapist— who were lured to the U.S. under false pretenses by an unethical recruitment agency. On arriving in New York, they were forced to accept deplorable, abusive working conditions that honored none of the terms of the recruitment agreements they had signed. When their complaints were ignored for months, the workers resigned, only to face criminal charges of patient abandonment and endangerment.
The PNAA provided financial, professional and emotional assistance to the workers, dubbed the “Sentosa 27” after the Philippines-based Sentosa Recruitment Agency that brought them to the U.S. The charges against the workers were dropped.
PNAA president Leo-Felix Jurado, PhD(c), NE-BC, APRN
As a result of its involvement in the landmark Sentosa case, the PNAA was asked by the health services research organization Academy Health to participate in the development of a Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States, which was published in 2008. Mayor represented the PNAA as president, and two other PNAA members were also at the table: past president Lolita Compas, who represented the NYSNA as its president at that time, and Virginia Alinsao, MSN, MBA, RN, who represented Baltimore’s Johns Hopkins Hospital as director of international nursing recruitment.
The PNAA has also worked to break down barriers to practice for foreigneducated nurses. In 2006, an advocacy campaign by the New Jersey Chapter resulted in the state’s elimination of the Commission on Graduates of Foreign Nursing Schools (CGFNS) qualifying exam, which was a requisite to approval for nursing practice in that and other states. The Michigan Chapter successfully followed suit in 2007, and petitions to eliminate the exam have reached the final stages of the approval process in Virginia and Indiana.
“The outdated qualifying exam was a duplication of requirements, because the NCLEX-RN® already tests nurses’ knowledge and skills necessary to practice nursing competently,” explains Jurado, who proposed the change to existing regulations to the New Jersey Department of Law and Public Safety. “The exam placed unnecessary financial hardships on foreign-educated nurses and discouraged them from practicing in [our] state.”
Giving Back
For many Filipino Americans who were once immigrants to the U.S., giving back to their native land is an important cultural value. Last year, PNAA’s ongoing efforts to give back to their nursing counterparts in the Philippines were recognized with the Banaag Award, presented to the association by Philippine president Gloria Macapagal- Arroyo. This prestigious presidential award is bestowed on Filipino individuals and organizations whose contributions have significantly benefited or advanced a sector or community in the Philippines.
Past president Remedios Solarte, MSN, NP, RN
In addition to honoring the PNAA for its work in helping to establish Manila as a NCLEX testing site, the Banaag Award also acknowledged the association for its achievements in unifying Filipino nurses in the U.S., and for its Balik Turo “teach back” initiative, launched during Mayor’s administration in 2008. The Balik Turo encourages Filipino nurses in the U.S. to return to the Philippines to impart their nursing knowledge and proficiencies. The program is designed to improve the exchange of medical and clinical information, enhance the education of nurses in the Philippines and sustain partnerships with collaborating associations.
Through the Balik Turo, Mayor and project co-chair Solarte coordinate volunteer efforts of RNs in the U.S. to share their areas of expertise with nurses in the Philippines. Counterpart coordinators at Philippine health care facilities request U.S. guest speakers on a variety of nursing topics—leadership, practice, administration, NCLEX-RN preparation, Joint Commission standards and more. The Balik Turo project also encourages Filipino American nurses vacationing in the Philippines to consider sharing their nursing knowledge through presentations and roundtable discussions.
Since becoming president in summer 2008, Jurado has expanded the Balik Turo by encouraging PNAA chapters to adopt a school of nursing in the Philippines. In addition to sending members to the school to help educate the Philippine students, he suggests that chapters develop scholarship programs, help develop nursing curricula, and/or create a faculty exchange program with internships, observational opportunities and seminars.
President-elect Rivera says he plans to not only continue the Balik Turo but enhance it by adding cutting-edge programs and research development. He also plans to focus on faculty development, including a faculty mentoring program via email. Most nursing faculty members in the Philippines are young and can benefit from experienced U.S.-based nurse mentors,” Rivera explains.
Looking Back, Looking Ahead
At the 2009 convention in Baltimore, a time capsule ceremony—the brainchild of convention co-host Vicky Navarro, MSN, RN, vice president of PNAA’s Eastern Region Chapter—marked important highlights of the association’s past 30 years. Members associated with each event or object placed commemorative symbols in the time capsule: the PNAA incorporation papers, a membership pin, a copy of the bylaws, logos, a financial report, the membership list, the first issue of the soon-to-be-launched PNAA Journal, a press release announcing the approval of Manila as a NCLEX-RN testing site, a scroll with signatures of attendees at the 30th anniversary convention and the Banaag Award.
Three teenaged daughters of PNAA members, dressed in white to represent future nurses, wheeled away the time capsule for safekeeping. Plans are to open the capsule at a future PNAA convention in 2029.
“Where will we be in 20 years?” says Miraflor wistfully. “At the time capsule ceremony, my mind raced through the years of the outstanding legacies and accomplishments of every past president who built up the PNAA to what it is today. It was a poignant moment, difficult to let go. [But for me, it was a moment filled with] thoughts of praise and thanksgiving for the opportunity of being the [first president of PNAA] and being part of an organization that has enriched the lives of Filipino nurses as they [fulfill their mission of providing quality health care to America].”
There’s no sugarcoating it: pursuing a doctoral degree is tough. Balancing a clinical job with classes and homework—not to mention family time and your social life—takes determination and sacrifice. But if you’re prepared for the challenge, that hard-won degree may be the best investment of your life.
That intimidating introduction aside, keep in mind that hundreds of nurses proudly graduate with a Doctor of Nursing Practice (D.N.P.) or another doctoral degree every year. So what does a D.N.P. program really entail? We asked two experts some common questions surrounding doctoral study, from the admission process to program requirements. Both doctoral-prepared nurses, they can speak to their personal experiences as they now guide other nurses as university administrators.
Q. D.N.P. or Ph.D.: How should nurses choose between them?
TORRES: Ph.D. and D.N.P. programs differ both in their goals and in the competencies of their graduates. The decision to pursue a D.N.P. or Ph.D. depends on your career goals. While a Ph.D. student generates and develops new knowledge, a D.N.P. student translates research already done, evaluates it to see if it works for a specific problem or project, and then puts it into practice.
Ph.D. programs focus heavily on scientific content and research methodology, so if you want to be a nurse scientist/scholar with a research-centric career, you should pursue a Ph.D. The D.N.P. is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs.
Generally, a D.N.P. is the choice for Advanced Practice Registered Nurses (Certified Registered Nurse Anesthetists, Nurse Practitioners, Clinical Nurse Specialists, or Nurse Midwives) or nurses in other areas of specialized nursing practice (nursing administration, informatics, public health) who want to continue practicing in their area of expertise and are interested in gaining advanced knowledge and skills.
In recent years, there has been a growing demand for D.N.P. programs and degrees. According to the American Association of Colleges of Nursing (AACN), currently there are 153 D.N.P. programs, and between 2009 and 2010, the number of students enrolled in these programs increased from 5,165 to 7,034. In the same period, the number of nurses graduating with a D.N.P. doubled.
RODRIGUES FISHER: The increasing need for practitioners with D.N.P.s stems, in part, from hospitals and health systems looking for skilled nurses who can provide primary care to many people and, in particular, to those in low-income communities. There is also a move to increase the number of Latino and African American nurses who have advanced practice degrees because patients want primary care providers who have the same understanding of cultural beliefs and health care issues.
In order to determine which advanced degree is best for you, it’s important to decide if you want to continue practicing or if you wish to pursue research and teaching.
TORRES: Rather than concentrating on dissertations or research, D.N.P. programs help nurses build upon their current practice, learn new skills, and conduct applied research. Many doctoral students also find great value in completing a project that they can readily apply in practice.
Q. How should nurses prepare for the doctoral program application process?
RODRIGUES FISHER: Start by brushing up on your writing, language, and math skills. They will serve you well. In my personal experience, because English is not my first language, it was important for me to study and brush up on my writing and math skills. I struggled until a professor in my master’s program recommended I take an English course; it was truly the best decision I could have made. After bolstering my language and writing abilities, I felt prepared to take the GRE for my doctoral program.
You should also generate a list of organizations you support, either as a member or otherwise. For example, if you participated in a fundraiser for the American Heart Association or did something to engage members of your community to encourage minority students to continue their education, be certain to list those activities in your application. If you are out in your community doing good deeds, institutions will recognize you as someone who would represent them well.
Make sure someone else reviews your application before you send it in! It’s important to submit a polished application. It should shine a light on you and your achievements, but any mistakes will be blinding.
TORRES: Some schools require Ph.D. and D.N.P. applicants to write an essay about why they want to earn a doctoral degree, what their career goals are, and what they hope to accomplish with the degree. The essay needs to be well-written, with no spelling errors and good grammatical structure.
Many doctoral programs also request written references. Be especially careful who you ask to provide a reference—preferably it should be someone in your area of practice or a faculty member who teaches in that area—and make sure they know you well. Check with the institution if you have any questions about the application or the process.
Q. What are admission counselors looking for in nurses’ applications?
TORRES: Counselors evaluate applications based on a variety of factors, including academic record, essays, and prior experience. Requirements may include a master’s degree or its equivalent, a 3.0 minimum GPA in that master’s program, an active R.N. license, two or more professional references, and official transcripts of highest course work completed, plus the completed application and fee.
RODRIGUES FISHER: Yet, it’s not just about the applicant’s individual grades. Admission counselors look at the whole person, and they want people with broad, varied experiences.
Some questions admission counselors will be asking themselves as they review applications are “What have they done?” “What committees have they served on either in their community or in their health care facility?” and “Have they demonstrated they will be successful in the program?” It’s important to list all activities and committees you are involved in and specifically what your role was on those committees.
TORRES: Doctoral programs may also prefer (or require) a number of years of professional nursing experience. International students may need to demonstrate equivalency via an additional evaluation from the Commission on Graduates of Foreign Nursing Schools (CGFNS).
The D.N.P. requires 1,000 post-bachelor’s clinical hours, of which 500 must be at the D.N.P. level. Admission counselors will obtain information on how many clinical hours the entering students had in their master’s program.
Q. What does the typical doctoral program entail?
TORRES: A typical D.N.P. program is developed based on AACN’s The Essentials of Doctoral Education for Advanced Nursing Practice and covers both course work and clinical hours. The publication outlines the curricular elements and competencies that must be present in programs conferring the Doctor of Nursing Practice.
Doctoral course work is very rigorous. Time management is important, and you will need to closely examine how you are going to complete the course work and use your time to your advantage.
An integral part of the D.N.P. program is the final D.N.P. project, which is usually based on an issue or problem at the student’s institution or facility. It’s important for students to work closely with their schools to ensure the institution supports the project’s implementation. During this project, the student will typically accrue the practicum hours needed. In some ways, the D.N.P. project is similar to a dissertation since it requires approval of the Institutional Review Board (IRB) and includes a committee to guide the project.
RODRIGUES FISHER: All doctoral programs require a lot of reading and library research. Once you get through your core course work, it will be important to identify your research area and possible mentors. One additional piece of advice: focus your course work in the direction of your research.
Q. How might doctoral course work impact a working nurse’s personal life?
RODRIGUES FISHER: Going back to school to pursue your doctorate will definitely impact your personal life. I worked full time, went to school, and had a family to take care of, but the great support from my family made it all possible. My husband made sure the children were taken care of and the housework was done. The house wasn’t always as clean as it could be, and I missed some of my children’s games, but because of the partnership with my husband, we made it work.
TORRES: Before you start a doctoral program, talk with your family so they understand what’s involved, how it may impact them, and how they can help you succeed. You will soon discover how many courses you can manage at a time and whether you can handle a full- or part-time commitment, based on your family, work, and other commitments.
Online programs typically offer nurses more flexibility to work their classes around individual schedules. But even if the delivery method is online, course work still takes time, and doctoral students quickly realize they won’t be able to continue to do all they were doing before deciding to pursue a doctorate. On average, each course is a minimum of 15 hours of work per week.
RODRIGUES FISHER: They say if you educate a woman, you educate a family, and I believe this to be true. Yes, going back to pursue my doctorate took away from some of the other things in my life, but my children benefited as they saw me working hard to achieve what I wanted, both for myself and our family. I was proud to be that kind of role model for them. Work hard and you will be rewarded.
Q. How will a nurse’s duties change after obtaining his or her D.N.P.?
TORRES: Most nurses pursue their D.N.P. because they want to advance in their careers and increase their income. According to the 2009 salary survey conducted by ADVANCE for Nurse Practitioners magazine, D.N.P.-prepared NPs earned $7,688 more than master’s-prepared NPs.
Many graduates move into a new job or position where they can use the skills they learned while acquiring their D.N.P. Others decide to take on additional responsibilities in their current jobs or go into teaching.
RODRIGUES FISHER: The biggest change is more responsibility. As a nurse with a D.N.P., you will be put into leadership positions supervising other nurses. You will also have a more familiar relationship with physicians at your facility. In short, a D.N.P. means increased opportunity.
Q. What do you think about the AACN’s push to have nurses earn a D.N.P.?
TORRES: I support the movement toward the D.N.P. In the transition to the D.N.P., nursing is moving in the direction of other health professions such as medicine (M.D.), dentistry (D.D.S.), pharmacy (Pharm.D.), psychology (Psy.D.), physical therapy (D.P.T.), and audiology (Aud.D.) to provide their professionals with a practice-oriented degree. Nursing is advocating having more nurses obtain their D.N.P., so we are headed in the right direction. In fact, the AACN membership approved a target goal for transition of Advanced Practice Registered Nurse programs to the D.N.P. by 2015.
RODRIGUES FISHER: It’s not just a push from the AACN, but also from the Institute of Medicine to have more educated nurses out there to deliver needed health care to the nation. We are an aging population that is living longer and needs more care. However, with a shortage of health care providers, we need to have nurses who are prepared to practice, are well educated, and can work in a colloquial role with physicians.
Many nurses who choose Walden University do so to advance their careers and become better practitioners. Colleges and universities are looking to develop lifelong learning programs, such as associate to master’s programs and B.S.N. to D.N.P. programs, in order to quickly meet the increased and growing demand for more educated nurses.
Q. What advice do you have for nurses debating whether or not they should pursue a doctorate?
RODRIGUES FISHER: My number one piece of advice is to think about what you are willing to give up for a short period of time in order to pursue your doctorate. I had to give up some of my personal and family time to advance my education and career. For me, the end results—making contributions in the quality and delivery of care and giving patients the best health services they can receive—are truly worth it.
TORRES: Know your career goals, assess your personal life, and identify your passion. Where are you in your career, and what do you want to do? Do you want to concentrate on research and academia, or do you wish to advance your practice?
Timing is everything, so ask yourself: Is this the right time in my life to do this? If not now, when?
We often say nurses are on the “front lines” of health care, meaning they work closely with patients and become intimately acquainted with the issues those patients face. And while hospitals can seem a lot like trenches sometimes, they are a far cry from the military operations taking place worlds away.
Here, two military nurses share their stories, from the stress of coordinating care in a combat zone to dealing with prejudice and personal growth, all while caring for the men and women serving in the U.S. armed forces.
Joseph D. Hacinas, R.N., M.S.N., C.N.S., P.H.N.
Lieutenant Commander, United States Navy Nurse Corps Last year, 2011, marked my 10th year as a nurse. Those years have been marked by personal and professional accomplishments. However, this was not always the case. In fact, my nursing career was almost never a career to begin with.
After graduating with honors, I had a great sense of pride and confidence. Perhaps I had too much self-confidence. As a result, I failed miserably with my nursing board exam. Worse, I blamed everything and anything but myself. Having failed this exam almost cost me my job and the opportunity to become a commissioned officer in the U.S. Navy. My mentality relied heavily on the fact that I was going to be a nurse. I intended to be an outstanding nurse, just like the hundreds of outstanding nurses of Asian/Filipino descent who came before me.
Yet, I assumed I could pass the nursing board exam without really studying or working for it. Well, lesson learned. An expensive lesson, I should add. Had I not eventually passed my nursing board exam, I would have been looking at an employer recoupment of about $20,000. Ouch! The good news is that I was able to overcome this barrier just in time.
Rookie nurse
I began my career in a military nursing at the Naval Medical Center in San Diego, and my goals were simple: learn as much as possible and don’t make mistakes with potentially dire consequences (e.g., a medication error). Not so different from civilian nursing, really!
I remember that rookie year vividly. Looking back, I am still not sure how I was able to succeed in such a demanding work environment. I was assigned as a staff nurse at a 28-bed medical-surgical unit. By far, we were the busiest nursing unit in our 250-bed facility. Every day was non-stop action. It felt like my heart rate increased by at least 10 beats per minute every time I set foot in the unit. It seemed like we never slowed down—and the tempo was dizzying. I would typically have six patients with an assistant. For any given shift, my duties would consist of AM care, vitals, assessment, medications, and procedures. I also had to coordinate MRI visits, CT consults, and X-ray availability while calling for discharge medications in pharmacy. No matter how physically and mentally prepared I tried to be, it was hard to maintain a sense of control. There were times that I was so stressed I literally made myself sick. Basic nursing skills such as prioritization of patients and critical-thinking skills were learned on the go. I wouldn’t exactly call it chaos. But it was close.
Yet, as crazy as it may sound, I actually did not mind it one bit. It’s the truth. One of the reasons was that I had great mentors around me. I used to look around our nursing unit and realized my nursing colleagues were more than willing to help, no matter what. Perhaps it was our sense of teamwork. Or it could have been our dedication to military nursing and our patients. Whatever it was, it didn’t take me long to realize that I had made the right career move. Unlike my civilian nursing colleagues, I have had the unique opportunity to care for patients who have served and are serving this great nation. It is a feeling like no other. To come in on a daily basis and know that I am part of something meaningful is incredible. This couldn’t have been more evident than after the events of September 11, 2001.
I was actually on my way to work when I heard of the terrorist attacks. Not knowing much at the time, I just remember thinking that my nursing skills were about to become a commodity, whether I was ready or not. It was a fearful and uncertain time for everyone, almost surreal to think that such an attack was even humanly possible. I just remember hearing from my supervisors, “Be ready.” There was a good chance most of us were bound for deployment overseas. Soldiers, marines, sailors, and airmen were counting on us to provide the best patient care possible under all circumstances. As it turns out, I was actually one of the nurses that ended up staying behind during the early stages of the war. Nevertheless, it was professionally fulfilling. It provided a great way for me to contribute. For the next few years, I found myself in various nursing assignments, from California to Japan. I have been blessed to grow professionally and gain a better perspective of my overall purpose as a military nurse.
Military minority
Like some people find their niche in a nursing specialty like pediatrics or oncology, I have found that being a military nurse has its own advantages. I work with an outstanding team. From physicians to social workers, it is a rewarding experience to collaborate and gain a sense of unity. This is especially important as nurses and the rest of the health care team are tasked to care for patients with complex disease processes. More importantly, my service to active-duty patients and beneficiaries truly defines who I am as a nurse. Whether I am teaching a dependent spouse about healthier eating habits or holding a patient’s hand and praying with him before a major surgery, I am there to give it my all. Because, chances are, they would do the same for me. And that alone is what matters most. In a sense, we are more than just a family. We are united as one.
Of course, to say my military nursing career has been nothing but great experiences wouldn’t be entirely accurate. I can recall one incident when caring for a retired military member. He rang his call bell for assistance. When I walked in to his room, he said, “I’m sorry, but I had asked for a nurse.” I politely answered that I would be the one taking care of him for the night. He quickly replied, “No, no, no. I asked for a nurse—the one who has blonde hair, blue eyes, and wears a nice skirt.” Obviously, I could have reacted in a negative manner. Rather, I chose to remain calm and respectfully informed him that not all nurses are females with blonde hair. Somewhat perplexed, the patient quickly changed the topic and turned his attention to the television. I did not feel anger towards that particular patient; all I could think of was trying to find ways to help him understand the evolving nature of nursing, which now consists of men as well as Asian/Filipino nurses like me.
As troubling as that patient’s reaction seemed at first, I truly felt he came to realize that male nurses were more than able and capable of caring for patients like him. Though he never said so directly, I just had a feeling. And if nothing else, I know my serving as his nurse was a concrete example that contradicted his former world-view.
The common thread
Nursing is an ever-evolving profession. And changes in our health care delivery system will happen, regardless. The past 10 years of nursing have taught me valuable lessons. For one, I have learned to remain humble. I have also learned to not take things personally when it comes to patient comments. Granted, some comments are downright ignorant and hurtful. But, I believe there is a common thread and human decency in everyone. As a military nurse, I am proud to be a part of their lives. In particular, I am proud to know that I have been given ample opportunities to touch lives and care for my patients. I never imagined I would be in the position to make an impact on someone’s life. Personally, those few minutes of comforting patients during the worst of times have turned to a lifetime of personal and professional satisfaction.
Yet, as with any profession, nursing is not for everybody. I have friends and colleagues who left nursing. I think some of the more common reasons for doing so were the stress of the patient workload and the lack of support from nursing leaders. Being a minority nurse, my advice is to truly and honestly evaluate one’s dedication and intention before committing to nursing. Nursing is a great and well-respected profession, but it does come with its challenges. For example, there have been times when I feared for my safety when caring for patients with developmental delays and mental instability. In addition, minority nurses may still encounter racial and ethnic stereotypes.
Once, a patient bluntly asked if all Filipino nurses speak Tagalog among one another in front of non-Filipino patients. Taken aback, I informed her that no, that is not the case. They only speak their native language during their off-duty time. In another instance, when reporting to my new supervisor (who happened to be a minority), she said, “I can already see two things that are against you. You’re an Asian and a male.” In the U.S. Navy Nurse Corps, we value diversity and strongly feel that concept results in a better work environment for all of our valued staff members, regardless of their race or color. Yet, we, as a health care organization, also understand that we are at risk for discrimination. The good news is that we have a solid support structure that enhances equal opportunity for all.
I learned there remains a small group of people in the nursing world who are who they are and believe what they believe, and there’s no changing them. More importantly, I learned the value of self-discipline while serving my patients at the most honorable level. Ignorance and immaturity exist in this world, but we, as minority nurses, have more than the power and ability to achieve the highest levels in long, fulfilling careers. We should not and cannot allow minor setbacks to dictate who we can become as professionals—we are simply too valuable to the profession. I have always seen nursing as a rewarding career, personally and professionally. Joining the nursing ranks seemed like a no-brainer. And, in general, my expectations of camaraderie, mentorship, and professional development have been met.
Who knows what the next 10 years will bring? I may pursue other interests such as golfing and traveling across the globe. I may even find myself teaching at a local university. I am okay with the unknown that lies ahead when it comes to my career as a military nurse. The one thing that I am certain about is that I will continue to strive in providing the best patient care. The ability to make a difference in patients’ lives means a lot to me. And sometimes, that is all you need. Here’s to another 10 years!
Artemus Armas, R.N., M.S.H.S, B.S.N, C.E.N.
Major, United States Air Force, North Carolina
I have been an Air Force nurse since January 2002. Before that I was in the National Guard and Army Reserve for 17 years before I went on active duty. In the Guard I was an Army Infantry officer.
During my fourth deployment, I was at the Camp Bastion Joint Operating Base in the Helmand Province of Afghanistan, the fiercest combat zone in Afghanistan at the time I was there. I was in charge of the Aeromedical Evacuation Liaison Team (AELT) at Camp Bastion Joint Operating Base Hospital. The team consisted of a flight nurse (myself), a medical service corps officer, and two radio technicians. We were primarily responsible for providing fixed-wing aeromedical evacuation for NATO forces and sometimes civilians. The team also helped anyone, including civilians, who may need to be seen by a specialist not stationed at Camp Bastion.
AELT responsibilities
The AELT’s key function is transferring patients, such as those with traumatic amputations or other combat injuries, who need more specialized treatment to a different facility. The hospital relies on the AELT to coordinate the patient’s transfer with a medical aircrew (Aeromedical Evacuation Crew, or AEC), which flies the patient from point A to point B. Once the patient is picked up by the AEC and en route to a higher level of medical care, the AELT advises the staff and hospital awaiting the patient’s arrival.
A secondary mission for AELT is providing emergency medical assistance to local nationals and Afghan National Security Theater hospitals. Camp Bastion is a joint hospital, meaning whichever nation’s military is in charge of the hospital collaborates with the other countries working there. When I was there we had the Danish, British, and U.S. military.
Camp Bastion is a Role 3 hospital. Role hospitals break down as follows: Role 1 hospitals are assigned to areas providing basic or initial care; Role 2 are facilities with some surgical capabilities; Role 3 facilities can support trauma care, surgical procedures, and burn care; and Role 4 is advanced medical center care. As the lead medical person on the AELT, I made sure patients were properly prepared for flight. I also trained coalition force physicians, nurses, and medical technicians regarding approved devices, brands, and materials, including pumps, chest tube drainage systems, and traction devices.
I also taught hospital leadership on how our system works, the process of getting a patient to a higher echelon of care; this education included Army, Navy, and Marines. While at Camp Bastion I authored and implemented new policies on moving patients through the theater hospital systems, called the Patient Movement Requirement (PMR). Fortunately, implementing these procedures cut down patient movements errors by 60%.
The AELT took the lead in teaching hospital personnel how to sanitize patients before entering the hospital. We sanitized over 500 ally and enemy casualties (patients), meaning we removed any guns, ammo, or explosives before injured personnel entered the hospital. This was for security, assuring nothing happened to hospital staff and patients.
Through these initiatives and two published articles, my goal was to educate AE crews as much as possible so they would not stress when they saw unfamiliar medications or procedures, while giving a report for patients being moved by the AECs. I also included a quick reference sheet of drugs used by the coalition facility and its U.S. equivalent. By the end of this deployment, my four-person team had moved 313 patients, including 102 battle injuries.
ICU in the sky
On my second deployment that year, I had a five-day notice to get my bags and go, due to an injured person who was deployed. I went to Southeast Asia, where I was in charge of the Aeromedical Evacuation Operations Team. I managed up to eight Aeromedical Evacuation Crews and two Critical Care Air Transport Teams (CCATT).
CCATT is basically an airborne intensive care unit. The team consists of a physician, nurse, and respiratory technician; they transport the most critical patients with the assistance of the AEC. I needed to make sure the crews were ready to fly 24 hours a day, seven days a week, so we could pick up patients in the Area of Responsibility, which covered seven countries. I planned and coordinated training as needed for the crews, from medical guidelines to how to use specialized communication equipment. Mentoring was also a big part of the job, including how to deal with crewmembers and patients, career planning, and writing military reports.
Another big aspect was scheduling AECs, by following regulations regarding when crews could and could not fly. Crews need enough time to recoup and rest to be able to perform their duties on the plane and provide high-quality patient care. Scheduling can sometimes be hectic, because you have crews both on call and on missions.
I also coordinated over two tons of Patient Movement Items to the AOR, while my team also maintained and managed 73 Portable Therapeutic Liquid Oxygen units (patient oxygen). This optimized five AE units and kept them fully mission capable. While there I functioned as a crewmember when personnel were unable to fly due to injury or illness. I flew three missions as part of an AEC and pulled 120 hours of alert status, resulting in the transfer of 18 coalition casualties to advanced care. During increased operations we relocated 12 Aeromedical Evacuation Crew members and two CCATTs to Bagram, Afghanistan, increasing Operation Enduring Freedom capabilities by 20%. The efforts during that time lead our team to win the Expeditionary Aeromedical Evacuation Squadron “Team of the Month.” While deployed, the team safely evacuated over 400 wounded personnel on 180 sorties.
The most important result of all that I do is making sure patients, whether military or civilian, receive the best, most comprehensive care possible throughout the AE system. You need everything: great patient care, equipment, leadership, management, and more. If you just focus on one, the system will not be optimal. It is crucial to be well-rounded on all aspects of the AE system. I am honored that my commanders have seen qualities in me to give me the opportunity to succeed in the positions where I have been placed. My philosophy is to do what is best for the patient and those who take care of them; everything else will fall in place.
While deployed as an AELT, I lead our team with a program called “Soldiers’ Angels” (www.soldiersangels.org). We would collect items such as books, food, soap, clothes, music, and blankets from people throughout the United States to give to personnel living in austere conditions and patients who needed supplies in the hospital. We ended up distributing over $50,000 in products to over 500 patients, 24 units, and 12 Forward Operating Bases.
Recently, I was honored with two awards: The Air Force Flight Nurse of the Year and Nurse of the Year. When my commander informed me I won, I was shocked. It is an honor just to win one. I had learned my commander had put a Flight Nurse of the Year package in for me when I was deployed to Southeast Asia, but I never expected to win. I gave her my information and didn’t think of it again until I won. It was a shock to both of us when I also won the Nurse of the Year. However, though I say “I” in describing all these events, I truly could not have done it alone. The team makes it happen—I just tried to lead them in the right direction.
Getting the opportunity to be a flight nurse has been the most satisfying job I have had thus far in my nursing career. Being a flight nurse in the Air Force has given me opportunities to be an effective leader and make an immediate difference for those I have taken care of that I would not have had as a nurse in a clinic or hospital. Like the rest of the nation, the Air Force needs more nurses and the AF Flight Nurse community needs even more, as a specialty. I would recommend this life to anyone who likes adventure, leadership opportunities, and enjoys taking care of our wounded warriors.
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.
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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.”
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.”
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].”
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.
“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.
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.
