“Why are there so many Filipino nurses in the US?”

rodisBy: Atty. Rodel Rodis  This was the question posed to me by a curious TV reporter on May 7, just three days after a stretch limousine hired to carry nine Filipino nurses to a bridal party across the San Mateo Bridge suddenly burst into flames killing five of the occupants, including the bride.
When she interviewed me in my law office in San Francisco, Ann Notarangelo, the weekend anchor of CBS 5s Eyewitness News, told me that many viewers were posing this question. She thought I might know the answer as I taught Filipino American History at San Francisco State University and I am the legal counsel of the Philippine Nurses Association of Northern California. Plus, I told her; I am married to a Filipino nurse.

nurses big
The reporter said that her preliminary research showed that at least one out of every five registered nurses in California is a Filipino, a considerably large percentage since Filipinos number only 2 million (officially 1.2 million) out of a state population of 38 million.
“I never noticed it before,” Ann observed, “because I generally don’t see people in racial terms.” But, she said, in reflecting back on all the times she visited friends and relatives in hospitals all over the San Francisco Bay Area, she now recalls seeing Filipino nurses everywhere.

The seeming anonymity of Filipino nurses in the U.S. – being there but not being there, being visible but invisible –  is likely no more. The video clip of the fire-engulfed limousine taken by a passing motorist using a cell phone was the top of the news throughout the U.S. over the weekend. The fact that all 9 of the limo passengers were Filipino nurses has triggered a curiosity about the number of Filipino nurses in the US.
The fatalities included Neriza Fojas, 31, a newlywed who was planning to get married again in the Philippines in June; Michelle Estrera, 35,  the bride’s Maid of Honor who worked with her at a Fresno medical facility; Jennifer Balon, 39, and Anna Alcantara, 46, of San Lorenzo, who both worked at the Fruitvale Healthcare Center; and Felomina Geronga, 43, who worked at the Kaiser Permanente Medical Center in Oakland.
The nurses who escaped the fire and were treated for burns and smoke inhalation were:  Mary G. Guardiano, 42; Jasmine Desguia, 34; Nelia Arrellano, 36; and Amalia Loyola, 48. In a TV interview, an anguished Nelia Arellano blamed the limo driver for failing to stop immediately and for failing to help them get out of the burning limo.



A. Notarangelo

Ann Notarangelo told me that her research showed that all nine Filipino nurses were petitioned from the Philippines by the Fruitvale Healthcare Center and that all of them had since become naturalized U.S. citizens. “So why are there so many Filipino nurses in the US?”
Salary, for one, I explained. The average annual salary of a nurse in the Philippines is $2500. In the U.S., it is $50,000. That’s 20 times more.
I told her not to be too surprised at the large number of Filipinos in the U.S. After all, the Philippines was a colony of the US from 1899 until the Japanese occupation in 1942 and, some would argue, a “neo-colony” for many decades after the Philippines gained its independence in 1946.  Just as it is not unusual to see many Indians and Pakistanis in England, and many Algerians in France, people from the colonized countries generally tend to immigrate to their “mother” countries, even long after their native countries were granted independence. That being said, there are four waves of Filipino nurse immigration to the US.

The first wave came after the U.S. began its colonization of the Philippines and needed health care professionals to meet the health needs of the subject population which is why the U.S. Army recruited Filipinos to work as Volunteer Auxiliary and Contract Nurses.
Under the Pensionado Act of 1903, many Filipinos were sent to the US  as government-funded scholars (*pensionados*) to obtain an education. Some stayed for employment and those who obtained a nursing education and became nurses formed the Philippine Nurses Association of New York in 1928. The association’s first president was Marta Ubana, who completed her Bachelor of Science in Nursing degree at Teachers College, Columbia University.

Many other “pensionado” nurses returned back to the Philippines to help set up and manage the 17 nursing schools that were established in the Philippines from 1903 until 1940. Large numbers of the graduates from these nursing schools thereafter immigrated to the US as, unlike with the Chinese and Japanese, there were no immigration restrictions against them since Filipinos were considered “US nationals” and even traveled with US passports.
My friend, Lissa Sobrepena, came to my office two months ago and excitedly told me that she just learned that her grandmother, who died before she was born, had lived and worked in the US as an RN. She showed me the photos of her grandmother, Isabel Mina, which she saw by logging on to Ancestry.com <http://Ancestry.com>. On it, she viewed various documents of her grandmother including the two passport applications of Isabel Mina who lost her U.S. passport while traveling in the US.

Lissa learned that her grandmother had immigrated to the US in 1921 with two other Filipino nurses, Josefa Cariaga and Petra Aguinaldo, and that they all worked as RNs in Hawaii and California before moving on to New York.
Lissa then learned to her astonishment that her grandmother’s best friend, Petra Aguinaldo, was the grandmother of her husband, Robert Sobrepena. Neither Lissa nor Robert knew that their grandmothers were nurses and were friends and that they had traveled together across the U.S.

According to Catherine Ceniza Choy, associate professor of ethnic studies at the University of California, Berkeley, and author of “Empire of Care: Nursing and Migration in Filipino American History” (Duke University Press, 2003), the next big wave of nurses from the Philippines came began in1948, as part of the Exchange Visitor Program that was set up by the US State Department to “combat Soviet propaganda”. Because of the “special relationship” between the mother country and its former colony, a large percentage of the exchange visitors came from the Philippines, and many of them were nurses.
arrow green with textAmong these nurses was Maria Guerrero Llapitan who came to the US in 1948 to take post-graduate nursing courses at Baylor University in Texas. Maria had served as the supervisor of the operating room of a hospital in Bataan before it fell to the Japanese invaders in 1942.
After completing her postgraduate studies at Baylor, Maria moved to Chicago to work at the Cook County General Hospital where she met her fiance. She then went to Hunter College for Women in New York to get her nursing degree while working at Sloane-Kettering Memorial Hospital in New York.
Maria later married her fiancé in San Francisco where they set up a family in 1951. She later was among them.

The third wave of Filipino nurse immigration to the US came after 1965 when U.S. Immigration laws were liberalized to allow Filipino nurses and other professionals to immigrate to the US. It also allowed Filipino nurses to come to the US on tourist visas without prearranged employment and to then adjust their status in the U.S.
During this period, the number of nursing schools in the Philippines soared from 17 in 1940 to 170 in 1990 to more than 429 at the present time.
But only 15-20% of the Filipino nurses who immigrated to the US after 1965 could pass the state nursing board exams. This led to the establishment in 1977 of the Commission on Graduates of Foreign Nursing Schools (CGFNS) to help prevent the exploitation of graduates of foreign nursing schools who come to the United States to work as nurses but who can’t pass the nursing board exams here.
The CGFNS developed a pre-immigration certification program that consisted of: a credentials review; a test of nursing knowledge (CGFNS qualifying examination), and an English-language proficiency examination (TOEFL).

Since 1977, CGFNS has administered more than 350,000 tests to approximately 185,000 applicants in 43 test sites worldwide. From 1978 to 2000, the data showed that 73% of CGFNS test takers came from the Philippines, followed by the United Kingdom (4%), India (3%), Nigeria (3%), and Ireland (3*%).

Menchu Sanchez immigrated to the US in 1980s and has worked as an RN for more than 25 years, the last three years at the New York University Langone Medical Center. When Superstorm Sandy battered New York last October, Menchu was taking care of 20 at-risk infants in the Intensive Care Unit of her hospital. Sandy knocked out the  electric power to the hospital causing Menchu to organize the nurses and doctors to carry the babies in warming pads down 8 flights of stairs to safety. Menchu was invited to sit beside First Lady Michelle Obama at the State of the Nation Address (SONA) of Pres. Obama on February 12, 2013.
In his SONA speech, Pres. Obama cited Menchu as a role model: “We should follow the example of a New York City nurse named Menchu Sanchez. When Hurricane Sandy plunged her hospital into darkness, she wasn’t thinking about how her own home was faring. Her mind was on the 20 precious newborns in her care and the rescue plan she devised that kept them all safe.”
Many Filipino nurses who entered the U.S. on H-1work visas after passing the CGFNS tests benefited from the passage of the Nursing Relief Act of 1989 which provided for their adjustment to permanent resident status if they had H-1 nonimmigrant status as registered nurses and had been employed in that capacity for at least 3 years.

But the “sunsetting” of this law in 1995 effectively decreased Filipino nurse immigration to the United States. The passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1998 (IIRIIRA) further discouraged nurse immigration to the US.

The passage of restrictive legislation was fueled by xenophobic fears of foreign nurses  as was expressed in July of 2009, when former Washington D.C. Mayor Marion Barry complained to the press: “In fact, it’s so bad, that if you go to the hospital now, you find a number of immigrants who are nurses, particularly from the Philippines,” Barry told the “Examiner”. “And no offense, but let’s grow our own teachers, let’s grow our own nurses — and so that we don’t have to be scrounging around in our community clinics and other kinds of places — having to hire people from somewhere else.”
Grow your own nurses the US did. According to the National Council of State Boards of Nursing, US nursing schools produced close to a million nurses from 2006 to 2011.
While the demand for Filipino nurses may have waned in the U.S., the demand for Filipino nurses in the rest of the world did not diminish. Filipino nurses working for the National Health System (NHS) in England drew national attention last February when Britain’s 91-year-old Prince Philip, while on a tour of a new cardiac centre in Bedfordshire, England, turned to a Filipino nurse and said: “The Philippines must be half-empty – you’re all here running the NHS.” Not quite, not by a long shot, your majesty.
According to Reuben Seguritan, the Philippines is the world’s largest supplier of foreign-trained nurses with 429 nursing schools and 80,000 nursing students.  To place this number in perspective, City College of San Francisco, with 89,000 students, does not have the resources to accept more than 75 students into its nursing program. The nursing students are chosen by lottery from a list of about 500 students who otherwise qualify for acceptance.

Is there a fourth wave of Filipino nurse immigration to the US? Yes, but it hasn’t arrived yet. According to recent CNN report, “Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a “massive nursing shortage will reemerge in the United States.”
The CNN report adds: “We’ve been really worried about the future workforce because we’ve got almost 900,000 nurses over the age of 50 who will probably retire this decade, and we’ll have to replace them,” [economist and nurse Peter] Buerhaus said.”
The fourth wave may come as early as 2014 when the US Patient Protection and Affordable Care Act, otherwise known as Obamacare, comes into effect and about 30-40 million Americans without any health insurance will finally be covered by health care.
Philippine party-list Rep. Arnel Ty believes that Obamacare will “stimulate” the U.S. hiring of foreign nurses. “This will hopefully spur a bit U.S. demand for new foreign nurses and other health practitioners such as pharmacists, physical therapists, medical technologists, radiologists, and speech pathologists,” Ty said.
As we reflect on the past and contemplate on the future, let’s all say a prayer for the repose of the souls of the five Filipino nurses who died in that limo fire on May 4 and pray also for the recovery of those nurses who were injured in that accident.

(Send comments to Rodel50@gmail.com or mail them to the Law Offices of Rodel Rodis at 2429 Ocean Avenue, San Francisco, CA 94127. n

6 thoughts on ““Why are there so many Filipino nurses in the US?”

  1. The best historical article I’ve read on Philippine nurses. I was part of the era when CGFNS was enforced. In 1977, Nursing recruitment agency from New York was actively recruiting and assisting and/or give info on processing requirements to be placed in hospitals that had nursing shortage.
    Your article brings back memories. I am a Realtor almost 10 yrs now, but still keeping my current nursing license to keep abreast with the nursing and medical field. Thanks for a nice detailed article.

  2. I came to the US in 1986 and will retire soon. Yes, we need the new breed of nurses,but who still are very compassionate about patient’s needs.

  3. I, for one has been officially informed on how the Filipino nurses started in USA. through this. It is quite a HISTORY that every Filipinos should KNOW and be PROUD OF…

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