I was asked this question by a curious TV reporter early last month in San Francisco. My response was quite simple. There are push and pull factors that are at play, I explained. The main push factor is the poor Philippine economy where an average Registered Nurse (RN) earns only about 5% of what an RN is paid in the US. The main pull factor is the nursing shortage in the US.
Americans should not be too surprised at the large number of Filipinos in the US. After all, the Philippines was a US colony from 1899 until the Japanese occupation in 1942 and, some would argue, a “neo-colony” for many decades after the Philippines was granted independence by the US in 1946.
It does not surprise the British to see many Indians and Pakistanis in England, nor does it surprise the French that there are many Algerians in France. They understand that people from the colonized countries generally tend to gravitate and immigrate to their “mother” countries, even after their native countries were granted independence.
Four waves of immigration
There are four waves of Filipino nurse immigration to the US. The first wave came after the US began its colonization of the Philippines and needed local health care professionals to meet the health needs of the subject population which is why the US Army recruited Filipinos to work as Volunteer Auxiliary and Contract Nurses.
Under the Pensionado Act of 1903, Filipinos were sent to the US as government-funded scholars (pensionados) including those pursuing a nurse education. Some of those who stayed for employment as nurses in the US went on to form the Philippine Nurses Association of New York in 1928.
Many other pensionado nurses returned to the Philippines to help set up and manage the 17nursing schools that were established in the Philippines from 1903 until 1940. Large numbers of the graduates from these nursing schools thereafter migrated 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 travelled with US passports.
The next big wave of nurses from the Philippines began in1948 when the US State Department set up an Exchange Visitor Program to “combat Soviet propaganda”. A large percentage of the exchange visitors came from the Philippines, and many of them were nurses or nursing students.
The third wave of Filipino nurse immigration to the US came after 1965 when US Immigration laws were liberalized to allow Filipino nurses and other professionals to migrate 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 US. 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. Many of these nursing schools were diploma mills exploiting the desire of many Filipinos to enter the nursing profession.
Unfortunately, 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.
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).
Many Filipino nurses who entered the US 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 non-immigrant status as registered nurses and had been employed in that capacity for at least 3 years.
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 re-emerge in the United States.”
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 insurance. ###