Filipina Nurses See Long Visa Delays Despite Nursing Shortage

Filipina Nurses See Long Visa Delays Despite Nursing Shortage

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This is the first of two articles resulting from the 2010 New America Media Fellowship, supported by The Atlantic Philanthropies.
Hannah Baslio had a difficult time when she first came to the United States four years ago and took a job as a nurses’ aide in a large New Jersey nursing home.
After a year of back-breaking work with too many patients and frequent double shifts, Baslio—one of the thousands of Filipina nurses or aides providing care to U.S. seniors--eventually moved to Maple Hill, a small group home in Maryland. There, she not only earns enough to help her family back home, but she grew to care for the seniors “in memory of my grandma, it’s like taking care of my family.”

“You have to have the right kind of heart and a lot of patience for this job. It’s not easy but if you love your job it’s easier,” Baslio said.

For decades the United States has turned to Filipina nurses, such as Baslio, and those from other countries, especially China, the Caribbean and India, to fill its growing shortage of nurses and nurses’ aides. American long-term care companies actively recruit nurses from the Philippines because of its U.S. style health care education programs.

Yet, despite the American nursing shortage, so many Filipino health care workers—even those with promised jobs—are caught in an effective freeze on U.S. work visas -- there is a seven year waiting period for admittance to the U.S.

According to Philippine Embassy Labor Attaché Luzviminda Padilla, “There is still a shortage of health care professionals, but whether or not these shortages will be filled by Filipinos, we cannot tell because currently we are experiencing difficulty in obtaining releases of visas for Filipino nurses and other caregivers.”

Aging Boomers Will Need Care

The U.S. nursing shortage is only expected to worsen as the huge boomer generation ages. The 78 million boomers start going on Medicare in 2011, as the first of them turn 65. And modern gains in longevity have given many of them very elderly parents. The U.S. Bureau of Labor Statistics projects that the country will need more than one million new and replacement nurses by 2016.
A 2004 report by the Immigration Policy Center titled “National Health Worker Shortage and the Potential of Immigration Policy,” found that 1.1 million immigrants account for 13 percent of heath care providers in the United States.

Philippine Health Education U.S. Style
History has it that foreign-born and foreign-educated health professionals have played an important role in providing care to the United States. In the mid-1940s, the U.S. sponsored nurse training in the Philippines comparable to the work culture and training in America, which includes the study of the English language.

“Education is big business in the Philippines. To meet the demand for nurses in other countries, many nursing schools were established,” said Aurora Soriano-Cudal, age 77, who was a health educator and senior health education adviser of the Philippines Bureau of Disease Control before moving to San Diego in 1994.

Cudal, who was also department chair of social and preventive medicine at the Manila Central University College of Medicine, added, “The nursing curricula are designed to meet the needs of nurse importing-countries, especially the United States; much to the disadvantage of the healthcare system in the Philippines. Nursing graduates are often perceived as nurses who can work better in the U.S.A. than in their own countries.”

A columnist for San Diego’s Filipino Press for 15 years, Cudal went on, “The whole educational system in the Philippines was established by early American educators or by Filipinos trained in the United States. Most of the deans of the colleges of nursing obtained post-graduate degrees in top nursing schools in the United States.”

Cudal, whose seven children are health care professionals in the U.S. and the Philippines, added, “My mother was one of the first nurses in the Philippines graduated from a mission school of nursing established by American missionaries with nursing degrees.”

--Maricar C. P. Hampton

The study stressed, “Foreign-born professionals play a crucial role in filling severe shortages within the two largest health care occupations: physicians and nurses.” The center reported that in the U.S., 25.2 percent of all physicians; 17 percent of nursing, psychiatric and home health aides; and 11.5 percent of registered nurses come from other countries.

“In long-term care, in many nursing homes, particularly in the West Coast, the vast majority of the director of nursing and the licensed practical nurses, who are working on the frontline as supervisors are from the Philippines,” said Robyn I. Stone, executive director of the Institute for the Future of Aging Services at the American Association of Homes and Services for Aging in Washington, D.C.

Stone continued, “Filipino nurses have been a very important part of the management structure and frontline-supervisor structure in many nursing homes, as well as other settings.”

Stone, a former head of the U.S. Administration on Aging in the Clinton administration, said she is especially concerned about the alarming lack of nurses: “It’s just going to get worse, partly because it is really difficult to attract nurses into the long-term care.” In a recent speech on health care, President Barack Obama called for more nurses to care for the aging population. But not many nurses are educated in geriatric care.

Overall, the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) officials states that “to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90 percent more nurses from U.S. nursing programs.”

Nurses' Union Opposes More Immigration

To solve this problem the American Nurses Association (ANA) and other groups are pushing for an increase in health care training in the United States. But because this long-range plan will not remedy the crisis at hand, some nursing home facilities and hospitals have been recruiting nurses from other countries to bridge the gap. This idea, however, is unpopular with some groups.

Cheryl Peterson, who directs nursing practice and policy at ANA, noted, “We certainly understand, that we don’t have sufficient supply of registered nurses who have specific education around geriatrics beyond what is included in our basic nursing education.”

However, she said, ANA opposes increasing the immigration of foreign-educated nurses as the solution, calling it a “band aid approach” to the problem.

Peterson went on, “If we allow for a large number of foreign-educated nurses to come to the U.S., and we make it easier for hospitals to get the providers that they need, they are not likely to address the issue of why we can’t have a sufficient supply in the U.S.

Before increasing immigration, she said, U.S. health care providers should take steps to attract “the 500,000 plus licensed nurses that we know we have, who are not working in nursing,” by improving the work environment and the wages.

ANA further justifies its resistance to nurse immigration claiming it doesn’t want to aggravate the global nursing shortage by recruiting nurses from other countries. Peterson asserted that U.S. health care providers “are not solely recruiting the new-graduate nurses, but we are actually recruiting the experienced nurses from the Filipino hospitals.” She said that this could be exacerbating the Philippines’ own shortage of nurses.

U.S. politics also plays a role in the long backlog of approvals for U.S. work visas. Peterson explained, “There is just a lot of anxiety around broadening immigration,” Peterson said. Some members of Congress have resisted efforts to move forward on nursing immigration “because they really want to force a broader debate about immigration reform.” They see the needs for more nurses here and want “to use that as a leverage to kind of force a bigger conversation,” Peterson said.

Representatives of the Philippines Nurses Association of America did not respond to several interview requests for this article, and the group includes no discussion of this issue on their website.
Seven-Year Visa Backlog

However, Virginia immigration lawyer Arnedo Valera declared, “There are just no visas available.” He continued, “The problem is, it’s really frozen. Maybe we can say it’s subject to quota, but in reality nurses cannot come to the U.S., because the immigrant visas are frozen.”

Valera said that the State Department’s backlog is processing the appropriate visas for health care workers from the Philippines and other countries in only up to February 2003 for people arriving this month. “So we are talking of a seven-year backlog, and that still doesn’t move,” he said.

According to the U.S. State Department website, The Immigration and Naturalization Act provides a yearly minimum of 140,000 employment-based immigrant visas, which are divided into five preference categories.

One category is the Employment Third Preference, or EB-3 visas, which includes healthcare workers. The State Department defines this group as follows: “Skilled Workers, Professionals Holding Baccalaureate Degrees and Other Workers receive 28.6 percent of the yearly worldwide limit, plus any unused Employment First and Second Preference visas.”

Stone of the American Association of Homes and Services for Aging, observed that nursing needs are greater in long-term care than in hospitals, which usually pay more and are more desirable clinical working environments.

“The long-term care sector is already struggling, and we are going to see that more as we have more and more elders, particularly those 85 and over who are going to require a lot of services in nursing homes and community-based settings,” she said.

She said a large proportion of frontline caregivers and supervisors are from other countries. “They are an important part of our sector, so you know I think immigration policy is really going to bump up against that.” Stone added, “I know that the Filipino nurse in long-term care has been a major source of labor.”





Posted Jul 10 2010

I am finding that it is very diffficult to understand the Phillipino nurses. They speak English but the nuances they certainly do not understand. I believe that they do not take time to understand our senior population and when asked a question about a patient's care the philliino nurses are very defensive and do not seem to understand orders written by the doctors.nby


Posted Sep 9 2010

Stop looking at other countries, us American nurses need jobs too!!


Posted Sep 13 2010

I hope the US isn't still importing nurses..I am a new grad RN US citizen and I have applied to every hospital and nursing home in my area and I still don't have a job yet.. and I'm not alone over 80% of my graduating class does not either.


Posted Sep 27 2010

Nursing new grads born and raised in the US, who have payed taxes, and who have taken thousands in student loans, and who will spend every dollar in the US to stimulate this economy can not find jobs now. They can not feed their children or pay their rent because no one will hire new grads. Why are we flooding the market with foreign nurses who will just send their earnings back home to their families? What about US families depending on nurse new grads to get a job?


Posted Oct 13 2010

Why are there so many foreign nurses entering the American medical job markets?
We have priced ourselves out of a job. Like many other job markets in the states, we have the highest standard of living in the world. In order to maintain that standard, the income must keep in step with that standard of living. Todays standard is to fire the american worker and then later hire back at a lower salary. More bonus for the in in chagre. In other words, 'American Capitalism.'


Posted Oct 13 2010

Why are there so many foreign nurses entering the American medical job markets?
We have priced ourselves out of a job. Like many other job markets in the states, we have the highest standard of living in the world. In order to maintain that standard, the income must keep in step with that standard of living. Todays standard is to fire the american worker and then later hire back at a lower salary. More bonus for the in in chagre. In other words, 'American Capitalism.'


Posted Oct 16 2010

i guess if local nurses will do their job, US dont need to hire foreign nurses...they just dont dotheir job right...


Posted Oct 26 2010

I have been a nurse for 15 years. The field is oversaturated, we do not need these nurses from the phillipines or anywhere else. Filipino nurses feel they are just as good if not better than American trained nurses because they get Bachelors degrees in the Phillipines, nothing could be further from the truth. The education in the Phillipines is inferior to US colleges and universities. Filipino nurses do not become nurses because they want to help others or better themselves...they do it for the money pure and simple. You don't see Filipinos pursing other fields, reaching out to become doctors or lawyers...because nursing is what easily gets them to the US to work for nothing and make it horrible for US nurses. They have nursing school factories in the Phillipines cranking out more nurses without any thought of quality. Hospital staffs with predominately filipino nurses act like the mafia and discriminate against american nurses. I also don't like that you filipino nurses are completely unapolagetic about taking jobs for less money and poor working conditions. I'm sorry your country is poor, but stop ruining the US nursing market. Be virtuous and hardworking and get a good education and make your way in the world through hard work...not by selfishly going to a nursing school factory and destroying the market over here. I am a nurse manager at a hospital and I do not hire FIlipino nurses unless I cannot find an American nurse to fill the job. If you nurses came here, spoke english, and worked with your fellow American nurses to improve pay and conditions for all nurses in the US, I would have no issue with bringing in fiipino nurses. But you nurses don't care about American nurses, rudely speaking Tagalog instead of English, taking their jobs, lowering pay, and doing illegal things to keep your jobs. You are selfish and only look out for yourself and other Filipinos...but we are the ones accused of being racist!


Posted Oct 29 2010

I am an American born "white" RN, and I find most Philippine RNs are hardworking, relentless about provinding great patient care. I can almost always count on the Filipina nurses to help me on days when I have a demanding patient load, whereas I get help from American born nurses sometimes or sometimes no help. The Filipina nurses may seen cliqueish to those of you are racist against them, but they usuallly work much harder than American born nurses who like most Americans have a sense of entitlement, are selfish, lazy and look down on other cultures. If I were a nurse manager I would hire Philippine RNs because they don't quit as often as other nurses and I could count on them.


Posted Oct 31 2010

I am a US-born, US-raised RN, maybe of Filipino ancestry, maybe not. My race is not the issue.

Culture IS the issue.

Cliquishness is such an understatement for the experience of working with nurses, the majority of whom are from the Philippines. Racist, dishonest, sexist, homophobic and clannish are more genuine, honest words for what it is to either work or receive care from nurses from the Philippines.

Some how family and religion justify taking care of employment within their own group, using things as extreme as falsifying legal documents, letting patients literally die if it could later be blamed upon any nurse or doctor who dares to challenge unethical or illegal behavior. Even if one tries to focus only on one's own work and patients, one is not safe from discrimination by nurses from the Philippines.

The shocking thing is that hospitals' management is just as afraid of challenging this growing majority clan. Much of this can be blamed upon the California Nurse's Association's apathy towards this growing racism.

No one, myself included, wants to label ANY entire group of people, and especially based upon race, but when it is done in Tagalog (or not), it is somehow no longer racist, sexist, homophobic or even dishonest.

It is simply "misunderstanding", that genetically Filipino love their grandparents more than anyone else on the planet loves their grandparents, and that they are trying to help the US or other countries out, not picking a job that makes money to be sent back to the Philippines, rather than address a more serious problem in the islands, which is a deadly lack of nurses.

Literally THOUSANDS of recent US nursing graduates are failing to get hired or find jobs. Those who do get jobs encounter hostility, dishonesty and discrimination that literally drive them out of the nursing profession, fearful to ever return if simply out of fear of their NOT being Filipino being a way that puts patients' lives at risk since safe nursing care requires teamwork and open, honest communication, something that does not frequently exist behind the soft, disingenuous tones of voice and fake pasted-on smiles of care and concern.

Speaking from first-hand knowledge, the second most severe discrimination in this is Tagalog-speaking Filipinos contempt for Visayans and other groups from the Philippines. As patients, Spanish-speaking and black patients get the worst care of any from Filipina nurses, unlike the majority of other nurses who make an effort to undo health care iniquity.

I hope this begins an even greater discussion about the threats to safe health care in the US, that cannot be solved by hiring people whose goal is to make money to send somewhere else, rather than take care of the lack of health care access in their own home communities.


Posted Nov 3 2010

I am a filipino nurse based in midwest and I could say that I have wholeheartedly embraced the American culture without abandoning my own roots. I have recently obtained my US citizenship and I genuinely care and love USA as my home. When I first came here I also started in a nursing home and experienced resistance from American nurses but I worked hard and ever mindful of my place as a minority. I did not speak my language in front of my colleagues even if I have a fellow filipino nurse working with me and we spoke about this and agreed not to speak tagalog infront of American workers. I've been an ICU nurse now for more than 7 years and still love it.I am also angry with how the Phil system works as far as producing hundreds of nursing grads yearly, because more than half of these schools have substandard qualities. I also understand the backlash on nurse migration because of the economic situation in the USA but please , to most of the people here who have commented, don't generalize. There are good as well as bad and unprofessional filipino nurses, just like any other race. I think filipino nursing grads have realized now the challenging process of getting a US visa and this reflects the declining filipino applicant for CGFNS exam and NCLEX . The 1st exam is given by the Commission on Graduates of Foreign Nursing Schools to any foreign grad wishing to work in the US( it's a nursing knowledge/competency exams and English competency- including listening test), and then only upon passing this, one can take the NCLEX. But the process does not stop there, because to be granted a resident status, foreign nurses have to undergo the VISA Screen process where the applicant has to take the TOEFL English exam, including TSE and TWE. It was never an easy road but I have no regrets. I hope the US gov't , ANA and the hospital owners will be able to come up with a comprehensive solution to this problem.


Posted Nov 25 2010

as i read all the comments here, i can say americans are really racists.


Posted Jul 20 2011



Posted May 6 2012

The shortage is a myth .


Posted May 8 2012

I have problems with the United States recruiting filipino nurses.
As an American nurse I find them to be arrogant and thinking that they are better nurses than American nurses.
Their culture and manners can be abrupt with patient's.
Yes, they are hard workers but lack the compasion that I see in American nurses.
In the 1970's and 1980's I worked in a hospital with nothing but filipino nurses.
I tried to befriend them but they were cold and indifferent to me as a new graduate nurse.
I feel that America needs to up grade their nursing schools so we won't have to import these foreign nurses.
Sometimes I feel they don't understand that they are quests in our country and don't have be so arrogant.
The American hospitals love them because they are willing to work like slaves and work up to triple shifts.
They are not union based and hurt us American nurses who are trying to not let the patient ratio keep on going up.


Posted May 17 2012

Yes, It's true. Filipina nurses are clanish, disrespectful, hard headed, jelous, pretentious, racist, but above all not professional in their chosen capacity


Posted Jun 28 2012

Is this the reason why my professor giving me a B letter grade even I score higher than my white classmate and he got A? Because I am a Filipina? ( I am in a nursing school here in the U.S) racist! compare us to animals seeking for a greener pasture...what is wrong with that ...the only difference is American was born here in the U.S....and I was born in the PI. Personally I have attitudes in response how you treat me.... it's my surviving instinct. The fact is we Filipinos adapt and evolve. Lucky y'all racist because someone in your ancestor recognized us Filipinos because if you were the ancestor and because of your state of mind America will not flourished because your mind is closed... :) besides we pay taxes too to feed your fellowmen who aren't working and just waiting for a child support and food stamp...I know my English needs improvement wait till I learn I can speak 2 languages in my case 3 how about you racist?


Posted Jun 29 2012

I've worked with filipino nurses for years, but just recently I've realized how self-centered, whiny and entitled most of them really are. I live in California where they recently tightened up the enforcement of rules for required education to take the NCLEX-RN. You should read the stuff they write on nursing message boards about how it's so unfair and racist to hire US citizens and graduates from US nursing programs before people who have never set foot here or are marrying an American just to get their foot in the door. It's disgusting. Not only that, they are all flocking to become LVNs which they think is beneath them, but are trying to wedge their way into the door sideways by clogging up the already tight job market for LVNs, too. They pay no attention to the fact that many readers don't understand their kabayan language but I guess they just figure anyone who really matters speaks Tagalog. I'm really sick of it. We don't owe you a damn thing, even if you do threaten to sue the United States (lol lol) - sorry but times have changed. The thousands of new US grads are having a hard time, too. What do you know.


Posted Jun 29 2012

To anonymous above me - your response is typical. The ONLY difference that MATTERS is where you were born. I'm really sorry you had the bad luck to be born in a crappy country where it takes two days to save up enough money to buy McDonalds but it really isn't our fault. Take your vast amounts of tax money and go work in Dubai or Saudi Arabia or stay in your own country and try to improve things there.


Posted Jul 5 2012

Stay in your own country and improve it!


Posted Jul 9 2012

I'm finding it hard to stomach all the comments here...if this is so, why do american hospitals prefer hiring filipinos since the 80's?

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