If you go to the Middle East, there are a lot of Filipino nurses working there. The same goes for countries such as the UK, Canada and the US. Yes, there are a lot of Filipino nurses working outside the Philippines.
There are two general and reciprocal reasons: there is a shortage of nurses and a consequent high demand for nurses in Western countries; while in the Philippines, there is an oversupply of nurses who studied nursing specifically because they want to work in Western countries.
The Philippines is a poor country that has been colonized for nearly 400 years first by Spain, then by the United States, and briefly occupied by Japan during World War 2. This experience of colonization created conditions that caused the oversupply of nurses in the Philippines.
- Cultural traits forged during colonization shaped Filipino nurses. Filipinos are very family-oriented. Pre-colonial society in the Philippines was based on family and extended family groups. During colonization, the family was the only social support Filipinos had because they were exploited by the colonial government system. Filipinos were required to plant crops such as cotton, sugar, and tobacco, products that Spain needed. This led to the enrichment of encomienderos (Spanish nationals who were given vast tracts of land) and the merchant classes of mixed parentage (mestizos) who profited from the Galleon Trade. The greater part of the Indios experienced poverty. Because Filipino society was largely poor, and because the family was our sole source of social support, we cared for the elderly members of our families in intergenerational homes and family structures. It is this caring and nurturing trait and training in the home that made Filipinos suited to the nursing profession. Until these modern times, this trait in Filipino nurses makes them attractive to foreign recruiters.
- Nursing education is a family investment. A whole family or sometimes, a whole clan would support the nursing education of its family members. Nurses working in the Philippines do not earn very much despite the fortune they spent on their nursing education. Most nursing students enter nursing programs in the hope of workIng abroad after gaining two years’ working experience in the Philippines as nurses. This is to ensure they get a good return on the investment their families made in their nursing education.
- Labor export policy of the government. Since the 1970s, the Philippine government has encouraged the migration of Filipino skilled, semi-skilled and unskilled laborers, as well as professionals. The dollars earned by Filipino laborers from working abroad helped prop up the Philippine economy. Estimates peg the remittances of Filipino overseas workers to comprise 10% of our gross national product. Nursing is one job that allows Filipino nurses to travel and work abroad, and maybe migrate, become naturalized citizens of Western countries and still continue to send remittances back to their family in the Philippines.
- Nursing is viewed as a respectable profession. In the Philippines, because our country is poor, education is a privilege and not a right, and that is why professionals are highly esteemed. Doctors, nurses, dentists, lawyers, accountants, engineers – – all types of work that require a four-year college education, passing a board examination, and obtaining a license have much social prestige. Filipinos are quite determined to study hard to become licensed professionals and by being a professional, to gain societal prestige and the social mobility that accompanies it.
- Nursing is often a step toward a medical degree. Most students in the Philippines who cannot afford medical or dental school will take nursing or physical therapy or other allied medical professional training instead. Some use a nursing degree to work and earn money so that they can go on and finance their medical education.
- Greater ease of immigration for nurses. I have heard of Filipinos who obtained medical degrees in the Philippines but could not make enough money so they went abroad and qualified as nurses first. They seem to find qualifying as nurses easier than qualifying as doctors. They would then save the money they earned as nurses to finance their training to be doctors. In that way, they would obtain medical training in the country where they already work as nurses.
- Training of Filipino nurses as US colonial policy. Historically, the US colonial government in the Philippines implemented universal basic education so that they could have a workforce that spoke English. The Americans also implemented the state college system so that there will be a professional workforce that not only spoke English but were trained under US professional standards. Although religious orders of nuns in the Philippines offered training for practical nursing, only the American colonial government offered professional nursing education to Filipinos. This was not altogether an act of altruism or benevolence by the Americans, however.
- Filipino nurses as reserve nursing complement in wars entered by the US. Because of American involvement in the two World Wars (1914–1918 and 1941–1945), there was a shortage of American nurses. The US healthcare system could not cope with the regular demand for nursing and healthcare of the Baby Boom era and still provide medical and nursing care to the casualties of the two wars that came within two decades of each other. Note also that after World War 1 there was an outbreak of the Spanish Influenza worldwide and World War 2 had a huge casualty count. Thus, the US colonial government in the Philippines began sending nurses for further training in the US to have a pool of US-educated, English-speaking, and American-trained and licensed Filipino nurses.
- Casualties of US military interventions increased demand for Filipino nurses. And then, after the Second World War, the US shed its isolationist policies and became involved in police actions in Korea (1950–1953) and Vietnam (1965–1975). Two decades later, the US sent troops to Kuwait (1991) Iraq (2001), and Afghanistan. The number of war casualties and veterans needing nursing care has increased.
- Personal reasons for nurse migration. Studies of Filipinos working overseas show that female Filipinos prefer to work abroad to escape bad marriages in the Philippines where there is no divorce. Please note that the absence of divorce in the Philippines is a vestige of Spanish Catholicism and colonization. Some nurses who have violent or wayward and unfaithful husbands take their children along or leave their children with their blood relatives while processing petitions to bring their children with them to their adoptive countries. For some nurses, working abroad is the ticket out of a violent or abusive relationship. Some nurses work abroad to escape strict parents or families with too high expectations of them or demands for them to support the family financially. Some nurses working outside the Philippines are their families’ sole source of support and income; their families rely on them for all financial needs and even treat them as cash cows or ATM machines. This creates pressure and stress on nurses such that working abroad is their only respite.
On the other hand, rich Western countries and countries in the Middle East experience an acute shortage of nurses in part because their societies are highly industrialized:
- Graying of the population. There is a greater need for nurses in developed countries that are now experiencing a “graying” of their population. In Western countries, people aged 60 and above are slowly outnumbering younger people. The elderly require nursing care and because of industrialization, it did not make much economic sense for young family members to care for their elderly relatives at home when they could get a job and pay for a professional private nurse to care for their old relatives. Well-to-do families where the mother works also hire professional nurse/nannies to care for their children while they work. A lot of nurses who do not qualify as nurses in Western countries work as caregivers for the elderly or nannies for young children instead.
- Caring for the oldest of the old. Also, because of medical advances, many more Westerners are living to their 80s and 90s and require nursing care. The segment of the population belonging to the “oldest of the old (80s-90s and beyond) is steadily increasing. Because of these factors, there is an increased demand for nurses but the number of nurses produced by Western countries cannot satisfy the increasing demand for nurses and nursing services. Thus, a lot of hospitals in the West must recruit nurses from Asia. The Philippines, on the other hand, has an over-supply of nurses.
- Prohibitive cost of nursing education in the US. A lot of young people cannot afford nursing education in Western countries as it is quite expensive. American university students often accumulate a lot of student debts. Thus, studying to be a nurse will drive them deeper into debt and poverty. Being a nurse is often just not worth the financial risk.
- Nursing as a physically demanding and emotionally draining job. Nursing is probably not a very attractive career for people in advanced economies because it is, at entry-level, a very physically-demanding job. People in countries like the Kingdom of Saudi Arabia, Canada, the UK and the US do not wish to work at jobs that are physically demanding such as nursing. Besides, nursing requires people to work with the sick or the injured and the emotionally disturbed. This increases the risk of mental and emotional health issues such as depression or anxiety, burnout or compassion fatigue. Some young people find the sight of blood unnerving. Working as a nurse exposes them to these emotional, psychological and mental hazards at work.
- Nursing as highly competitive careers. A nursing student must do internships, pass licensure examinations, and get periodic training and retraining in the use of technology and processes that have been recently developed. Nursing is also academically demanding. A lot of younger Westerners are turned off by all the studying that nurses have to do just to get their license. On the other hand, Filipinos are trained from childhood to respect the value of education. Filipinos are raised with the idea that education is the golden ticket out of poverty. Most parents are willing to work hard and spend their money to have their children become nurses because they fully expect their children to land nursing jobs abroad and increase the family wealth and prestige.
- High risk of malpractice litigation. Western countries are litigious societies. Medical malpractice cases are inevitable and so medical and healthcare professionals need to spend on malpractice insurance. This is another reason why there are few young people who opt for nursing careers in Western countries. It is too financially risky to practice as a nurse when you could be sued for malpractice and lose your license and your source of livelihood.
- Requirement for specialization and re-qualification. In order to rise in the nursing profession, there is a requirement for specialization. This means more studying, more training, and more expenses for further nursing education. To be promoted to an administrative nursing position, nurses must study and train, and get different licenses. They must undertake studies and write papers if they want to get promoted. This makes nursing an unpopular career choice for Westerners who want to rise in their profession without costing them too much time and too much effort.
- Risk of bullying in the nursing profession. There is also a growing incidence of bullying experienced by nurses in Western countries. Some nurses become a target of hostility or violence perpetrated by patients or patients’ relatives. Nurses are frontliners; they deal directly with patients and their families on a daily basis. Whatever frustration the patients or families feel may easily be taken out on nurses. Thus, people in Western countries are not keen on working as nurses. Those nurses who are already employed do not stay long in the profession.
- Resulting understaffing, longer shifts, and low retention of nurses in wards. These factors (numbers 2–8) cause a shortage of qualified nurses, a low retention rate for nurses, which then cause severe understaffing in hospitals in Western countries. This understaffing often means longer shifts and more overtime work for nurses already employed. These conditions put nurses at risk of mental illness, injury, and burnout or compassion fatigue. Thus, nursing is not a popular career choice for Western teenagers. It is considered by some a very risky type of job as nurses are exposed to all manner of stresses. On the other hand, Filipino nurses are willing to face these risks in exchange for salaries that are higher than what they would earn working in the Philippines.
So, how does the hiring of Filipino nurses solve the shortage of nurses in the US and other English-speaking countries?
- Filipino colonial experience shaped Filipino nurses’ temperaments. Because of their long history of colonization and because they live in an archipelago that endures devastating typhoons, Filipinos have developed resilience and emotional self-regulation necessary to thrive in less than friendly working conditions for extended periods. Some would say that the nearly 400 years of Spanish and American colonization of the Philippines have shaped a population inured to suffering that has made them suited to provide empathetic nursing care. They are used to hard work.
- English as a second language in the Philippines. Filipino nurses do not have as much difficulty with the English language (compared with other Asians) as it is one of the official languages in the Philippines as well as the medium of instruction in schools, thanks, in part, to American colonialization. Naturally, when there are nursing staff shortages in English-speaking countries, they would hire Filipino nurses who were already speakers of English because it would not cost as much to train Filipino nursing recruits in using English as a second language.
Filipino nurses crucial in healthcare systems. These are some reasons why you see a lot of Filipino nurses working in the US, and also in countries such as Canada, the UK and the Middle East.
Prevalence of Filipino nurses. Once, there was a news report of Filipino nursing staff getting caught in armed conflict in Libya. The Philippine president threatened to recall all the Filipino nursing and other medical and healthcare professionals working in Libya if the government of Libya could not ensure their safety. The medical and healthcare system of Libya would have failed if all the Filipino nursing staff would repatriate.
Yes, there are a lot of Filipino nurses working abroad. Even countries such as Japan and Germany have begun recruiting Filipino nurses because of the graying of their population, because of the understaffing at their hospitals, and because there are always Filipino nurses who would be willing to work abroad, learn new languages and adapt to different cultures.
For a quick overview on why there are so many Filipino nurses in the US, you can watch this video from Vox Why the US has so many Filipino nurses
Pandemic frontline work. In light of the Covid-19 pandemic (2020–2023), nurses have become frontliners in this struggle. Filipino nurses are fighting. They are caring for their patients to the best of their ability and with what materials and resources are available.
There are two sides to this: the side of the patients in rich countries where Filipino nurses work and the side of the Filipino nation those nurses had left behind.
Discrimination experienced by Filipino nurses. Filipino nurses are working abroad caring for patients in their adoptive countries where they often suffer racism and wage discrimination. Yet, they still serve. They are unable to care for patients in their own country. They are unable to see or be with their families at home and they are certainly away from their families back in the Philippines.
There have been reported instances in the US, for example, where Asian people walking on the street were beaten up solely because they were thought to be Chinese and thus, responsible for the Covid virus spread. A few of those Asians were Filipinos and not Chinese but they got blamed for the pandemic, anyway, even if they had nothing to do with it. They were mistreated only because of the color of their skin which was unfair. It is also ironic that Filipinos who are nationals of the Asian country that is helping the US fight Covid by providing nurses have become a target for bullying.
Human cost of exporting nurses from the Philippines. The Philippine medical community is overwhelmed in this pandemic. Numerous nurses and doctors have died in the fight. It is ironic that the nation known for exporting nurses abroad is now in dire need of them. At the height of the pandemic even student nurses served in hospitals.
If you are hospitalized and cared for by a Filipino nurse or doctor, please bear in mind that they are caring for you instead of caring for their own family and countrymen. They may likely get sick or die while caring for sick people thousands of miles away from their homes and family. If they die, they will very likely not see their families. They will not even return home in a pine box for their families to give them a proper burial. They may come home in an urn.
Please be kind to Filipino nurses in your community. Tell them the truth about your travel history and exposure, symptoms and underlying conditions when you see them. Your life and theirs may depend on your honesty.
Do not hoard essential supplies such as alcohol, gloves, personal protective equipment, N95 masks.
Most importantly, do not add to the number of the sick they have to care for. They are getting tired, too. Stay at home if you can. Wear masks. Maintain social distance. Get vaccinated. Help them fight. Help them survive the fight. Help them see their families again.