Ofelia Solem is the president of the New England Chapter of the Philippine Nurses Association of America and works for a major hospital in Boston. But not so long ago, she was a frantic caretaker – working per diem in a nursing home, while also working at a long-term acute care hospital in Roxbury. To make more money to send home to the Philippines, she faced long hours, a heavy workload and emotional exhaustion. As a recent immigrant from the Philippines, her family was depending on her. The nursing home job gave her extra cash that her family needed, but it was not an easy one, and it gave her a window into the struggles that many immigrants in those jobs face.
“One time I had to give medication to 40 patients in the morning, and then by the time you’re done at 10 or 11 o’clock, you have to go give medication at noon for another 40 patients,” Solem said. “So, sometimes you’re not giving the care, the attention, to the patient, because you are running around, trying to catch up [with] the time. The time is not enough.”
Filipino registered nurses make up 4% of all U.S. nurses, according to National Nurses United, a percentage similar to the U.S. Department of Health & Human Services’ finding that around 3% of nurses – or 123,165 – in the U.S. speak Filipino in addition to English. Around 10% to 15% of nurses in the U.S. were born outside the country.
But high-skilled nursing jobs – such as those in hospitals – tend not to be given to nurses with education or experience from outside the country, according to Solem, as many immigrant workers end up employed in those nursing homes and home-care jobs that American-trained nurses aren’t willing to take.
“There is a shortage of American nurses who would take those horrible working conditions and will suck it up,” agreed Kaye Mendoza, another Filipino nurse in the Boston area. “There’s an abundance of foreign grads who have no idea of their labor rights and their nurse rights, and they would come here.”
Solem said she’s even seen some doctors that graduated in the Philippines that ended up being a nurse here, because they don’t meet the criteria to work as a surgeon.
The hard road to working in skilled jobs in hospitals can be a loss for not only these new immigrant healthcare workers, however, but all medical facilities, suggested Sonia Casiano, a longtime registered nurse and health care consultant, who was previously an associate director of critical care at Lenox Hill Hospital in New York.
“I had recruited nurses from the Philippines for Lenox Hill Hospital and am proud to say that out of some 30 nurses I successfully recruited in the early 1980s, almost all of them were retained till many years later,” said Casiano in an email to the Sampan. “Filipino nurses are boon to hospitals not only in the U.S. but in many other countries.”
While the national supply of nurses is rebounding to levels seen prior to the pandemic, staffing in nursing homes is still struggling, according to experts, likely because of lower pay and the tougher working conditions.
A recent analysis led by the Massachusetts Health Policy Commission’s Research and Cost Trends director, Dr. David Auerbach, finds that staffing levels among registered nurses over all is recovering from the pandemic, when the nation lost a total of 100,000 registered nurses – the biggest drop in four decades.
Auerbach said that while he disagrees with projections released in March from the National Center for Health Workforce Analysis that predicts continued problems in the supply of registered nurses, he said nursing homes remain an outlier in the industry, failing to recover from pandemic losses.
“That sector has kind of been devastated and hasn’t come back at all,” Auerbach told the Sampan in an interview, noting that nursing homes tend to pay lower than other health care facilities, and rely more heavily on lower-skilled workers, such as licensed practical nurses.
As Mendoza and Ofelia point out, however, landing in a nursing home or home care job is often an easier a point of entry for nurses trained in the Philippines. And it’s not what many necessarily signed up for. Solem said the ratio of patients to nurses makes nursing home jobs in particular especially tough. Plus, the work requires empathy for an aging stranger.
“We are respectful, we do care for them even though they are not our parents,” said Solem.
Solem took care of her own mother who lived with her in the U.S. for several years, before she became sick and moved back to the Philippines. She said her love of family and its role in Filipino culture is what drew her to work in the United States.
“I came to the United States to help out my family,” Solem said. “In the Philippines, we are just trying day-by-day to get food on the table, and this way I am able to provide help. I sent money every month when I came here to Massachusetts.”
Solem does her best to visit her family in the Philippines every year, and her children do the same. She now works as an infection prevention at Brigham Women’s Hospital, after working as a case manager at Lemuel Shattuck Hospital.
When she first came to the U.S. in the early 1980s, she said the most needs were in long-term care, like nursing homes, and were in unsafe areas.
“When you’re trying to find opportunities, you’re not asking for gold and silver, you take whatever they hand you,” Solem said.
Kaye Mendoza has been a travel nurse for 16 years, filling positions at different hospitals when nurses go on leave. She has also experienced shortages in healthcare workplaces, but of high-skilled workers.
“Based on my experience, when I go to big cities where there is a lot of supply of nursing students, I don’t see much of a shortage when it comes to new nurses,” Mendoza said. “What I see is more on the shortage of experienced nurses.”
Mendoza came to the U.S. in 2006 by what she calls a coincidence.
“I didn’t know that was a job interview that I attended,” Mendoza said. “It was a connection that was done between me and my aunt, who was also having a vacation in the Philippines and met American employers by accident.”
This is a pattern that many overseas workers experience, caused by employers setting up international hiring establishments directly in countries like the Philippines, Ghana and Nigeria. Mendoza said the pattern seems to be going toward a staffing model where a recruiter connects a worker to a random employer who has a need at the time of immigration.
“For me, before coming to the United States, I already knew where I’m going. I know who my employer is, so I can find housing in that location,” Mendoza said. “But with a lot of staffing company nurses right now, they don’t know where they’re going yet, so they’ll just sign contracts, literally not knowing where they’re going to be sent.”
Companies like Health Carousel and others that have hiring establishments abroad have sometimes been accused of unfair working conditions. Travel-nursing firm Health Carousel, which places nurses from the Philippines, recently agreed to pay $6 million in class action lawsuit alleging fraud and violations of labor trafficking laws, according to a report in the Cincinnati Enquirer newspaper. The company denied the accusations, according to the paper.
Mendoza said she believes the industry itself – the hustle and sometimes poor conditions – contribute to the shortage of talent.
Because of the shortage of workers in nursing homes and home health, the jobs are advertised as needing little experience. But according to Mendoza, these are jobs that often include critical care patients.
“I have heard of nurses who have no experience in the Philippines being brought here under home care and they’re taking care of vented patients,” Mendoza said. A vented patient requires a high-skilled caretaker to regularly clean the ventilator, so that it can keep giving oxygen to the patient that can’t breathe on their own.
If Filipino workers want to hire directly to an employer in the U.S., some companies have online hiring services available to them that lets them bypass recruiters. But the issue here is the country’s limitations on hiring.
“In the Philippines there is a law where you cannot do that,” Mendoza said. “You have to go through the Philippine accredited agency before you can hire a Philippine national.”
If direct hire is overused, Mendoza said, the Philippine government won’t be able to track how many nurses are being deployed.
When Mendoza herself moved to the U.S., she was on a three-year contract, which she ended up staying with for six years. She worked as an operating room nurse at Harlem Hospital in New York.
Mendoza also worked in a rehabilitation facility, where she said it was hard to witness poor care of elders.
“It was really hurting me, because I want to give the best to the elderly people,” Mendoza said. “It’s a heartbreaking situation when we saw that a lot of these elderly people are not being taken care of well, not because of the nurses’ problem, but because of the short-staffing.”
The export of nurses is a pattern that has persisted between the U.S. and the Philippines since the U.S. occupation of the islands. The Philippines gained independence from the U.S. in 1946, after 48 years of occupation. The U.S. implemented nursing school programs in the Philippines with the goal of them eventually working as nurses in the U.S. A common phrase, according to Mendoza, is Overseas Filipino Workers (OFWs). These workers leave their family behind to work overseas and send money back home. Mendoza said initially she was sending $800 a month to the Philippines.
“The Philippines is really built to copy what the U.S. is doing for education,” Mendoza said. “It was an agreement that was done that we have to follow the U.S. path of education because we’re supporting the U.S.”
Now that there’s a global shortage of nurses, Mendoza said Filipino nurses are not only for U.S. consumption, they’re going to Saudi Arabia, Ireland, the United Kingdom, the Netherlands and elsewhere.
But Mendoza said the U.S. is unique in that family can be brought over with the worker once they become a citizen.
“That’s the end goal,” Mendoza said. “To bring the entire family with us.”
Adam Smith and Mary Chin contributed to this story.