For more than 60 years, nurses from the Philippines have been immigrating to the U.S. in search of higher-paying jobs, opportunities for professional growth and the hope of a better life for themselves and their children. In the late 1940s and again in the 1960s, two successive generations of Filipino nurses migrated here in large numbers. While many of the nurses in this second wave of migration succeeded in finding the American dream, others encountered obstacles of discrimination, economic hardship and exploitation, with no one they could turn to for help.
But today, Philippine immigrant nurses do have a resource they can turn to: the Philippine Nurses Association of America (PNAA), an organization that provides a strong, unified voice to support and advocate for all Filipino nurses in their quest to provide compassionate nursing care in the United States.
This past July, PNAA celebrated its 30th anniversary at its 2009 national convention, held in Baltimore. In her keynote address, Clarita Miraflor, PhD, RN, CHCQM, the PNAA's first president, recalled the association's beginnings, when local groups of Filipino American nurses representing New Jersey, New York, Michigan, Illinois and California met in New Jersey at the invitation of Phoebe Andes, MA, RN, to form a national organization, then known as the National Federation of Philippine Nurses Associations in the U.S.
Since its inception on April 21, 1979, PNAA has grown to encompass four U.S. regions, 37 local chapters, 13 subchapters and more than 4,600 members. It has become a charter member of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA). The PNAA Foundation, the association's non-profit charitable arm founded in 2002 by Andes, a PNAA past president, provides opportunities for philanthropy to support the professional advancement of Philippine American nurses and the promotion of health through nursing care, education, scholarships, management and research.
The need for an organization like PNAA arose from a variety of problems immigrant nurses from the Philippines were experiencing in the 1970s, Miraflor explains. These included exploitation by recruitment agencies and employers; high failure rates on RN licensing exams due to insufficient test-taking skills; discriminatory hiring practices; unfair staff scheduling that placed Filipino nurses on evening or night shifts; difficulties in adapting to American culture, and inability to communicate effectively with employers and patients.
"The price of silence is high," says Miraflor. "[As Filipino nurses ourselves,] we couldn't turn our heads the other way. We had to direct our destiny."
One particularly troubling incident that directly contributed to the formation of PNAA was the legal case involving two Philippine nurses, Leonora Perez and Filipinas Narciso, who were accused of causing the deaths of 11 patients at the Veterans Administration Hospital in Ann Arbor, Mich., in 1976, says PNAA past president Remedios Solarte, MSN, NP, RN.
Despite the lack of evidence against Narciso and Perez, the backdrop of racial tension in the 1970s due to the increased numbers of Asian immigrants to the U.S. set the stage for the nurses' conviction. Although the verdict was eventually overturned, the nurses suffered adverse affects from the lengthy trial. The case made international news that bonded Filipino nurses and their countrymen.
Since then, PNAA has continually been in the forefront of advocacy efforts to ensure fair treatment for Filipino nurses in the U.S. In 1989, for example, the association rallied around the dilemma of Philippine nurses who faced deportation because they were nearing the expiration of their five-year H-1 visa limit. Under the leadership of its fifth president, the late Filipinas Lowery, MA, RN, CNOR, the PNAA and its chapters engaged in several months of concerted lobbying, in collaboration with other national nursing and hospital organizations. As a result of this campaign, the federal government enacted the Nursing Relief Act of 1989, which provided for the adjustment to permanent resident status for H-1 RNs who entered the U.S. prior to September 1, 1989.
"PNAA had to articulate the vital role of Filipino nurses in alleviating the acute nursing shortage and the [negative] impact their departure would have had on health care [in America]," says Solarte, who is writing the association's history with two other founders, past president Lolita Compas, MA, RN, CEN, and past executive director Ampy de la Paz, MS, RN.
Current PNAA president Leo-Felix Jurado, PhD(c), NE-BC, APRN, credits the association's founders as visionaries who have made PNAA the strong and successful organization it is today. "[Over the years,] 14 presidents have left a legacy that impacts PNAA as it continues to champion the welfare and advancement of Filipino American nurses in the U.S.," he says.
For example, Solarte's theme as sixth PNAA president (1990-1992) was "Visibility, Viability and Vitality." "In a spirit of teamwork, we advanced the organization by making it visible to nurses in the U.S. and the Philippines, by strengthening its viability through increasing membership, and renewing its vitality [by establishing our] first Nurse Excellence Awards program for members," she explains.
Jurado's own presidential theme, "the PRISM of PNAA," is based on his conceptualization of a framework that the national organization, its chapters and subchapters can use to work in unison for the association's advancement. PRISM, he says, is an acronym that stands for:
Meanwhile, president-elect Reynaldo Rivera, DNP, RN, CCRN, NEA-BC, ANP, who takes office in 2010, is already constructing the framework for his presidency, "Engage and Make a Difference." Building on a strong leadership foundation, he envisions three pillars—membership development, community partnerships, and financial and operational strength— that will enable members to become role models and make a difference in the lives of those they serve.
"We are studying what makes nurses engage and have that passion for nursing," Rivera says. "We plan to invite RNs to join [the association] and [we hope to] inspire and motivate them to continue their journey with the PNAA."
As PNAA has grown in size and scope, it has also emerged as an internationally recognized voice. One of the association's most exciting international achievements was its work with the National Council of State Boards of Nursing (NCSBN), along with a coalition of other U.S. and Philippine organizations, to establish the firstever NCLEX® testing center in the Philippines. Following five years of advocacy efforts spanning the three PNAA presidential administrations of Anunciacion (Seny) Lipat, MA, RN (2002-2004), Mila Velasquez, MN, RN, CS, ANP, CCRN (2004-2006) and Rosario-May Mayor, MSN, RN (2006- 2008), and led by the dedicated work of PNAA NCLEX Task Force chair Filipinas Lowery, the NCSBN awarded international NCLEX test site status to Manila in February 2007.
"No longer would nurses from the Philippines, who supply the largest percentage of foreign-educated nurses to the world, have to make a journey from their native country to take the RN licensing exam," says Mayor.
During her presidency, Mayor represented PNAA at three major international conferences: the World Health Organization (WHO) Global Advisory Group on Nursing and Midwifery conference; the Call to Action: Ensuring Global Human Resources for Health conference, sponsored by WHO, the American Hospital Association and the Bill & Melinda Gates Foundation; and the Global Forum on Migration and Development, an annual forum sponsored by Migrants Rights International and other international civil society organizations (CSOs).
"[Our representation] at these conferences was a major breakthrough that [positioned] the PNAA as a player on the international health care stage," says Mayor.
Working conditions for Philippine nurses in the U.S. have come a long way over the last 30 years, thanks in large part to PNAA's efforts on their behalf. "When comparing the early days to now, Filipino nurses are better positioned to advocate for other nurses and speak out for human rights," Mayor believes.
"Advocacy has always been at the core of the PNAA's activities, even from its beginnings as the umbrella organization for PNAA chapters in 1979," adds Mary Joy Garcia-Dia, MA, RN, chair of the association's Human Rights Committee. Initially, PNAA's advocacy work focused on assisting the transition of immigrant Philippine nurses to the U.S., providing safety nets and support through networking, mentorship and education, she explains.
An increase in unscrupulous recruitment practices in the early 1980s triggered an expansion of PNAA's involvement with nurses' rights issues, both at the national and local chapter levels—a mission that has continued into the 21st century. "PNAA has been monitoring these cases based on anecdotal stories and direct referrals," Garcia-Dia says.
During Garcia-Dia's term as PNAA New York Chapter president (2006- 2008), the PNAA Human Rights Committee strengthened alliances with community-based and professional organizations to fight for the cause of nurses' rights. For example, the chapter joined with the New York State Nurses Association (NYSNA) and other organizations to support a group of health care workers from the Philippines—26 nurses and one physical therapist— who were lured to the U.S. under false pretenses by an unethical recruitment agency. On arriving in New York, they were forced to accept deplorable, abusive working conditions that honored none of the terms of the recruitment agreements they had signed. When their complaints were ignored for months, the workers resigned, only to face criminal charges of patient abandonment and endangerment.
The PNAA provided financial, professional and emotional assistance to the workers, dubbed the "Sentosa 27" after the Philippines-based Sentosa Recruitment Agency that brought them to the U.S. The charges against the workers were dropped.
As a result of its involvement in the landmark Sentosa case, the PNAA was asked by the health services research organization Academy Health to participate in the development of a Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States, which was published in 2008. Mayor represented the PNAA as president, and two other PNAA members were also at the table: past president Lolita Compas, who represented the NYSNA as its president at that time, and Virginia Alinsao, MSN, MBA, RN, who represented Baltimore's Johns Hopkins Hospital as director of international nursing recruitment.
The PNAA has also worked to break down barriers to practice for foreigneducated nurses. In 2006, an advocacy campaign by the New Jersey Chapter resulted in the state's elimination of the Commission on Graduates of Foreign Nursing Schools (CGFNS) qualifying exam, which was a requisite to approval for nursing practice in that and other states. The Michigan Chapter successfully followed suit in 2007, and petitions to eliminate the exam have reached the final stages of the approval process in Virginia and Indiana.
"The outdated qualifying exam was a duplication of requirements, because the NCLEX-RN® already tests nurses' knowledge and skills necessary to practice nursing competently," explains Jurado, who proposed the change to existing regulations to the New Jersey Department of Law and Public Safety. "The exam placed unnecessary financial hardships on foreign-educated nurses and discouraged them from practicing in [our] state."
For many Filipino Americans who were once immigrants to the U.S., giving back to their native land is an important cultural value. Last year, PNAA's ongoing efforts to give back to their nursing counterparts in the Philippines were recognized with the Banaag Award, presented to the association by Philippine president Gloria Macapagal- Arroyo. This prestigious presidential award is bestowed on Filipino individuals and organizations whose contributions have significantly benefited or advanced a sector or community in the Philippines.
In addition to honoring the PNAA for its work in helping to establish Manila as a NCLEX testing site, the Banaag Award also acknowledged the association for its achievements in unifying Filipino nurses in the U.S., and for its Balik Turo "teach back" initiative, launched during Mayor's administration in 2008. The Balik Turo encourages Filipino nurses in the U.S. to return to the Philippines to impart their nursing knowledge and proficiencies. The program is designed to improve the exchange of medical and clinical information, enhance the education of nurses in the Philippines and sustain partnerships with collaborating associations.
Through the Balik Turo, Mayor and project co-chair Solarte coordinate volunteer efforts of RNs in the U.S. to share their areas of expertise with nurses in the Philippines. Counterpart coordinators at Philippine health care facilities request U.S. guest speakers on a variety of nursing topics—leadership, practice, administration, NCLEX-RN preparation, Joint Commission standards and more. The Balik Turo project also encourages Filipino American nurses vacationing in the Philippines to consider sharing their nursing knowledge through presentations and roundtable discussions.
Since becoming president in summer 2008, Jurado has expanded the Balik Turo by encouraging PNAA chapters to adopt a school of nursing in the Philippines. In addition to sending members to the school to help educate the Philippine students, he suggests that chapters develop scholarship programs, help develop nursing curricula, and/or create a faculty exchange program with internships, observational opportunities and seminars.
President-elect Rivera says he plans to not only continue the Balik Turo but enhance it by adding cutting-edge programs and research development. He also plans to focus on faculty development, including a faculty mentoring program via email. "Most nursing faculty members in the Philippines are young and can benefit from experienced U.S.-based nurse mentors," Rivera explains.
At the 2009 convention in Baltimore, a time capsule ceremony—the brainchild of convention co-host Vicky Navarro, MSN, RN, vice president of PNAA's Eastern Region Chapter—marked important highlights of the association's past 30 years. Members associated with each event or object placed commemorative symbols in the time capsule: the PNAA incorporation papers, a membership pin, a copy of the bylaws, logos, a financial report, the membership list, the first issue of the soon-to-be-launched PNAA Journal, a press release announcing the approval of Manila as a NCLEX-RN testing site, a scroll with signatures of attendees at the 30th anniversary convention and the Banaag Award.
Three teenaged daughters of PNAA members, dressed in white to represent future nurses, wheeled away the time capsule for safekeeping. Plans are to open the capsule at a future PNAA convention in 2029.
"Where will we be in 20 years?" says Miraflor wistfully. "At the time capsule ceremony, my mind raced through the years of the outstanding legacies and accomplishments of every past president who built up the PNAA to what it is today. It was a poignant moment, difficult to let go. [But for me, it was a moment filled with] thoughts of praise and thanksgiving for the opportunity of being the [first president of PNAA] and being part of an organization that has enriched the lives of Filipino nurses as they [fulfill their mission of providing quality health care to America]."