St.

Paul College of Ilocos Sur

DEPARTMENT OF NURSING

Name: Charina Aubrey Riodil Instructor: Melanio P. Rojas Jr MAN Score: ____________
Section/Year Level: BSN-II Serviteurs Defenseurs De Saint Joseph Date: March. 04, 2020
Agency: Ilocos Sur Provincial Hospital – Gabriela Silang/ Week No. 2_

Organization 25 %
Content 50%
Grammar 10%
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the topic in
Nursing
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Learning to Fill the Labor Niche: Filipino Nursing Graduates and the Risk of the

Migration Trap

Yasmin Y. Ortiga

As policymakers highlight the growing health care demands of the aging

populations of developed nations, foreign nurse recruitment has become the fastest and

most common strategy to fill local manpower needs (Brush and Berger 2002; Rother

and Lavizzo-Mourey 2009). With scholars estimating a shortage in the United States as

severe as 1 million registered nurses by 2020, the United States has emerged among

receiving countries as the most active recruiter (Buchan 2006; Keuhn 2007). This

demand has created an immigrant labor niche within the American health care system:

foreign nurses now fill positions in large urban hospitals as well as in a growing number

of rural hospitals and nursing homes (Brush 2008). To date, the largest group of foreign-

born nurses comes from the Philippines, a country whose colonial ties with the United

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States have facilitated nurse migration for more than a century (Brush 2010;

Choy 2003).

This article challenges such celebratory notions of export-oriented education by

discussing how attempts to educate aspiring migrants to fill overseas labor demands

actually exacerbates the problems of deskilling, youth unemployment, and a growing

mismatch between post secondary education and available jobs within the local labor

market. Drawing on two years of ethnographic research within Philippine nursing

schools, I argue that as Filipino aspiring migrants educate themselves to fill the U.S.

nursing labor niche, they also risk getting caught in two types of traps. The first is

the migration trap (Jimenez-David 2008): aspiring migrants obtain specific credentials in

the hope of working overseas, yet are unable to leave when labor demands or

immigration requirements change. In the context of the most recent U.S. nursing

shortage, a backlog of immigrant visa applications in the mid-2000s severely curtailed

the outflow of Filipino nurses to the United States (Acacio 2011), and the financial crisis

in 2008 reduced migrant nurse hires around the world (International Centre on Nurse

Migration 2012). Lacking public funds, Philippine hospitals could not offer permanent

positions to the staggering number of nursing graduates within the country, leaving

many unemployed and unable to obtain the work experience needed for jobs in

alternative destinations like Japan and Singapore. Filipino nursing graduates caught in

this situation then find themselves in an opportunity trap(Brown 2003): the never-ending

need to collect credentials in order to secure a positional advantage in the job market.

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The struggles of Filipino nursing graduates caught in these two traps show that however

much the continuous need for foreign nurses benefits migrants and the U.S. hospitals in

need of their labor, the impact of such immigrant niches on migrant-sending countries is

far more complicated. Even as researchers predict a global demand for nurse labor,

aspiring migrants grapple with the loss of time and money in an effort to remain

“employable” for jobs they have yet to obtain. Rather than brain drain, I argue, the U.S.

migrant nurse labor niche is more likely to lead to a problem of brain waste as qualified

nursing graduates find themselves in industries and jobs that have little need for their

skills.

THE U.S. NURSING LABOR NICHE

Nurse shortages in the 1980s were attributed to hospital expansions and changes in the

Medicare payment system that increased nurse-to-patient ratios. Foreign nurses played

a significant role in filling this need until the recession of the early 1990s, when hospitals

offered higher salaries to entice more Americans to enter the nursing profession

(Glaessel-Brown 1998; Gordon 2005). The recruitment of foreign nurses increased

again toward the turn of the century as American nurses became disillusioned with the

emergence of managed care—a set of structural changes designed to make hospitals

operate in line with a corporate model of efficiency and financial viability (Aiken  2007).

Already faced with heavier workloads and more administrative duties, American nurses

also encountered higher risks of retrenchment, given the entry of more “unlicensed

assistive personnel,” such as nurse's aides and licensed practical nurses (LPNs), who

took on some of nurses' work (such as changing beds and turning patients). Hospital

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administrators justified this change as a way to decrease the number of nurses needed

on the hospital floor, yet they still expected nurses to take on the extra work of

monitoring nurse's aides (Gordon 2005). When these conditions led to another exodus

of nurses from U.S. hospitals, the most recent wave of recruitment for nurse labor

overseas began. According to researchers, one of the largest inflows of foreign nurses

occurred during this particular period: more than 50,000 migrant nurses entered the

United States from 2000 to 2006 (Acacio 2011).

In seeking to understand the pervasive nursing shortages in the United States, scholars

have pointed to the inability of U.S. nursing programs to train a sufficient pool of

registered nurses for local hospitals. The majority of U.S.-educated nurses possess a

three-year associate degree obtained from a community college, while roughly one-third

hold a four-year baccalaureate degree from a college or university. In recent years,

nursing schools have offered an eighteen-month “accelerated program” for applicants

who already have a bachelor's degree (Ellenbecker 2010). Despite these different

pathways to a nursing credential, U.S. colleges and universities continue to admit only

limited numbers of students owing to the lack of qualified nursing faculty (Aiken,

Cheung, and Olds 2009; Gordon 2005; Rich and Nugent 2010). Nurses who hold an

associate degree are less likely to pursue graduate studies and take on a faculty

position, and more likely to take longer when they do. Thus, recruiting foreign nurses

continues to be the quickest way to address nursing needs (Buchan 2006; Rother and

Lavizzo-Mourey 2009).

Establishing the Labor Niche

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Nurse migrants have moved across U.S. borders in a variety of ways, taking advantage

of education and training opportunities in the United States or, in the case of the

Philippines, previous colonial ties (Brush 2010; Choy 2003; George 2005). What

differentiates post-1965 nurse migration is the emergence of brokers: private agencies

that facilitate the entry of foreign nurses into local hospitals (Acacio 2011; Aiken 2007;

Kingma 2006). Agency representatives take on the work of advertising open positions in

source countries like the Philippines and navigating the bureaucratic process of

preparing foreign nurses' paperwork for emigration (Guevarra 2010; Kingma 2008;

International Council of Nurses 2006).

The next section illustrates how institutions within foreign nurses' countries of origin

have also sought to take advantage of nurse shortages in the United States, eventually

exploiting the nursing labor niche as a lucrative source of profit. Focusing on the

Philippines, I discuss the role of private colleges and universities and its impact on

aspiring migrants and their families.

EDUCATING FOR EXPORT: THE PHILIPPINE MODEL

As one of the largest migrant-sending countries in the world, the Philippines has been

well known for its response to overseas labor demands, with state-run institutions

playing a key role in certifying migrants' exit papers and qualifications, ensuring their

safety, and brokering their labor to potential employers (Goss and Lindquist 1995;

Rodriguez 2008, 2010).1 In the case of nursing, the Philippine state promoted Filipino

nurses as an ideal source of labor to address global nursing shortages, and

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government-regulated agencies marketed Filipino women's inherent ability to do care

work (Guevarra 2010).

Although given less attention in the migration literature, the growth of commercial

industries catering to Filipino nurse migration came with the expansion of nursing

programs within Philippine colleges and universities—all eager to produce the nursing

graduates their U.S. counterparts were unable to provide. Corporations and family-

owned businesses operated the majority of these schools and relied completely on

student tuition for profit. Although Philippine media reports highlighted the dubious

operations of “fly-by-night” nursing schools (Bagaoisan and Ching 2009; Uy 2008), most

private colleges and universities actually complied with standards set by the Philippine

Commission on Higher Education (CHED) and were state-recognized institutions.3

Although the Philippine state brokers Filipino nurse labor to many destination countries,

the United States remains the students' ideal destination—a preference strongly

informed by the country's history as a former American colony, but also reinforced by

the promise of higher wages and the best possibility of permanent settlement, as

compared to other receiving nations like Japan and Saudi Arabia (Buchan 2006). Thus,

Filipino families invest in nursing education with the hope that their children will

eventually be able to work in the United States and send remittances home.

Until the mid-2000s, Philippine state officials celebrated the expansion of nursing

education as an opportunity for both aspiring migrants and the Philippines as a whole.

On the one hand, nursing shortages in the United States encouraged aspiring migrants

to work toward obtaining higher education, which both policymakers and migration

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scholars associate with immigrants' likelihood of success. Studies have shown that the

better social networks and resources of highly educated migrants make it easier for

them to be economically incorporated into their host society (Csedo 2008;

Menjivar 2010; Portes, Fernandez-Kelly, and Haller 2005).

However, the growth of the foreign nurse labor niche in the United States has also led to

problematic outcomes not easily captured in the brain drain narrative. Given the

Philippines' largely private higher education system, aspiring migrants pay the cost

themselves of enhancing their overseas employability, leaving the Philippine state free

to benefit from their future remittances without having to invest in their education.

Aspiring migrants also absorb the risk involved in obtaining necessary qualifications for

future jobs in the context of an unstable market. Although these uncertainties affect

undergraduates all over the world, they are magnified in the Philippine context, where

both students and schools aim to fill nursing labor needs beyond national borders.

When the most recent nursing “boom” that propelled an outflow of Filipino nurses to the

United States ground to a halt during the 2008 financial crisis, stemming the recruitment

of foreign nurses, visa processing for Filipino immigrants went into “retrogression”—the

term used by embassy officials when the number of visa applicants exceeds the number

of visas available (Acacio 2011). Here I discuss the implications of such events for the

everyday lives of Filipino nurse graduates and their plans for the future.

LEARNING TO FILL THE LABOR NICHE

Despite the growing emphasis on academic credentials, the global economy has seen a

decline in permanent employment and increasing instability within workplaces (Brown,

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Lauder, and Ashton 2011; Kalleberg 2009; Smith 2010). As a result, students today

spend more on schooling but are less likely to get the jobs they want (Brown and

Hesketh 2004; Tomlinson 2008). Yet the promise of higher education and future

immigrant success remains a convincing reason for many Filipino students to pursue a

four-year degree in nursing. A quick glance at Philippine migration statistics shows that

an aspiring migrant could easily leave the country as a domestic helper or construction

worker, with little need for academic training or credentials. Still, my interviewees

wanted to obtain jobs with better wages, higher social status, and protections against

employer abuse—privileges that many of their migrant relatives had not been able to

enjoy. College education thus served as an expensive “investment” in a better future

and a better migration experience. Joey, a 2011 graduate, explained that the idea of

becoming a nurse came from his mother, who was working as a domestic helper in

Italy:

The Migration Trap

The opportunity offered by the U.S. nursing labor niche to Filipino nurses is often

fleeting and unstable. Open positions are filled very quickly, and U.S. officials change

immigration policies depending on nationality quotas and domestic conditions. Thus,

Filipino students who invest in certain degrees in the hope of migrating often discover

that they are unable to leave the country because they have graduated at the end of an

overseas job trend. This is the problem of the migration trap.

Rina Jimenez-David (2008) describes the migration trap as a problem for those who

have already obtained their degree, but aspiring migrants among my interviewees

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shared that they felt “trapped” even before they graduated. As students, many of them

were well aware that overseas opportunities for Filipino nurses were dwindling;

subsequently, many were left stuck in the Philippines and struggling to find work. Gina,

a nurse who graduated in 2006, said that even while the number of students enrolled in

her college was still high, she started to hear stories about previous cohorts who could

not find work:

I could tell something was wrong [in senior year] when I would see some of our

graduates around town. I would ask them what they've been doing, and they'd say,

“Wala!” [Nothing!], or, “Nasa bahay lang, tambay!” [Just hanging out at home!] Or

sometimes I would see them in the hospital, working as volunteers … with no salaries!

That's when I started to wonder what would happen to me.

Despite these signs, many nursing students did not want to “waste” the money they had

already spent on books and nursing courses by shifting to another program. Daisy, who

graduated in 2014, said that after she graduated from high school, “my parents told me

that nursing is a very expensive major so they really asked me if I could handle the load.

They said, ‘Once you start, no more shifting to another major!’” Similarly, Patrick,

Daisy's classmate, shared that college was a “luxury” for his family. As such, paying

extra money for more classes would have been out of the question. He explained, “My

mother told me that college is a one-shot deal. If I flunk a class or drop a class, they will

pull me out. I think it's because the money for my tuition is not from them, it's from my

aunt in Canada. So yeah, just one shot.” Although Patrick and Daisy knew that the

opportunities for migrant nurses had waned, financial and time constraints prevented

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them from pursuing other courses of study. Because Philippine college curricula require

students to take major subjects as early as the first semester, it is harder for students to

shift majors without worrying about delaying their graduation.

My sister-in-law passed all her requirements in 2005, and they processed all her papers

in less than a year. I thought I would still make it, but it was too late. Maybe because of

the financial crisis in the U.S., they became stricter with visa applications. The agency

tells me there's still a demand. The government just doesn't want to bring in more

people. … Now, I just think that if a new opportunity comes again, at least I'll be the first

in line.

Lorna comforted herself with the idea that her investments in certification would open up

the possibility of migration in the future. Yet she was unsure as to when the “next time”

would be, and she admitted that some of her exam results would become invalid in five

years. She would then face the risky decision of whether to invest even more money in

her migration plans, given the unpredictable timing of nurse recruitment in destination

countries.

These Philippine aspiring migrants were not stereotypical Third World immigrants,

desperate to leave under any circumstances, but rather sought particular conditions for

emigration. Even though caught in the migration trap, they did not necessarily have no

means of leaving the country. Rather, they were unable to leave in the manner they had

envisioned and in which they had invested. At the time of my interviews, government

agencies still reported a need for nurses in places like Yemen, Jordan, and Saudi

Arabia. However, few of my interviewees would consider working in the Middle East,

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mainly because of what they had heard about Arab employers. Tanya, a 2014 nursing

graduate, said that employers in the Middle East were “violent” and “abuse women.”

Although she knew little about Middle Eastern countries, she said that she had seen

enough on TV to decide that she did not want to work in the region. Similarly, Mara, a

2011 nursing graduate, said that her parents wanted her to work only in the United

States and that “they would worry too much if I went anywhere else.”

The Opportunity Trap

Nursing graduates caught in the migration trap face two choices: find other ways to

practice nursing, or leave the profession altogether. Yet, whichever decision they make,

nursing graduates often find themselves caught in another difficult situation: struggling

to accumulate more and more credentials to improve their chances in a poor job market.

The sociologist Phillip Brown (2003) calls this the problem of the opportunity trap:

individuals continuously pursuing training and education to obtain tough-entry jobs,

despite little evidence that more qualifications will lead to better opportunities. As more

people engage in this strategy, the harder it becomes for anyone to get ahead. Yet few

can forgo this race for credentials given the risk of completely losing out in the end.

In the Philippines, the massive number of nursing students has worsened the effects of

the opportunity trap. As the number of jobs in the United States began to drop,

graduates scrambled to differentiate themselves from the thousands of others with the

same academic qualifications. Many of my interviewees remained hopeful that the U.S.

market would open up for the recruitment of migrant nurses in the future and worked

fervently to “build up” their résumés with extra training and certification. With only limited

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open positions, however, Philippine hospitals were unable to absorb the thousands of

nurses flooding the market. Mirielle Kingma (2007), a consultant for the International

Council of Nurses, notes that this problem is common in countries that experience high

rates of nurse migration, not because of a lack of need, but because local hospitals lack

funds and support for staff. Desperate for work experience, many of my interviewees

resorted to paying for their own professional development, thereby adding to the

thousands of pesos their families had already invested in their education.4

One expensive option was pursuing a master's degree in nursing. For many of my

interviewees, “going back to school” seemed like a better way to spend their time, given

the lack of hospital jobs for nurses in the current market. Yet these nurses had only a

vague idea of whether such a credential would actually lead to higher returns in the

United States. Rey, a nurse who graduated in 2007, was one of the lucky few who

found full-time work, at a children's hospital in Manila. He attended graduate classes

during his free time and eventually obtained a master's degree in nursing. Rey admitted

that he was not really sure what opportunities a master's degree would bring, but he had

enrolled in the program because his colleagues were doing the same thing:

A lot of people believe that a [master's] will help you get to the U.S., but that's not true. I

took it because I would hear all the other nurses talking about wanting to take a

master's. There would be all this talk about how their master's will be credited abroad or

how it will make sure you get a higher rank when you go abroad. Now I find it funny

because they wanted the degree, but they don't really know what it involves.

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For nursing graduates who find pursuing a master's degree too costly and time-

consuming, enrolling in short-term “training sessions” can be a more viable alternative.

Offered by both public and private hospitals, these sessions provide nursing graduates

with “certified” skills in specialized areas of the hospital. Amy, who graduated in 2008,

shared that since she passed the board exams, her mother had spent 26,000 pesos

(about U.S.$523) on two training sessions: a three-week seminar on inserting

intravenous tubes, and a six-week session on being a dialysis nurse. Amy confided that

she was ashamed to ask her mother for more money, given that her parents had

already financed her college education. However, her mother had insisted that she go

for the training rather than give up and work at a call center. Sheila, who graduated in

2007, paid for two training seminars; focused on occupational health and safety, they

catered to would-be company nurses. Like Amy, Sheila paid for her extra training with

the help of a cousin in the United States, who also funded her nursing education. She

believed that the extra investment increased her ability to perform certain hospital tasks,

thereby enhancing her employability. Both Amy and Sheila rationalized their decision to

undergo further training by arguing that training certificates would be useful when

applying for work overseas.

Although paying for what was once offered for free may have seemed unfair, many

nursing graduates felt that enrolling in these training sessions was still better than

volunteering at local hospitals. With nurses outnumbering the available positions in

Philippine hospitals, many resorted to providing their labor for free, just to get the work

experience required by many foreign employers. At one point, local hospitals even

started charging nursing graduates for the “experience” of working in the hospital. One

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interviewee shared that administrators in her university charged their own graduates

6,000 pesos for only three months of “exposure” in the campus hospital. The fees were

higher for work in specialized areas such as kidney dialysis. Eventually, news of nurses

paying to work led to a public uproar, prompting Philippine politicians to ban hospitals

from collecting these fees. However, hospitals—both public and private—could still

accept nurse “volunteers,” thus continuing to benefit from their free labor.

In response to this problem, Philippine state agencies implemented short-term

programs that employed nurses in health centers and provincial hospitals in the

country's rural areas. Interviewees saw this program as a temporary way to pay the

bills, but not as a training ground to enhance their chances of migration. Patrick, who

finished a one-year stint with this program, did not find the experience useful in his

migration plans because he had been limited to routine procedures like administering

vaccines and taking vital signs. In fact, his nursing job was so “easy” that he worked

part-time at his aunt's convenience store and transcribed interviews for a researcher at

a local university. Many of his classmates avoided these government programs, despite

the lack of nursing jobs elsewhere. “No one really wants to work in [rural communities],”

Patrick said. “Your work there is not credited if you want to go abroad, so it's pretty

useless.” The only “break” Patrick caught came when the head nurse at the government

hospital where he was volunteering secretly gave him a certificate of experience as a

staff nurse. “Actually, what she did was illegal, because we were volunteers, not full-

time staff. Naawa lang talaga siya sa amin [She just felt so sorry for us].” With his COE,

Patrick applied for a nursing job on a cruise ship. He had given up on making it to the

United States.

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INTRODUCTION
Many immigrants are concentrated in an occupation, or a segment of an

occupation, that we call a labor market niche a specific line of work found either within a

single community or nationwide. A specific line of work represents an immigrant niche if

an immigrant group is overrepresented in it relative to the group’s portion of the

country’s employment. Some occupations are dominated by immigrants in general in

other cases, specific immigrant groups are associated with specific labor market niches.

Some heavily niched immigrant groups come from particular regions of a country or

from specific ethnic groups in a country.

BODY
The Philippines is a nation with talented people. They often aspire to achieve big

in their career or to pursue higher education in fields like nursing, teaching, research,

etc. Foreign countries such as Canada, Australia, New Zealand, the UK and the USA

are go-to destinations for them. Apart from this, there are other socio-economic reasons

that entice Filipinos to leave their homes, enroll in Nursing Programs for International

Nurses, and work abroad. The Philippines has a persistent high unemployment rate.

Every year, thousands of fresh graduates enter the job market after pursuing the most

popular education and courses, but fail to find a job. As a result, the unemployed are

increasing the competition for others. To escape this situation, they prefer to work in

foreign destinations to pursue higher studies like Global Nursing Programs to find work

opportunities. Many employers in the Philippines have their necessary workforce

working at low salaries. This is why others seek opportunities to work abroad with better

pay packages. Filipinos working in high-demand jobs like nurses, teachers or engineers

are also poorly paid within the home country. No wonder so many enthusiasts leave the country, and

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prefer to work abroad with better pay and benefits. Employers in the Philippines prefer

to recruit employees on a contractual basis, as it is easier for them to let go and they

don’t have to provide any health benefits or insurance coverage. From sales executives

to food servers, the practice is widespread in the country. These biased conditions help

employers save money, no matter how unsatisfying the job offer is for an employee.

This causes a great deal of job insecurity for those who are employed in the Philippines.

It sounds unbelievable, but it is happening. When these OFWs return to their homeland,

they are being pampered and offered numerous advantages like health insurance

discounted rates, special lanes for overseas workers at the airport, and they are

covered under better protection. They are even regarded as the nation’s new breed of

heroes, pumping in billions of remittance dollars. This is what motivates and inspires

most Filipinos. To fulfill their dreams and achieve a rewarding career, they prefer foreign

destinations like Canada, Australia, New Zealand, the UK and the USA. Whether it is to

continue their higher education, pursue Academic Courses for International Nurses or to

find opportunities that allow them to study and work altogether, Filipinos find this a

promising avenue for career growth.

CONCLUSION

In seeking to enhance their chances of migration through education, nursing

graduates face the risk of getting caught in the migration trap and the opportunity trap

continuously upgrading their skills and credentials in the hope of getting jobs that do not

exist. These problems do not affect only migrant-sending countries. These export-

oriented education strategies complicate typical narratives about the impact of U.S.

nursing labor shortages on source countries. On the one hand, the influx of Filipino

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nurses into the United States motivates young Filipinos to pursue four-year degrees in

nursing, thus increasing the number of students seeking higher education in the

country. The cyclical nature of the U.S. nursing labor shortage then provides long-term

opportunities for aspiring migrants looking to invest in nursing education.

SUGGESTIONS OF IMPROVEMENT:
 The government should increase the salary of nurses so that they would not

leave in our country.

 Nurses in the Philippines should be respected, increase their salaries and give

them many benefits because their work is not easy.

 The government should take an action about the delayed salaries of nurses.

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