In this article the author tells her story of migrating from the Philippines to the United States shortly after her graduation from nursing school. She describes how she adjusted to life in the United States, advanced her career, and is now helping other nurses adapt to life in a new country.
Key Words: cultural adaptation, career advancement, nurse migration, Philippine nurse
On the wave of my Philippine nursing classmates saying, “Let’s go to the States,” I, and 25 other Philippine nurses, headed for the same hospital in New York City, all on the same TWA flight not long after graduation from nursing school. Some of the nurses with me on that flight had lived previously in the United States (US) as part of their Exchange Visitor’s Program, but had returned to the Philippines after a two year stint in the US. They were now headed back to the US. Adventure in my veins was propelling me to go to the United States of America (USA) for the opportunity to travel, find professional fulfillment, further my educational opportunities, and have some fun. I was a young lady with a “world is mine to conquer” spirit at the age of 22.
My classmates and I actually began our adventure at a recruitment agency in Manila, bringing with us the papers the agency had specified. Can you picture this “herd” of ladies coming through the doors of the agency? In no time at all, I was on my way. There were no hitches or glitches in terms of the application, and no delays. There was no pressure from parents or economic need to migrate at that time in the 1970s. We simply wanted to do so.
The Story of My Sojourn in the USA
It was a cold winter in New York City in 1971, the year of my arrival in the “land of milk and honey.” I started shivering in my teeth and in my feet as soon as I landed at John F. Kennedy (JFK) International Airport. The hospital management met us at the airport. They gave us a warm reception and welcome, and a nice, hot breakfast. It was a good sign.
My first hospital assignment, arranged by the recruitment agency here in the US, was at Metropolitan Hospital, part of an 18-city hospital system called the Health and Hospitals Corporation. It was almost like the Philippine General Hospital (PGH) where I had trained as nursing student. PGH was the training hospital of the University of the Philippines and can be compared to Bellevue Hospital in New York City, both in its complexity and its care of indigent patients. Our first home in New York was Draper Hall. Living in this hall was like dorm life to a “T,” including “hunk watching” from the window across the parking lot as interns, residents, and other healthcare professionals went to their cars. Breakfast cost 20 cents; lunch, 30 cents; and dinner was 40 cents. We had ticket vouchers.
...everyday conversations on the units were interspersed with different accents; and I had to get used to different twangs. My ears sometimes could not catch what was being said. I went through the hospital orientation and caught on rather rapidly. I attribute my quick learning to the fact that I had trained in one of the best nursing schools in the Philippines and had been exposed previously to a very complex, tertiary hospital. I had fun going to Chinatown at 1AM in the morning after having worked the evening shift, going home at 3 AM, sleeping until 12 noon, waking up and watching the soaps, and getting ready to work... that was my routine.
Then I was noticed by an administrative supervisor on the evening shift. She “plucked” me from my work on the female medical floor to become the evening head nurse of the Medical Intensive Care Unit. I did not know what hit me; but in my naiveté, I went and just did the job. I attribute my being noticed for this position to the fact that I communicated well, spoke English well, and spoke my mind. I asked questions, and asked for explanations, and was not shy in doing so. I spoke my mind in a forthright and direct manner. One administrator with whom I was working in those early years told me later that I had not shown the usual timid and shy Philippine behaviors they were seeing in many Philippine nurses of that time. Although I thought I was shy, people around me said that I was not shy about asking questions. They could see I had a curious mind. I read the newspapers, watched the news and sports reports, and was conversant regarding everyday topics with patients and my co-workers. Although I faced many leadership challenges at that time, including those of supervising Licensed Practical Nurses and nursing assistants, I had good support from the Evening Nurse Administrator named Vernell; and I will always remember her. It was her mentoring that helped me weather the many trials and tribulations of being a head nurse.
...I had to learn American humor. I watched Johnny Carson and Merv Griffin on late night shows so that I could learn to understand American jokes. On one front, however, I was having problems. These problems were with the English language and phonetics. Although I prided myself on being very conversant in English, and knowing the English grammar rules, everyday conversations on the units were interspersed with different accents; and I had to get used to different twangs. My ears sometimes could not catch what was being said. Sometimes I had to ask staff to repeat what they had said. Also I had to learn American humor. I watched Johnny Carson and Merv Griffin on late night shows so that I could learn to understand American jokes. Commonly the conversations on the units turned to sports. At first, I got confused between all the teams and did not know whether a certain team was a basketball, a baseball, a hockey, or a football team. I knew from living in the Philippines that the New York Yankees was the name of a baseball team, yet it took a while for me to learn that the New York Giants was the name of a football team.
Although I was a Registered Nurse (RN), I did not have the baccalaureate degree that I knew I needed to advance in nursing. Knowing that I had to pursue a BSN, I enrolled at New York University (NYU). However, taking even only three credits almost broke my personal bank. I was working full time on the evening shift at Metropolitan Hospital on 96th Street in Manhattan, and trekking to NYU in Washington Square in the morning was a chore.
I spoke to my very supportive mother who agreed that going home to the Philippines and pursuing my BSN there would be a practical and efficient way of doing things. In the Philippines, I would be financially supported and could become a full time student. I would not need to work at another job. So I went home to the Philippines where I was subsidized by Mom, and I studied full time to obtain this degree.
With a BSN next to my name after one year of full time studies and carrying a load of 18 credits a semester, I came back to the US and worked in various staff positions in critical care units and as a hemodialysis nurse at Cabrini Medical Center where I met some people who really touched my life in many wonderful and enlightening ways.
Yet again I knew I wanted to further my educational pursuits even more and study for a master’s degree. Because Cabrini was able to provide only minimal tuition reimbursement, I sought other employment opportunities that would provide greater tuition reimbursement for master’s degree study. I took a position at Memorial Sloan Kettering Cancer Center because their tuition reimbursement benefits allowed me to gain a Master’s in Nursing degree from Columbia University in New York City.
After completion of my master’s at Columbia University and a broken relationship, I felt the world was beckoning me. In 1980, at the height of the Kampuchean War, I went to Thailand and worked for the International Rescue Committee for several months, ministering to war torn patients at Camp Khaoi Dang. This was a rewarding and tough experience. It broke my heart to see suffering families, separated families, and small children not knowing what their future held. After seeing the ravages of war, I considered myself quite fortunate, and made a pact with myself that I was going to try to never again be unhappy with my lot in life. To this day, I think I have met this goal.
I have been employed with the Department of Veterans Affairs (VA) (2008) since 1983. I began my VA career as an RN in the Intensive Care Unit at the Manhattan, New York, VA Medical Center, a complex, tertiary medical center. After demonstrating my professional dedication, compassion, caring ways, knowledge, skills, and abilities, I was promoted to a position in quality management and utilization review. I continued in this role until 1992 when I became the Staff Assistant/Health Systems Specialist. In this new role I served as the Quality Improvement Coordinator and was responsible for managing the Quality Improvement Section. This work included ensuring that patient care was safe, appropriate, and efficient. I was also responsible for the accreditation of many different programs and was instrumental in ensuring that the Medical Center complied with all quality and performance standards.
Looking for further challenges in my career, I transferred to the Bronx VA Medical Center in 1997 as a Health Systems Specialist/Staff Assistant to the Medical Center Director, who was the Chief Executive Officer (CEO). During my time at the Bronx VA, I assumed many different roles, such as Data Validation Coordinator, Credentialing and Privileging Coordinator, and Compliance Officer. When the CEO requested that I do a job, I did it.
Currently I am the Director of Performance Improvement/Quality Management, responsible for the Medical Center’s compliance with The Joint Commission’s (TJC) standards in the Hospital, Hospital-Based Home Care, Opiate Treatment, and Long Term Care Programs. The Joint Commission work remains one of my toughest challenges. I spend endless hours in documentation preparation for the Medical Center so that it is complete, accurate, and in compliance with the mandates of regulatory agencies. I am told that I am encyclopedic in my Joint Commission knowledge. I am a consultant to patient care centers regarding TJC standards specific to credentialing and privileging of medical staff and other monitoring committees. I am an active member of several of the Medical Center’s Boards; and I provide consultation on resource allocation issues impacting the Veterans’ Equitable Resources Allocation and other medical center activities/issues emanating form the Director’s Office. I also assist the Chief of Staff and Program Chiefs with performance measures and conduct focused reviews in areas where there maybe bottlenecks in process completion.
In 2006 I was elected, and currently serve, as President of the Philippine Nurses Association of America (PNAA) (2006). One of the benefits of this position has been attendance as a nurse stakeholder member at the World Health Organization Global Advisory Group on Nursing and Midwifery. I am also a member of the Advisory Council with the Academy Health/MacArthur Foundation initiative on developing ethical guidelines in the recruitment of foreign educated nurses to the US and the Board of Directors of the National Coalition of Ethnic Minority Nurses Association (NCEMNA), where I represent the needs of the ethnic minority nurses, specifically the Asian voices. The NCEMNA is comprised of five ethnic organizations: Hispanics, Black, Asian Pacific Islanders, Native American/Native Alaskan, and Philippine nurses. As President of PNAA and a member of the NCEMNA Board of Directors, I am able to articulate the needs of Philippine nurses, address disparity issues, and help Philippine nurses seek scholarships that will “boost up” their nursing careers.
I have lived in Manhattan for almost 35 years now, and I love its pulsating energy, its many places to visit and things to do, its restaurants, and of course its shopping. Traffic can sometimes be at gridlock status, but I survive this gridlock just as I survived 9/11. One of my wishes I have not yet achieved is that of furthering my educational at the doctoral level; though in looking back I do not know if I would have done things differently. Life’s outcomes often depend on decisions made at a moment in time, rather than on a planned career trajectory. I have enjoyed traveling and seeing the world. Although I feel very satisfied and fulfilled with my career, I may still pursue a PhD degree should the opportunity arise — who knows?
I do believe I have accomplished a mission. PNAA is an apostolate for me; and I can say that I have lived well, served well, and loved well here in the US. I’ll end this article by offering my advice for the next generation of migrants aspiring to make it here in the USA, or any other wealthy country.
Advice for Aspiring Nurse Migrants
- Be aware that you are moving into a very different environment and setting. Although there are certain values common to all, there are many different cultures, and different ways of doing things. In a culture that values direct communication, a beating-around-the-bush style is like a poor translation. Read well and research the areas to which you are thinking of migrating.
- Be knowledgeable about the geographic areas you to which you have been assigned.
- Develop a support system that can give advice, love, affection, reality checks, sanctions, and sometimes money.
- Learn both to speak well and to communicate well. Remember that your ability to speak in English does not necessarily mean you can communicate in an English-speaking country. Learn the nuances of speaking and articulating well so you can be understood.
- Disengage, when needed, from your previous ways of doing things. A case in point is the need to give up the Philippine way of “beating around the bush” when the situation demands that, to communicate effectively, you get straight to the point you are trying to make. In a culture that values direct communication, a beating-around-the-bush style is like a poor translation.
- Be aware of the dangers of escalating credit debt resulting from buying too many things that you really do not need, and/or buying too many brand-name items. Before making a purchase, ask yourself whether or not you really need this item.
- Practice being assertive. Mental toughness is a positive force in the workplace. Yet gaining this skill sometimes take practice because it takes one out of one's comfort zone. I’ll describe here how I continue to work in developing my assertiveness skills:
When I am waiting in a grocery store or bus line, and someone sneaks ahead of me, I politely mention that the line forms way to the back. My old way would have been to “give in” and allow this sneaker to get ahead of me. Now each time I use my new, more assertive, behavior, I cheer myself, recognizing that I have gained a little more “stamina” and “fortitude” in my battle for assertiveness.
- Do your homework diligently. When I was new in my supervisory position, and still very “green,” I did not go into a situation “blinded.” Rather I recognized that I needed to prepare myself. I needed to rehearse what I wanted to say to my staff. First, I did my homework, researching union agreements, policies, and directives; then I came prepared to meet with my staff. I also studied the situation and the people involved in the situation, recognizing that sometimes intuition works, sometimes it does not. I worked to judge what was real, and what was for show; what information had significance and what had little, long-term meaning.
- In summary, be curious and read, read, read. Be aware, be knowledgeable, and be mindful of all that is going on around you. Develop your interpersonal skills and treat everyone with dignity and respect.
Be aware, be knowledgeable, and be mindful of all that is going on around you. It is my hope that by reading my story, nurses who might be thinking of migrating to America will be motivated and make the move to do so, that nurses “on their way” will be better prepared to develop a successful nursing career in a new land, and that nurses who have always lived in the US will better understand what it is like to be a nurse who leaves a homeland and migrates to the USA, hoping to find professional fulfillment, make a contribution, and have some fun.
Rosario-May P. Mayor, RN, BSN, MA
Rosario (May) Mayor is a graduate of the University of the Philippines, Philippine General Hospital School of Nursing. She holds a BSN from the Philippine Women’s University and a MA in Nursing from Columbia University-Teachers College, New York. She came to the United States shortly after graduating from the Philippine General Hospital School of Nursing to find professional fulfillment, further her education, and have some fun. May worked to learn the American nursing ways of doing things and soon became a supervisor and subsequently a Health Systems Specialist/Staff Assistant to the Medical Center Chief Executive Officer. Currently she is the Director of Performance Improvement/Quality Management at the Bronx Veteran’s Administrator Medical Center and President of the Philippine Nurses Association of America.
Article published May 31, 2008