Working With Filipino Nurses

I’ve always had a deep interest in other cultures. It started when I lived in South Africa as a young girl. It was in Johannesburg that I first had turtle soup and escargot. I learned the English tradition of tea time, as well as the significance of long, elongated necks in women of certain tribes of Africa (basically the longer the neck, the higher the status).

Now I find myself in a culturally diverse world of nursing. There are many different cultures represented in nursing, depending on where you live, and one large group is Filipino nurses.

The general traits discussed here should not be mistaken for stereotyping.  Cultural generalizations do not fit every individual and every person may not behave like others in their group.These are just the impressions of one nurse.


 

One time, while holding an in-service in a large conference room, I thought it would be a fun touch on my part to have a silent, giant full screen of the Wizard of Oz in HD playing in the background as the participants filed in and registered. I know all of the scenes and so many of the lines by heart.

I noticed the attendees were polite, but not overly responsive to the familiar images of Dorothy and the flying monkeys. Then all of a sudden the light came on. I asked “How many of you know this movie?” Very few hands went up. It seems so obvious to me now. Very few of the nurses who attended were raised in the States. Turns out that the Wizard of Oz was not huge in the Philippines. That day I realized my cultural IQ was not particularly high.

History

The Philippines and the United States are long time allies and friends. When the U.S. experienced a nursing shortage, the Philippines responded by training thousands of nurses. Parents urged their sons and daughters to become nurses, as their ticket to the States, or elsewhere abroad.

Filipino nurses are the largest group of minority nurses. In some hospitals, they comprise the majority of nursing staff. Although the United States is not actively recruiting in the Philippines as they did several years ago, a large group of Filipino nurses remain.

Social and Family Values

Smooth interpersonal relationships are at the core of social interactions. A sense of shared identity with others means a value of group harmony and loyalty. Supporting and honoring your parents and repaying a favor is essential. Filipino values include a debt of gratitude.

Children are expected to respect and love their parents and older family members. Caring for aging family members is deeply embedded in the culture. Family households are multigenerational and interdependent.

Filipino nurses are very hard-working, and many have mothers or mother in-laws in the home to help with the children, cooking, and laundry.

Tess, a nurse I know, works two jobs. Her scrub uniforms are always pressed, she always looks fresh, and she brings homemade food every day. As the breadwinner, she is expected to work as much as she can, and to send money back to family in the Female nurse talking to co-workerPhilippines. Her mother-in-law cares for her two small children. Tess works five to six twelve-hour shifts a week for her two different employers. Basically on days that she works, she works, eats and sleeps.

Avoid Conflict

Asian nurses avoid interpersonal conflicts if  possible. They do not rock the boat or challenge authority. For the most part, a Filipino nurse is not going to be a union activist. This comes from the value of group harmony over individuality. Many of the females are soft talkers. Relatively small in stature and with a life-long youthful appearance, they are agreeable and rarely strident in social groups.

They can be less direct than their American counterparts to avoid hurting anyone’s feelings. In their efforts to be cooperative, they may say “Yes”, or nod to indicate they agree or understand even when they do not fully agree or are uncertain.

Individual versus Group

Filipinos are more likely to be found together in groups than alone. Individuality is much more of a Western value. In staff meetings, the Filipino nurse is not likely to draw attention to himself or herself  as an individual. To Filipinos, individuality is subjugated to the group’s well being for the greater good. Bringing shame to yourself is bringing shame to the group.

It’s not “my fair share” but “share with the group”. So at lunch food is pooled and shared. Filipinos rarely eat alone. Every day is a potluck. The stay-at-home Filipino Moms and mother-in-laws cook adobo and pancit, sending delicious meals to work with their nurse sons and daughters to share with all. I would totally change my work schedule to be there on lumpia day.kare kare, filipino oxtail stew, philippine cuisine

Hierarchy, Age and Authority

Brought up in hierarchical cultures, Asian nurses are respectful and obedient to their elders and expect the same from their subordinates. Subordinates can include “junior” nurses, or new grads, as well as patient care technicians.

In some hospitals in the Philippines, there are junior nurses and senior nurses. Junior nurses do not question authority and nurses do not question a doctor’s orders.

A young Filipino nurse who was chosen to be a preceptor confided that she was feeling very uncomfortable in the role. Why? Because it required her to instruct and even correct a new grad nurse who was old enough to be her mother. She could not bring herself to do it.

Doing things in a new way may be seen as criticizing the old way or even as disrespecting your elders.

Nursing Role

Training can vary. Once when precepting a bright young Filipino nurse, I asked “Where’s your stethoscope?” She replied “I don’t have one.” I was puzzled, because I knew she was an experienced RN in the Philippines. “What unit did you work on?” I asked. “The ICU.” In my mind, this conversation was getting stranger and stranger. “How did you assess your patient’s breath sounds?” “I didn’t. The doctor did.” Since there was a doctor in the ICU at all times, the doctors performed many tasks that Western nurses do. While all Filipino nurses hold a Bachelor’s degree, she went on to tell me that nursing education varies greatly from university to university in the Philippines.

The role of the nurse is very different. Providing personal care is not part of the nurse’s role in the Philippines. Families consider it an honor and a duty to care for their hospitalized loved one, and nurses do not bathe patients.

Autonomy in nursing practice is greater among Western nurses than Asian nurses. Western nurses are taught to evaluate and question orders for appropriateness, whereas Filipino nurses are taught to carry out orders. This can cause different expectations.

Western and Asian cultures view pain differently. Filipino nurses are more sparing with pain medication than Western nurses. Reasons may be that pain medication is scarce in the Philippines, so using as little as possible makes it go further. Stoicism is highly valued and, for Catholic Filipinos, suffering can be an opportunity to demonstrate virtue. Filipinos do not rely on pills, do not complain of pain, and are afraid of addiction.

Western nurses enjoy more resources and high-tech equipment, and both Western and Asian nurses are proficient at work-arounds!

Communication

Tagalog (one of the Filipino languages) doesn’t include “he” or”she” and so  I learned when receiving report, that every patient is a “she”….until I get to the room. Many Filipino nurses have nicknames, like Tess, or Bong, even though their name badge reads Maria or Nelson.

You can totally bond with a Filipina over designer shoes and bags and bargain shopping. Filipinos have always been techno-savvy. Many are world traveled, and they are known for an excellent sense of humor. There is nothing funnier than a Filipino making jokes about themselves and their own culture.

To me, the overriding quality of Filipinos is their fun-loving nature. They gather and party on a moment’s notice. Alcohol is not a main feature, but food and music, family and friends are. They love music and karyoke.

They laugh and laugh and make the silliest jokes. I love their playfulness and joy and warmth.

Exploited

Filipino nurses have been known to be exploited by dubious American employers, and shame on those employers. Many Filipinos new to the country are vulnerable, trusting, and do not know their rights in a strange country.

Filipino nurses themselves who are in leadership positions can be hard on their own, at least from an outsider’s point of view. If a Filipino manager calls a nurse in to work on their off day, they simply come in. It’s not a request; it’s a directive and no one seems to question it or complain about it. They are here to work, and they are loyal to their bosses.

Conclusion

Even though Filipino nurses make up the majority of immigrant nurses, the topic of nursing diversity is never directly talked discussed when inevitable minor cultural misunderstandings arise.

In hospitals where two cultures co-exist- Western and Asian-  the similarities and differences are rarely addressed by hospital leadership. This despite vastly different upbringing, socialization, and values. Foreign nurses are expected to simply transform into Western nurses, and Western nurses do not understand the deeply held beliefs and values of their Asian sisters and brothers.

More open discussion is needed to truly appreciate each other.

The best solution is to acknowledge our differences and similarities without judgment with the mutual goals of providing culturally-competent nursing care.

In the meantime, my hat is off to the hundreds of Filipino nurses I know who were courageous enough to leave their homeland for a better future.

Until next time,

Nurse Beth aka “Miss Beth” to my Filipino nurse friends

 

 

Galanti, G. A. (2000). Filipino attitudes toward pain medication: a lesson in cross-cultural care. Western Journal of Medicine, 173(4), 278. Accessed April 30, 2016 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071118/

Vestal, V., Kautz, D., Vestal, V., & Kautz, D. D. International Perspectives: Responding to Similarities and Differences Between Filipino and American Nurses.

Xu, Y. (2007). Strangers in strange lands: a metasynthesis of lived experiences of immigrant Asian nurses working in Western countries.Advances in Nursing Science, 30(3), 246-265.