A lifeline for Filipino nurses in America: The compassionate network behind cultural and clinical success

If you’ve ever been treated in a U.S. hospital, there’s a strong chance a Filipino nurse was part of your care team. For decades, these dedicated professionals have been an indispensable backbone of the American healthcare system, and their presence is more vital now than ever amid persistent nursing shortages. As of 2021, Filipino nurses constituted approximately 27% of all foreign-born nurses in the U.S., a testament to a migration trend stretching back to the early 1900s.

Yet, their journey to the U.S. and subsequent integration is often fraught with challenges, from navigating complex immigration policies to adjusting to a new culture. This is where the Philippine Nurses Association of America (PNAA) steps in, acting as a crucial lifeline for Filipino nurses, just as these nurses serve as a lifeline for American patients and providers.

A Legacy of Care and Migration

The migration of Filipino nurses to the U.S. began over a century ago, enabled by Presidents McKinley (1898 executive order) and Taft (Pensionado Act of 1903) with a focus on education, assimilation, and reciprocal relationships. This historical connection led to an American-modeled nursing education system in the Philippines, facilitating an easier transition for Filipino nurses seeking opportunities abroad. While a desire for professional advancement and better working conditions plays a role, a primary driver for leaving the Philippines remains significantly higher salaries—up to ten times what they might earn in their home country—and the heavy workload they often face there. As PNAA President-elect Army Col. (retired) Bob Gahol, RN, shared, “Low salary is the primary factor why they’re leaving the country. And the second one is the workload”.

The numbers underscore this trend: In early 2022, approximately 300,000 out of 900,000 nurses in the Philippines had migrated to work abroad. For 46 years, the PNAA has actively addressed this phenomenon, evolving from a professional organization focused solely on professional standards to one that offers comprehensive support for its members.

PNAA: A Multi-faceted Support System

The PNAA, with its 57 chapters across the United States, doesn’t engage in recruitment. Instead, it focuses on ensuring ethical labor migration and preventing issues related to unfair working conditions, salaries, or misrepresentation by recruiters. This commitment includes educating nurses on U.S. standards of practice and the intricate migration processes, partnering with organizations like CGFNS and consulate offices.

“When they arrive here, they’re not provided with the education that they need for acculturation and appropriate for the job that they’re given,” noted PNAA South Central Region VP Riza Mauricio, PhD, APRN, highlighting a critical gap the PNAA aims to fill. PNAA chapters offer crucial “acculturation programs”, extending practical assistance.

Gahol recalled a powerful example of community support, when PNAA provided winter clothing to a group of 70 nurses moving to Washington state. “You can’t get a winter coat in the Philippines,” he said, noting the absence of winter in the Southeast Asian archipelago. PNAA used a winter coat drive to collect coats. “We were able to provide them all with winter clothing and other necessities when they arrived, so they could focus on being ready for nursing”. PNAA also helped the nurses get driver’s licenses and find housing.

Nurturing Wellness and Skills

Beyond practicalities, the PNAA recognizes the profound emotional and mental toll that migration and demanding healthcare work can take. The impetus for their highly successful resilience program, “kabalikat” — a Filipino term meaning “shoulder to shoulder helping one another”— arose during the COVID-19 pandemic. With 31% of nurses who died from COVID-19 being Filipinos, the social isolation and mental burden on these frontline workers became undeniable. The Kabalikat emotional wellness program, supported by organizations like the Entertainment Industry Foundation (EIF), offers peer support groups that continue to meet monthly, fostering a sense of community and addressing mental health challenges often culturally suppressed within the Filipino community.

This commitment to the well-being of Filipino nurses gained national attention with the film Nurses Unseen, produced by a team led by Emmy Award-winning Michele Josue and including famous stand-up comedian Jo Koy. The documentary spotlights “the little-known history and humanity of the unsung Filipino nurses who risked their lives on the frontlines of the COVID-19 pandemic while facing a resurgence of anti-Asian hate in the streets.”

Related Content: How foreign nursing schools prepare for the U.S. market

Their resilience in the face of such adversity is matched only by their proactive dedication to professional preparedness. Even while navigating the arduous and often lengthy immigration process, Filipino nurses demonstrate a profound commitment to honing their clinical expertise and embracing new technologies, ensuring they are always ready to serve. While awaiting visas — a process that can take up to two years — many nurses work in non-nursing positions like telemedicine or call centers in their home countries. To ensure their skills remain sharp, PNAA offers programs like “Balik Turo” (meaning “back to school” or “return to teach”) where members return to the Philippines to teach and update skills at universities. PNAA chapters also conduct medical missions in the Philippines, sharing knowledge and expertise with local healthcare professionals.

Tech-Ready with a Human Touch

Even before arriving in the United States, many Filipino nurses are actively engaged in building the skills needed to thrive in a modern, technology-rich care environment. According to Mauricio, the Filipino workforce is not only highly engaged in digital culture and social media, but also in health technologies, particularly simulation-based learning. “Filipinos are really up on technology,” she noted. “But what is important in nursing is not only knowledge acquisition, but also skills acquisition … that’s where simulation enters in.”

Simulation is especially vital as many nurses face long waits for their EB-3 visas. To maintain clinical and technical readiness around digital health, some recruitment agencies provide forward-loading of simulation activities, helping nurses practice scenarios and learn new technologies before they even arrive in the U.S. Once they do arrive, PNAA chapters continue this support with hands-on training that helps new nurses adapt not only to cultural differences but also to specific workflows and technologies used in U.S. healthcare.

Teaching emerging technologies and standards of care at Philippine universities is a key focus of PNAA’s Balik Turo program. “Simulation is crucial for repeated performance so that you get skillful,” Mauricio said. “That’s what keeps our nurses ready, both in the Philippines and in foreign countries like the United States.”

Navigating Immigration Barriers and Advocating for Change

Despite being highly skilled and often “board-qualified” for the U.S., thousands of foreign-trained nurses, including Filipinos, remain “stuck in bureaucratic limbo” due to outdated U.S. immigration policies. The primary route for international nurses, the EB-3 visa, is capped at around 40,000 annually and shared across multiple professions, leading to significant backlogs. As Gahol explained, “They are still processing December 2021 applications. That’s four years behind. It is creating a huge backlog of about 10,000 international nurses stuck in the pipeline.”

This bottleneck is profoundly frustrating for both nurses and U.S. hospitals scrambling to fill vacancies. PNAA leadership firmly believes that policy changes are needed to create a dedicated labor migration path specifically for healthcare workers, especially nurses. “Policy needs to change in terms of labor migration, particularly healthcare in the healthcare industry,” Mauricio asserted, stressing that the current system forces nurses to “compete with all other professions”.

Related content: Should the US create a healthcare-specific visa program?

 The Valued Contributions of Filipino Nurses

Filipino nurses are not only well-educated — most nursing programs in the Philippines are bachelor’s-prepared — but they also bring a unique cultural richness to the diverse U.S. patient population. They are “highly respected for their clinical skills and compassion,” treating patients “like our families”. Values like aruga (nurturing) and pakikisama (getting along) are deeply embedded, contributing to a holistic and empathetic approach to care that is widely recognized and appreciated. As Riza Mauricio recounted, the Mayor of Houston proclaimed May 13 as Filipino Nurses Day partly because he was so impressed by the care a Filipino nurse provided to a family member.

Looking ahead, PNAA President-elect Gahol aims to encourage members to return to the Philippines to mentor local nurses, addressing the “brain drain” — more than 300,000 nurses in the Philippines have left the profession, and an estimated 51% of licensed nurses have left the islands to work in foreign countries, according to the Harvard International Review. Gahol also plans to advocate for Filipino nurses to have a greater voice and “a seat at the table” in mainstream professional nursing organizations like the American Nurses Association (ANA).

The story of Filipino nurses in the U.S. is one of enduring commitment, resilience, and invaluable contribution. Just as these highly qualified, deeply caring nurses have been a lifeline for U.S. healthcare and patients, the PNAA stands as a testament to the power of community, providing a vital lifeline that ensures these essential professionals can continue to deliver high-quality, compassionate care on the front lines of American healthcare.

Check out DHI’s May 2025 Nursing Workforce Special Content Series: Immigration and the U.S. Healthcare workforce: A system in crisis