SAN DIEGO -- The face of nursing is changing significantly in San Diego and elsewhere in Southern California. According to a survey by NurseWeek earlier this year, 15 percent of registered nurses in San Diego are Asian or Pacific Islander, compared to 12 percent of the total population.
At Kaiser, the ratio is double that. Of 1,565 nurses working for Kaiser Permanente in San Diego, a third, or 528, are Asian, according to Kaiser spokesperson Sylvia Wallace. And at UCSD Medical Center, where Crystal Hsaio works, the majority of nurses on her floor are Asian or Pacific Islander.
"When people see an Asian face they feel more comfortable," said nurse Hsiao, a native of Taiwan, adding that having someone available to translate for a patient can be critical. So is awareness of cultural differences. For example, some nationalities believe that washing a mother and baby after birth can be harmful to both by changing the temperature of the body and thereby altering the chi or flow of energy which, in turn, prevents elimination of toxins. Nurses need to know how to deal with a variety of cultural views such as that.
"Even if we are not the same (in nationality), we are more open-minded about cultural differences," Hsaio said. While the nationwide average of Asian Pacific Islander nurses, according to the NurseWeek survey, is still only 4 percent but increasing, Southern California has become a magnet for nurses from Pacific Rim countries.
While less and less Americans are enrolled in nursing, more and more nurses are emigrating or being recruited from countries such as India, Taiwan, China, and even Korea. The largest source, however, remains the Philippines.
Training as a nurse in the Philippines and coming to work in America is a tradition that began in the 1970s and 1980s, according to Ben Macapugay, spokesperson for Paradise Valley Hospital in Southeast San Diego.
Quality of labor and quality of training is another factor. The Philippines is known to produce more nursing graduates and have more nursing schools than any other country in the world – 186 with the combined ability to graduate 20,000 nurses a year, according to Dr. Jaim Z. Galvez-Tan of the University of the Philippines in Manila.
Supply also dictates salary. In the Philippines, a nurse can expect to earn between $150 and $250 a month. In the United States, where demand is greater, salaries range from $3,000 to 4,000 and often come with signing bonuses, according to Galvez-Tan.
Coming from a poor country makes coming to the United States an easy choice to make, especially when many people in the Philippines already have family here.
"People prefer places like San Diego, where they already have relatives," said John Pasamonte, a recruiter for International Nurses Solutions, one of many companies recruiting foreign nurses for U.S hospitals.Patt Mareschal, lead nurse at Fallbrook Hospital's Medical Surgical Unit, who has spent 30 years in the profession, sees an even greater shift.
For one, nurses have to work more effectively with fewer resources, caring for sicker patients for shorter periods of time. Their responsibilities extend well past a patient's general health and often include sociological and psychological issues, such as domestic violence or mental illness, according to Mareschal.In addition, today's nurses are older; the average age is 46. And they are increasingly male – 6 percent nationwide.
Despite the economic advantages, becoming a nurse in the United States isn't all that easy. No matter how well trained, foreign nurses must pass the NCLEX (National Council for Licensure Examination) and must demonstrate a proficiency in English. Still, the number of nurses passing the NCLEX exam rose to 16,490 in 2003, nearly double what it was in 2001, according to NurseWeek. Many believe a large part of that is the level of education supplied by such institutions as UCSD and United Education Institute of San Diego and El Cajon, which offers, among other things, training for medical assistants, pharmacy technicians and dental assistant, in addition to nursing careers.
For a hospital, the attraction of Asian and Pacific Islander nurses is two-fold: one cultural, one economic. "There is no question that cultural diversity is important, said Wallace. "At Kaiser we work hard to provide faces and cultures that reflect the community at large."
Culture aside, there is a critical need for skilled nurses, period.
"The nursing crisis is grave and only growing worse. Nationwide, there are 130,000 nursing vacancies, a deficit that is expected to double in the next five years. By 2012 it will be 1.1 million," said Pasamonte.
Here in this country, nursing school enrollments have dropped 16 percent in the last five years because of other opportunities opening up, according to Mareschal. "There are new avenues for women now. We no longer have to go the teaching, nursing route," she said.
Meanwhile, those trained as nurses don't always stay in the profession. Many leave in their 20s and 30s to raise families or to pursue other careers. Others go on to related careers such as nurse practitioners or physician assistants.
For their part, the nursing schools are working hard to respond to the crisis, but it has not been easy. "We can't get educated students fast enough," said Dottie Crummy, head of the nursing program at Point Loma Nazarene University. "All the nursing programs in the city are filled to more than capacity. This year we took in an extra five students. Last year we took in 10, and we still had to turn away qualified students."
While the vast majority of students in nursing programs are native born, a high percentage are Asian – a sharp change from past years. "The majority of our students were white Anglo-Saxon Protestants," said Crummy. "Now, Filipino/Pacific Islanders are our largest ethnic group, followed by Asians, then Hispanic."Many of the Filipinos, she added, are the children and nieces of the nurses who came here to practice their profession 20 or 30 years ago.
Michelle Capati, a nursing student at Grossmont College is one of them. When asked why she wants to be a nurse, her answer is simple: "My Mom."Capati's mother has been a nurse for more than 20 years, logging 12-hour shifts seven days a week. But she wouldn't have it any other way, her daughter said.
Hard work or the capacity for hard work may be another reason Asians and Pacific Islanders are swelling the nursing ranks."The Philippines is a third world country. People there are used to stress and hardship, Pasamonte said, adding that "Asians are also known for their compassion."
Mareschal agrees: "They work hard and are generous, caring people."