The Guardian November 22, 2000

Importing nurses: a money-making venture

by Grace Chang

Currently, there are 100,000 registered nurses in the Philippines, but 
almost none actually reside in the country. Similarly, 90 per cent of all 
Filipino medical school graduates do not live in their country. Since the 
1970s, the United States has imported women from the Philippines to work as 
nurses, ostensibly in response to domestic shortages in trained nurses.

This importation system became institutionalised in the H-1 nursing visa, 
which enables a hospital or nursing home to sponsor or bring a nurse with a 
professional licence from abroad to work in the USA for two years.

Under the H-1 program, an applicant must take the US nurses' licensing 
exam. If she passes, she can gain permanent residency after two years.

During those two years, she is nearly captive to her original sponsoring 
employer. If she fails the exam, she loses her sponsorship and technically 
must leave the country. More often, such women go underground until they 
can take the exam again.

Sometimes, they work in nursing homes, where they are paid as little as 
US$5 an hour; others arrange green-card marriages.

In 1988, the Filipino Nurses Organization fought for the Nursing Relief 
Act, which has provided some rights and stability to H-1 nurses in the last 

The law grants nurses permanent residency after five years of living in the 
United States and working in the nursing profession.

Mayee Crispin, a Filipino nurse, organises H-1 nurses at St Bernard's 
Hospital on the south side of Chicago. At St. Bernard's, 80 per cent of the 
nurses are single Filipino women on H-1 visas.

The starting wage is US$14 an hour, in contrast to US$16 an hour at other 
hospitals, and the ratio of patients to nurses is high. But many of the 
nurses are reluctant to organise, fearful of losing their jobs, or their 
employer's immigration sponsorship, if they are identified as being pro-

Many are sending remittances to their families at home and struggling to 
pay off their debts from migration.

Crispin proposes that importing nurses from the Philippines is a 
moneymaking venture for hospitals and the nursing recruiters they contract.

According to Crispin, a hospital typically gets workers from overseas by 
making an official certification that it cannot find US workers to fill its 
nursing positions. (This is usually because the hospital offers wages that 
few US workers are willing to accept.)

The hospital is then free to contract a recruiter to go to the Philippines 
in search of nurses.

A nurse must pay, on average, between $7,000 and $9,000 to the recruiter. 
Since most women cannot afford this fee, they agree to have it deducted 
from their wages.

After paying off such fees and sending roughly 25-30 per cent of their 
wages to their families at home, their monthly wages disappear quickly.

In essence, most of these women live in a situation much like indentured 
servitude or debt bondage for at least two years.

Crispin says that hospitals, by hiring migrant nurses, not only get cheap 
labor, they also get a workforce that is extremely vulnerable, fearful, 
uninformed of its rights, and thus likely to resist unionisation.

With few US citizens going in the field or willing to work for such low 
wages, many Jamaican and Filipino women migrated to the US to do this work. 
With the downsizing in health care, many of those same nurses who have been 
in the US for more than a decade are now finding themselves just as 
vulnerable as new immigrants.

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Grace Chang is a writer, activist, and mother of two. This article appeared in Dollars and Sense a bi-monthly publication of economic issues and opinion.

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