Quitter les Philippines : récits oraux sur la transition que vivent les infirmières dans le processus d adoption de pratiques infirmières canadiennes - PDF

CJNR 2012, Vol. 44 N o 4, Résumé Quitter les Philippines : récits oraux sur la transition que vivent les infirmières dans le processus d adoption de pratiques infirmières canadiennes Charlene Ronquillo

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CJNR 2012, Vol. 44 N o 4, Résumé Quitter les Philippines : récits oraux sur la transition que vivent les infirmières dans le processus d adoption de pratiques infirmières canadiennes Charlene Ronquillo Les infirmières philippines constituent le plus important groupe d infirmières immigrantes au Canada. Bien qu elles comptent pour une grande proportion de la main-d œuvre infirmière, nous avons peu d information sur les contextes dans lesquels s inscrivent leurs expériences individuelles d immigration et de transition. Cette étude se penche donc sur les expériences de transition d infirmières philippines ayant immigré au Canada entre 1970 et Utilisant les récits oraux comme cadre et méthode de travail, elle établit un corpus de travaux en examinant l histoire de ce groupe d infirmières en contexte canadien. Des entrevues individuelles ont été réalisées auprès de neuf infirmières philippines qui occupent des emplois dans deux provinces canadiennes. L étude met en lumière les raisons qui ont fait que certaines infirmières ont tardé à entamer les démarches qui leur permettaient de devenir une infirmière autorisée : elles accordaient la priorité à leur famille; elles constataient que l ajustement que nécessitaient le rôle et la portée de la pratique infirmière canadienne exigeait du temps; elles se sentaient comme des «étrangères» et avaient l impression de devoir prouver qu elles étaient compétentes aux yeux de leurs collègues canadiennes. Mots clés : infirmières immigrantes, Philippines, main d œuvre infirmière, transition, récits oraux, contexte canadien 96 CJNR 2012, Vol. 44 N o 4, Leaving the Philippines: Oral Histories of Nurses Transition to Canadian Nursing Practice Charlene Ronquillo Filipino nurses are the leading group of immigrant nurses in Canada, making up a substantial portion of the nursing workforce, yet little is known about the contexts surrounding their immigration and transition experiences at the individual level. This study examines the transition experiences of Filipino nurses who immigrated to Canada between 1970 and Using oral history as the framework and method, it establishes a body of work in examining the history of this group of nurses in a Canadian context. Individual interviews were conducted with 9 Filipino nurses working in 2 Canadian provinces. Findings suggest that nurses may have delayed the process of becoming a Registered Nurse because the family was considered a priority, they found that adjusting to the role and scope of Canadian nursing practice required time, and they felt foreign and sensed a need to prove their competence to Canadian nurses. Keywords: immigration, migration, transition, Philippines, history of nursing, Canada, oral history, culture Background The Philippines is often identified as the leading producer of nurses for global export (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Bach, 2003; Lorenzo, Galvez-Tan, Icamina, & Javier, 2007). It has been identified as one of the main source countries of Registered Nurse (RN) immigrants for the Canadian workforce (Baumann, Blythe, Kolotylo, & Underwood, 2004; Canadian Institute for Health Information [CIHI], 2011). Recent statistics show that nurses from the Philippines make up Canada s largest group (31%) of RNs who graduated from an international nursing program in 2010 (CIHI, 2011). Considering the predicted shortage of nurses in North America in the coming years (Bach, 2003), the general trend of nurses migrating from the global South to the global North (Kaelin, 2011), and an overall increase in the immigration of health professionals, Canada continues to grow as an important destination country for Filipino nurses (Goode, 2009). To gain insight into the immigration and transition experiences of Filipino nurses in Canada and implications of these experiences, an important initial step is to explore Ingram School of Nursing, McGill University 97 Charlene Ronquillo the roots of this phenomenon. Therefore employing a historical lens to examine the context surrounding their experiences is timely. The work of the historian Catherine Choy on the history of immigrant Filipino nurses in the United States highlights the importance of the colonial relationship between the United States and the Philippines and shows that the seemingly recent popularity of immigration and of nursing as a career choice for Filipinos is in fact deeply rooted in their country s colonial history. These roots lie in US efforts in the 1940s to popularize and promote immigration of Filipino nurses to the United States as a move towards educational and professional advancement (Choy, 2003). The US establishment of an Americanized model of nursing training and education in the Philippines in the early 20th century included the use of American textbooks focused on Western medical knowledge and with a substantial English-language component (Choy, 2003). The Westernized training model facilitated the initial migration of Filipino-trained nurses to the United States and arguably served as an important precondition for the mass emigration of Filipino nurses in the last decades of the 20th century (Choy, 2003; Kingma, 2006). Choy s seminal work emphasizes the importance of an oral history perspective in obtaining a detailed look at the life histories of this group. This approach provides a complementary perspective to dominant economic and policy discourses and also mitigates the common depiction of migrant health professionals as faceless workers (Choy, 2003, 2010). By bringing attention to the lived experiences of foreign-trained nurse migrants and immigrants, the theme of international immigration complements two new approaches to nursing history: the agenda to internationalize its frameworks and the call to move away from great women, great events and toward the experiences of seemingly ordinary nurses of nursing. (Choy, 2010, p. 15) This study is part of a larger study providing a regional and personal picture of immigration as voiced by those who have experienced it firsthand. The larger study examines two distinct temporal periods: (1) the motivation surrounding the choice to pursue immigration and leave the Philippines, and (2) the transition experience and the process of integrating into the Canadian nursing workforce and Canadian life. The present study focuses on the transition period, the part played by social, cultural, and historical influences in the transition experiences of the group, and how these influences have coalesced at the individual level. The research question for the part of the study presented here was as follows: How are the motivations behind the decision to migrate and the transition to the Canadian workforce and Canadian life remembered by RNs who have emigrated from the Philippines? CJNR 2012, Vol. 44 N o 4 98 Filipino Nurses Transition to Canadian Nursing Practice Global Transition of Nurse Migrants An increasingly globalized world is facilitating the rapid movement and growth in numbers of migrant nurses. With some countries taking in a larger number of immigrant nurses each year, there is an increased focus on immigrant nurses transition experience the process of acculturating to work and life in the host country. A systematic review of transitional programs for internationally educated nurses (IENs) in the United States found that many studies focus on the effectiveness of transitional programs (Zizzo, 2009). A number of studies have explored the experiences of migrant nurses employed by the National Health Service in the south of England (Alexis, Vydelingum, & Robbins, 2007; Allan, Larsen, Bryan, & Smith, 2004; Daniel, Chamberlain, & Gordon, 2001; Withers & Snowball, 2003). Some of these studies report contradictory findings on support received by Filipino nurses from their British counterparts (Alexis et al., 2007; Daniel et al., 2001; Matiti & Taylor, 2005). A metasynthesis of the experiences of immigrant Asian nurses working in Western countries found four overarching themes in the literature: the daunting challenges of communication; marginalization, discrimination, and exploitation; cultural differences; and differences in nursing practice (Xu, 2007). Studies discussing the transition experiences of IENs in Canada are emerging. Early work reveals challenges similar to those reported in the British and American literature, such as language and communication barriers to workplace integration (Blythe & Baumann, 2009). Canadian studies similarly reveal difficulty becoming registered in Canada as a significant challenge for IENs, including a tendency to underestimate the amount of time and effort required to complete the process (Blythe, Baumann, Rheaume, & McIntosh, 2009). Nurse Immigration History: Race, Gender, and Identity The exploration of nursing immigration history in Canada has been analyzed within the frameworks of gender, identity, and race, in an attempt to understand the experiences of immigrants. Caribbean nurses are one of the few groups of immigrant nurses for whom there exists a historiography in Canada. Calliste (1993) and Shkimba, Flynn, Mortimer, and McGann (2005) discuss the roles played by race, class, and gender in controlling Canadian immigration in the post-world War II period. Nursing historians have argued that a perceived shortage of nurses in Canada in the mid-20th century prompted changes in immigration policies to facilitate immigration of foreign nurses and their incorporation into the Canadian workforce (Calliste, 1993; Shkimba et al., 2005). Notably, race played a prominent role in shaping the recruitment of foreign nurses. CJNR 2012, Vol. 44 N o 4 99 Charlene Ronquillo Calliste (1993) explores the different immigration policies based on the nurses race and country of origin. For example, in the 1950s and early 1960s Caucasian nurses general admissibility was sufficient for them to be admitted as permanent settlers. In contrast, Caribbean nurses were admitted only as cases of exceptional merit, and it is argued that Canadian immigration policies were subsequently changed to further Canada s trade interests in the British Caribbean (Calliste, 1993). Establishment of nursing education and practice in the Philippines is influenced heavily by its colonial ties with the United States in the mid- 20th century. Therefore a historical context is essential to any analysis of Filipino nurses experiences (Choy, 2003, 2010). Analyses of the global immigration of nurses often focus on economic- and health-policy issues as the dominant contextual frameworks (Calliste, 1993; Choy, 2003, 2010; Connell, 2008; Damasco & Knowles, 2008; Kelly, 2003, 2006; Kelly & D Addario, 2004; Kingma, 2006, 2009; Lorenzo et al., 2007; Yeates, 2010). Recent work examining the contexts of Filipino nurses immigration to Canada from a historical perspective solidifies the importance of the historical colonial US-Philippines relationship as well as the cultural and societal pressures that come into play in the nurses immigration decision (Ronquillo, Boschma, Wong, & Quiney, 2011). The present study adds to this historical perspective through an analysis of oral histories in order to complement ongoing work with respect to Filipino nurses. Oral History Study Method and Framework Oral history research involves interviews with a select group of individuals those with firsthand knowledge of the event or period under study and a narrative of each individual s experiences in the context of the topic under study (Boschma et al., 2008). As both a method and a framework, oral history provides a bottom-up view, highlighting the everyday experiences of ordinary people (Boschma et al., 2008; Burke, 2001; Thompson, 2000). Experiences are captured in oral history research as they are presented by participants, complete with their possible ambiguities, disorganization, complexities, and inconsistencies (Boschma et al., 2008). Instead of a chronological and concrete telling of history, the focus is on how events are experienced, interpreted, and remembered by individuals (Sugiman, 2004). Oral history does not focus on the events themselves but instead explores the meaning that speakers give to their own experiences and how they view their relationship to their history (Boschma et al., 2008; Portelli, 1998). By examining how events are recollected over time, we gain insight into how they have shaped and coloured the individuals perspectives on their experiences. CJNR 2012, Vol. 44 N o 4 100 Filipino Nurses Transition to Canadian Nursing Practice Sampling and Recruitment This study examined the experiences of nine female Filipino nurse immigrants residing in the provinces of Alberta and British Columbia. Health-care structures in Canada are governed provincially and this study provides a regional look at the experiences of Filipino nurse immigrants in western Canada. Alberta and British Columbia have seen rapidly increasing numbers of new RN registrants from abroad, with numbers doubling in British Columbia and increasing fivefold in Alberta between 1999 and 2002 (Baumann et al., 2004). Participants were recruited through purposive and snowball sampling, as the study called for individuals who had had particular experiences and were willing and able to share them. Volunteer third parties from the author s professional and personal networks initiated contact with potential participants and facilitated the recruitment process. Ethics approval was granted by the University of British Columbia s Behavioural Research Ethics Board in the fall of The study was carried out from December 2009 to May 2010 inclusive. Data Collection and Analysis Written informed consent was obtained from all participants and interviews were conducted individually in person or by phone. Face-to-face interviews were conducted in locations convenient for participants. Some locations were public (coffee shops and restaurants) and others private (participants homes). Participants were encouraged to speak freely and openly so that the nuances of their experiences could be captured. An open-ended script was used to guide the interviews. Consistent with oral history research methodology (Boschma et al., 2008), a semi-structured interview guide was used, but precedence was given to the stories that participants wished to tell. All interviews were conducted by the author, digitally audiorecorded, and stored on a secure drive on the author s password-protected personal computer. All recordings were transcribed by the author and de-identified during transcription. Quotes that appeared unclear were checked with the interviewee for clarification. All participants were assigned pseudonyms. Transcripts were analyzed and concepts related to motivations for migrating to Canada, and experiences related to the transition to becoming an RN in Canada, were identified. Sub-themes were identified across the transcripts, facilitated by continuous comparison between narratives as they were produced. The oral historian Alice Hoffman (1974) describes validity in oral history methodology as the degree of conformity between the reports of the event and the event itself as recorded by other CJNR 2012, Vol. 44 N o 4 101 Charlene Ronquillo primary resource material such as documents, photographs, diaries, and letters (p. 29). Using Hoffman s description as a guideline, the study employed continuous comparison between the oral history narratives and the literature on the events. In this way, participants experiences could be contextualized and placed within the historical, social, and cultural influences that ultimately shaped their experiences. Broad themes were identified from the data as a whole. Results Participant Demographics Of the nine participants, eight were practising as RNs at the time of the interview and one was on medical leave. All nine women had completed their nursing education in the Philippines. They ranged in age from early thirties to late fifties. Seven participants had a baccalaureate degree in nursing and two had graduated from hospital-based schools of nursing. Dates of departure from the Philippines ranged from 1974 to Five participants had lived and worked as RNs in other countries (Austria, Saudi Arabia, United Arab Emirates, United Kingdom, United States) prior to arriving in Canada. Five migrated with other family members and four as individuals. Seven migrated with the aid of a sponsor and two entered Canada through the Live-In Caregiver Program. Two nurses migrated independently, without aid from a sponsoring person or agency. Five of the nine participants indicated that they provided financial support to family members in the Philippines, either regularly or according to their family s needs. Family First, Nursing Later The concept of the loyal, cohesive family is central to the Filipino identity (Wolf, 1997). The narratives revealed that, for these nurses, family cohesive ness often took priority over any professional goals they may have had upon arrival in Canada and the need to provide immediate financial support and other familial responsibilities often took precedence. One consequence of putting the family first was a delay in obtaining RN registration in Canada. Often, this was coupled with being unaware of the amount of additional time and education required in order to register and work as a nurse in Canada. RNs who had worked in other countries where their Filipino nursing education and experiences were deemed equivalent were particularly frustrated by these delays. Many recalled that their entry to Canada coincided with a period in their lives when they began to raise a family. To contribute to the financial support of their families, many nurses first worked for a number of years as care attendants or nurse s aides until they were able to obtain RN CJNR 2012, Vol. 44 N o 4 102 Filipino Nurses Transition to Canadian Nursing Practice registration. Participants recalled that it became comfortable to continue working as aides or assistants indefinitely; they valued a guaranteed income over their career pursuits. (All names presented hereafter are pseudonyms.) Carmen was sponsored upon entering Canada by her grandparents and arrived at a time when nursing standards and reciprocity for IENs in Canada were beginning to change. Upon her arrival in 1974, she was able to obtain a graduate nurse position in a small town in Alberta. After taking time off to start a family, she found that the situation for IENs in Canada had changed: When I m ready to come back, I can t come back as a graduate nurse any more... I worked as a nursing aide. And actually I worked for a long time as a nursing aide. I was really comfortable... having a family... you never really think of [going back to school]. Until I got a call from [the registrar in] Edmonton, and they re saying: What are you going to do? Are you going to still take your exam, or what? Carmen recalled the registrar s persistence in encouraging her to pursue nursing registration in Canada. After working as a graduate nurse and nurse s aide for 16 years, she obtained her RN licence in She emphasized that she had wanted to complete the registration process immediately after re-entering the workforce but the demands of her new family took priority. Carmen s story mirrors the experiences of many of the nurses: Starting a family and establishing a nursing career in Canada came to be at odds. A number of nurses explained that familial relationships were an important reason for choosing to immigrate to Canada versus another country. Nurses who actively chose Canada as a destination country often did so in order to bring their families together. Lydia recalled: My husband got his immigrant visa here [in Canada]. He applied when he was single and I was waiting to be a citizen back in the States. It would take at least 3 more years before we can be together. Because we have a so
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