March 14, 2007 -- Several recent press pieces have profiled second-career nurses, including those who once worked in fields with higher social and/or economic status. On January 7, USA Today ran Adam Geller's Associated Press piece "Filipino Doc Picks Life As Nurse in U.S." This is a long profile of Elmer Jacinto, a nurse and a physician who chose not to practice as a physician in the Philippines in order to earn more money as a nurse in the U.S. Because Jacinto scored highly on physician exams in the Philippines, he became a controversial public symbol of the health worker migration away from that nation. The piece includes some helpful information about the nursing shortage. But it is full of subtle suggestions that nursing is less important than medicine, and that Jacinto has turned his back on the common good by not practicing as a physician, as if nursing had little social utility. Today, The Seattle Post-Intelligencer published Susan Phinney's "Nursing student still works long hours, but the reward is priceless." This article reports that Mike Nicholls left a lucrative career as a Wall Street analyst to study nursing at the University of Washington. The piece stresses the differences between the two fields, highlighting the non-material rewards of nursing and the fact that nursing education actually is a serious academic endeavor. It could have done more to convey that nurses improve patient outcomes, but at least it does not suggest that Nicholls has suffered a loss of social worth. We thank Ms. Phinney and the Post-Intelligencer.
The January 7 AP article recounts the odyssey of Jacinto, the Filipino nurse and physician who elected to come to the United States and work as a nurse because he could make far more money that way. The article includes some of the standard information about the exodus of Filipino health workers during the U.S. nursing shortage. Some sources note that the exodus has crippled the Filipino health system, and others argue that the emigrants are merely seeking better lives for themselves and their families. Jacinto is special, though, because when the media and politicians in the Philippines learned that he was at the top of his medical school class, they made him the poster child for the nation's soul-searching about the exodus. He was accused of putting his own interests before those of his nation. And the publicity reportedly helped spur a movement to persuade physicians to stay in the Philippines as a matter of patriotic duty.
The piece avoids overt expressions of contempt for nursing, but it is full of subtle suggestions that nursing is not good enough for a promising physician, and that nursing does not have as much value as medicine. The assumption seems to be that only money could justify Jacinto's decision, particularly since not one word in the long piece suggests that Jacinto is doing anything important by being a nurse. When Jacinto, on his way to start a shift at St. Vincent's Hospital in Manhattan, notes that he has "[s]o much to learn," the reporter immediately describes him as "self-deprecating"--presumably no physician could really have anything to learn about nursing. Later, the piece returns to the theme, noting that Jacinto is "reluctant to tout himself":
"Mister is fine," asked how he prefers to be addressed. "Here I am not a doctor."
In describing Jacinto's decision to board a plane to the U.S., the piece explains why he did it in a separate paragraph:
To make more money. To become...a nurse.
Horrors! We get that part of it is the change in social status, but it's pretty obvious there's more to it. Jacinto has gone from helping his nation to helping himself.
One irony is that Jacinto actually was a nurse in the Philippines before he became a physician. Of course, even his decision to become a nurse there is presented as relating solely to a desire for money, rather than saving lives--his father had told him there was "money in nursing." To its credit, the piece at least notes that Jacinto was at the top of his nursing school class (nurses go to school! and get grades!). But the piece wastes little time on Jacinto's nursing career. After he finished medical school at the top of his class and placed first in the national medical exam, it explains, the real tragedy was just unfolding:
Jacinto...was already making other plans. His parents deserved more than even a doctor could give them. In a world where jobs and workers are shifted back and forth across borders like game pieces, he would play his hand -- setting aside the goal of becoming a neurologist to work as a nurse in America for far greater pay.
Obviously, that would be the only reason to choose nursing; after all, we "become" a neurologist, but we merely "work as" a nurse. We do not learn what nursing specialty Jacinto has pursued (do nurses have specialties?). The piece goes on to observe that Jacinto's decision should not have been surprising, given the high number of Filipinos who work overseas, and that "[s]ome of the most successful" are nurses, who have prospered during the shortage that afflicts wealthy nations.
But now the Philippines was bleeding doctors.
In other words, massive nursing emigration is one thing, you go girl, but if it's physicians--that strikes at the national soul. Would there have been a national outcry had Jacinto simply emigrated after finishing at the top of his nursing school class? The piece notes, relying on former Philippines health minister Jaime Galvez Tan, that in the last five years some 9,000 Filipino physicians have retrained as nurses, and more than half have gone abroad.
The result? Some rural hospitals have few, if any, doctors and nurses. And care suffers.
In fairness, the piece does include a few paragraphs about the nursing shortage. The article reports that the Philippines legislature has considered requiring all new nurses to spend a few years working in the Philippines before migrating. However, there is no indication that anyone lamented the fact that Jacinto left nursing to become a physician. The piece also mentions the U.S. Congress's consideration, as part of pending immigration reform legislation, of a measure that would allow an unlimited number of foreign nurses to enter the U.S. That is a move that Tan argues would mean "the Philippine health care system will bleed to death."
The piece describes Jacinto's experience after coming to the U.S., which included a bitter controversy between the Filipino nurses who came with him and the Long Island nursing home operator that brought them over. After some months, Jacinto and 25 others quit ("including five trained as doctors"!), accusing the nursing home operator of housing them in squalid conditions and badly shortchanging them. Jacinto's problems reportedly were big news back in the Philippines, as part of a "revised morality tale" in which the grass is not always greener overseas.
However, Jacinto and the others soon found other work, and the piece concludes with a description of Jacinto's current life working at St. Vincent's. Jacinto now shares a "spare" but "spotless" apartment with several other nurses, and each month he wires $500 to his parents back home. He has found "a sense of peace," freed from the pressure to be "the model Filipino" (i.e., a physician) so he can pursue "something for myself" (i.e., nursing). On the other hand, his new hospital treats AIDS patients who would be "quarantined" to a few hospitals back in the Philippines. Manhattan's "jungle of buildings" remains overwhelming. And Jacinto is "so tired that he now thinks he may remain a nurse rather than pursue his dream of becoming a doctor in the United States." That's nursing--OK if you're too tired to do something better. The piece says nothing about whether Jacinto might be doing some good as a nurse, except, of course, for himself.
The March 14 Seattle Post-Intelligencer piece also focuses on a man making the transition to a U.S. nursing career, but here it is former Wall Street analyst Mike Nicholls, who is now a nursing student at the University of Washington. The piece makes much of the contrast. Nicholls once had a hired car waiting to take him home after 20-hour work days; now he still puts in long hours, but often takes the bus. Before he had a six-figure salary, but the piece notes that the average salary for a Washington state nurse is about $64,000. (Of course, a few nurses do have six-figure salaries.) On the other hand, to its credit, the piece notes that some of Nicholls' Wall Street skills "also work in his new career -- multitasking and teamwork, for example."
Nicholls is "so pleased with his new career path he could be a poster child for career-switching," "raving" about all he is learning about work that is focused directly on improving lives. The piece explains that he had been consumed and hardened by his New York job, which he got after some college work in finance and economics. Nicholls ended up as a hospital patient because of "exhaustion." He decided--partly because of the "compassion" he saw in the nurses at the hospital--that it was time for a career change. He wanted "to be part of something larger, more meaningful and humane."
Nicholls and his wife moved to Seattle in 2004. After Nicholls took some prerequisites at Seattle Central Community College, he enrolled at the UW, which had "kept popping up as one of the best." Nicholls: "It's a school with lots of research going on, and it emphasizes diversity." This is a somewhat unusual depiction of undergraduate nursing, suggesting that nursing school is hard enough to have prerequisites, that some nursing schools are actually better than others, and that they do "lots of research." The article also relies on the UW's "director of admissions and multicultural student affairs," Carolyn Chow. Chow explains that the nursing school is "not interested in just GPA" but also professional potential. She says that the school accepts about one quarter of the roughly 400 annual applications it gets--a valuable note because it suggests that not just anyone can become a nurse. Chow says that Nicholls "brings a lot of experiences and perspectives to the program," noting that this is typical of students who are switching careers, who tend to have "a level of maturity."
The piece links Nicholls' background to his new goals as a nurse. His parents had emigrated from the Bahamas, raising Nicholls and his siblings in Brooklyn. Nicholls's twin brother (his "role model") still works at JP Morgan Chase, but Nicholls sounds happy with the "daily sense of satisfaction" nursing offers, despite the lower pay. He wants to work in mental health care, an area that he says was not accepted in the culture in which he was raised.
The article closes with an interesting question for Nicholls:
Does he learn anything from hospital shows on television? The question makes him laugh. "They're dramatic and sensationalized," he said. "They seem to miss the compassion involved in health care."
Our view is that the hospital shows don't so much miss the "compassion" involved in health care, though they probably do focus more on physicians interacting with other physicians than they do on the extended, hour-to-hour patient care Nicholls may have in mind. The shows certainly do miss the compassion involved in nursing care, since they generally show physicians providing it.
These two pieces reflect different approaches to the stories of those who have become nurses after pursuing other endeavors. To some extent the AP piece's many subtle suggestions that nursing is a sad substitute for medicine flow naturally from the story it's telling. But it's also true that the Post-Intelligencer piece could have included direct suggestions that Nicholls' new job is somehow less important than his Wall Street position, and it did not, instead sticking to obvious differences in money and workplace culture, and stressing the rewards of nursing. Of course, neither piece conveys very well that nurses save lives and make a huge difference in patient outcomes. Curiously, neither pursues the obvious issue of what it is like to be a man in nursing when more than 90% of nurses are still female. Perhaps that is a type of progress--a man in nursing is no longer so remarkable--though we could imagine some men in nursing feeling that gender issues would be an important part of the experience of these nurses.
We thank Susan Phinney for her Post-Intelligencer article "Nursing student still works long hours, but the reward is priceless." Please send her a note of thanks at firstname.lastname@example.org and copy us at email@example.com. Thank you.
Send your letters of concern about the "Filipino Doc Picks Life As Nurse in U.S." article to author Adam Geller at:
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