Behind Hospital Doors: The Systems That Shaped Filipino Nurse Migration

To understand how Filipino nurses emerged as a major labor force in the 1960s and beyond, we must first understand the complex history of US colonialism in the Philippines.

On December 10, 1898, the Treaty of Paris was signed, marking the end of both the Spanish-American War and over 300 years of Spanish colonial rule in the Philippines. The Spanish-American War began in 1898 after tensions rose between the US and Spain over contrasting ideas about Cuban independence and American economic expansionist ambitions in the Caribbean and the Pacific. Through yellow journalism, American newspapers vastly exaggerated Spanish acts of military aggression (such as the explosion of the USS. Maine), shaping public opinion against Spain and constructing an image of the US as noble, benevolent, and antagonized.^¹

drawing and article of uss maine — A newspaper article covering the sinking of the USS Maine, stating that the incident killed over four hundred US soldiers and that “Spain is Open to Suspicion."

Escalating territorial tensions between the declining Spanish empire and ever-expanding American one, all fueled by media propaganda, pushed US Congress and President William McKinley to declare war in April 1898.

In 1898, the Philippines also found itself in the midst of conflict with the Spanish empire as it approached the close of the Philippine Revolution, a two-year long armed struggle for Philippine sovereignty and independence. Emilio Aguinaldo, the first president of the Philippines and a key architect of the Philippine Revolution, frames this struggle as the inevitable product of centuries of colonial domination, writing:

“Spain maintained control of the Philippine Islands for more than three centuries and a half, during which period the tyranny, misconduct and abuses of the Friars and the Civil and Military Administration exhausted the patience of the natives and caused them to make a desperate effort to shake off the unbearable galling yoke on the 26th and 31st of August, 1896.”^¹

Thus, during the eight month period of overlap between the Philippine Revolution and the Spanish American War, US expansionist ambitions coincided with the Philippine struggle for national liberation, creating a temporary (and brittle) alliance between the two nations.

As Aguinaldo later accounts, the US’s desire to establish a monopoly over Pacific trade routes and labor markets eclipsed any possibility for true Philippine independence from any colonial power. In the final months of the Philippine Revolution and Spanish-American War, “Americans openly commenced hostilities against [Aguinaldo’s army], especially in the respect of the conduct of Admiral Dewey, who, without any reason or justification, one day in the month of October seized all [Philippine] steamers and launches.”^¹ The US’s strategic disarmament of the Philippines at the end of these wars laid important groundwork for the latter’s annexation and, eventually, assimilation into American labor markets.

On December 10, 1898, the Treaty of Paris was signed, ending the Spanish-American War and, importantly, requiring Spain to cede its overseas territories, including the Philippines, to the US for $20 million.^¹ Instead of bringing the independence that Filipinos so desperately fought for two years prior, the US ruled over the Philippines as one of many colonial acquisitions, alongside Puerto Rico and Guam.

four filipino diplomats seated at table with historic document — Filipino diplomats in Paris, France, around the time of the signing the Treaty of Paris, c. 1898-99.

negotiating the spanish american peace treaty — Politicians and military officials — from all appearances, all white — sign the negotiated peace treaty between Spain and the United States, which transferred the Spanish colonial territories of Guam, Puerto Rico, and the Philippines to the US.

The US justified its takeover through the idea of benevolent assimilation, claiming it would simultaneously prevent government collapse and introduce democracy in the Philippines. In reality, this idea served to reveal the truth of American imperial ambitions: to control the Pacific Ocean with their military, gain access to Asian markets, and increase overseas economic expansion.

civilization begins at home political cartoon philippines — A political cartoon satirizing American President William McKinley's policy of "benevolent assimilation." The cartoon mocks McKinley's hypocritical declaration of the United States as a "civilizing influence" over the Philippines, while the curtain of justice reveals the rot of American racism in the background.

On a global scale, the Treaty of Paris was incredibly significant for the US, showing its shift from a somewhat isolated nation to a sprawling overseas imperial power. The Treaty also showed how imperial nations like the US could create extractive political and institutional connections within their new territories. In this broad territorial transfer, the US gave itself clear authority to build systems – including mass educational institutions like nursing schools – that directly served its own political and economic needs following the conclusion of the short but bloody Spanish-American War. As I will explore in my next section, the imperial roots of nursing institutions in the Philippines would shape patterns of migration well beyond the end of US imperial rule in the Pacific.

As a public school student and Filipino-American, I was taught to see the Philippine-US relationship as progressive for the Filipino community, a necessary transition phase from Spanish occupation after the conclusion of the Spanish-American War. However, US education systems often depict imperial power and colonization as development rather than domination to disguise the violence of imperialism in the Philippines.

Viewing this history critically challenges that common nationalist narrative portraying the United States as a benevolent country at the peak of its imperial expansion. By exploring the US’s betrayal of the Philippines during the Spanish-American War and Philippine Revolution, we can understand the reality that benevolent assimilation acted as an excuse to limit Filipino independence and benefit American expansion. This side of history also matters because it helps the Filipino diaspora of the US to understand migration patterns better, including how and why Filipino nurses were positioned to meet US labor demands following the conclusion of the Spanish-American War.

group photo filipino nurses at missionary nurse school — A group portrait of the St. Paul's Hospital nursing school student body, Manila, Philippines, November 1927.

Under the American colonial rule that followed the Spanish-American War and Philippine Revolution, Filipinos were forcibly assimilated into Western traditions, language, and government systems through the importation of American schooling systems. The “benevolent” tool of education served to produce Filipino laborers and citizens that could easily fit into the American economy.

In the early 20th century, the United States established hospitals and nursing schools in the Philippines, such as the Philippine General Hospital School of Nursing. These institutions trained Filipino nurses according to US medical standards, teaching Western medical practices almost entirely in English.

group of nurses observes operating room theater — The senior class at the Philippine General Hospital School of Nursing observes a lesson on operating room techniques, c. 1915-1916.

In addition to building mass training facilities for nurses in the Philippines, the US passed legislation like the Pensionado Act of 1903 to further solidify systems of Americanized Education by Filipinos themselves. The Pensionado Act created a scholarship program for pensionados – literate, educated, and largely upper class Filipinos – to travel to the US to get degrees in government and administration. After receiving American training in the States, pensionados would then return to the Philippines to restructure governmental, educational, and public health institutions in the American image. Many of these pensionados were nursing students, who brought American training and national sympathy back home with them as they founded nursing schools in the Philippines between 1903 and 1940.

Produced by a combination of direct and indirect American presence in the Philippines, this Americanized education system worked to construct a workforce that was both compatible with and portable to US hospitals. In practice, this workforce of American-trained Filipino nurses would be used to fill growing hospital staffing shortages in the US after WWI and WWII, when reduced government funding for hospital staffing left many hospitals severely under-resourced and under-staffed.^¹ The US had a need for nurses, and decided to fill this labor shortage outside of its country borders.

three young filipino nurses and a young boy patient — A Catholic school boy has his ear irrigated by three young nurses at St. Paul's Hospital, Manila, Philippines, October 31, 1927.

In Empire of Care: Nursing and Migration in Filipino American History, historian Catherine Ceniza Choy argues that the process of Americanized nursing education was actually part of a longer tradition of labor extraction from the Philippines to the US.^¹ In fact, the creation and mass export of Filipino nurses was one of many systems put in place after 1898 to train and prepare Filipinos to meet hyper-specific labor demands across the American empire. Filipino farmers were trained and recruited as cheap, expendable agricultural labor in California and Hawaii, for instance, where they were perceived as reliable and trustworthy laborers. This racial archetype of the passive, hard-working, and trustworthy Filipino migrant laborer across many different sectors of the American workforce also paved the way for Filipinos to be seamlessly recruited into US hospitals.^¹

But how did these newly trained Filipino nurses actually come to the US? The Immigration and Nationality Act of 1965, signed by Lyndon B. Johnson, opened many doors to many people from Mexico, India, China, and most importantly, the Philippines.

politicians surrounding LBJ new york skyline in background — President Lyndon B. Johnson signs the Immigration and Nationality Act as Vice President Hubert Humphrey, Lady Bird Johnson, Muriel Humphrey, Sen. Edward (Ted) Kennedy, Sen. Robert F. Kennedy, and others look on.

The Immigration and Nationality Act of 1965 reformed earlier quota systems that limited immigration from non-European countries. Thus, instead of focusing on origins, the law gave opportunities for migrants from previously restricted zones to come to the US, particularly those who could provide “skilled labor.”^¹ This meant that people who were trained in professions like nursing had increased opportunities to receive visa sponsorship.^¹ In this way, immigration policy became even more connected to the American economy, defining which laborers would be prioritized entry based on domestic labor shortages.

law text — The text of the Immigration and Nationality Act of 1965, which abolished immigration quotas and discrimination against national origin.

These policy changes reshaped the Philippine economy in many ways. As more skilled workers left, local hospitals faced shortages, since many trained professionals opted to work abroad and support their families at home.^¹ As a result, the Philippine government started to rely on the remittances that Filipino migrants sent home, which made overseas employment an important part of the national economy. In due course, migration became an expected and in many ways unavoidable pathway for nurses whose Americanized training was deeply tied to the needs of the metropole.

Because Filipino nurses were already educated to American medical standards, this laid the groundwork for mass migration beginning in the late 1960s to the 1980s. Later on, they grew as a vital part of the American healthcare system, continuing to meet labor shortages in the US through the COVID-19 pandemic.

filipino nurses will fill state's shortage — An institutional advertisement, likely from the 1960s-1970s, proclaiming that "Filipino Nurses Will Fill State's Shortage."

This official nursing newspaper is one example of an institutional advertisement in which US hospitals recruited foreign-trained nurses during the 1960s and 1970s. Recruitment advertisements promoted US Visas, wages far higher than the Philippines could offer, and permanent placement in American hospitals.^¹ Because nurses were given significant benefits like higher wages and housing, as well as significant opportunities to sponsor family members, hospital recruitment in the diaspora often resided in family relationships, incentivizing migrants to petition their families to become nurses as well.^¹ These ads did more than offer jobs; they made pathways that connected employment, visas, and long-term settlement in the United States. Thus, early migrants became anchors for their relatives, turning individual recruitment opportunities into chains of family-based migration.

These advertisements also demonstrate how institutional recruiters operated alongside federal immigration pathways such as the Exchange Visitor Program and later employment-based visas (EB-3 category).^¹ By advertising visa access and job opportunities, US hospitals transformed immigration policy into a labor recruitment tool. Filipino nurse migration was not just the result of personal choice, but by hospitals, recruitment agencies, and US immigration systems, all of which were rooted in the history of American imperialism in the Philippines.

there's a job waiting for you — In an ad in the 1969 issue of the Philippine Journal of Nursing, Michael Reese Hospital and Medical Center urges its former exchange visitor nurses from the Philippines to return to the United States for permanent employment. The ad also lists starting salaries, hours, and benefits, including tuition remission and paid travel expenses.

Beyond shaping migration by policy, these recruitment efforts had generational effects within Filipino families. In an interview, Catalino Guzman, a Filipino nurse in my community who works at Lincoln Health Hospital in the Bronx, explains how his migration was shaped by family sponsorship.^¹

Guzman grew up in a small farm of Divisoria in the Philippines and came to NYC in 1996 at age sixteen after his Auntie Greg, who had been inspired by a US nursing recruitment ad in the 1970s (such as the nursing advertisement previously mentioned) and later petitioned his father, eventually enabling the entire family to move. Although he hoped to major in computer science, Kuya Catalino’s experience working in a long-term care facility in the US led him to choose nursing. His story demonstrates that Filipino nurse migration wasn’t driven by advertisements alone, but also by a combination of strong family networks and US immigration policies that were friendly to family sponsorship for Filipino nurses. Earlier generations of overseas Filipino workers often inspired their relatives to migrate, linking family obligation and recruitment.

FM declares martial law headline — Newspaper headlines document Ferdinand Marcos's decision to place the Philippines under martial law in September 1972, allowing Marcos to consolidate his power and form a dictatorship.

In 1972, President Ferdinand Marcos ruled the Philippines as a harsh dictator, incarcerating, torturing, and killing thousands of Filipinos for their civil disobedience.^¹ The regime enforced strict curfews, military checkpoints, and heavy surveillance, setting this daily fear onto its citizens. Many were constantly worried about relatives being detained without warning. Filipinos didn’t only face political abuse and corruption but economic recession as well. The GDP of the Philippines was failing, unemployment rates rose and wages stagnated. However, Marcos ignored this issue; instead, he expanded labor export programs, encouraging workers, particularly trained nurses all around the world. Roughly 20,000 nurses left the Philippines each during the 1970s.^¹

Marcos’ purpose behind the labor export policies was not to actually give these people jobs and a better life. Instead, these labor brokerage programs functioned as an economic strategy to allow overseas Filipino workers to send money to their relatives in the Philippines.^¹ Having said that, much of the wealth was taken by the Marcos regime through state-controlled banks and monopolies, allowing the government to convert migrant earnings into national revenue and political power. This corruption was less about providing opportunity and more about exploiting workers for political control and individual power.

Consequently, Filipino nurses became a vital part of the US healthcare system while also serving as a source of income for their families back home. This policy also deeply impacted the Philippines itself: the large scale of departed nurses weakened local hospitals and increased the country’s dependence on remittances, reinforcing migration as an economic necessity for many Filipino families.^¹

Understanding this history is incredibly meaningful to me because it helped me to understand my own family’s migration story as it connects to the systems that shaped Filipino nurse migration.

My mother, Brenda, works at Flushing Hospital Medical Center and migrated to New York when my father petitioned her after she earned her nursing degree in the Philippines.^¹ Her experience reflects the generational pattern discussed in the previous section: earlier groups of Filipino nurses were drawn to the United States through immigration acts and recruitment ads, while more recent generations migrated through family petitions from relatives. These systems – rooted in complex, multi-generational encounters with US empire – produced a highly skilled yet an expendable workforce of Filipino nurses like my mother. As a result, Filipino nurses became essential to the US healthcare system but were never fully protected, which helps explain why the mortality rates were high during the pandemic.

During the COVID-19 pandemic, Filipino nurses faced disproportionate risks while working on the front lines of American hospitals. Research from the Berkeley Interdisciplinary Migration Initiative found that although Filipino nurses made up only about 4.5% of the US nursing workforce, they accounted for 31.5% of nurse deaths from COVID-19 in late 2020.^¹ This disparity highlights how Filipino nurses were put at risk, more likely to be exposed to the virus while caring for ill patients. Many Filipino nurses also were regularly staffed in higher-risk hospital settings than their white colleagues, such as inpatient and critical care units, placing them directly in contact with COVID-19 patients and increasing their vulnerability during the pandemic.^¹

Advocacy organizations such as Damayan Migrant Workers Association also emphasize the disparity of working conditions among Filipino nurses during the pandemic. In their report “Pandemic Tales,” Damayan describes how, alongside facing long hours and high infection risks, Filipino healthcare workers faced the incredible emotional strain of caring for the ill while worrying about their own families overseas.^¹ Though Filipino healthcare workers were essential to the functioning of New York City hospitals, they were simultaneously and disproportionately unprotected from the physical and emotional tolls of COVID-19.

Journalists covering the pandemic in the New York Times similarly documented how deeply the virus impacted Filipino healthcare communities. In New York City, Filipino nurses routinely faced high-risk exposure to the COVID-19 virus, as they were the first to treat patients in the early stages of the pandemic, when little was known about the proper precautions to take or the proper protections needed to ensure worker wellbeing.^¹ The rate of deaths among Filipino healthcare workers also shocked the larger Filipino community of Little Manila, Woodside, prompting community members to find ways to memorialize the precarious, but essential, work of their parents, neighbors, elders, and friends.

mabuhay floral mural blue and yellow — The Mabuhay mural on 69th Street and Roosevelt Avenue in Queens' “Little Manila." The vibrant mural celebrates Filipino art and culture, while also honoring the many Filipino nurses on the front lines of the COVID-19 pandemic.

The Mabuhay Mural was created on the side of the Amazing Grace Restaurant in a Filipino neighborhood at Woodside, Queens. The Amazing Grace Restaurant was run by the De Leon and Cera families, my family, and all of us helped operate it before COVID-19. The mural was a collective family project. A group of 5 people, including my sister, painted this mural.

In English, “mabuhay” translates to “long live.” The mural was intended to honor the people that died due to COVID-19, especially the Filipino nurses who lost their lives while serving on the front lines.^¹ Their loss affected Filipino communities in New York, where nearly every family knew someone in the healthcare system. By painting the mural in such a prominent space in the Filipino community of Woodside, it turns this memory into a constant reminder to viewers of the human cost behind the essential labor of Filipino nurses during the pandemic.

Filipino nurse migration was shaped by interlocking systems of empire, policy, labor demand, and family networks that developed over more than a century. Learning this history is important because it challenges the idea that particular migration patterns in my diaspora are purely individual decisions. Instead, structural forces emerging from US empire determined who migrated and why – and how their overrepresentation in the healthcare sector resulted in long-term precarity for Filipinos at home and overseas. This history reminds us that the presence of Filipino nurses in American hospitals today is the outcome of a long and complex historical process. At the same time, I hope this history also reminds us of the resilience and awareness of Filipino communities who strive to honor their healthcare workers and preserve their stories.

Ultimately, by understanding these layered histories, we recognize both the sacrifices and the enduring strength of Filipino nurses and their families. And with that recognition, we say Mabuhay to the nurses, to their communities, and to the histories that continue.

Secondary Sources

Abrenica, Clarisse. “Mabuhay Mural Paying Tribute to Front-Line Workers Unveiled in Queens’ Little Manila.” Asian Journal.

Brice, Anne. “Why Are There So Many Filipino Nurses in the U.S.?” Berkeley News, 28 May 2019.

Choy, Catherine Ceniza. Empire of Care: Nursing and Migration in Filipino American History. Duke University Press, 2003.

Choy, Catherine Ceniza. Filipino Nurses in the United States and the COVID-19 Pandemic. Berkeley Interdisciplinary Migration Initiative, 2020.

Choy, Catherine Ceniza. Filipino Nurses in the U.S.: Migration, Labor, and Policy. Berkeley Institute for Migration and Integration, 2020.

“Filipino American Nurses’ Influence on the Profession.” Oncology Nursing Society.

“Filipino and Filipino American Nurses in the United States.” University of Washington School of Nursing.

“FM Declares Martial Law.” Philippines Sunday Express, 24 Sept. 1972.

“From Imperialism to Inpatient Care: Work Differences of Filipino and White Registered Nurses in the United States and Implications for COVID-19.” PubMed.

“Reports.” DAMAYAN Migrant Workers Association, https://www.damayanmigrants.org/reports.

“Resilience and Community: Filipino Americans, Nursing, and COVID-19.” New-York Historical Society.

“Source Country Perceptions, Experiences, and Recommendations Regarding Health Workforce Migration: A Case Study from the Philippines.” Human Resources for Health.

“Treaty of Paris (1783).” American Corner.

United States Congress. Immigration and Nationality Act. U.S. Citizenship and Immigration Services.

YouTube. “Filipino Nurses in the U.S.”

Zimmerman, Jill. “Filipino Nurses, on the Front Lines, Are Dying at an Alarming Rate.” The New York Times, 15 Jan. 2021, https://www.nytimes.com/2021/01/15/nyregion/filipino-nurses-coronavirus.html.

Oral Histories

Cera, Brendalyn. “Oral History with Brendalyn Cera.” Interviewed by Sean Cera, 29 Dec. 2025.

Guzman, Catalino. “Oral History with Catalino Guzman.” Interviewed by Sean Cera, 21 Jan. 2026.