I am writing in response to Eseta Finau’s recent opinion piece arguing that young Pacific migrants are not the solution for aged care staffing.

I strongly support our Pacific colleagues’ outcry for respect for Pacific nurses, safe staffing, and increased investment in nursing workforce development and retention.

I also share my colleague’s opinion that the World Bank report – suggesting attracting young and unemployed workers from the Pacific as a solution to Australia and New Zealand’s aged care worker shortage– is short-sighted. In fact, I view it as rife with neoliberal arrogance.

While I do not agree with the statement that “In New Zealand, aged care workers often have poor wages and conditions so the workforce is mostly made up of skilled migrants who are willing to work for lower pay in their struggle to get by …”, my respect for our Pacific colleagues remain strong.

On migrant nurses working in aged care settings

The Nursing Council of New Zealand’s 2017 workforce profile showed that for Filipino migrants alone there were 1,371 Filipino nurses working in rest home/residential care settings.

This is less than half the number of Filipino nurses who worked in acute care, private hospital, community and various other settings in 2016-17 which totalled nearly 3000. However, it is worth noting that internationally qualified nurses – including Filipinos – are placed in aged care settings during the competency assessment process they undertake to register as a nurse in New Zealand. How this affects their future employment is an area that requires research.

It is also worth noting that nurses migrate for various reasons – like social, cultural and professional – apart from economic reasons1. There is no evidence to support the idea that migrants are out to get the jobs of domestic workers or that migrants will cause domestic wages to drop1. While some studies state that the wage of domestic workersin the area of unskilled labour may be modestly lowered by the influx of immigrants2,3, this, however, is not true for nursing which is a highly skilled profession.

Labour export policy, neocolonialism and nurse migration

Historical colonial ties is one of the strongest predictors of nurse migration from developing countries4.

An important factor for the Filipinos alone is that universities and colleges of nursing educate students in the language of their colonial masters so English is the medium of instruction. Text books and other teaching tools are mostly published by American publishers, and the entire public school system itself is patterned after the American public school system.

Permanent overseas migration was a trend in the Philippines prior to 1970. However, this was replaced by the larger temporary labour migration that started in the 70s and continues up to this day as perpetrated by a labour export policy that started during the reign of deposed Philippine dictator Ferdinand Marcos. To further embed labour export as a state policy, recruitment was liberalised in the 1990s to aggressively channel foreign exchange income through the efforts of licensed agencies5.

In 2009, the Philippine legislature passed a labour export bill which aimed to actively promote overseas employment to boost national income. The bill was developed cognisant of the local economy’s failure to sustain population needs, while highlighting the role of overseas Filipino workers in keeping the national income afloat.

This law supports the agreement between ASEAN countries, signed three years earlier by the government,which eliminates the restrictions to trade-in services amongst ASEAN member countries and expands the depth and scope of liberalising trade-in services including nursing service6. These laws were followed by other laws that further entrenched Philippine labour export policy to this day.

Behind the aggressive stance of governments to export labour isneoliberal globalisation and its promoters7.The World Bank itself promotes migration and labour export to generate remittances for the Pacific, the Philippines and other developing countries as a way to repay its debts.

Choosing aged care nursing should be personal choice

Pursuing aged care nursing as a specialty in New Zealand should be done out of free-will. While there are numerous nurses who choose aged care nursing out of interest, innate respect for older people and their values, this specialty should not be treated less than any other nursing specialty.

Migrant nurses should be given an opportunity to choose an area of clinical placement that suits their interest or fits their previous work experience. They should not be forced to go into clinical placements in aged care settings because there is no other option.

Migrant nurses’ personal autonomy should be respected and all parties involved in recruitment should practice transparency and accountability (especially in the areas of clinical placement, competency assessment and job placement). The principles of fairness, mutual benefit and reciprocity should be demonstrated in the recruitment process and its outcomes; and a programme for workplace and cultural integration for migrant nurses should also be put in place.

Increase workforce investment in aged care nursing

Workforce planning to address shortages in aged care nurses should focus on how to make the work enticing for those who have the innate love of caring for older people and those who may be positively challenged by caring for older people. The workforce should also reflect the diversity of the population it serves.

For Pacific, migrant and Kiwi nurses, this would mean not only better pay and a safe and healthy work environment, but also equitable workplace practices where they feel respected and supported. Indeed, aged care nursing deserves more investment in workforce planning, development and retention to improve health outcomes for a growing and ageing population.

Author: Monina Hernandez, RN, RM, BSN MNur (Hons) is the president of the Filipino Nurses Association of New Zealand and a lecturer at the School of Nursing, Massey University.


  1. Hernandez M (2017).Migrant nursesdon’t affect domestic nurses’ wages. Kai Tiaki Nursing New Zealand, 23(4), 26-27.
  2. McGovern P (2007).Immigration, Labour Markets and Employment Relations: Problems and Prospects. British Journal of Industrial Relations, 45(2), 217-235. doi:10.1111/j.1467-8543.2007.00612.x
  3. Ottaviano G & Peri G. (2012). Rethinking the Effect of Immigration on Wages. Journal of the European Economic Association, 10(1), 152-197. doi:http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291542-4774/issues
  4. Rondeau, Kent.“Global Migration of Nurses from Sub-Saharan Africa: Human Capital Development and Neocolonial Perspectives – Forging an Ethical Framework.” Humanistic perspectives on international business and management, edited byNathaniel C. Lupton and Michael Pirson, Palgrave Macmillan, 2014. pp.39-54.
  5. Executive order no. 450.(1991).https://www.lawphil.net/executive/execord/eo1991/eo_450_1991.html Retrieved August 26, 2018.
  6. Professional Regulation Commission(n.d.) ASEAN MRA. Retrieved from *https://www.prc.gov.ph/asean-mra
  7. IBON (2009).“Declining OFW Remittances.” IBON Facts and Figures – Special Release, 32(14), p. 31.


  1. A very well-written piece, truly deserving of a place in textbooks. But let me tell you something that will never be written in books or taught in nursing schools. Let me tell you something practical, something honest. Something that will stay in your head for the next 10 weeks.

    The truth of the matter is that Filipino nurses became nurses for one reason alone – they want to escape the grinding poverty in the Philippines. Have you ever met a Pinoy nurse who dreamed of becoming a nurse since they were 5 years old? Have you ever seen a Pinoy nurse who wakes up every morning and can’t wait to scrub feces-soiled beds? Have you ever heard of a Pinoy nurse who is so excited to work in understaffed wards and expose themselves to AIDS or Hepatitis? Have you ever heard of a Pinoy nurse who enjoys attending to violent patients and loves being screamed at by families?

    Probably not, because most of us never dreamed of wiping bums for a living or being bullied into depression by senior co-workers. Most of us had ambitions of belonging to respectable professions such as being an accountant, an engineer, or a lawyer perhaps. It’s just so unfortunate that most of us Pinoy nurses were so sold out on a dream, believing that nursing can give us a better life. It may be a better country but it is not a better life, and no amount of editorial sugarcoating can hide this fact.

    My raw opinions come from personal experience and that of my colleagues, armed with the knowledge that nurses are now starting to speak up about the real horrors of the job and how they are expected to accept it as part of the profession. The poor, poor nurses. It is probably safe to say that Nursing is among the worst professions in the world, as supported by reports from international news agencies. It is physically dangerous and it is a psychological hazard at the same time. The sorry state of nurses all over the world is proof that nurses may as well sit at the very bottom of the labor food chain: overworked, understaffed, disrespected, exposed to workplace violence, low pay and the inherent culture of bullying – will all point out that Filipinos were pushed into becoming nurses because no one in the Western world would want this job because it is yuck. No wonder the global nursing shortage remains unresolved for decades because no one in their right mind would really ever want this job. And as a nurse myself, I will never wish upon anyone to become a nurse. My only wish is that I should’ve done further research before entering nursing school back home in the Philippines, and that I should’ve had the courage to go against the grain. Parents, relatives, friends and almost everyone in the country expects you to take up nursing, believing that it can bring economic rewards. Economic rewards? The recent strikes in NZ, UK, Ireland, Canada, Australia, and pretty much everywhere else has proven to be a slap in the face. Money can never buy peace of mind.

    You don’t need a PhD to come to terms with reality.

    Hypocrisy disgusts me. There is simply no substitute for truth.


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