Article in the Colorado Nurses Association newsletter by Armi Earlam

See link to the article in the Colorado Nurses Association Newsletter

Interview with Filipino Nurse Leaders:

Caring for Colorado, the USA, and the Rest of the World

Armi Earlam DNP, MPA, BSN, RN, CWOCN, the current Vice President of the Philippine Nurses Association of Colorado (PNACO), interviewed the following leaders of PNACO:

Edith Pasion MS, RN, CCRN | Founding Member and Advisor

Jisebelle “Jiji” Tizon RN MSN ACNS-BC | PNACO Current President 2020-2022 Carina Madriaga BSN, RN, CCRN-CSC | PNACO Incoming President 2022-2024

Armi’s notes: The Philippines became the first U.S. colony after Spain ceded the islands for $20 million in 1898 after the defeat of Spain in the Spanish-American War. The Philippines was then a colony of Spain. After World War II, the Philippines gained independence from the United States on July 4, 1946. English is one of the official languages of the Philippines. The other official language is called “Filipino”, a standardized version of Tagalog. The Filipinos (and, for that matter, the Filipino nurses educated in the Philippines) are educated using mostly English. Our books are in English and the language we use in our schools is mainly English. Yes, even our government constitution, is written in English and so are our legal contracts and the like.

Armi: Edith, tell us about the founding of the Philippine Nurses Association of Colorado? What were the goals of the association when it was initially established? How have the goals evolved throughout the years?

Edith: Large numbers of Filipino nurses were recruited in the early 1970’s to address the nursing shortage in the United States. Sadly, Filipino nurses were subjected to discriminatory and exploitative practices when we immigrated here. To address these growing concerns for the welfare of the Filipino nurses, the Philippine Nurses Association of America (PNAA) was formally formed in 1979. PNAA is a 501c (6) nonprofit professional nursing organization representing 55 chapters with over 5000 members. The mission of the PNAA is to uphold and foster the positive image of the Filipino American nurses and advocate for their welfare. PNAA is a member of the National Coalition for Ethnic Minority Nurses Association (NCEMNA) and an affiliate member of the American Nurses Association.

As a Philippine-trained nurse, I first worked in Kansas City in 1979 where a large group of Filipino nurses were recruited to staff a local KS hospital. This facility, fortunately, took care of us, giving us ample orientation and supportive mentors, some of them were Filipino nurses of the same background. Transitioning to the American work force was challenging but manageable due to the support and camaraderie among the fellow Filipino nurses.

I met my husband who is also Filipino. His family was family living in Colorado back in 1982. There were very few Filipino nurses in the Metro Denver area at that time. Adjustment to working full time and raising family was difficult. I was the only minority nurse working in the Critical Care Unit. It was challenging and I felt subtle discrimination. I had to prove myself that I belong in this specialized unit. I missed the support and the camaraderie that I had in my previous hospital in Kansas City. It was a difficult time for me, and I wished I had the support of my fellow Filipino nurses like I had before in Kansas City.

Then other Philippine-trained nurses started filling up the Metro Denver hospitals, especially the arrival of Filipino nurses from England. At around this time, I was also introduced to the Philippine Nurses Association of America through my classmate in college. She was a previous President of the organization.

Around 2007, I started gathering small number of Colorado-based Filipino Nurses, who I personally know. Thus, I was able to form the chapter of PNAA in

Colorado. We created our constitution and by-laws with the assistance of the national organization, and we officially became a chapter of the PNAA in 2007. We also applied and was granted a 501c (3) nonprofit organization for our community service and scholarship activities.

Our mission statement read as follows:

1. Promote activities that will unify Filipino-American nurses in Colorado

2. Collaborate with other professional organizations and agencies in Colorado in developing and implementing programs related to nursing practice, education, and research.

3. Participate actively in nursing and health care activities in the community. 

4. Provide scholarship and foster continuing education of its members.

5. Contribute to charitable endeavors in the community

To this day, we are proud to state that the organization continues to meet our mission.

Armi: Jisebelle “Jiji,” you work in an ICU. Please tell us about the heroic acts of the ICU nurses on the frontlines. How do the ICU nurses develop their resilience and keep on serving their patients?

Jiji: Unfortunately, we’re still in the pandemic that no one prepared for or could have ever prepared for, for that matter. In the first surge, I contracted COVID, so I was unavailable for our ICU team. During my leave, I was still able to request for virtual meetings with the administration and our ICU RNs. The meetings provided opportunities where both parties could exchange dialogues about safety, especially around the use of appropriate PPE (personal protective equipment), as we needed to conserve PPEs due to their limited supply. When I came back to work again in the ICU, the nurses voiced out their concerns about limited PPEs and limited patient supplies. They also verbalized their perception of providing suboptimal care due to lack of skilled ICU nurses, leading to hospital acquired infections and pressure injuries.

With cancellations of elective surgeries, the OR nurses and anesthesiologists were assigned to help in the ICU. The anesthesiologists were able to help with intubations, and nurses with proning patients, for example. There were also nurses from other floors (units/departments) who were sent to help. However, due to inadequate or no training at all, they couldn’t effectively help even though they were given an hour-by-hour list of tasks. As a CNS (clinical nurse specialist) by training, I performed a gap analysis by sending a survey to the non- ICU nurses to help identify learning opportunities. The high-priority opportunities they identified were education about the basics of ventilator management, medication administration through enteral feeding tube, and proning and repositioning the ICU patients. With the help of some of our ICU nurses, we were able to create relevant educational objectives, develop a curriculum, and provide classroom and simulated hands-on education.

When we had our 2nd surge in November, nurses felt more prepared, but the number of patients still overwhelmed our staffing. At around this period, the hospital continued providing essential surgeries. By December, our ICU nurses were receiving mental health support per their request. By the end of spring, nurses started to leave for different jobs outside the ICU and there were others who took traveling assignments which offered much higher pay.

As of now, we have gone through 4 COVID surges. Despite our nurses exhibiting continued outstanding resilience, many are experiencing internal struggles. Indeed, it is very concerning – what the future holds for us nurses and what the acute care settings will look like in the coming days, months, and years. At present, we’re taking it day by day and us, nurses, just try to support one another as much as we can.

I think all of us at the bedside are resilient. We wouldn’t be in this profession if we weren’t. What we’re currently dealing with is the acquired moral injury: no matter how hard we work, we’re no longer sure of how much of that makes a difference. Many nurses are experiencing physical and mental exhaustion and at the same time they not feeling the value of the work they provide.

Armi: How did COVID 19 impact the Filipino community?

Carina: COVID-19 impacted my Filipino community in the United States along with the rest of the global population. Psychologically, as part of the Asian- American ethnic group, some of us experienced harassment and attacks that adversely affect our well- being. Some experienced racial discrimination during the COVID-19 outbreak. An example is anti-Chinese speeches given by politicians using different social media platforms and traditional news outlets naming the virus “the Chinese virus.” Use of words like these exacerbates racial tension and promotes racial discrimination. For example, one day, my niece who is lives in California, a second-generation Filipino, arrived home from school very upset. She reported that one of her classmates harassed her in the school campus. She called my niece “Chinese” and said that “she must have the Chinese virus—COVID.” My niece is only eight years old. She is just a little kid. She and other members of the numerous Asian communities in the USA (Chinese, Filipinos, etc.) are not safe from cruel name-calling and harassment.

After the above school incident, her mother, my sister, addressed this issue by talking with my niece informing her that her classmate made a mistake. My sister also stressed that my niece should be proud of her identity as an Asian, and she encouraged her to stay kind. My sister also spoke with the teacher about this horrible event.

In the medical setting, COVID-19 caused overwhelming strain on the Filipino healthcare professionals and the rest of the clinicians and the ancillary staff. In the US, Filipinos overrepresent the nursing profession. Only 1% of the US population are Filipinos and yet 4% of the nurses here are Filipinos. In CA, 20% of the nurses are Filipinos. Filipinos are also disproportionately at risk contracting COVID-19. What increases their risk is that Filipinos are susceptible to also suffer from heart disease, diabetes type II, and asthma. These are the conditions that the Centers for Disease Control and Prevention (CDC) identified as factors that tend to increase the likelihood for hospitalization, needing ventilator support, and death due to COVID-19. Last year, a Colorado-based Filipina nurse I knew died in the hospital after a long fight with COVID. That day caused me overwhelming strain, that I had to excuse myself from work and thus left early before the end of shift.

Armi: What has the community done to help its members?

Carina: The Filipino community does several works to support other Filipinos in the US. Based in California, the Filipino Workers Center supplies money, food, and yes, give hope to Filipinos living in the US. In Los Angeles, they even assist with temporary housing so that the healthcare workers could live away, even for a short while, from their families as these ill workers recover from COVID-19.

A local non-profit group in Colorado, Filipino American Association of Colorado (FACC), run by Filipino Americans, had been offering COVID-19 vaccinations since March 2021. They even offer food to encourage the members of the community to come in and get their vaccine. This upcoming event is on October 3, 2021: FACC will provide on-site services such as blood pressure checks, Hemoglobin A1C, COVID-19 immunization, and flu shots, among other screenings and relevant health services. This health outreach will be held in Edgewater, Colorado. Members of the Philippine Nurse’s Association of Colorado (PNACO) will also participate in the activities of this event.

Armi: How does PNACO help the local Colorado communities? How does it help its members?

Carina: On another date, October 16, 2021, PNACO will host a Health Fair in partnership with the Asian Health Equity Practice (AHEP). We will give free flu shots, provide lab tests such as HbA1C for diabetes, and personalized health teachings. In this event, individuals can speak to nurses about their tests and screening.

Earlier this year, PNACO members raised funds to benefit a few of the Filipino families in Colorado affected by COVID-19 through a virtual BINGO game. PNACO members also created and sold hand-painted greeting cards.

Our parent organization, the Philippine Nurses Association of America (PNAA), offers virtual meetings, conventions, education, and links to members on its Facebook page and website with the goal of supporting and teaching the community about COVID-19. Other topics covered also included training in resiliency. Please check mypnaa.org for more information.

Edith: PNACO also provides scholarships for Filipino nurses and nursing students. We also have service projects/community outreach programs, and we participate in Colorado health fairs. We also take part in local nursing events such as the Nursing Collaborative where one of our leaders, well, you, Armi were invited as a speaker. So we educate and mentor other nurses as part of our service to the community.

How can Coloradans know more about PNACO and how can the public help support your organization? Edith: St. Gabriel’s Episcopal Church located in Cherry Hills Village, Colorado hosts some of PNACO’s events. Crosswinds Church in Aurora is also hosting one of our health fairs. Collaborating with local non- profit organizations who allow us to use their halls as venues for our events help us a lot, too.

Carina: I would like to invite nurses and everyone in Colorado and in the USA, to join us and support our efforts to help the community. Please check our website, pnaco.org. Find the “Join PNACO” link for more information, for the nurses who wish to join our organization. We would like to have more nurses and other healthcare professionals become members of our group. As the saying goes, “There is strength in numbers.”

One way for the public to support our fundraising is by supporting our “helping heART” project. They can buy our hand-painted cards online or directly from The Gift House in Belmar, Colorado. For more news and announcements from PNACO, please visit pnaco2005.blogspot.com/.

Carina, Edith, and Jiji, thank you very much for your time. Thank you for sharing this valuable information about PNACO and about the wonderful work of the Filipino nurses here in the USA. November 2021