By Lucy Fisher, RN, PhD
After several years as a supervisor in a large California nursing home, I decided to return to graduate school for a PhD in nursing. I knew my dissertation would center on CNAs, for although aides have the least power and authority within the nursing hierarchy, they are the staff making a difference in residents’ lives. I did my field work in three homes: a large county-owned institution, one that was part of a national chain, and a small, Christian-affiliated home. One was located in the center of a large city, another in a suburb, and the third in a wealthy town. Although these homes differed in size, location and ownership, the great majority (89%) of research participants were immigrants. Most, but not all, were women, and most, but not all, came from the Philippines.
The immigrant experience, as Lolita Lledo wrote on April 26, is “rarely discussed.” I’d like to invite discussion about three issues that foreign-born workers in my study spoke about. These topics are separation from family, racism and legal status, and change in job status.
Family separation weaves though the back stories of many of the workers, even those who have been in the US for years. When I asked about work hours, CNAs told me they held two or sometimes three jobs to send money “home” to their extended families. This telling often included a story of loss. A young man said he immigrated to support his family in Mexico but was saddened by not being able to watch his young children grow. He said he only talks to his family about “happy things” because he doesn’t want them to worry. A Filipina began crying when she spoke about her father’s funeral. “I’m still new here when that happened”, she said, and didn’t want to go home and jeopardize retaining her job. Another Filipina said she was proud to support a niece through nursing school but couldn’t afford a plane ticket to see her graduate. Separation from family is a consequence of immigration. Whether coming alone or with members of the immediate family, immigrants leave others in the home country. Fathers and mothers miss the daily rewards of raising children, and participation in life markers such as graduations and funerals may not be possible.
A second theme is racism and legal status. Particular CNAs spoke of overt and subtle comments from American-born residents and families, believing they were singled out because of their accented English. Examples of these ranged from “Asian girls, go back to your country – where did you learn to speak English?” to questions about “having papers” or sponsorship. Foreign-born CNAs brought up feelings of pain, anger and embarrassment about being made to feel different or unwelcome. These statements were particularly stinging, as CNAs said their job was to care for others but the relationship wasn’t reciprocated.
The third issue is a change in job status from a position in the home country. A former high school teacher from a small town in the Philippines said she tells her “colleagues” there that she’s a nurse’s aide and takes vital signs. “I don’t tell them I do this” she told me as she changed a resident’s diaper. Other CNAs with training in nursing, engineering and architecture said they derived considerable personal satisfaction from doing hands-on work for the elderly and disabled. They stated that because of the opportunity to be a meaningful part of others’ everyday lives, they would remain in the care giving role. Whether the job as a CNA is framed as a step-down from a former position or a role that enhanced their lives and others, immigrant workers are confronted with personal decisions and identities often different from native-born workers.
DCA has gathered statistics on the growing need for direct care workers. Although exact numbers of immigrants working as care givers is difficult to determine, they clearly comprise a large part of the workforce. Interest in their situation and knowledge of their concerns will assist nursing home leaders, policy-makers, and labor advocates create systems and policies which include the needs of foreign-born workers.
Dr. Fisher’s work reflects many of the observations and data collected by my organization. Is there a way to contact her? My contact info is included in my name above.
I would add one other feature to this discussion. In the residential settings in which I work, (group homes for developmentally disabled adults and emotionally disturbed children), the staffing often includes persons who have immigrated to this country. It seems especially difficult for some of the men to adapt to the job situation. They are often uncomfortable accepting direction from a female supervisor or doing housekeeping and meal prep chores. Again, I think this is an area which requires more open and honest discussion. Thanks for getting it started.
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