Nurses have a significant role to play in our healthcare system, and this role has been amplified due to the pandemic...
A field serviced by traditionally oppressed populations, such as people of colour and women, it is important to recognize and learn from the work that has been done by nurses in a historical and present context. This piece will reflect on the history of nursing in a Canadian and American perspective, as well as the current climate for nursing in the COVID-19 pandemic.
It must first be acknowledged that nursing history does not begin with European colonizers in Canada. It truly begins with the Indigenous Peoples who lived here long before anyone else. We, as a country, must do a better job recognizing the history of Indigenous Peoples. Pre-Colonization, Indigenous Peoples had their own healthcare systems with practitioners such as healers and midwives, who supported the health of their communities. Their knowledge of plants and their medicinal uses allowed them to treat ailments successfully. Records show Indigenous caregivers had cures for ailments colonizers lacked, such as dysentery, which they shared with early colonizers. Regrettably, Indigenous Peoples lost their ability to practice their own culture and health practices at the hands of colonizers. Colonizers suppressed Indigenous culture through residential schools, racist government policies, and attempting to assimilate Indigenous Peoples into colonizer ways of living. Indigenous healers lost the ability to practice their own medicine and were largely barred from entering nurse training schools until the 1930s. Indigenous Peoples’ culture and their healthcare practices have been routinely ignored when presenting the history of nursing in Canada, while the emphasis was placed on colonizers' contributions. We must acknowledge the Indigenous, their practices, and how they have been ignored and oppressed by colonizers. There is no accurate history of the origins of nursing without including the practices of Indigenous Peoples.
Subsequent nursing was primarily fulfilled by nuns who owned and ran hospitals, opening extensive networks across Canada to meet medical needs. These religious women ran non-profit hospitals and maintained a high level of autonomy, serving as architects, business women, and healers. Reports from the 1820s tell of a Mother Joseph from Quebec, who took up carpentry and lived on construction sites around North America to help build hospitals. These hospitals prioritized their mission above profit, helping to set early precedents of medical caregiving. The nursing profession, as it is now known, came from Englishwoman Florence Nightingale’s efforts in the 1850s, after witnessing medical conditions of soldiers in the Crimean War. Her approach shifted nursing to focus on treatment and therapy and introduced sophisticated apprenticeship and training for nurses. Worldwide, this shifted attitudes of nursing towards being seen as a respectable position for young women and correlated with middle-class patients being willing to pay for healthcare in hospitals. This went hand-in-hand with a shift in the role of hospitals, moving from places of “mental asylums” and end-of-life care to reputable places for anyone seeking medical care. This formed the basis of modern nursing training and care systems.
This brings us to World War II, where over 4000 female nurses provided care to wounded soldiers on behalf of the Canadian Armed Forces. During their time as “Nursing Sisters”, they utilized the positions that they held. With more responsibility, they were able to obtain new skills and take on new roles they otherwise would not get. This environment had fewer skilled personnel and thus taking risks was acceptable due to the conditions of war. The Nursing Sisters were able to hone their skills and gain experiences others would never gain if not for being at war. However, the increase in autonomy and duties were only “for the duration” of the war. War presented a time of growth for healthcare institutions and practices, and was also seemingly present for nurses. The autonomy and risk-taking that was promoted during the war allowed female nurses to develop their skills in an environment they would likely never see again. When they left the war, they were able to pass these skills on to future colonizer nurses. Today, Canadian nurses are distinguished around the world, with some of the highest educational requirements and standards. This is due to the fact that unlike other countries, Canada requires nurses to obtain a Bachelor in Nursing to become a Registered Nurse (RN).
Looking at the nursing landscape today, it is important to recognize Black, Indigenous, and people-of-colour (BIPOC) healthcare workers and their contributions to the field. A significant amount of BIPOC nursing history goes unrecognized due to systemic discrimination against the community. In America, Filipino-Americans are one of the largest immigrant populations within the nursing field. They represent 28% of American immigrant nurses as found by the Migration Policy Institute. This statistic is likely to leave out 2nd and 3rd generation Filipino Americans, so it is possible that the percentage is even higher. America’s colonization of the Philippines may have contributed to the rise in Filipino nurses in America; and when the USA experienced a shortage of nurses, they brought more Filipino nurses into their healthcare facilities. UC Berkeley Professor, Catherine Cenzia Choy, doubted this was the full picture and began her research into why there were so many Filipino nurses in America. During the colonization of the Philippines by the USA in 1898, American nursing programs were implemented throughout the country. Choy found that these nursing programs had central themes of Euro-American ideologies, bringing Christianity and “civilization” to the Philippines. Essentially, the US nursing schools were used to teach American studies and values to the Filipino students in an attempt to “civilize” the population. The first influx of nurses came through the Exchange Visitor Program in 1948. As an effort to spread American values during the Cold War, this two-year program allowed individuals from other countries to live, work, and learn in the USA. The goal was that when they were finished, they would go home to the Philippines and share their new American education and values. As Filipino nurses were already educated under American ways from the nursing programs that had been implemented at the beginning of colonization, many migrated to the country to live and practice. The next major influx was in 1965, when the Immigration and Nationality Act was passed. This allowed even more Filipino nurses to come to America, and they were heavily recruited when there was a shortage of nurses during WWII. Even today, these trends continue with Filipino immigrants and subsequent generations, forming an integral part of the healthcare workforce.
Canadian-Filipino nurses also have a concerning history. Due to a shortage in caregivers, Filipino trained nurses were brought to Canada under the Live-in Caregiver Program. However, this program exploited these nurses for cheap labour and made them work as full-time caregivers and nannies, as opposed to nurses. Filipino nurses that desired to immigrate to Canada were forced to take this route because the Citizenship and Immigration Canada point system does not give credit for being a nurse (professions are supposedly plentiful in Canada). The Live-in Caregiver Program presents itself as an opportunity for skilled workers to leave their poor conditions at home and gain citizenship in a first-world country. However, these workers can be making little income while working very long hours. In reality, they can work up to 24 hours a day while only being compensated for a fraction of the time. Many factors continue to contribute to the immigration of Filipino nurses to Canada today, including cultural and economic factors.
The reason to highlight some parts of nursing history is because it is a field served by people who routinely face injustice - women, especially women of colour. Unfortunately, Filipino-American nurses are disproportionately impacted by COVID-19 on the frontlines. In America, over 193 RNs have died from COVID-19, and 30% of these deaths have been Filipino-American nurses. This is disturbing when National Nurses United (NNU) reports 4% of all nurses are Filipino. While it is still unclear why this is occurring, Zenei Cortez (President of NNU and the California Nurses Association) believes there are multiple factors that are contributing. Specifically, there has been a lack of testing for frontline workers, as well as lack of access to personal protective equipment (PPE). As a group, Asian-Americans appear to have the least coronavirus infections, but this generalization misrepresents the experience of Filipino-Americans. Filipino-Americans are more likely than any other group to be working in healthcare services and tend to live in multi-generational households, increasing risk of transmission. This trend is not exclusive to the US. In Canada, frontline workers are dealing with lack of access to PPE. Debbie Dul Mundo, a Filipino-Canadian nurse in Toronto, is given approximately 20 masks for a week, or 2 masks per day. This lack of PPE has been a sentiment seen across Ontario. Nearly 17% of all COVID-19 cases have been in healthcare staff, and when the Canadian Union of Public Employees and Ontario Council of Hospital Unions polled 3000 workers, 97% felt there was a lack of access to PPE on the frontlines of their work. For communities that provide such an essential service and sacrifice so much to do so, it is outrageous that they are facing such unsafe workplaces, insufficient pay, and lack of support.
The history of nursing in both Canada and America are not linear. Both have complex pasts that involve Euro-centered populations colonizing groups of people who they deemed needed to be “civilized” with their religious values. Despite these damaging practices, Filipino and Indigenous Peoples continue to remain strong in terms of their culture and identities. They continue to work as frontline healthcare workers, supporting the health of their populations in the face of extreme difficulties. It is as vital as ever that we remember and recognize the sacrifices made by nurses and healthcare staff throughout history and the present.
We wish to acknowledge this land on which the University of Toronto operates. For thousands of years it has been the traditional land of the Huron-Wendat, the Seneca, and most recently, the Mississaugas of the Credit River. We want to recognize that this land is home to many Indigenous Peoples from across Turtle Island and we are grateful to have the opportunity to work on this land.
Podcast on Filipino Nursing
1. Benoit, C., & Carroll, D. (2005). Canadian midwifery: Blending traditional and modern practices. In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 27-41). Ottawa: University of Ottawa Press.
2. Ronquillo, C., Boschma, G., Wong, S. T., & Quiney, L. (2011). Beyond greener pastures: exploring contexts surrounding Filipino nurse migration in Canada through oral history. Nursing inquiry, 18(3), 262-275.
3. Toman, Cynthia (2007). "Front Lines and Frontiers: War as Legitimate Work for Nurses, 1939-1945". Social History/Histoire Sociale. 40 (79): 45–74.
- Written by Saloni Gupta and Olivia Earl, edited by Jerry Li