As a young girl in India, Sheba George was just 10 years old when she tearfully bid her mother good-bye at the Bangalore airport. Her mother was leaving behind her husband and three young children to find work as a nurse in the United States, and George would not see her again for two years. Eventually, George’s mother sent back enough money to have the rest of the family join her, but George recalls that when her mother left, I felt my heart breaking, and I remember that I could not stop crying.
The George family reunited in Chicago, and eventually settled in Los Angeles. Chicago was too cold for my parents, George says. We came out to visit friends in California and see Disneyland, and ended up living here.
While not a nurse herself, George has lived among nurses her entire life. My mother, several of my aunts, the mothers of many friends, and now a new generation of cousins and friends, are nurses, says George, who earned three degrees in sociology: a Bachelor of Arts from Pomona College in Claremont, Calif. in 1988, a Master of Arts from the University of California, Berkeley in 1992, and a PhD from UC Berkeley in 2001.
Her childhood experience and her family’s post-immigration transition have given George a unique insight into the immigration phenomenon and influenced her choice of life work. It helped me connect and realize it was not just my experience alone, says George, now an assistant professor at the Biomedical Research Center at Charles Drew University of Medicine and Science in Los Angeles. It was part of a much larger movement.
Immigrants’ ChallengesSheba George
In her doctoral research, George carried out an ethnographic study, field work in which she examined the experiences of Christian Indian nurses in the state of Kerala, India from 1994 to 1997. Just as in her family, the women immigrated to the United States first, getting established in jobs, and then bringing their families over.
This was, in itself, a huge challenge for these nurses who came from a society where traditionally women do not tend to travel alone, particularly to faraway lands to establish themselves as breadwinners, George says. She described tensions that arose between couples as the husbands were forced to take lower-status jobs in the United States relative to their RN wives.
In her research, which resulted in the book When Women Come First: Gender and Class in Transnational Migration (University of California Press, 2005), George found Indian nurses faced multiple challenges. From language comprehension difficulties and differences in curriculum and test-taking formats to prohibitively expensive costs for preparatory classes and the taking of licensing exams, the nurses faced many logistical and substantive hardships in passing their board exams, George says.
Before passing board exams, many women George interviewed spoke of a racialized division of labor and being relegated to work as nurses’ aides with other minority women. Even after passing board exams, they were more likely to be recruited to inner-city hospitals and to positions American-trained nurses had passed over. Immigrant nurses faced discrimination from patients, doctors, and hospital administration, as well as from their peers, George says. Many of the nurses spoke of their experiences of being rejected by patients who asked outright for ‘white nurses.’
George believes the U.S. workforce has grown more diverse — racially, linguistically, culturally, and nationally. The issues I have discussed touch upon the unspoken burdens often carried by this global workforce, she says.
She suggests there be comprehensive and standardized orientation programs to integrate foreign-trained nurses into their work settings, and that healthcare organizations that employ such workers educate their patients, administrators, and others about the qualifications and competencies of foreign-trained nurses.
With foreignness comes the questioning of qualifications and credentials and the implication that nurses from other countries may bring down the professional nursing standards of the host country, George says. Yet recent U.S. census data show immigrant nurses have, on average, higher educational levels than their U.S.-born counterparts and the technical qualifications necessary to do the job.
There was a positive side to George’s research as well. Despite numerous difficulties, many of the women were empowered by their nursing positions in the United States and spoke of total patient care and opportunities that had not been available in India. As patient care managers, as teachers, as students, and as consultants, immigrant nurses talked about how they were able to practice their profession in new and varied ways, George says.