Notes on Ethnic Studies: What It Is and What It Offers to the History of Nursing

Although attention to race, class, and gender have long been part of the social history framework, the Nursing History Review has renewed its interest in centering narratives of people of color.1 Recent issues of the journal are the first to contain a new section entitled “Hidden in Plain Sight,” inspired in part by 20th Century Fox’s 2016 film Hidden Figures. This special section attempts to “highlight a wide variety of racially and ethnically diverse nurses who have long been overlooked.”2 Finding nurses of color whose roles in history have been overlooked or ignored is important. However, beyond a more inclusive history, historians of nursing can also pursue a more critical one—a history of nursing that examines why these nurses were hidden in the profession and in historical scholarship. Historians of nursing can formulate more analytical questions about how nursing has shaped and intersected with nurses’ race and ethnicity.Therefore, the purpose of this article is to acquaint historians of nursing with a particular field of study that can help in this regard, namely the field of ethnic studies. Ethnic studies is the study of race and ethnicity, as well as indigeneity and nationality. An interdisciplinary field, ethnic studies draws on history as well as other disciplines in the social sciences and the humanities. As this article will explore, the field grew in the United States in the 1960s from coalitions of students demanding a more analytical approach to understanding the experiences of Black and African Americans, Indigenous Americans, Latina/o Americans, and Asian Americans. In centering the perspectives of the racialized communities that it studies, the field explores themes such as identity, belonging, resistance, inequality, and exclusion.3This article underscores the fact that ethnic studies as a field has existed and grown over the past five decades. Yet it would be wrong to claim that the history of nursing has been totally devoid of these perspectives.4 Classic work by Darlene Clark Hine as well as more recent work by Charissa Threat have documented the experiences of Black and African American nurses. Karen Flynn has written about Black Caribbean nurses in Canada. Sujani Reddy’s work traces Indian nurse migration to the United States. Scholarship by Phoebe Pollitt, Jim Kristofic, as well as Barbara Charbonneau-Dahlen and Karine Crow has also added perspectives from Indigenous Americans to the social history of nursing. Catherine Ceniza Choy and Barbara L. Brush, whose work I will compare in this article, have written about Filipino nurse migration to the United States. However, historians of nursing must still familiarize themselves with the broader literature in ethnic studies in order to deepen their discussions about race and ethnicity.Additionally, an engagement with ethnic studies would help historians of nursing to recognize the work that other scholars have already contributed. In other fields of nursing and health-equity research, credit has not always been given where it has been due. In 2020, the murder of George Floyd in Minnesota as well as the racial health disparities that came to light during the early months of the 2019 coronavirus pandemic brought a renewed commitment to understanding and addressing systemic racism. As a result, healthcare research institutions announced new funding priorities to support researchers in elucidating the effects of structural racism on health outcomes. However, longtime health-equity researchers noticed a disturbing trend—other healthcare researchers were capitalizing on these new funding streams and on calls for papers on racism despite little background in structural racism or health-equity research.5 For historians of nursing, this introduction to ethnic studies may prevent them from similar forays into writing histories of racialized groups without due attention to the scholarship that already exists about nurses, caregivers, and patients of color.6First, I will sketch more background about the development of ethnic studies and its origins in the San Francisco Bay Area in California in the 1960s. Then, as an example for the history of nursing, I will focus on Asian American and Filipino American history and juxtapose the work of two different historians: historian and ethnic studies scholar Catherine Ceniza Choy and nursing researcher Barbara L. Brush. Both of them have produced historical work that has been foundational to understanding Filipino nurse migration to the United States. Together they provide an opportunity to compare the commitments of ethnic studies to those of the history of nursing. Finally, I will describe ways that historians of nursing can draw from ethnic studies to ask new questions about race and ethnicity, to expand the social history of nursing and blend in questions from political and labor history, to utilize more complex conceptualizations of culture, to recognize the diversity of experiences and beliefs within racialized groups, and to challenge overgeneralizations and stereotypes about these groups.The field of ethnic studies started in the San Francisco Bay Area in California in the 1960s.7 The first formal programs for ethnic studies were established at San Francisco State College (now San Francisco State University). At San Francisco State and the University of California, Berkeley, student movements joined together as the Third World Liberation Front, a coalition of student groups representing the Black Student Union, the Latin American Student Organization, the Mexican American Student Confederation, the Asian American Political Alliance, Intercollegiate Chinese for Social Action, and the Pilipino American Collegiate Endeavor.8 These movements would advocate for what would become, in various universities, African American studies, American Indian studies, Asian American studies, and Latina/o/x studies.For Asian American identity formation, the ethnic studies movement was crucial. In fact, the term “Asian American” emerged at this time. Articulated by historian Yuji Ichioka, the term became a way to describe and unite Asians in the United States.9 Historian Madeline Hsu characterizes the ethnic studies movement as a thread in broader Asian American movements that sought to display the actions of Asian Americans as part of mainstream American culture and politics, not simply as a niche population.10At San Francisco State, the coalition demanded an independent School of Third World Studies—an entire administrative unit on equal footing with other schools in the college. The coalition circulated ideas for courses in topics such as “Introductory Ancient Pilipino History” and language classes such as “Introductory Pilipino,” as well as African American literature and social science courses on African Americans and institutions.11 Students and faculty drafted syllabi and curricula to teach ethnic studies, with curricula based on self-determination and centered on their perspectives. To voice their demands, the coalition boycotted classes and formed picket lines throughout campus. One of the longest student strikes in the United States, the protest by the coalition lasted from November 1968 through March 1969.12 As a result, in 1969, San Francisco State established a School of Ethnic Studies. Similar programs and departments were established at UC Berkeley, as well as the University of California, Los Angeles, and the University of Hawai’i at Mānoa.13Today, these programs still exist—while at other universities, smaller programs have faced institutional challenges—and their missions still emphasize similar commitments to self-determination and community empowerment. The information online for San Francisco State’s College of Ethnic Studies describes the field as one that “redefines the lives of people of color from their own perspectives.”14 Additionally, the coursework and faculty “critically inform [students’] professional and vocational skills in areas such as business, social welfare, law, and medicine.” Nurses and historians of nursing can follow the same critical perspective that ethnic studies offers, a perspective that has also been applied to examine the historical question of why numerous Filipino nurses have migrated to the United States.15According to the U.S. Census Bureau’s American Community Survey, approximately 5 percent of all registered nurses in the United States in 2018 were of Filipino descent—including first-generation Filipino immigrants, second-generation Filipino American children, as well as people with mixed Filipino heritage.16 Many nurses from the Philippines come to the United States to work; many of them stay as permanent residents of the United States, while others also become naturalized citizens. The National Council Licensure Examination, the licensure examination for registered nurses in the United States, has been offered outside of the United States since 2005. The first time it was offered in the Philippines was in 2007. Of all the internationally-educated nursing candidates who took the examination in 2020, close to half of all candidates (47.4 percent) were from the Philippines.17 The 2019 coronavirus pandemic has brought renewed attention to the presence of Filipino nurses in the United States, but for an unfortunate reason. During the first waves of the hospitalizations and deaths during the pandemic in April 2020, Filipinos represented an outsized proportion of healthcare worker deaths.18 Later in 2021, as healthcare systems such as the Henry Ford Health System in Michigan reported nursing shortages, they recruited nurses internationally from the Philippines.19Filipino nurse migration to the United States has been part of the historiography of American nursing for the past three decades. The works of two particular historians provide an opportunity to compare an ethnic studies approach to a nursing history approach. Historian and ethnic studies scholar Catherine Ceniza Choy published her book Empire of Care in 2003.20 It won the book award from the Association for Asian American Studies. It also gained honors from nursing, too, having won the American Journal of Nursing’s Book of the Year Award. In addition, nursing researcher Barbara L. Brush completed her dissertation on Filipino nurse migration in 1994 and published several articles through 2010 about the recruitment of nurses from the Philippines.21 These articles appeared in the Nursing History Review and other nursing journals. Other coauthored articles were published in the American Journal of Public Health and the health-policy journal Health Affairs.Both Choy and Brush link current patterns of nurse migration from the Philippines to the United States’ control of the Philippines at the end of the Spanish-American War in 1898. Choy traces Filipino nurse migration back to the United States’ colonial influence in the islands in order to question the idea that Asian professional migration is actually a more recent phenomenon. She cites scholars who characterize the migration as a “post-1965” trend, after the passing of the United States’ 1965 Immigration and Nationality Act.22 The 1965 immigration reform law ended the United States’ previous National Origins Quota System, in which visas were limited by country, privileging Northern and Western European countries and restricting immigration from Africa and Asia. Instead, the 1965 reform created visa categories available to various types of laborers, including skilled, professional, and “unskilled” laborers, as well as visas available for family reunification so that migrants’ relatives could also join them and arrive in the United States. Although the 1965 law became a watershed moment for Asian nationals, including Filipinos, to migrate to the United States, Choy intervenes and points to an earlier starting point from which we can understand Filipino nurse migration.Brush also traces the colonial influence of the United States in the Philippines as a factor foregrounding nurse migration to the United States.23 Although the Philippines would become formally independent of United States officials serving in the Philippine government in 1946, Brush notes that American influence persisted. The United States continued to influence the Philippines and created opportunities for Filipino nurses to migrate to the United States through public health and nursing education campaigns from philanthropic organizations like the Rockefeller Foundation, the United States’ Exchange Visitor Program, and the 1965 Immigration and Nationality Act.24Choy’s work diverges from Brush’s in her critique of push/pull models of explaining drivers for nurse migration. Push/pull models emphasize the circumstances “pushing” nurses to leave their home countries—conditions like lack of job opportunities and low wages. The circumstances “pulling” nurses to destination countries such as the United States are higher pay, more professional opportunities, and recruitment strategies that aid nurses with immigrating and relocating. Often, Brush uses economic push/pull language to describe trends in global nurse migration from the Philippines and other countries. Along with her coauthors, Brush calls attention to the dwindling “supply” of nurses in the nurses’ home countries due to migration.25 Elsewhere, Brush and Julie Sochalski describe the Philippines as a case study wherein the “production” of nurses is geared toward export, and thus their nurses are lost to “higher income countries.”26 The economic terminology extends from push/pull frameworks.To be sure, the economic dimensions of nurse migration are crucial, and Choy also discusses these economic dimensions. Her work notes that the Philippine government designed an export-oriented economy that capitalized on the “commodification” and “mass production” of nurses to meet the “demand of an international marketplace” and its healthcare workforce needs.27 Apart from the Philippine government’s interests, Filipino nurses themselves pursued socioeconomic opportunities as well as the myriad of cultural opportunities that living in the United States would offer them—what Choy describes as the “accumulation of material goods unobtainable and new forms of leisure unavailable in the Philippines.”28However, Choy is careful to note that Filipino nurses did not think about their mobility only in terms of pay. As ethnic studies often devotes more attention to the meaning that racialized groups construct around their experiences, Choy moves away from a push/pull framework and brings forward a culture of migration, or the ways that “narratives of the promise of immigration to the United States . . . shape Filipino nurses’ desire to migrate abroad.”29 Choy elucidates the processes through which Filipino nurses learn to dream about and aspire to migrate to the United States. Nurses in the Philippines hear about these narratives of opportunity from school and alumni networks, from relatives who migrated before them, through media such as advertisements for travel and relocation services, and through messaging from government officials intended to entice Filipinos to participate in the Philippines’ export-oriented economy. Although push/ pull frameworks highlight the significant economic drivers for migration, they miss the influence of these narratives, which could also translate to more realistic understandings of why nurses migrate and to more robust policy recommendations.Addressing implications for nursing workforce policy, Brush and various coauthors have discussed implications for migration trends from the Philippines and other countries, especially to enact measures to protect internationally educated nurses from exploitation. They mention agreements, guidelines, and policy statements describing ethical recruitment practices.30 They mention initiatives from international organizations such as the World Health Organization, the International Labour Organization, and the National Academy of Medicine.31 Brush has also outlined the various government agencies in the Philippines that have institutionalized the migration of its laborers, such as the Philippine Overseas Employment Agency.32 As scholars from the international community and the nursing profession address issues that internationally educated nurse face, they can incorporate how nurses understand and create meaning about their experiences in proposals for more responsive policy solutions.Ethnic studies introduces new questions for historians of nursing. First, as discussed, it can inform policy implications for the history of nursing. How have policies affected racialized groups of nurses? How have nurses of color advocated for or resisted healthcare legislation and policy? What have been the impacts of movements based on racial and ethnic solidarity on health policies and patient populations? Cynthia Connolly has advocated for blending together the social history framework—which has also informed history in ethnic studies—with a new political history framework, one that seriously considers race, class, and gender in understanding power, political movements, and nurses’ roles in influencing public policy.33 Erika Lee and Nicole Shibusawa have described approaches to Asian American history that “de-center the state, but do so without ignoring state power,” and similarly, historians of nursing can analyze the state while still centering on nurses of color, creating a fuller understanding of how policymakers and stakeholders relate to each other.34Ethnic studies also points to new directions in a labor history of nursing, exploring connections among various racialized groups of laborers. In her history of Filipino nurse migration, Choy positions her study alongside other studies of Filipino men who were recruited into the United States Navy as well as studies of Mexican nationals participating in the United States’ bracero program for agricultural workers.35 Ethnic studies provides a place wherein nurses, labor, and migration intersect. How does the professionalization of nursing relate to nurses of color and their class status? How have some nurses’ visa statuses impacted the types of career trajectories they can access? How have Filipino nurses’ backgrounds as licensed professionals impacted their roles in their communities in the United States and the Philippines? How have their careers, located mostly in the United States, shaped their notions of citizenship and loyalty, whether to the United States or the Philippines?Additionally, using approaches from ethnic studies, historians of nursing can realize the diversity within particular racialized groups. Within groups, individuals may hold different or even conflicting views, depending on the intersection of other attributes such as gender or class. For example, in Choy’s examination of Filipino nurses and community organizing, she demonstrates that Filipino nurses living in various regions in the United States formed different professional and political organizations. As they organized over distinct issues, these multiple groups reflected the distinct needs among Filipinos in the United States compared to the needs of nurses in the Philippines.36 Additionally, Choy notes that Filipino nurses’ activism also challenges stereotypes that cast Asian American and Filipino women as “docile and submissive.”37 Ethnic studies can help counter stereotypes, and historians of nursing can stop overgeneralizing about ethnic groups.Ethnic studies also provides a way of of culture not simply as race, ethnicity, or nationality. of culture to a of and ethnic studies ways to culture as and more and As Choy about Filipino nurses’ to work in the United States, she draws for by and and experiences available only outside the of the Filipino culture, in this beyond a and racialized of and Filipino cultural and a broader that opportunity in the United States. In historians of nursing can approaches from ethnic studies to examine how cultural and racial and For nursing researchers more these conceptualizations of culture can offer more ways of understanding cultural cultural and cultural have these nurses been has been These nurses have not been hidden in the field of ethnic studies. Ethnic studies can historians of nursing to construct narratives that people of color as historical Ethnic studies challenges the idea that racial and ethnic groups are the field historians a way to understand the of racial and ethnic identity, in to new questions that over into political and labor Although historians of nursing have been in with scholars racialized groups, the history of nursing would it the of the field of ethnic studies and what it can earlier of this article was as part of a at the International Nursing History online by the University of for Nursing on March I Julie and for their and

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.