LEAD 6173 Module 2 Cross-National Comparison Example

Two Systems, One Nurse: Comparing How the Philippines and the United States Educate and License Nurses, and What the Differences Mean for a Houston Hospital

Student Name

American College of Education

LEAD6173: Global Perspectives

Module 2 Assignment

Instructor Name

October 19, 2026

Introduction

In Module 1 I examined what global citizenship asks of a leader who recruits about 150 internationally educated nurses a year for a composite Houston health system, most of them from the Philippines. To support those nurses well and to recruit responsibly, I need to understand the system that prepared them. This paper compares how the Philippines and the United States educate and license nurses, examines how migration shapes Philippine nursing education and draws practical conclusions for a receiving hospital.

Entry to Practice

In the Philippines, the entry route to professional nursing is a four-year Bachelor of Science in Nursing, followed by the national nurse licensure examination administered by the government's Professional Regulation Commission. In the United States, nurses may enter practice through an associate degree, a baccalaureate degree or, less often, a diploma program, and all take the same national licensure examination before receiving a state license. In this respect the Philippine system is more uniform: every newly licensed nurse holds a baccalaureate degree, whereas many American nurses begin with an associate degree. For our hospital, that means Filipino recruits typically arrive with more formal education than some of the domestic nurses beside them. Internationally educated nurses must also have their credentials evaluated and pass the American licensure examination before a state board will license them, and agencies usually shepherd recruits through those steps, which often stretch past twelve months.

How Migration Shapes Philippine Nursing Education

Philippine nursing education cannot be understood apart from migration. Masselink and Lee (2010), interviewing nursing school administrators and policymakers, described Philippine nursing schools as migrant institutions that expanded nursing education to more and more diverse students partly to meet demand from those planning to work abroad, and found that some schools formed commercial relationships with licensure review centers and recruitment agencies. They argued that these practices perpetuated a culture of migration and contributed to declining quality in parts of the sector and to imbalances in the domestic workforce. The finding is a warning against assuming that every nursing school in the source country is of equal quality, and a reminder that recruitment from abroad is part of what shapes those schools.

How the United States Uses Foreign-Educated Nurses

On the receiving side, Brush et al. (2004) examined the history of American recruitment of foreign nurses and found that it has repeatedly served as a response to domestic shortages, creating a lucrative business for recruiting agencies at home and abroad. They argued that relying on foreign recruitment has implications for both domestic and global workforce policy, since it can substitute for the harder work of educating and retaining enough domestic nurses. My system's pattern fits: international recruitment expanded each time local hiring fell short, while investment in local nursing school partnerships stayed flat.

Practice Differences

Comparing the systems also means comparing the settings nurses are prepared for. The global review of nursing published in 2020 reported that nurse-to-population ratios vary greatly between countries and regions, and that many countries with lower ratios face shortages while also losing nurses to migration (World Health Organization, 2020). Recruited nurses tell us that in Philippine hospitals they often cared for far more patients per shift than American ratios allow, with family members providing much basic care, fewer support staff and less technology. They arrive skilled at clinical assessment under pressure and at working with families, and less familiar with American documentation systems, delegation to unlicensed assistive personnel and the legal environment of American practice. The gap is not in competence but in context: they were prepared to be excellent nurses in a different system.

What Recruits Bring

A comparison focused only on gaps would mislead. The same differences in practice context give recruited nurses strengths our system undervalues. Nurses who cared for many patients with few resources are often skilled at prioritizing, at physical assessment without immediate access to tests and at working closely with families, who in Filipino culture are frequently present and involved in care. Several of our recruits have become the unit's informal experts on supporting large families at the bedside, a skill that matters in a city as diverse as Houston. Their baccalaureate preparation also means that some arrive with more formal education in community health and research than colleagues who entered with associate degrees. A receiving hospital that treats recruits only as nurses needing remediation wastes what they bring and signals the second-class status recruits described in Module 1.

Four Gaps a Receiving Hospital Should Address

The comparison points to four gaps. The first is regulatory and legal: American scope of practice, documentation standards and liability differ from what recruits know, and our orientation covers them only in a general session. The second is delegation: working with unlicensed assistive personnel is common in American hospitals and less familiar to nurses from settings where families provide basic care. The third is communication with physicians and patients: recruits are fluent in English, but American norms for speaking up, questioning orders and patient-centered conversation can differ from the more hierarchical norms some describe. The fourth is quality variation among schools, which suggests that competency validation during orientation should be individualized rather than assuming all recruits arrive with identical preparation.

Implications for Recruitment Policy

The comparison also bears on how we recruit. Because quality varies among Philippine schools and some schools have commercial ties to agencies, our system should not rely on an agency's assurances alone; it should review each applicant's school, licensure results and clinical experience directly. Because migration shapes the schools themselves, our recruitment contributes, in a small way, to the culture Masselink and Lee (2010) described, which strengthens the case made in Module 1 for investing in nursing education in source communities as well as recruiting from them. And because American reliance on foreign nurses has historically substituted for domestic investment, as Brush et al. (2004) found, our recruitment budget should be reviewed alongside local nursing school partnerships, not separately.

What the Comparison Does Not Show

This comparison rests on published research, international reports and the accounts of nurses we have hired, not on direct study of Philippine schools or hospitals. Practice conditions vary widely within the Philippines, between urban private hospitals and provincial public ones, and our recruits come disproportionately from schools with strong licensure results. Generalizations about the Philippine system therefore describe tendencies, not individual nurses.

Conclusion

The Philippines and the United States prepare nurses through different structures for different practice conditions, and migration links them in ways that shape both. Philippine nursing education is more uniform in degree but more varied in quality and deeply influenced by the demand for nurses abroad; American hospitals have long used that supply to fill shortages rather than solving them at home. For a receiving hospital, the practical response is an orientation that addresses context rather than competence, and a recruitment policy that does not rest on assuming that every school, or every nurse, is the same.

References

Brush, B. L., Sochalski, J., & Berger, A. M. (2004). Imported care: Recruiting foreign nurses to U.S. health care facilities. Health Affairs, 23(3), 78-87. https://doi.org/10.1377/hlthaff.23.3.78

Masselink, L. E., & Lee, S.-Y. D. (2010). Nurses, Inc.: Expansion and commercialization of nursing education in the Philippines. Social Science & Medicine, 71(1), 166-172. https://doi.org/10.1016/j.socscimed.2009.11.043

World Health Organization. (2020). State of the world's nursing 2020: Investing in education, jobs and leadership. https://www.who.int/publications/i/item/9789240003279