acculturation and job satisfaction among filipino - · pdf filelevel of acculturation and job...

KeywordsFilipino registered nurses, immigrants, job satisfaction,acculturation, skilled nursing facilities

Despite the current recession in the UnitedStates, the Bureau of Labor Statistics (2011) re-ported that healthcare employment has been in-creasing. There has been an increase of 44,000jobs in the ambulatory healthcare services andin hospitals, and, employment for registerednurses (RNs) is expected to increase by morethan 581,500 new jobs by the year 2018 (Lacey &Wright, 2009). With this increase in availablejobs, the healthcare industry might consider im-porting nurses from other countries to help re-solve the nursing shortage. According to Brush(2010), the demand for nurses in different coun-tries around the world, including the United-States, has resulted in an increase in theexportation of nurses from the Philippines. Thenursing curriculum taught in the Philippines re-sembles the nursing standard of practice in theUnited States, which is a factor that facilitatedthe exportation of the Filipino nurses to otherdeveloping countries.

Registered nurses make up the largest por-tion of the healthcare workforce in the UnitedStates (Bureau of Labor Statistics, 2009). Eventhough the employment of RNs is projected to

AbstractThis study investigated the relationship between thelevel of acculturation and job satisfaction among Fil-ipino immigrants working as registered nurses (RNs)in skilled nursing facilities (SNFs) in the South SanFrancisco Bay Area (SSFBA). This research utilized across-sectional, descriptive, correlational, quantitativedesign to assess the two variables under investiga-tion. Participants included 42 Filipino immigrant RNs,working in 13 SNFs, in SSFBA. Written surveys in-cluded: A Short Acculturation Scale for FilipinoAmericans (ASASFA) and Part B of the Index ofWork Satisfaction Scale (IWS). The participants hadan acculturation level closer to the American culturethan the Filipino culture; however, their job satisfac-tion level was neutral and had no relationship to ac-culturation. The acculturation and job satisfactionlevels of the participants might have been influencedby environmental factors that Filipino immigrantswere exposed to in their home country and numberof years in the United States.

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Online Journal of Cultural Competence in Nursing and Healthcare Volume 3, No. 1, 2013

Online Journal of Cultural Competence in Nursing and Healthcare

Volume 3, No. 1, (2013)

Nursing in a New Land: Acculturation and Job SatisfactionAmong Filipino Registered Nurses Working in

Skilled Nursing Facilities

Reyes, L.Q., & Cohen, J. (2013). Nursing in a new land: acculturation and job satisfaction among Filipino registered nurses working inskilled nursing facilities. Online Journal of Cultural Competence in Nursing and Healthcare, 3(1), 16-25. doi:10.9730/ojccnh.org/v3n1a2

Copyright © 2013 The Authors. Reprints and Permissions: www.ojccnh.org/copyrightsDOI: http://dx.doi.org/10.9730/ojccnh.org/v3n1a2

Reyes & Cohen 16

Lourdes Quiason Reyes, MS, RNJayne Cohen, PhD, RN, WHNP-BC

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increase, the rate of growth between the differ-ent industries of healthcare will vary. It is ex-pected that by year 2018, physicians' offices willhave the highest employment growth for RNs.Skilled nursing facilities (SNFs) will come inthird, while hospitals, the largest of the health-care industries, are expected to have the slowestgrowth. The reason for this is an increase in earlydischarge and outpatient services.

Filipino RNs consist of 20.8% of all ethnic mi-nority groups with active nursing licenses inCalifornia (Spetz, Keane, & Hailer, 2011). Eventhough Filipino RNs constitute a large portionof ethnic minorities in California, little researchhas been conducted on this group, especially inthe area of acculturation and job satisfaction. Thepurpose of this study was to examine the levelof acculturation and job satisfaction among Fil-ipino immigrants working as RNs in the SNFsin the SSFBA, and to investigate the relationshipbetween acculturation and job satisfactionamong the sample.

BackgroundAcculturation and job satisfaction were the

two variables assessed in this study because ofthe effects of these variables on a person’s phys-ical health, professional growth, and success(Applebaum, Fowler, Fiedler, Osinubi, & Rob-son, 2010).

AcculturationAcculturation has been found to have both

positive and negative consequences. Researchdocumented that the effects of acculturation in-cluded depression (Choi, Miller, & Wilbur, 2009;Chou, Wong, & Chow, 2011), stress (Torres, 2010;Bhattacharya, 2011), and smoking cessation(Garcia, Romero, & Maxwell, 2010). However,little is known about the effects of acculturationon Filipino immigrant nurses, particularly theones working in SNFs who are usually given the

responsibility of taking care of a high number ofpatients (American Nurses Association, 2011).

A large number of Filipino immigrant nursesare recruited to work outside of their countryevery year (Brush, 2010). These nurses, just likeother immigrants go through acculturation asthey try to adapt to a new culture. Miller (2010)found that Asian immigrants’ acculturationprocess was bilinear, meaning that the immi-grants adopted both their culture of origin andtheir host culture. This was concluded after thestudy of two types of acculturation processesamong Asian Americans (Miller, 2010). The sam-ple group consisted of 306 Asian Americans whoidentified themselves as Korean, Chinese, AsianIndian, Vietnamese, Japanese, Taiwanese, Cam-bodian, biracial, multiracial, and other. Milleralso examined which models of acculturationwere common among Asian Americans, andnoted that bilinear models were most prevalent.The linear model of acculturation suggests thatwhen a person goes through the process of ac-culturation, they adopt the host culture and losetheir culture of origin. The bilinear model of ac-culturation, on the other hand, states that the im-migrant retains both their culture of origin andthe host culture (Torres & Rollock, 2009).

It was also very important to a person’shealth to identify with a certain culture or havea sense of belonging (Choi, Miller & Wilbur,2009). Choi and his colleagues examined 200 Ko-rean immigrant women who lived in two met-ropolitan areas in a Midwestern state, and noteda decrease in acculturation to both Korean andAmerican culture in 46 of the women. These 46women exhibited high levels of depression com-pared to the other women, who were accultur-ated to either their culture of origin or their hostcountry. This study suggested that the accultur-ation process a person experiences has negativeconsequences on their health. When one’s levelof acculturation increases after residing in the

Reyes & Cohen 17www.ojccnh.org



United States for quite a while, only then willthey experience satisfaction in their work (Ea,Griffin, Eplattenier & Fitzpatrick, 2008). Limitedresearch has been done on the acculturationprocess of Filipino immigrants, especially nursesworking in the United States.

Job SatisfactionAccording to the American Mobile Nurses

Healthcare’s (AMNH) Survey of RNs (2011),many RNs nationwide are planning a change intheir career when the economy recovers from thecurrent recession. From the nurses surveyed,58% stated that they were satisfied with theircurrent job; however, 34% stated that they oftenthought about resigning from their jobs. Thirtypercent were thinking of looking for a new job ayear from now, and 48% worried that their jobswere affecting their health. Furthermore, 45% ofthe nurses stated that they would switch to a lessdemanding position in the next one to fouryears. The statistics suggest that job dissatisfac-tion existed among nurses from different health-care settings. These results, compared to theprevious AMNH (2010) survey of RNs, showedthat the job satisfaction of RNs is declining.

A number of factors could affect the level ofsatisfaction an employee can experience withtheir job. Factors such as: the availability of re-sources, skills for health and emotional needs ofemployees (Hayne, Gerhardt & Davis, 2009), agood work environment (Choi, Flynn & Aiken,2011), and personal values, were found to affectan employee’s level of job satisfaction (Cabigao,2009). Hayne, Gerhardt and Davis (2009) foundin their study that Filipino nurses who were re-cruited to work in the United States were satis-fied with their jobs when they had resources andskills that helped them enhance their health andemotional needs. For example, in the Filipinoculture, asking too many questions is seen as asign of being incompetent. Therefore, providing

resources, such as a mentor or supervisor whocan help clarify certain information, will aid inthe nurses’ success and satisfaction in their jobperformance. Nurses who were brought up inanother country have different values and tradi-tions from the ones who grew up in the UnitedStates. According to Cabigao (2009), nurses whowere satisfied with their jobs did not placemuch importance on values such as tradition,belief, and faith. This created a problem for Fil-ipino nurses who were born and raised in thePhilippines because of their strong associationwith the traditions of their home country.

The job design in long-term care, such as inSNFs, also had an effect on the satisfaction levelof nurses (Tyler et al., 2006). A study of twentylong-term care (LTC) facilities in Eastern Massa-chusetts found that licensed nurses, which in-cluded licensed vocational nurses (LVNs) andRNs working in LTC facilities, differed in theirlevel of satisfaction with certified nursing assis-tants (CNAs). This was due to the lack of inter-action between the licensed nurses, theirpatients, and other employees. The licensednurses reported feeling more isolated, whichthen affected their level of job satisfaction. Thelow job satisfaction level of licensed nurses inLTC facilities may also have been due to the factthat they experienced higher levels of burnout.One study by Hasson and Arnetz (2007), re-ported that the staff in nursing homes experi-enced significant physical and emotional strainfrom their work. Kennedy (2005) demonstratedin his study that RNs have the highest level ofburnout compared to other nursing personnel.This was found in a study of 125 nurses workingin a LTC facility. This may be due to the type ofpatients residing in nursing homes who are usu-ally very dependent and cognitively impaired.Based on a nationwide survey conducted byJones, Dwyer, Bercovotz and Strahan (2009),only 1.6% of the residents in nursing homes in




the United States had an independent functionalstatus. This means that they required no assis-tance with Activities of Daily Living (ADLs),which included toileting, bathing, dressing, andeating. However, more than 50% of nursinghome residents in the United States requiredmaximum assistance with their ADLs.

There have been a number of studies on ac-culturation and job satisfaction that were inves-tigated in this research; however, limitedresearch has been done on the relationship ofthese two variables and the effect of these fac-tors on Filipino RNs working in SNFs. Ea, Grif-fin, Eplattenier & Fitzpatrick (2008) looked at theeffect of these two variables on Filipino nurses;however, the nurses in the study were recruitedat a Philippine Nurses Association of America(PNAA) conference, and were not working inSNFs.

MethodsA cross-sectional, descriptive, correlational,

quantitative design was used to assess the twovariables, acculturation and job satisfaction. Ad-ministrators and directors of nursing in 46 dif-ferent SNFs in the SSFBA were invited toparticipate in the study. Letters of permissionwere obtained from 14 facilities. One facility de-clined to participate. The target population con-sisted of Filipino immigrant RNs employed inSNFs in the SSFBA. To be included in the study,the participants needed to be able to read andunderstand English, be over 18 years of age,have been born in the Philippines, and work asan RN in the United States at a SNF. Participantsborn in the United States were excluded fromthe study.

Approval from the institutional review board(IRB) was obtained for this study. The FilipinoRNs from the 13 SNFs were recruited throughtwo ways, depending on the preference of theirrespective facilities. The nurses were informed

either through flyers posted around their facili-ties or through flyers given out by the directorsof nursing and administrators. After the employ-ees were informed of the research study, theywere given two weeks before the packets ofquestionnaires were distributed. The directors ofnursing, administrators, or designated employ-ees distributed the packets to the participants.All participants were informed that participa-tion was voluntary. The nurses received apacket, which included: an informed consentform, three kinds of questionnaires, a returnstamped envelope, and a gift for participating inthe study. The participants received a letteropener or a keychain that was made in thePhilippines. The surveys were anonymous, andparticipants were not required to write theirnames anywhere on the questionnaires; how-ever, the packets were coded in order to knowthe response rate per facility. This helped iden-tify the facilities that had a poor response rate.The participants were given one month to fill outthe questionnaires and to mail them back. Thereturn stamped envelopes given to the 13 facili-



Table 1Demographic Characteristics of the Sample (N=42)

n %

GenderFemaleMale

3537

83.316.7

Marital StatusMarriedDivorcedSingle (Never MarriedSingle (Living Together)

262131

61.94.8

31.02.4

EducationDiplomaAssociate Degree4 year BSNSome Graduate SchoolCompleted Master’s

343041

7.19.5

71.49.52.4

Note: Percents do not sum to 100 due to missing dataand/or rounding.


ties were addressed to the primary researcher.However, one facility was provided a differentreturn address due to the affiliation of the pri-mary researcher. This was done to prevent anyconflict of interest.

From the 128 sets of questionnaires that weredistributed, only 117 sets were actually given outto the nurses because facilities only gave an es-timate of Filipino immigrant nurses during therecruitment process. A second round of flyersand questionnaires were given out to two facili-ties that had a poor response rate. For this study,there were 49 (38%) completed sets of question-naires. However, seven sets were taken out fromthe analytic sample because three of the respon-dents were born in the United States, while fourmailed back incomplete questionnaires. Thus,the final sample was 42 (33%) Filipino immi-grant RNs working in SNFs (See Table 1).

InstrumentsThe data instruments that were used in this

research were the Background Information sur-vey, A Short Acculturation Scale for FilipinoAmericans (ASASFA) (De la Cruz, Padilla &Agustin, 2000), and Part B of the Index of WorkSatisfaction (Stamps, 1997). The Background In-formation survey included age, gender, maritalstatus, number of years residing in the UnitedStates and employed at their current job. Accul-turation was assessed with ASASFA (De la Cruz,Padilla & Agustin, 2000), which is a 12-item self-report tool in either English or Tagalog, used tomeasure which culture, Filipino or American,with which the person identifies more strongly.In this study, the English version was utilizedsince the rest of the survey tools were in English.The response choices for the questions were ona Likert-type scale, which took two to three min-utes to complete. The lowest possible score was12, while the highest score was 60. A high scoremeant that the participants strongly identified

with the American culture. Permission from Dr.Felicitas De la Cruz was obtained for the use ofboth the Background Information survey andASASFA. Changes were made on some of thequestions on the Background Information sur-vey to better fit the target population. For in-stance, a question asking about the participants’professional field was taken out from the Back-ground Information survey because only RNswere asked to complete the questionnaires. Inaddition, the words “high school,” “elemen-tary,” and “some college” were taken out aschoices from a demographic question about theeducation level completed by the participants.

Job satisfaction was measured using the PartB of the Index of Work Satisfaction (IWS)(Stamps, 1997). This was a 44-item tool, writtenin English, which measured how satisfied a per-son was with his or her current nursing job. Theresponse choices were on a 1 to 7 Likert-typescale, in which numbers 1 to 3 showed differentlevels of agreement, and numbers 5 to 7 pointedtowards levels of disagreement. The number 4as a response meant that the person was unde-cided.

FindingsThe sample was made up of mostly women

whose age of immigration ranged from 3 to 44years old, and length of residence in the UnitedStates ranged from 1 to 32 years. Based on Table1, 83.3% of the respondents were female and61.9% were married. All of the respondents in-cluded in the analytic sample had listed thePhilippines on the Background Information sur-vey as their place of birth as well as their par-ents’. Furthermore, 71.4% finished a 4-yearBachelor of Science in Nursing degree. Predic-tive Analytics Software 18 (PASW 18) was usedfor analysis, which included response frequen-cies, percentages, descriptive statistics, and Pear-son’s correlation coefficient.




The participants’ overall acculturation meanwas 2.71 out of a possible score of 5, whichmeant that the nurses had a stronger identifica-tion with the American culture rather than theiroriginal culture. For the job satisfaction score, thenurses had a Total Scale Score (TSS) of 185.3from a total score of 308, which was in the lowerend of the third quartile (Stamps, 1997). Themean score was 4.22 out of a scale of 7, indicat-ing no large degree of agreement or disagree-ment. Therefore, the sample of nurses did notexpress strong satisfaction or dissatisfactionwith their jobs at the SNFs. The Pearson Corre-lation Coefficient was generated from the indi-vidual means of ASASFA and TSS, which wasthe same process used in the Ea et al. (2008) ar-ticle. There was no correlation found betweenacculturation and job satisfaction.

LimitationsThis study was not without limitations. First,

the sample involved a limited number of SNFsin SSFBA, and as a result, only reflected the ac-culturation and job satisfaction of this group.Second, some of the contact persons from eachfacility might have been unreliable in terms ofdistributing the packets of questionnaires to thenurses. Also, after the first round of question-naires were mailed back, most of the facilitiesthat had a poor response rate, refused to distrib-ute the second round of questionnaires to theirnurses. These factors may have contributed tothe small sample size of the study. Third, themethodology used to collect the data inhibiteddirect access to the participants. Having directaccess could have ensured that the nurses whofit the criteria of the study were the only oneswho received the questionnaires. In addition, thestaffing ratios in SNFs made it difficult to recruitnurses who would fit the criteria of the study be-cause the licensed nurses who worked in theselongterm care facilities were predominately li-

censed vocational nurses (LVNs). Last, the re-sults were based on the Filipino immigrantnurses’ self-reported level of acculturation andjob satisfaction. This limited the reliability of theresults because of potential sources of bias fromself-reported data, such as selective memory andexaggeration.

DiscussionIn the sample, the representation of male

nurses was very small, however, the percentageof male nurses in this study was very similar tothe percentage of male nurses noted in the 2010Survey of RNs in California (Spetz, Keane andHailer, 2011). In 2010, 10.7% of RNs who workedand resided in California were males.

For the level of acculturation of the sample,the nurses were closer to the American culturerather than the Filipino culture. This is consistentwith other research which showed that the Fil-ipino nurses’ acculturation level usually leanstowards the host culture (Ea, Itzhaki, Ehrenfeld,& Fitzpatrick, 2010; Ea et al., 2008). The age ofthe participants when they arrived in the UnitedStates, as well as the social media in the Philip-pines, were factors that might have influencedthe level of acculturation. The sample’s averageage of immigration was 22 years old, and dura-tion of stay in the United States was 11 years. Ac-cording to Brown, Schale, and Nilsson (2010),female immigrants who have resided in theUnited States for a longer period of time andwere younger at the time of arrival, are embrac-ing certain aspects of the American culture to alarger extent, specifically the English language.Arriving in the United States at a younger agemeant that they were more likely to have beenexposed to the American education system andthe English language. Moreover, Moon and Park(2007) found in their study of acculturation andbiculturalism on Korean immigrants who wereexposed to both American and Korean media,




were more Americanized rather than bicultural.The researchers stated that this may be due tothe strong effects of the American media. In thePhilippines, they have an equal share of English-language media; however, their print media ispredominately in English (as cited in Dayag,2004; Dayag, 2010). Since the Filipino nurses inthe sample were exposed to the English lan-guage in their home country, this might havehelped them to become proficient with the lan-guage, making them more connected to theAmerican culture. Therefore, even though thenurses were born and raised in the Philippinesand have strong ties with their home country,they were still able to acculturate to the customsof another country.

Research suggests that the staff in long-termcare (LTC) facilities, (especially the RNs), expe-rienced a high level of burnout, which couldlead to a decrease in job satisfaction (Hasson &Arnetz, 2007; Kennedy, 2005) because of the re-lationship between these two variables (Alarcon,2011). In this study’s sample, the nurses wereneither satisfied nor dissatisfied with their jobs.The nurses’ level of job satisfaction is not consis-tent with the findings of other studies, whichshowed that when the nurses are closer to theAmerican culture, their job satisfaction increasesas well (Ea et al., 2008). This may have occurredfor several reasons. Even though the sample wasmade up of RNs, who had been found to be atrisk for burnout, especially when exposed to awork environment such as a nursing home(Kennedy, 2005), certain aspects of the Philip-pines could have caused the nurses to be neutralin terms of their job satisfaction. Life in thePhilippines is hard for everyone (Geller, 2007).In 2007, nurses in the Philippines earned $150 to$250 a month, compared to nurses in the UnitedStates, who earned $4,000 a month. This mighthave affected the job satisfaction level of thenurses. The nurses in the sample had a neutral

job satisfaction level because of how difficult lifeprobably was for them in the Philippines. Thisexplains that although research has shown thatthe job design of SNFs promoted isolationamong RNs, which decreased the nurses’ levelof satisfaction (Tyler et al., 2006), this could havebeen compensated by the kind of life Filipinonurses experienced in their home country. In ad-dition, the recent scarcity of RN jobs for inexpe-rienced nurses in acute care settings inCalifornia (Stokowski, 2011) could have influ-enced the sample’s job satisfaction level. Whileaccepting employment in a SNF might not be theFilipino nurses’ first choice of setting, they mayhave felt grateful to at least have a job duringthese changing times. Contrary to a previousstudy by Ea et al. (2008), there was no correlationfound between acculturation and job satisfactionin this study’s sample. This indicates that thelevel of acculturation of Filipino immigrantnurses working in SNFs did not have an affecton the level of job satisfaction and vice versa.

The findings of this study can be used inidentifying factors which will help increase thejob satisfaction of Filipino immigrant nursesworking in LTC facilities in the United States.Conducting research in this area will broadenthe knowledge about other elements in the workenvironment of LTC facilities which contributeto a decrease in the nurses’ level of satisfaction.Furthermore, a qualitative study, which willlook at the experiences of Filipino nurses withthe use of the English language and Americancustoms, will aid in the exploration of the accul-turation process Filipino immigrants gothrough. These studies should focus on thestruggles the nurses might have with the conno-tations of certain words and phrases that may af-fect their communication and interaction withtheir patients.




Implications for PracticeFindings from this study can be used to in-

form administrators and directors of nursing inSNFs about Filipino immigrant RNs. Since it wasfound that Filipino nurses working in LTC facil-ities were neither satisfied nor dissatisfied withtheir work, administrators could start develop-ing ways to increase the satisfaction level of theirFilipino nurses by assessing the group for waysto enhance their work environment and imple-menting a plan to ameliorate their perceivedchallenges. It is important that leaders in thehealthcare industry become aware of the cul-tural needs of their immigrant nurses. When thenurses’ needs are met, they are able to better per-form and provide quality patient care. Further-more, problems regarding the turnover andretention of nurses are prominent among nurs-ing homes and on the rise (Donoghue, 2010). Fo-cusing on how to increase the level of jobsatisfaction of nurses in LTC will help addressthese problems.

ConclusionsThe results of this study suggested that there

is no relationship between acculturation and jobsatisfaction among Filipino immigrant nursesworking in SNFs. The nurses in the sample hadan acculturation level closer to the American cul-ture, which might have been influenced by cer-tain factors. For instance, the culture in thePhilippines where the English language is usedin most social media might have facilitated theacculturation process of the Filipino immigrantnurses. Furthermore, the way of life in thenurses’ home country might have made themsatisfied with their jobs, despite flaws in the de-sign of the environment in nursing homes. Nev-ertheless, the results of this research cannot begeneralized to other groups of immigrants be-cause of the differences that exist among cul-tures.

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The AuthorsLordes Quiason Reyes, MS, RN graduated with her Mas-ter’s Degree in Science with an emphasis in nursing administra-tion from San Jose State University. Ms. Reyes is currentlyemployed as an assistant director of nursing at a 185-skillednursing facility.

Jayne Cohen, PhD, RN, WHNP-BC is the director ofthe school of nursing at San Jose State University. She receivedher graduate education from the University of California, SanFranscisco. Dr. Cohen’s current professional work and researchfocuses on finding solutions to ameliorate the critical nursingshortage and improving the work environment for acute carestaff nurses.




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