‘We finally feel seen.’

In 2015, Kathleen (Kat) Jabasa achieved her dream to live in the United States. The third-generation nurse from the Philippines was recruited by an agency based in Cebu, one of the country’s main islands.

Jabasa’s first job in the United States was in Arizona as a wound care nurse. She didn’t know about wage steps or how past working experience is often included in how nurses are paid. She said no one even asked her if she had experience.

“We were told your rate is $28 an hour. That’s it,” she said. “Coming from the Philippines, you don’t question your pay.”

Today, the average pay for a beginning nurse in the Philippines is about $513 a month, according to SalaryExpert, which looks at salaries in other countries based on surveys and public documents. In India, the rate is about $685 a month, according to SalaryExpert. And in Ghana, the rate is about $208 a month, according to GlassDoor.

Jabasa said many nurses in the Philippines even had to pay to get experience.

It was only years later, when she was precepting nurses at St. Joseph Medical Center in Tacoma, that Jabasa questioned why she was getting paid less than nurses with less experience.

St. Joseph Medical Center had an unwritten practice that credited international experience (Canada excluded) at one-half of U.S. experience. The hospital did not have a formal policy, and the practice did not align with the contract language. The hospital’s contract with the Washington State Nurses Association (WSNA) calls for placing nurses on wage steps based on experience; it doesn’t matter where that experience comes from.

Jabasa wasn’t alone. Many of her colleagues from the Philippines, India and Ghana, were put on lesser steps as well.

WSNA sought justice for these nurses — 31 in all — and won. As part of the three-year contract ratified Dec. 19, 2024, the steps of nurses at St. Joseph Medical Center with international experience will be recalibrated to reflect their actual years of experience.

Jabasa is now going from step 16 to step 24.

“As international RNs, we finally feel seen as whole professionals, not just half the nurses we were once perceived to be,” Jabasa said.

Widespread practice

The issue of internationally educated nurses not receiving pay commensurate with their experience is a national one. WSNA could not find data on how common this issue was nationwide but talked to experts who confirmed the practice is widespread among nurses recruited from other countries.

But it shouldn’t be.

In March 2023, the advisory board of the Alliance for Ethical Recruitment Practices publicly released a revised voluntary healthcare code that sets standards for employers and recruiters hiring foreign educated health professionals (FEHP). The standards include the following language:

• “Provide compensation for work performed by FEHPs based on performance-related criteria, including education, experience (both in the U.S. and comparable experience in source countries), tenure, level of practice, and relevant skills.
• Compensation, length of contract, and/or breach fees shall not be based on national origin or gender.
• Inform the FEHPs of applicable prevailing wage (PW) requirements and explain which PW level will be used and why.”

WSNA’s journey for justice

The issue at St. Joe’s Tacoma first came to WSNA’s attention in June 2024.

Jared Richardson, WSNA’s nurse representative for St. Joe’s, requested information from the hospital on this practice and surveyed members of the bargaining unit to see who was affected. On Aug. 23, 2024, Richardson filed a grievance over article 9.3 of the collective bargaining agreement, which defines recognition for past experience as “clinical nursing experience in an accredited hospital or clinic without a break in nursing experience which would reduce the level of practical nursing skills, in the opinion of the employer.”

Richardson said nothing could justify this practice.

When contract negotiations for the 1,250 nurses at St. Joe’s started Aug. 21, 2024, international pay parity was part of discussions. Jabasa and other nurses with foreign experience educated their colleagues on their training and the exams they needed to pass.

To practice in the United States, nurses are required to pass the National Council Licensure Examination, a nationwide examination for the licensing of nurses in the United States, Canada, and Australia. They also need to attain a minimum score on an English proficiency examination.

After graduation, Jabasa’s first job was at Cebu Doctor’s University Hospital — a privately owned tertiary level hospital located in Cebu City. She was assigned to the peri-operative department and rotated as a scrub nurse, circulation nurse, post-anesthesia care unit nurse, and as a nurse in the sterile processing department. She received her master’s degree in nursing and was invited to join the nursing faculty at Cebu Doctor’s University.

Jabasa said in the early 2000s, when she was a floor nurse, it was common to be assigned 25 patients. And at her hospital, emergency department nurses rotated being the code nurse. In other hospitals in the Philippines, Jabasa said nurses rotated in dialysis units.

“As Filipino nurses, our training is on par with the United States,” said Jabasa. “We use the same books. We treat the same kinds of patients. There is no reason a Filipino nurse should be valued as half… What do they see in us to view us as half of what they are?

Members of WSNA’s negotiating team said hospital management did not have a reason for this policy other than that is the way it has been done.

Pamela Chandran, WSNA’s lead negotiator on the St. Joe’s contract, called the treatment of international nurses discriminatory and unjustified.

“This is not just a wage equity justice issue,” she said. “An injury to one is an injury to all. If management could bring in nurses of equal experience and pay them substantially less than nurses with U.S. experience, this undermines the wages of all nurses.”

When the hospital said it would take seven months to recalibrate the steps, Jabasa said she cried.

“During bargaining, I was emotional,” she said.

Jabasa said her emotional response stemmed from a deep sense of injustice, not merely impatience.

“The struggle felt far larger than my personal experience; it represented a collective fight for justice on behalf of all international nurses who have faced similar challenges, many for significantly longer periods,” she said.

The union’s bargaining team pushed hard until the early hours of the last day of bargaining to win retroactive increases back to the beginning of the contract for the international nurses.

“I hope this justice is brought throughout this country,” Jabasa said.

Roxy George

Roxy George, another nurse at St. Joe’s, went to nursing school for three years and nine months in Bangalore, India. George said the nursing school was part of the hospital and the hospital never had a nursing shortage because students studied, worked, and slept on the hospital grounds until they graduated.

After her training in India, George worked as a pediatric nurse in Saudi Arabia, away from her family, sleeping at a dorm on the grounds of the modern hospital. Then, she worked in Oman, a country bordering Saudi Arabia.

She, too, was recruited to work in the United States and didn’t understand how her pay was calculated.

By the time she came to St. Joseph Medical Center, she had 20 years of experience. She was placed at Step 10 on the wage scale.

“I didn’t know what a step was — I was just so excited I got the job,” she said. “I should have fought for it, but I didn’t know.”

George is already on the highest step at St. Joseph Medical Center — step 25. It’s not clear what will happen to her compensation, but WSNA will continue to fight for justice.

Resolved to fight

WSNA and other organizations have been working to address this issue for a number of years. In 2023, WSNA membership adopted a resolution at the General Assembly on “Rights of Internationally Educated Nurses” that included, among others: “RESOLVED, that WSNA supports equitable credit for nursing experience acquired in other countries.” In 2024, AFT, WSNA’s national union with 1.8 million members, passed a similar resolution.

WSNA will be looking to achieve justice at other facilities that give less credit for experience to internationally educated nurses.

“This victory is a prime example of what a union can do in standing up for fairness and winning,” said WSNA’s Executive Director David Keepnews. “I hope it will spur further efforts to advocate for equity for our colleagues from other countries.”

St. Joseph Medical Center is part of the Virginia Mason Franciscan Health system, which is a regional subgroup of CommonSpirit Health, the largest not-for-profit hospital chain in the United States.