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A precarious journey : experiences of nurses from the Philippines seeking RN licensure and employment… Hawkins, Margery Edith 2013

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   A PRECARIOUS JOURNEY: EXPERIENCES OF NURSES FROM THE PHILIPPINES SEEKING RN LICENSURE AND EMPLOYMENT IN CANADA  by MARGERY EDITH HAWKINS  B.S.N., The University of British Columbia, 1973 M.S.N., The University of British Columbia, 1995   A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY  in  THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Nursing)   THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)  August 2013   ? Margery Edith Hawkins, 2013   ii  Abstract Increasingly, registered nurses (RNs) from lower income countries are seeking RN licensure and employment in Canada. Despite efforts to support their integration into the workplace, a significant number do not complete the registration process. To explore this phenomenon, using ethnographic methods informed by postcolonial feminism and relational ethical theory, I set out to learn from nurses educated in the Philippines about their experiences seeking RN licensure and employment in Canada. These nurses make up the greatest percentage of internationally educated nurses (IENs) in Canada and have a long history of migration to learn from.  My goal was to understand how the experiences of these nurses shaped and were shaped by social, political, economic, and historical contexts and mediating oppressions at international, national, and local levels. Over the course of a year, I engaged 47 nurses in individual and focus group interviews. They had come to Canada with diverse immigration histories and work experiences. To enhance understanding of their perspectives I also collected data from secondary participants, such as nurse educators and immigration counselors, and reviewed immigration and regulatory documents.  My analysis revealed that decisions at each stage of the nurse migration journey, which began in the Philippines and progressed to Canada, were not made in isolation. Rather, decisions were influenced by structures embedded within prevailing ideologies of neo-liberalism and neocolonialism and intersecting relations of gender, race, and class. Such structures and processes have the capacity to constrain agency and put nurses in jeopardy of marginalization, exploitation, and powerlessness. In this context, issues considered cultural might be better understood as partial and dynamic implications of broader social inequities. Consequently, it is iii  imperative to extend our gaze beyond everyday practices of individual nurses, programs, and institutions and critically expose root causes of such inequities. Moreover, it is vital that the voices of IENs be included in health care planning and policy making.   iv  Preface Ethics approval for this study was received from the University of British Columbia, Behavioural Research Ethics Board. This study was originally approved in July 2010; the last annual renewal was received in February 2013 (Approval number H10-00137).    Permission to interview nurses educated in the Philippines was also granted through Vancouver Community College (Approval Number REB 201004-01) and Kwantlen Polytechnic University (Approval Number 2010-018).   v  Table of Contents Abstract ......................................................................................................................................................... ii Preface ...........................................................................................................................................................iv Table of Contents .......................................................................................................................................... v List of Acronyms ....................................................................................................................................... xiii Acknowledgements ...................................................................................................................................... xv Chapter One: Situating the Study ................................................................................................................ 1 A Nurse Migration Trajectory .................................................................................................................... 3 Structures creating a demand for nursing skills. .................................................................................... 3 Structures compelling nurses to migrate. ............................................................................................... 4 Structures influencing entry into RN practice in Canada. ...................................................................... 6 Supports to ease integration. ............................................................................................................. 8 The Complexity of Nurse Migration ........................................................................................................... 9 Developing a Focus for the Study ............................................................................................................. 10 Reflecting on the literature................................................................................................................... 11 Generating a problem statement and defining a purpose. .................................................................... 13 Setting Up the Study ................................................................................................................................. 14 Delineating the research question. ....................................................................................................... 14 Locating a meta-theoretical commitment. ........................................................................................... 15 Postcolonial feminism. .................................................................................................................... 15 Relational ethical theory. ................................................................................................................ 16 Sketching the Study Design ....................................................................................................................... 16 Articulating Relevance ............................................................................................................................. 17 Organization of the Thesis ........................................................................................................................ 18 Chapter Two:  Surveying the Organizational Context of Nurse Migration ........................................... 20 vi  Structures Creating a Demand for Nurses ............................................................................................... 20 Representation of IENs in the Canadian workplace............................................................................. 20 The nature of the demand for nurses in higher income countries. ....................................................... 21 Source countries: The Philippines. ...................................................................................................... 23 Implications for nurse migration experiences. ..................................................................................... 26 Structures Compelling Nurses to Migrate ................................................................................................ 26 Pressure from the Philippine government. ........................................................................................... 27 Familiarity with an Americanized model of nurse education. ............................................................. 31 Enticements from recruitment agencies. .............................................................................................. 32 Financial incentives. ............................................................................................................................ 33 A desire for a better future for their families. ...................................................................................... 34 Encouragement from social networks. ................................................................................................. 35 Implications for nurse migration experiences. ..................................................................................... 36 Job opportunities and reception in destination countries. ............................................................... 36 Family relationships. ....................................................................................................................... 38 Structures Influencing Entry into Professional Nursing Practice in Canada ........................................... 40 Immigration processes. ........................................................................................................................ 40 Federal skilled workers (FSWs). ..................................................................................................... 41 Live-in caregivers. .......................................................................................................................... 44 Temporary foreign workers (TFWs). .............................................................................................. 45 Professional credential assessment and recognition procedures. ......................................................... 46 Supports to ease integration. ................................................................................................................ 49 The provincial regulatory college. .................................................................................................. 49 Trade unions. ................................................................................................................................... 49 Immigrant serving organizations. .................................................................................................... 50 Professional support groups. ........................................................................................................... 51 Health human resource planning ......................................................................................................... 51 vii  Implications for nurse migration experiences. ..................................................................................... 55 Immigration processes. ................................................................................................................... 55 Professional credential assessment and recognition procedures. .................................................... 57 Entry into the workplace. ................................................................................................................ 60 Reflections on the Literature .................................................................................................................... 61 Chapter Summary ..................................................................................................................................... 62 Chapter Three: Surveying the Theoretical Terrain ................................................................................. 64 The Complexity of Nurse Migration ......................................................................................................... 65 The Critical Theory Paradigm.................................................................................................................. 67 Postcolonial theory. ............................................................................................................................. 70 Feminist theory. ................................................................................................................................... 74 Postcolonial feminist theory. ........................................................................................................... 76 Intersectional theory. .................................................................................................................. 77 The convergence of postcolonial and intersectional theory. ...................................................... 79 Relational ethical theory. ................................................................................................................ 80 Chapter Summary ..................................................................................................................................... 82 Chapter Four: Implementing the Study .................................................................................................... 84 Understanding Ethnographic Traditions .................................................................................................. 85 Conceptualizing an Ethnographic Approach Informed by Postcolonial Feminism ................................. 87 Beginning from the standpoint of those at the margins. ...................................................................... 88 Accounting for intersectionality. ......................................................................................................... 90 Orienting towards praxis. ..................................................................................................................... 91 Adopting a reflexive stance. ............................................................................................................ 92 Bringing my own location and position into the research. ......................................................... 93 Incorporating reciprocity. ................................................................................................................ 97 viii  Engaging in dialectical theory-building. ....................................................................................... 100 The Process of Research: Constructing Meaning and Knowledge ......................................................... 100 Constructing data. .............................................................................................................................. 101 Forming an Advisory Group. ........................................................................................................ 101 Negotiating access to the field and recruiting participants. ........................................................... 105 Creating a sample. ......................................................................................................................... 109 Collecting data. ............................................................................................................................. 111 Conducting interviews. ............................................................................................................. 112 Utilizing observations. ............................................................................................................. 117 Employing documentary evidence. .......................................................................................... 119 Managing data. .................................................................................................................................. 119 Analyzing data. .................................................................................................................................. 120 Organizing data. ............................................................................................................................ 120 Open coding. ................................................................................................................................. 122 Focused coding. ............................................................................................................................ 122 Fostering Scientific Credibility............................................................................................................... 123 Epistemological integrity. .................................................................................................................. 124 Interpretive authority. ........................................................................................................................ 124 Representative credibility. ................................................................................................................. 124 Analytic logic. .................................................................................................................................... 125 Attending to Research Ethics .................................................................................................................. 125 Disseminating Data ................................................................................................................................ 127 Chapter Summary ................................................................................................................................... 128 Chapter Five: Beginning the Journey - Seeking ?Greener Pastures? .................................................. 129 Deciding to Migrate:  ?We Created a Story? ......................................................................................... 129 Their dreams: ?Land of milk and honey?. ......................................................................................... 130 ix  Structures shaping their dreams: ?So I?ll go there?. .......................................................................... 135 ?The salary is just too small for a family?. ................................................................................... 135 ?Everybody was going away?. ...................................................................................................... 138 ?So you?ve got to make a sacrifice?. ............................................................................................. 140 ?I?m sorta westernized in the American system?. ......................................................................... 142 ?This is a chance for us?. .............................................................................................................. 143 ?It was God?s plan us coming here to Canada.?............................................................................ 146 Summary. ........................................................................................................................................... 147 Preparing to Migrate: Using ?Stepping Stones? ................................................................................... 147 Stepping stone #1: ?Taking up nursing?. ........................................................................................... 148 Stepping stone #2: Finding ?a training ground?. ............................................................................... 151 Stepping stone #3: Immigration, ?a lot of fees.? ................................................................................ 153 Stepping stone #4: ?Parallel processing". .......................................................................................... 156 Summary. ........................................................................................................................................... 159 Chapter Summary ................................................................................................................................... 160 Chapter Six: Being a New Immigrant in Canada - ?It?s Not for the Faint of Heart? ......................... 162 The Federal Skilled Worker Story: ?They Don?t Accept Us? ................................................................ 163 ?What am I supposed to do to survive?? ............................................................................................ 167 ?But in reality, it?s really very hard?.................................................................................................. 173 The Live-In Caregiver Story: The ?Countdown? ................................................................................... 177 ?The homesickness and loneliness, you name it?. ............................................................................. 180 ?You have to budget?. ....................................................................................................................... 181 ?In the Philippines we have someone doing that for us?. .................................................................. 182 Chapter Summary ................................................................................................................................... 184 Chapter Seven: Being an IEN in Canada - ?And One Block After the Other? ................................... 186 x  ?It?s So Hard to Pass the English Test? ................................................................................................. 186 Preparing for an English language proficiency test. .......................................................................... 187 Taking an English language proficiency test. .................................................................................... 188 ?I Haven?t Applied Yet? ......................................................................................................................... 192 Untangling the complexity of the registration process. ..................................................................... 192 Fearing rejection. ............................................................................................................................... 193 Considering family and financial responsibilities. ............................................................................. 195 Considering future aspirations. .......................................................................................................... 196 ?I Tried All the Techniques That I Know in Preparing for the SEC? .................................................... 197 Limited transparency. ........................................................................................................................ 199 Preparing for the assessment. ............................................................................................................. 200 Waiting for the assessment. ............................................................................................................... 201 ?I Will Not Be Taking Anymore Because You Know We Will Go Hungry? ........................................... 202 Waiting to enroll in supplemental education classes. ........................................................................ 202 Meeting educational expenses. .......................................................................................................... 203 Accessing educational facilities. ........................................................................................................ 204 Contemplating usefulness of the re-entry program. ........................................................................... 205 ?If Only They Will Give Me a Chance? ................................................................................................. 206 Obstacles encountered finding an employer. ..................................................................................... 208 Strategies used to find an employer. .................................................................................................. 212 ?When the Time Comes That We Pass the Exam They?ll Say That We?re Not in Practice? .................. 213 Chapter Summary ................................................................................................................................... 215 Chapter Eight: Reconciling the Journey - ?I Have to Move On? ......................................................... 217 ?My Main Goal Is at Least to Go Back to My Profession? .................................................................... 217 ?But if It?s Not for Me, It?s Not for Me? ................................................................................................ 219 xi  ?You Should Always Have an Option? .................................................................................................. 221 Chapter Summary ................................................................................................................................... 225 Chapter Nine: Discussing the Complexity of the Nurse Migration Journey ........................................ 226 A Culture of Migration ........................................................................................................................... 228 Deciding to migrate. .......................................................................................................................... 228 Preparing to migrate........................................................................................................................... 230 Summary. ........................................................................................................................................... 233 The Precarious Status of Being a New Arrival in Canada ..................................................................... 234 Seeking a means of survival. ............................................................................................................. 234 Enduring the live-in caregiver contract. ............................................................................................. 241 Summary. ........................................................................................................................................... 242 The Elusive Canadian RN Credential ..................................................................................................... 243 An increase in regulatory scrutiny. .................................................................................................... 243 Inaccessibility of educational upgrading. ........................................................................................... 247 Seeking RN employment. .................................................................................................................. 248 Insufficient support. ........................................................................................................................... 249 Summary. ........................................................................................................................................... 252 Agency and Capacity to Act .................................................................................................................... 252 Chapter Summary ................................................................................................................................... 254 Chapter Ten: Conclusions and Recommendations for Moving Forward ............................................ 256 Overview of the study ............................................................................................................................. 256 Methodological reflections ..................................................................................................................... 257 Substantive Reflections ........................................................................................................................... 261 Prior to arrival in Canada. .................................................................................................................. 262 After arrival in Canada. ..................................................................................................................... 263 xii  Recommendations for Moving Forward ................................................................................................. 266 Political action. .................................................................................................................................. 266 Policy. ................................................................................................................................................ 267 Regulation. ......................................................................................................................................... 268 Health human resource planning. ...................................................................................................... 269 Education. .......................................................................................................................................... 270 Research. ............................................................................................................................................ 270 Chapter Summary ................................................................................................................................... 273 References .................................................................................................................................................. 274 Appendices ................................................................................................................................................. 304 Appendix A: Pathway to RN Licensure in BC for IENs ........................................................................ 304 Appendix B: Field Work Calendar .......................................................................................................... 305 Appendix C: Table of Participants .......................................................................................................... 309 Appendix D: Consent Forms .................................................................................................................... 312 Appendix E: Data Sheet ............................................................................................................................ 323 Appendix F: Interview Guide ................................................................................................................... 324 Appendix G: Confidentiality Agreement ................................................................................................ 325 Appendix H: Recruitment Advertisement .............................................................................................. 326 Appendix I: Recruitment Letter .............................................................................................................. 328 Appendix J: The Journey to RN Licensure in Canada .......................................................................... 330      xiii  List of Acronyms ARNBC Association of Registered Nurses of British Columbia  BC British Columbia BCNU British Columbia Nurses? Union BREB Behavioural Research Ethics Board BSN Bachelor of Science in Nursing CELBAN Canadian English Language Benchmark Assessment for Nurses CIC Citizenship and Immigration Canada CIHI Canadian Institute for Health Information CIIP Canadian Immigration Integration Program  CNA Canadian Nurses Association CLPNBC College of Licensed Practical Nurses of British Columbia CRNBC College of Registered Nurses of British Columbia CRNE Canadian Registered Nurse Examination ESN Employed Student Nurse FNSG Filipino Nurses Support Group FSWP Federal Skilled Worker Program FSW Federal Skilled Worker GNIE Graduate Nurse, Internationally Educated HPA Health Professions Act ICN International Council of Nurses IELTS International English Language Testing System IEN Internationally Educated Nurse IEP Internationally Educated Professional ISO Immigrant Serving Organization LCP Live-in Caregiver Program LPN Licensed Practical Nurse MHH Multicultural Helping House MOH Ministry of Health OECD Organization for Economic Co-operation and Development PNA Philippine Nurses Association PNAM Philippine Nurses Association of Manitoba  PNP Provincial Nominee Program RNABC Registered Nurses Association SEC Substantially Equivalent Competency TFW Temporary Foreign Worker TFWP Temporary Foreign Worker Program  UAE United Arab Emirates UK United Kingdom xiv  UN United Nations US United States VCC Vancouver Community College WHO World Health Organization xv  Acknowledgements The process of participating in this research study and completing my dissertation has been a humbling journey. The issues I have addressed are ones I have long felt passionately about but the endeavour presented significant challenges. My greatest concern was that I would not be able to adequately expose the injustices endured by study participants. It is to these nurses that I would first like to extend my gratitude. They willingly shared their time, their stories, and their emotions with me and for that I will be forever grateful. Becoming acquainted with them was the highlight of my journey and their voices sustained me during the endless hours of analysis and writing. I am also deeply indebted to my Advisory Group. These expert nurses directed me to strategies for fostering interest in the study, recruiting participants, and interpreting data. They challenged my insights, provided me with rich information, and gave me the courage to continue. Their enduring support and guidance were invaluable. As well, I would like to extend my profound thanks to the immigration societies who believed in my work and assisted me with the recruitment of study participants. To the immigration counselors, nurse educators, regulators, English language teachers, administrators, and colleagues who shared their concerns and knowledge and offered me their encouragement, my thanks also goes out. This truly was a collaborative undertaking. I am also deeply appreciative of the stellar academic advice and unfailing support provided by my Dissertation Supervisory Committee. I feel so fortunate to have had the opportunity to work with such a talented group of individuals. In particular, I express my heartfelt thanks to my supervisor, Dr. Patricia Rodney. Without her steady encouragement, xvi  unflagging enthusiasm, and invaluable experience, this study would not have moved forward. I will be forever grateful. Thank you, Paddy.  Lastly, but not least I must acknowledge my family and friends. My parents, my four children, their partners and children, provided ongoing love, humour, patience, and advice that nourished me during this seemingly endless process. Similarly, my friends played a vital role in sustaining me through this journey. Their words of encouragement and support along the way will not be forgotten. However, it is my husband, Robert, who deserves the greatest recognition. His patience and his belief in the worthiness of this endeavor were inestimable. This was a journey in which I explored the experiences of others but was it also one of self-discovery. Like any worthy endeavor, it pushed me beyond the frontiers of my own comfort and for this I am indebted.    1  Chapter One: Situating the Study Nursing is becoming an increasingly mobile profession. Thousands of nurses, the majority of them women, migrate each year in search of better pay and working conditions and an improved quality of life (Kingma, 2006; WHO, 2006). In 2011 internationally educated nurses (IENs) comprised 8.6 percent of the registered nurse (RN) workforce in Canada (CIHI, 2012). Although Canada, like other higher income countries, has always relied on IENs to play a pivotal role in the provision of health care, as nurse shortages intensify, it is increasingly relying on nurses from lower income countries (CNA, 2006; Dumont, Zurn, Church, & Le Thi, 2008; ICN, 2006; International Centre on Nurse Migration, 2007; Kingma, 2007; McIntosh, Torgerson, & Klassen, 2007). Currently, the leading source country of nurses worldwide is the Philippines (Choy, 2010; Kingma, 2007)  and accordingly nurses educated in the Philippines make up the greatest proportion  (32.7%) of IENs in Canada (CIHI, 2012). Despite the rise in nurse migration from lower to higher to income countries, the phenomenon remains poorly understood. It is complex and weighted with many ethical concerns (Allan & Larsen, 2003; Bach, 2003; Ball, 2004; ICN, 2007b; Kingma, 2006; Smith, Allan, Henry, Larsen, & Mackintosh, 2007; WHO, 2006). Indeed, as a nurse educator responsible for teaching IENs in Canadian nurse bridging programs1, I have become increasingly aware of the complexity of nurse migration and concerned about the vulnerable status of my students. For example, I clearly recall the despair expressed by one student as she recounted her story of separation from her four children and husband for ten years while she came to Canada as a domestic worker through the Live-in Caregiver Program (LCP) and then proceeded to seek                                                  1Nurse bridging programs refer to nurse re-entry programs or educational programs that are specifically designed to help individuals who have completed basic nursing education in other countries meet Canadian licensing requirements and integrate into the Canadian health care system (Jeans, Hadley, Green, & Da Prat, 2005). 2  Canadian RN licensure. While studying to meet the requirements for this credential and working to cover expenses associated with its acquisition, she also supported her family in the Philippines. Although recently reunited with her family in Vancouver, she confided she would never have come to Canada if she had foreseen the difficulty of acquiring RN licensure and employment. In the Philippines she had been a nurse educator, but in Canada, years later, she was working as a care aide in a community hospital while attempting to acquire RN registration. Listening to this story and others, I became curious about broader structures2 and processes that shape nurse migration experiences from lower income countries, ones not readily visible to the nurses or to me. Moreover, I realized in my role as a nurse educator that in order to effectively facilitate IEN integration into the workplace, I needed to understand the context of these migration experiences. Thus, in this dissertation I set out to explore how social, economic, political, and historical contexts mediated by the intersection of social relations3, such as gender, race4, and class5, come to shape the everyday experiences of IENs seeking RN licensure and employment in Canada. In the remainder of this first chapter I lay out the empirical and theoretical background that enabled me to move forward with this plan and in subsequent chapters will expand on this content.                                                   2I use the term ?structures? as it is used by Sewell (1992) to depict sets of mutually sustaining schemas (virtual) and resources (actual) that empower and constrain social action and that tend to be reproduced by that action. In this regard structures are both the medium and the outcome of practices which constitute social systems. The process of enacting structures entails reciprocity between structure and agency: structures are enacted by human agents and agents act by putting into practice their necessarily structured knowledge.  3Social scientists view peoples? doings as embedded within social relations or temporal sequences of action in which ?the foregoing intends the subsequent and in which the subsequent ?realizes? or accomplishes the social character of the preceding? (Smith, 2005, p.228). 4 I understand race to be a social construct; not a biological essence (Anderson, 1998). 5 In this thesis I draw on the Marxian premise that class is defined by one?s relationship to the process of production:  autonomy over production and control over the labour process (McPherson, 1996).  3  A Nurse Migration Trajectory As nurses move along a trajectory towards securing RN licensure and employment in a higher income country, their lives are shaped by a myriad of social, economic, political, and  historical contexts. Structures at international, national, and local levels overlap to influence the demand for nursing services in destination countries, the willingness of nurses to migrate, and the capacity of IENs to enter professional nursing practice in foreign workplaces (Buchan, 2006; Kingma, 2006, 2007, 2010; Kline, 2003).  Structures creating a demand for nursing skills. As the need for health services in higher income countries escalates, the domestic supply of nurses is dwindling and is expected to shrink (WHO, 2006). For instance, it is anticipated that Canada will experience a shortage of 60,000 full-time RN equivalent positions by 2022 if the health needs of its citizens continue to grow  according to past trends and if no new remediation policies are implemented  (Murphy, Birch, Alder, MacKenzie, Lethbridge, Little, & Cook, 2009) The term ?nurse shortage?, however, is a relative term as it is measured in relation to a country?s own historical staffing levels, economic resources, and estimates of the demand for health services (Buchan, 2003). As such, it is a label that is used differently by different stakeholders. For example, Canada, with one of the healthiest populations and highest densities of nurses in the world at a ratio of approximately 10 nurses per 1000 population, claims to have a nurse shortage (WHO, 2006). On the other hand, lower income countries, such as the Philippines, China, India, Indonesia, and Viet Nam, with greater health needs and nurse to population ratios of approximately only one to 1000, claim to have an oversupply and encourage the outflow of nurses (WHO, 2006). 4  While it is important to acknowledge the serious global inequities related to the availability of nurse resources and that the amelioration of nurse shortages in Canada may in fact worsen the provision of health care in lower income countries, nurse shortages in higher income countries are not to be ignored. Thus, it is worth noting the structures that appear to be contributing to the undersupply of nurses in higher income countries; structures such as an aging workforce, the increasing incidence of chronic illnesses, increasing population growth rates, and alternative career opportunities for women (Buchan, 2006). However, it is also reported that this undersupply may be symptomatic of larger systemic problems causing  nurses to leave their jobs (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Ball, 2004; Buchan, 2006; ICN, 2006, 2007a; Kingma, 2007, 2010; McIntosh et al., 2007; Rodney & Varcoe, 2012). For instance, it is speculated that in many countries (both high income and low) nursing continues to be undervalued as women?s work and consequently inappropriately funded and supported (Buchan, 2002, 2006; ICN, 2004a). Structures compelling nurses to migrate. Frequently nurse migration is conceptualized in terms of ?push factors?, or those  causing discontent in source countries, and ?pull factors?, or those  making destination countries more attractive (ICN, 2007b; Kingma, 2006; Kline, 2003). For instance, push factors, such as low pay, poor working conditions, unemployment, and political instability, are commonly cited as reasons that nurses decide to emigrate (Jeans et al., 2005).  On the other hand, pull factors, such as opportunities for better pay, improved working conditions, and professional advancement, are often described as attracting nurses to higher income countries (Kingma, 2006). However, on closer examination structures compelling nurses to migrate are not so straightforward. In some lower income countries nurses who migrate are viewed as ?heroes of 5  development? and their governments have labour policies and international agreements in place to support their migration. The Philippines6 is an example of a country that deliberately encourages nurse emigration for employment abroad and the channelling of remittances, skills, and knowledge back to the home country (Castles & Miller, 2009; Choy, 2006; 2010; Guevarra, 2010; Kingma, 2006, 2007; WHO, 2006).  Indeed, the Philippine government has implemented an official overseas labour policy and established the Philippine Overseas Employment Authority (POEA) and the Office of Workers Welfare Administration (OWWA) to facilitate international migration and protect citizens working abroad (Choy, 2006; Guevarra, 2010; ICN, 2005; Kingma, 2006). As well, to meet the increased global demand for nurses the government has supported the growth of a large number of domestic private nursing schools7 (International Labour Office, 2005; Kingma, 2006; WHO, 2006). While the emergence of these schools has significantly increased opportunities for nursing education, it has also been problematic. As one illustration, in 2006 it was reported that with the increased number of these institutions the national regulatory body of the Philippines had difficulty enforcing and maintaining educational standards, which consequently compromised students? performances on national licensing exams and ultimately opportunities for  international employment (Kingma, 2006).  Although factors such as opportunities for better working conditions in higher income countries are frequently cited as factors that attract nurses from lower income countries, for many, migration offers an opportunity to escape from structures rooted in gender inequality and poverty. For instance, it is suggested that migration can be an empowering experience for women                                                  6Other countries that are either actively involved or considering export strategies include China, India, Indonesia and Viet Nam (WHO, 2006). 7Private-sector companies are opening up their own nursing schools. For example, in the Philippines the number of nursing schools has increased dramatically since in the 1970s when there were 63 schools. In 1998 there were 198 schools and in 2004 there were 370 schools and most are  private (Kingma, 2006). 6  as it may provide increased status, a sense of independence and accomplishment, liberalization from traditional duties, and an acceptable way out of unsatisfactory relationships (Kingma, 2006; Parrenas, 2001; Pratt, 2012; Sarvasy & Longo, 2004; UN, 2006). As well, the exposure to active recruitment strategies may strengthen a nurse?s resolve to migrate (Kingma, 2006). As higher income countries turn to lower income countries to address their nurse shortages, they are increasingly engaging in intensive recruitment campaigns (Buchan, 2006). In 2008 the province of Saskatchewan recruited 108 nurses from the Philippines (Saskatoon Health Region, 2008) and a  provincial recruitment team from Manitoba made conditional offers of employment to a group of 131 nurses from the Philippines (Recruitment Canada, 2008).   Many IENs also seek the services of recruitment agencies, that is, for-profit organizations that link employers wishing to hire staff with nurses looking for jobs (ICN, 2004a; Kingma, 2006; Smith et al., 2007). Although these agencies can be useful, there are ethical concerns around risk of exploitation and abuse (Allan & Larsen, 2003; Bach, 2003; Ball, 2004; ICN, 2007b; Kingma, 2006; Smith et al., 2007; WHO, 2006). For instance, reports from the UK suggest that IENs may be misled about the nature of their employment or charged exorbitant placement fees (Allan & Larsen, 2003; Jeans et al., 2005; Kingma, 2006; Smith et al., 2007). Structures influencing entry into RN practice in Canada. As nurses move along the trajectory towards RN licensure and employment in destination countries, numerous structures at international, national, and local levels have the potential to both facilitate progress and impede advancement. Policies related to labour and immigration, credential assessment and recognition, and educational programs subject IENs to numerous challenges. 7  For many, the first challenge, after deciding to emigrate, is the task of navigating through foreign immigration policies. For those intending to migrate to Canada there are several immigration pathways and each has implications for RN licensure and employment. For example, if IENs enter Canada as permanent residents under the Federal Skilled Worker Program (FSWP), pre-arranged RN employment is not a pre-requisite8 nor is permanent resident status a guarantee of RN employment since RN licensure, unlike immigration, is a provincial or territorial responsibility (Dumont et al., 2008). If IENs enter Canada through the LCP as domestic caregivers they must complete their LCP responsibilities before they can become eligible for nurse bridging programs (CIC, 2012b). However, if IENs enter Canada under the Temporary Foreign Worker Program (TFWP) they must have a RN job offer before they arrive in Canada (Dumont et al., 2008). In addition to navigating their way through complex immigration policies, IENs must also untangle foreign credential assessment and recognition processes. In Canada, all IENs, regardless of their immigration pathway, must have their credentials assessed and recognized by a provincial or territorial body and pass the Canadian Registered Nurses Exam (CRNE) before they can acquire full practice registration status. This can  be a lengthy and  costly process and a significant number of IENs residing in Canada never become registered (Jeans et al., 2005); as a consequence, many risk remaining marginalized in low-paying jobs (Dumont et al., 2008; McKay, 2002; Pratt, 1999, 2003, 2010, 2012).                                                  8 On April 18, 2013 CIC announced that nurses will only be eligible to apply to enter Canada under the FSWP if they have a qualifying offer of arranged employment or they are in the PhD stream (CIC, 2013d).     8  Contributing to the challenge of securing RN licensure is the fact that IENs need an adequate number of recent practice hours and specific educational and language qualifications  before they can be eligible to write the CRNE and in British Columbia (BC) they must also complete a 250 hour monitored Canadian work experience9 (CRNBC, 2011). Meeting these requirements may be especially daunting for IENs immigrating to Canada through the LCP, as many lack recent nursing experience (Dumont et al., 2008; Pratt, 1999). For IENs who qualify to write the CRNE, passing it may also prove difficult. In 2011 only approximately 50 percent of internationally educated first time CRNE writers passed the exam, compared to about  87 percent of Canadian educated first time writers (CNA, 2012b). Supports to ease integration. Acknowledging that migration may have adverse effects on lower income countries and on IENs, the International Council of Nurses (ICN) ( 2007a, 2007b) and the World Health Organization (WHO) (2006) propose urgent attention to global nurse retention issues and ethical recruitment and integration practices. Although these organizations accept that nurses should have the freedom to pursue work where they choose, they stipulate that higher income countries must ensure fair treatment of IENs. The Canadian Nurses Association (CNA) also encourages governments, employers, recruiters, and other stakeholders to respect ethical recruitment and integration practices (CNA, 2009). Accordingly, the CNA supports a national integrated health human resource strategy that includes the expeditious licensure and integration of IENs wanting  to immigrate or already residing  in Canada (Jeans et al., 2005). As a consequence of this                                                  9 On March 13, 2013 the RN regulatory college of BC announced that it was removing the requirement for a Canadian reference following 250 hours of practice as a professionally registered nurse and that the change will be implemented over time (CRNBC, 2013c).  9  initiative, nurse refresher courses and bridging programs have been implemented in many Canadian jurisdictions (Dumont et al., 2008). The Complexity of Nurse Migration As IENs from lower income countries move along a trajectory towards RN licensure and employment in destination countries their experiences are influenced by an array of contexts: structures that create a demand for nurses in higher income countries; those that compel nurses in lower income countries to migrate; and still others that influence entry into foreign professional nurse practice. Further, such structures mediated by intersecting social relations, such as gender, race, and class, overlap at international, national, and local levels to create a multi-dimensional phenomenon fraught with ethical concerns. Accordingly, it is evident that individual migration experiences cannot be examined in isolation; rather, they must be viewed as embedded within complex social and historical contexts. Further, it appears that licensure experiences in foreign countries need to be viewed as part of a trajectory that begins when nurses decide to migrate and that the trajectory does not necessarily conclude with licensure.  It is also important to consider that the demand for nurses in higher income countries may be related to the low status assigned to nurses and to women, thus IENs are at risk of filling positions that have been directly or indirectly rejected by others. Additionally, the fact that a significant number of IENs residing in Canada never acquire Canadian registration requires explanation. Further, it is crucial to recognize that migration may not be a matter of choice for some nurses, but something imposed on them and renders them vulnerable to exploitation and abuse from recruitment agencies, intense recruitment campaigns, or future employers. Indeed, structures creating a demand for nurses in wealthier countries and those compelling nurses to migrate from poorer countries should prompt exploration of how much control IENs have over 10  their own actions and raise ethical questions such as ?whose interests are served and whose are harmed by traditional ways of structuring thought and practice? (Sherwin, 2000 p. 76). In this light, there is need to consider whose interests are being served by the rapid expansion of private schools in some lower income countries or by immigration or professional regulatory procedures that make it more difficult for some ethnic groups to gain licensure or employment.  Developing a Focus for the Study Recognizing that IENs from different source countries may have unique challenges and that to study them as a homogeneous group may render such challenges invisible (Kingma, 2006; Pratt, 2004), I focused on the experiences of  nurses educated in the Philippines. These nurses make up the greatest percentage of IENs in Canada and have a long history of migration and thus significant experience to learn from. Moreover, I suggest that knowledge gleaned from the Philippine experience will inform understanding of migration from other lower income countries. Further, I limited my study of nurses educated in the Philippines to those who reside in the lower mainland of BC. BC has the highest percentage of IENs in its RN workforce (16.4 percent) compared with other provinces in Canada (CIHI, 2010). The greatest percentage of RNs in BC (94.1percent) work in urban areas (CIHI, 2010). In addition, due to the profound impact that women have on nursing and nurse migration10, I focused on female nurses; specifically, my aim was to uncover knowledge that may be relevant for female nurses educated in the Philippines as they strive to integrate into the Canadian health care system. However, to illuminate the experiences of these nurses, I solicited information from male Philippine nurses though they were not the focus of my study.                                                  10In 2009 females comprised approximately 93.8 percent of the RN workforce in Canada (CIHI, 2010). Although I am unable to find statistics that indicate the proportion of female IENs in Canada, a study conducted in the UK indicates that females represent 84 per cent of IENs (Buchan, Jobanputra, Gough, & Hutt, 2005).  11  Reflecting on the literature. On stepping back to reflect on the literature related to the phenomenon of nurses educated in the Philippines seeking to continue their professional practice in BC, I found several bodies of knowledge particularly helpful. Beginning with Canadian literature, numerous published accounts provide an overview of credential assessment and recognition policies, challenges encountered by IENs seeking licensure, and strategies to recruit and integrate IENs into the workplace (Baumann, Blythe, McIntosh, & Rheaume, 2006; Blythe & Baumann, 2008; Blythe, Baumann, Rheaume A., & McIntosh, 2009; Brush & Sochalski, 2007; Jeans et al., 2005; Little, 2007; McGuire & Murphy, 2005; Sochan & Singh, 2007). Unfortunately IENs in these studies are grouped together as a common lot, regardless of their origin, whether a higher income country, such as the UK, or a lower, such as the Philippines. This renders their unique experiences less obvious. As well, these accounts fail to provide an in-depth analysis of how experiences are influenced by intersecting oppressions embedded within broader social, economic, political and historical contexts at international as well as national and local levels. However, in her Master?s thesis, Ronquillo ( 2010) does provide a historical perspective of nurse migration from the Philippines and sheds light on how colonial relations between the Philippines and the US continue to shape experiences of nurses educated in the Philippines as they transition into the Canadian workforce.  Although not focused specifically on nurses, there are several Canadian studies that provide a thoughtful analysis of how social relations, such as gender, race, and class, intersect within broader contexts to shape migration experiences of women from lower income countries.  Pratt (1999, 2003, 2012) and McKay (2002) explore the experiences of domestic workers (many of whom are RNs) from the Philippines living in Canada and raise ethical concerns related to the 12  marginalization and exploitation of these women. Man (2004) also illuminates gendered and racialized processes, such as professional accreditation systems, affecting the experiences of female migrants from Asia seeking employment in Canada. However, her study population is skilled professionals from China, rather than nurses from the Philippines. Although not examining Canadian conditions or necessarily focused on nurses? experiences, there are several studies that add clarity to the context of migration from the Philippine in general. For example, Parrenas (2001, 2008)  reveals the shifting gender ideologies that affect women?s emigration from the Philippines; Guevarra (2010) identifies how a neo-liberal framework for managing labour migration in the Philippines influences migration experiences; Lan (2003) illustrates how overseas domestic workers from the Philippines remain burdened with gendered responsibilities associated with their families back home; Choy (2006) examines the effect of American colonialism and racialization on nurses from the Philippines residing in the US; and Lorenzo, Galvez-Tan, Icamina, and Javier (2007) present the benefits and costs associated with nurse migration from a perspective of those residing in the Philippines. Finally, while not specifically addressing the experiences of those from the Philippines, nor those who have migrated to Canada, findings from two exhaustive studies undertaken in the UK shed light on broader processes and ethical concerns related to IEN transition experiences into workplaces in upper income countries. Studies conducted by Allan and Larsen (2003) and Smith et al. (2007) both explore the experiences of IENs working in the UK and reveal IENs may face discrimination in terms of access to employment and treatment by colleagues. In another study that compares the labour and human rights of Philippine nurses working in the UK and those working in Saudi Arabia, the author argues that IENs in both countries often occupy 13  marginalized and racialized positions since they typically fill positions that, for a variety of reasons, domestically educated nurses are unable or unwilling to fill (Ball, 2004). Generating a problem statement and defining a purpose. The existing body of research and policy literature informs an understanding of the complexity inherent in the phenomenon of nurses educated in the Philippines seeking RN licensure in Canada. It does not, however, adequately represent the perspectives of nurses from the Philippines or from other lower income countries. Additionally, it does not help us to understand why a significant number of IENs never acquire Canadian licensure and remain underemployed in low-paying jobs. Nor does it sufficiently expose how social relations, such as race, gender, and class, combine to influence  experiences and how these nurses may themselves participate in perpetuating such processes. In a similar vein, this research does not satisfactorily address the myriad of ethical concerns related to nurse migration experiences in Canada. Nevertheless, with only a limited understanding of nurse migration experiences, Canadians are increasingly relying on nurses from lower income countries, especially the Philippines, to play an important role in the provision of health care. I argue that to add clarity to this complex situation and to fulfill responsibilities for fair recruitment and integration practices outlined by the WHO (2006) and ICN (2007a, 2007b), Canadian nurse leaders and policy makers need to have a contextual understanding of this phenomenon. My purpose in pursuing this study, therefore, was to critically examine the processes that shaped the experiences of nurses educated in the Philippines before and after arrival in Canada as they sought or considered seeking Canadian RN licensure; produce knowledge that can be used to inform policy making and ethical decision-making related to IEN recruitment and integration practices; assist nurses educated in the Philippines to participate in 14  choices that will make for better overall migration experiences; and ultimately enhance health care delivery in Canada and the health and well-being of Canadians themselves. Setting Up the Study The next step in moving forward with my research plan was to formulate a research question and situate my meta-theoretical commitment.  Delineating the research question. The overarching research question guiding this study was: How do social, political, economic, and historical contexts mediated by intersecting oppressions come to shape the everyday experiences of nurses educated in the Philippines as they seek11 RN licensure in BC? Specifically, my objective was to learn from these nurses about their subjective experiences seeking Canadian RN licensure and to work with them, in consultation with an Advisory Group, to understand how their experiences both shape and have been shaped by social, political, economic, and historical contexts imbued with structures at international, national, and local levels. The knowledge generated from these experiences inspired analysis of structures at the international level that compelled nurses to leave the Philippines and at national and local levels that influenced the ease with which they acquired Canadian RN licensure. It was also my intent to explore the reciprocity between structure and agency and to note how nurses negotiated these structures at various points of their trajectory.                                                   11In my research question I used the expression ?seek RN licensure? to include ?have considered to seek RN licensure?? as I was also interested in learning from nurses not necessarily actively seeking licensure at the time of this study (they may have delayed or abandoned the notion).  15  Locating a meta-theoretical commitment. In selecting an interpretive lens for this study I considered four issues. First, I acknowledged that structures coordinating the everyday experiences of this cohort of nurses may not necessarily be visible to themselves or to me. Second, I considered that nurse migration is a multi-dimensional phenomenon, embedded in broader social, economic, political, and historical contexts, and mediated by important issues of social relations, such as gender, race, and class. Third, I realized that such complex structures may constrain the ability of IENs to exercise autonomy over their own nurse migration trajectory. Fourth, I view my work as a catalyst for social change. To address these issues, I located the meta-theoretical context for this study within the critical theory paradigm, in particular, within feminist scholarship. Toward this end I drew on traditions of postcolonial feminism, including intersectional and postcolonial theory, and relational ethical theory. Postcolonial feminism. Postcolonial feminism provided an analytic lens for a multi-layered examination  of  intersecting oppressions such as gender, race, and culture located within broader historical and political contexts (Anderson, 2002). It gives voice to racialized women who have been silenced and it provides a means to examine how broader social contexts variously position and shape lives, knowledge, opportunities and choices (Anderson, 2000a). Anderson (2002) proposes a postcolonial feminist scholarship generated through the convergence of black feminist theory, in particular intersectional theory, and postcolonial theory, arguing that these two scholarships are complementary. While black feminist scholars often focus on how social relations combine  to create social injustices, postcolonialism focuses on the construction of  race and racialization and 16  cultural identity (Anderson, 2002). Ultimately, the aim of postcolonial feminism is to generate knowledge that will achieve social justice (Anderson, 2000a).  Relational ethical theory. Relational ethical theory views individuals as rooted in an interconnected dynamic web of social relationships and affinities with others; not as isolated, social units fixed in time (Rodney, Burgess, Phillips, McPherson, & Brown, 2013; Rodney, Canning, McPherson, Anderson, McDonald, Pauly, Burgess, & Phillips, 2013; Rodney, Kadyschuk, Liaschenko, Brown, Musto, & Snyder, 2013).  Moreover, it recognizes the importance that such relationships have on influencing each person?s  identity, development, and aspirations (Sherwin, 2000). The relational ethical theory that I drew from, however, does not refer only to social relationships; rather, it also refers to political relationships of power and powerlessness. In this regard, relational ethical theory accounts for how forces of oppression can interfere with someone?s ability to exercise autonomy (Rodney, Kadyschuk et al., 2013; Sherwin, 2000).Thus, relational ethical theory directed me to look at the context that influences and sometimes constrains decisions made by study participants pursuing  RN licensure and/or employment in Canada.  Sketching the Study Design The nature of my research question led me to a qualitative research design inspired by ethnographic traditions and informed by postcolonial feminism and relational ethical theory. An ethnographic approach offered an opportunity to explore data from a variety of sources and to use interviews, observations, field notes, and documentary evidence to enhance understanding of complex concepts and practices (LeCompte & Schensul, 1999; Sherwin, 2000). Moreover, an ethnographic approach informed by postcolonial feminism directed me to begin my inquiry with the experiences of study participants and to reflect upon and examine how intersecting 17  oppressions and broader social and historical structures shaped and were shaped by their everyday experiences (Anderson, 2002; Reimer Kirkham & Anderson, 2002). To refine my understanding of this complex phenomenon I also explored documents, such as CRNBC regulatory procedures, and I interviewed secondary participants such as an immigration counsellor, nurse educators, and individuals educated in the Philippine but who became RNs after arrival in Canada.  I was aware that as a white, middle-class professional woman, who is not only a nurse but also had recent experience as a nurse educator responsible for assisting IENs with their integration into the Canadian workplace, I  needed to be reflexive and to critically evaluate how matters of privilege associated with whiteness and professionalism affected my research (Anderson, 1991a; Harding, 1987b). Therefore, to operationalize my research plan I continually explored and acknowledged my beliefs, assumptions, and preconceptions about nurses educated in the Philippines and assimilated this understanding into my analysis (Burns & Grove, 2009). I also sought guidance from my thesis supervisory committee and from an Advisory Group of nurses educated in the Philippines and/or of Philippine ethnic descent. Articulating Relevance Canada is increasingly relying on nurses educated in the Philippines to play an important role in the provision of health care. However, little is known about the experiences of these nurses aspiring to nursing practice in Canada. Existing literature suggests many have challenges in acquiring Canadian RN credentials and are at risk of underemployment. This study illuminates how structures that extend beyond the boundaries of nurse experiences come to affect their everyday lives. As such, these research findings have the potential to deepen understanding of the daily realities of these nurse migrants. 18  So far, the voices of nurses from the Philippines have been missing from nursing policy and education initiatives. By positioning these nurses at the centre of this project, this study offers new insights to the phenomenon of nurse migration from the Philippines, in particular, and from other countries in general. The knowledge generated here extends understanding beyond the everyday challenges confronting nurses, regulators, educators, and employers to the broader ethical concerns about whose interests are being served and whose may be harmed. Such knowledge can be used to inform policy making and ethical theorizing related to RN credential assessment and recognition, workplace integration practices, and health human resource planning.  Organization of the Thesis Having described the key components of my research study, I now turn to a review of the literature in Chapter Two. Here I will offer a detailed discussion of structures that influence the trajectory of nurses educated in the Philippines striving to continue their nursing practice in Canada: structures that create a demand for nurses in Canada; those that compel this migration; and those that influence entry into professional nursing practice in Canada. Using examples from the literature I will demonstrate how such structures may both shape and be shaped by nurse migration. In Chapter Three I describe the theoretical perspectives that provided support for the pursuit of my research question and informed my interpretive lens. In Chapter Four I address the strategies I used to answer my research question, ensure scientific quality, and attend to research ethics. In Chapters Five, Six, Seven, and Eight I present the results of the research study. Consistent with an ethnographic approach informed by postcolonial feminism, each of these four results chapters is grounded in the experiences of the study participants. In Chapter Nine, I offer a theoretical synthesis of the key study findings in an effort to extend understanding of the 19  broader context of nurse migration. Additionally, I seek to clarify how nurses themselves are active agents in shaping their own experiences and to advance understanding of ethical concerns associated with nurse migration and meaningful ways to promote social justice. Chapter Ten concludes the dissertation with an overview of the study and a presentation of the key conclusions and recommendations for moving forward.  20  Chapter Two:  Surveying the Organizational Context of Nurse Migration In the preceding chapter I presented the context for my study. In this chapter I propose to summarize the state of knowledge regarding experiences of nurses educated in the Philippines as they strive to continue their nursing practice in Canada. I will review literature that sheds light on  the demand for IENs in higher income countries such as Canada, that compel many to migrate, and that influence entry into professional nursing in Canada. Structures Creating a Demand for Nurses Higher income countries including Canada are becoming more reliant on IENs from lower income countries to deal with domestic nurse shortages. Consequently professionally active nurses have become a prime resource in an increasingly competitive global labour market (Gordon, 2005; Kingma, 2006, 2010; Little, 2007). Thus the complex of social, economic, political, and historical conditions creating shortages of nurses in these countries have implications for nurse migration experiences. Representation of IENs in the Canadian workplace. Data from higher income countries indicate that IENs are making significant contributions to their health workforces. At 21 percent of the RN workforce, New Zealand ranks first amongst countries hiring IENs; Ireland, is second with 14 percent; and the UK is third at 10 percent (WHO, 2006). Canada ranks in fourth place, with IENs comprising 8.6 percent of its RN workforce (CNA, 2012a). Canadian statistics further reveal that there has been a steady increase in the proportion of IENs over the past decade. For instance, in 2002 6.9 percent of RNs employed in Canada graduated from a foreign nursing program (CIHI, 2003). Statistics gathered by Canadian provincial and territorial regulatory bodies indicate that provincially the highest concentration of IENs work in British Columbia (BC) (16.4 percent), 21  next Ontario (11.6 percent), while the lowest concentration is in New Brunswick (1.5 percent) and Newfoundland (1.6 percent) (CIHI, 2010). Despite these numbers, it is not known exactly how many IENs reside in Canada, licensed as nurses or otherwise, as the data only represent those registered to nurse not the number living in Canada12. However, in a study published by the CNA,  Navigating to become a nurse in Canada: Assessment of international nurse applicants, it was estimated that approximately two-thirds of IENs coming to Canada never complete the registration process (Jeans et al., 2005).  A study of IENs in Ontario in 2006 reports that approximately 40 percent of IENs applying  to the College of Nurses of Ontario fail to complete the registration process and do not enter the workforce whereas between 86.7 percent and 94.6 percent of RNs educated in Ontario register within 12 months of application (Baumann et al., 2006). Further, recent statistics indicate that only approximately 50 percent of internationally educated first time CRNE writers passed the exam, compared to about  87 percent of Canadian educated first time writers (CNA, 2012b). The nature of the demand for nurses in higher income countries. While the increasing number of IENs employed in RN positions in Canada partly reflects the general trend of movement across national boundaries13, it also reflects a complex of social, economic, political, and historical conditions that creates a shortage of nurses in higher income countries (Ball, 2004; Buchan, 2006; Kingma, 2006). For instance, in Canada while there was a shortage of nurses in the 1980s due to increased acuity of clients and the demand for increased nurse to patient ratios, there was an oversupply of nurses in the 1990s as a result of restructuring,                                                  12Citizenship and Immigration Canada (CIC) cannot provide statistics on the number of IENs residing in Canada as they record immigrants by applicant class, not by occupation.   13Recent population projections show that immigration is a major contributor to Canada?s economy, representing 67 percent of its demographic growth and this number is expected to reach  over 80 percent in 2031 (Statcan, 2012). 22  downsizing, and fiscal restraints (Barry, 2002). After several years of nursing shortages in the early 2000s, there was again an oversupply due to the economic downturn of 2008 that prompted many jurisdictions to implement cuts to patient and nursing services. It is reported that in the Vancouver Coastal Health Authority only 171 new graduates found work in 2010, down from 225 in 2009 and the Fraser Health Authority in BC hired only 337 new grads in 2010, down from 460 in 2009 (BCNU, 2011). The shortage of nurses may vary greatly across jurisdictions and at different times but it is generally acknowledged that due to aging populations and a growing incidence of chronic illnesses there is an increasing demand for nurse. At the same time the supply of available nurses in some countries is declining and is expected to worsen (ICN, 2006). In Canada, for example, it is estimated that the shortage of RNs will increase to almost 60,000 positions by 2022 if the health needs of Canadians continue to follow past trends and if no policy interventions are implemented (Murphy et al., 2009).  Much of the cyclical nature of the shortage of nurses in higher income countries appears on the surface to be related to external conditions. There is, however, speculation among some scholars that the shortage may be closely related to poor work environments and low professional satisfaction (Aiken et al., 2004; Buchan, 2006; ICN, 2006; Rodney & Varcoe, 2012). Kingma (2010) draws attention to the high vacancy rates in caring for the elderly that generates aggressive recruitment strategies and Aiken et al (2004) suggest that the inordinate amount of time RNs are required to spend on non-nursing tasks contributes to job dissatisfaction. A Canadian study indicates that the inability of nurses to find full time employment is another factor leading to nurse attrition (Dumont et al., 2008).  In BC, 12 percent of RNs aged 25 to 34 years did not renew their license between 2003 and 2004 (Dumont et al., 2008).  23  Indeed, it is contended that a long-term underinvestment in the nursing profession and its career structure is ultimately affecting the willingness of nurses to stay in their jobs and the desirability of nursing as a career option (Buchan, 2008). Moreover, some hold that nurse shortages are a symptom of a more deep seated problem in which nursing in many countries continues to be undervalued as ?women?s work? (Buchan, 2002, 2006; ICN, 2007b). Source countries: The Philippines. It is not only high income countries that are experiencing critical nurse shortages. With few exceptions, nurse shortages are present in all regions of the world (ICN, 2004b). Although it is suggested that there are approximately 59 million health workers14 worldwide, it is also estimated that there is a corresponding shortage in the order of 4.3 million health workers (WHO, 2006). WHO (2006) has identified 57 countries with critical shortages but paradoxically these countries also report large numbers of unemployed health professionals. However, there is no universally accepted definition of what a shortage is; rather it is a relative term and is measured in relation to a country?s own historical staffing levels, economic resources, and estimates of the demand for health services (Buchan, 2003). As such, it is a label that is used differently by different stakeholders. For instance, both Canada and the US, which have an average of nearly 1,000 nurses per 100,000 population15, as well as several countries in Africa, with fewer than 10 nurses per 100,000, claim to have nurse shortages (Buchan, 2006).  Despite these disparities, it is the countries with the higher incomes and the most resources that are fuelling the demand for nurses and nurse migration (Buchan, 2006).                                                  14The term ?health workers? refers to all people (including doctors, nurses and others) who are engaged in paid activities in which the  primary intent is to enhance health (WHO, 2006). 15Between 2007 and 2011 the number of RNs per 100,000 population remained largely unchanged (from 783 to 785 per 100,000 (CIHI, 2012)). 24  Traditionally, international nurse migration tended to be a North-North or South-South phenomenon (e.g., Irish nurses working in the UK and Canadian nurse practicing in the US) (Kingma, 2007). However, the accelerating  movement of nurses from lower to higher income countries is intensifying as higher income countries struggle  to fill positions created by their own shortages (Buchan, 2002; Kingma, 2007; WHO, 2006).  Further, some nurses take an indirect route to their final destination, using stops along the way to develop their skills and credentials (Kingma, 2006, 2007). The leading source country of IENs worldwide is the Philippines (Choy, 2010; Kingma, 2007). The precise number is difficult to ascertain, however Kingma (2006) estimates that approximately 250,000 Philippine nurses are working abroad. Reports from the US indicate they comprise 50.2 percent of the IEN workforce (Xu, 2007) and recent statistics from the Canadian Institute for Health Information (CIHI) indicate that they constitute 32.7 percent  of the IENs in Canada (in contrast to 15.3 percent of IENs in Canada educated in the UK) (CIHI, 2012)16. Although nurses from the Philippines have been making a significant contribution to the Canadian RN workforce since the first major wave of migration from that country in the 1960s and 1970s (McKay, 2002; Ronquillo, 2010), it was not until approximately 2003 that their numbers started to surpass those educated in the UK and the US. For instance, while the percentage from the UK and the US combined was 30.2 percent in 2003 compared to 27.9 percent from the Philippines (CIHI, 2004), in 2009 those from the UK and US equalled 25 percent compared to 31.6 percent from the Philippines (CIHI, 2010). While the US remains the                                                  16Individuals from the Philippines also make a significant contribution to the nurse aides, orderlies, and patient services workforce in Canada, representing 25.8 percent of visible minority workers, second to black workers who comprise 40 percent of visible minority (Statcan, 2012).Those from the Philippines also make up 44 percent of childcare and home support workers in Canada, the largest visible minority group in this category, and 60 percent of babysitters and, nannies in Canada (Statcan, 2012). 25  destination of choice for most Philippine nurses, Saudi Arabia, the UK, South East Asia and other higher income countries such as Canada have also become popular destinations (Buchan, Kingma, & Lorenzo, 2005; Lorenzo, Galvez-Tan, Icamina, & Javier, 2007). We do not have specific demographics for Philippine nurses working in Canada, but data collected from 48 focus groups that include Philippine health workers in the UK report that these IENs are predominantly female, young (in their early twenties)17, single, and come from middle income backgrounds18 (Lorenzo et al., 2007).  A few of the migrant nurses have acquired a Master?s degree and, the majority hold a Bachelor of Science in Nursing (BSN) degree (Lorenzo et al., 2007). Some have specialization in ICU, ER, and OR and have rendered between one and 10 years of service before migration (Lorenzo et al., 2007). Although some nurses working overseas eventually return to live in the Philippines, it appears that the majority do not, and others may return temporarily while en route to another job abroad (Lorenzo et al., 2007).  It is interesting to note that migration is not an option for everyone in the Philippines. In an ethnographic account of Philippine migrants working as domestics in Taiwan, participants report that not everyone can work abroad; rather, migrants have to be sufficiently educated, have adequate funds to secure employment abroad, and have a serious and determined nature (Lan, 2003). Thus, migratory flows from the Philippines are selective, as the poor or unemployed seldom migrate (Lan, 2003).                                                  17Although this study reports that Philippine nurses are predominantly in their early twenties, this may not be the case for those working in Canada. It is reported that the average age of IENs writing the CRNE was over 30 years of age (CNA, 2008). 18In the Philippines the majority of families live in poverty and a middle income status does not constitute a comfortable and secure lifestyle (Parrenas, 2001). 26  Implications for nurse migration experiences. Since the demand for nurses in higher income countries is related, at least in part, to an underinvestment in nursing practice environments, IENs may be in jeopardy of filling RN positions deemed less desirable by others (Allan & Larsen, 2003; Bach, 2003; Ball, 2004; Choy, 2006; Kingma, 2006). In a study commissioned by the Royal College of Nurses (RCN) that explores the motivations and experiences of IENs working in the UK, IENs claim they are exploited in a variety of ways, but most commonly by managers who use them to cover undesirable shifts (Allan & Larsen, 2003). Other studies from the UK indicate that IENs may face discrimination in terms of access to employment and be at risk of assignment to the lower echelons of the job market more than would be expected on the basis of their education (Bach, 2003; Smith et al., 2007). Another study compares the labour and human rights of Philippine nurses working in the UK with those working in Saudi Arabia. The author argues that IENs in both countries often occupy marginalized and racialized positions since they typically fill positions that, for a variety of reasons, domestically educated nurses are unable or unwilling to fill (Ball, 2004). Further, data from an Australian study shows a disproportionate concentration of IENs working in the least prestigious nursing homes (Hawthorne, 2001). Unfortunately, we do not have data to inform us about the nature of IEN employment in Canada. Structures Compelling Nurses to Migrate The demand for nurses in higher income countries may foster nurse migration, but the literature suggests there are also a variety of social, economic, political, and historical conditions that further compel nurses in lower income countries to seek employment abroad. As mentioned in the introduction of this thesis, nurse migration is frequently conceptualized in terms of ?push factors?, or, conditions or circumstances causing discontentment in source countries, and ?pull 27  factors?, or conditions or circumstances making destination countries more attractive (Kingma, 2006; Kline, 2003). Push factors compelling nurses to migrate often include things such as low pay, poor working conditions, unemployment, and political instability; whereas pull factors enticing nurses to seek re-location may include opportunities for better pay, improved working conditions, and professional advancement (Kingma, 2006). However, it is also argued that most migration does not begin with a rational decision to migrate; rather, it is initiated by enticements made to people who previously had no intention of doing so (Mahler & Pessar, 2001). For nurses from the Philippines, enticements can take the form of government policies; an Americanized model of nursing education; job opportunities promoted by recruitment agencies; financial incentives; and family and social networks. I begin this section with an overview of these various conditions and will conclude with how they may influence nurse migration experiences. Pressure from the Philippine government. It is widely acknowledged that overseas labour policies initiated by the Philippine government compel many nurses to migrate (Buchan, 2006; Choy, 2006). Although the Philippines has a long history of migration, it is only since the early 1970s that there has been massive and state-encouraged movements of workers and immigrants; movements that have become part of the country?s everyday life (Rafael, 1997). In the early 1970s, as an attempt to alleviate unemployment and revitalize a failing economy, President Ferdinand Marcos initiated a ?labour export policy? and started to actively promote the export of  nurses and labourers (Choy, 2006; Sarvasy & Longo, 2004). This led to the establishment of the Philippine Overseas Employment Authority (POEA) and the Office of Workers Welfare Administration (OWWA) to encourage international migration and to protect citizens working abroad (Choy, 2006; ICN, 2005; Kingma, 2006; Sarvasy & Longo, 2004). Previously nurse migration initiatives had been 28  established to promote cultural and technological advancement but this new labour policy transformed nursing into a nation building enterprise (Choy, 2006). Under it, Philippine educated nurses working abroad became national heroes through their remittances of foreign currency back home (Choy, 2006; Guevarra, 2010). According to Choy (2006), Marcos? address to the Philippine Nurses Association (PNA)19 at the 1973 convention in Manila revealed this new commitment to exporting nurses when he stated: It is our policy to promote the migration of nurses?We intend to take care of [Filipino nurses] but as we encourage this migration, I repeat, we will now encourage the training of all nurses because as I repeat, this is a market that we should take advantage of. Instead of stopping the nurses from going abroad why don?t we produce more nurses? If they want one thousand nurses we produce a thousand more [sic] (Choy, 2006, p. 115-116).  President Marcos encouraged Philippine nurses working abroad to earn for the country as well as for themselves and as such, recommended that they participate in the dollar repatriation plan by depositing their money in a bank that had a correspondent bank in the Philippines (Choy, 2006). To further show its appreciation and support for workers who sought employment abroad, the Philippine government developed economic and legal means to ease their return to the Philippines and allowed them to bring home duty free purchases (Glick Schiller, Basch, & Blanc-Szanton, 1992). While previously Philippine nurses working abroad had been viewed as  abandoning the Philippines, they were now perceived as national heroes and an important economic development strategy (Choy, 2006). Indeed, the economy of the Philippines depends heavily on remittances from nurse and other migrant labourers working abroad (Buchan, 2006;                                                  19 The purpose of the PNA is to promote professional growth towards the highest standards of nursing. As such, it directs its attention to the provision of programs to enhance the competencies of Filipino nurses to be globally competitive (PNA, 2011).The association is a member organization of the ICN (PNA, 2011) and accordingly has a voice in advancing nurses and nursing worldwide and influencing health policy (ICN, 2013). It has numerous chapters in Europe and the Middle East, as well as in the Philippines.  29  Guevarra, 2010; Kingma, 2006). It is estimated that the total mass of migrants from the Philippines remit eight billion US dollars annually (Kingma, 2006).  In Marketing Dreams, Manufacturing Heroes, Guevarra (2010) also provides insight into how the market economy of the Philippines is sustained by labour migration. She contends that in order to produce responsible economic citizens the government has created a culture of sacrifice whereby workers have become both objects and subjects of the state: as the country?s resources they are commodified as objects of the state and offered globally in exchange for national economic survival; and as national heroes and ambassadors of goodwill they are subjects of the state and conditioned to save not only their families but the nation through their remittances (Guevarra, 2010).  Empowering them by culturally inscribing them as heroes and ambassadors, the government is manufacturing a workforce that can effectively compete in the global marketplace (Guevarra, 2010). Guevarra further argues that while the Philippine government institutionally and ideologically conditions its citizens to believe their future resides outside the Philippines, it maintains that overseas migration is a matter of choice. She asserts that this strategy of empowerment, whereby the responsibility for economic livelihood is shifted onto citizens, reflects a combination of neo-liberal market rationality of economic competitiveness and entrepreneurship and Western values of freedom, individualism, rationality and self-accountability. Moreover, she puts forth that it represents a gendered and racialized moral economy; gendered because women migrant workers? productivity is informed by the state?s perception of women and racialized because it hinges on the construction of a culturally essentialist notion that Philippine citizens are ideal labour objects or commodities. Shedding further light on the gendered nature of the Philippine economy, sociologist Rhacel Salazar Parranes (2008) describes the Philippine?s contradictory stance towards the work 30  of women. On the one hand, its society generally considers that women should assume responsibility for care work in families, values reflected in the 1986 Constitution of Philippines and the 1987 Family Code that construct women as wives and mothers. Yet on the other hand the government promotes the deployment of women workers to help it pay the interest it owes on loans from multilateral institutions such as the World Bank. As she points out, the Philippine government encourages women to leave their home at the same time it reaffirms the belief that they belong inside the home and, indeed, the majority of migrant workers are women and many are re-locating with or without men. Moreover, in its reliance on women to travel abroad and  fill low wage positions as nurses and domestic workers in higher income countries it ironically retains the notion of women?s domesticity and gender inequality (Parrenas, 2008).  Further, it is argued that this neo-liberal framework for managing labour migration is a product of colonial and neo-colonial relations (Choy, 2006; Guevarra, 2010; Kingma, 2006; Parrenas, 2008; Rafael, 1995,1997).  For instance, the nation?s conversion to Christianity during Spanish occupation from 1565 to 1898 is reflected in the narratives of suffering, sacrifice, and martyrdom that underpin the economic framework. As well, colonial relations with the US between 1898 and 1945 that resulted in economic and trade policies detrimental to the country?s long term economic development, contributed to a vulnerable economy that became receptive to an overseas employment strategy. It is also put forth that the reorganization of the country?s political and educational system under the directive of the President McKinley?s 1898 ?benevolent assimilation proclamation? strategy was a pre-condition of contemporary migration (Guevarra, 2010; Rafael, 1995). Rafael (1995), a historian often cited for his research on Spanish and American colonial relations with the Philippines, asserts that in an attempt to govern or control the people of the Philippines the US constructed a parent/child relationship with them: it 31  infantilized them as racial ?others? in need of nurture and education. Just as the Spaniards before them had sent missionaries to convert individuals to Catholicism as a means of having them submit to Spain?s colonial authority (Guevarra, 2010), the Americans built public schools and sent teachers to transform the people into a type of American citizen that embraced an American way of life (Guevarra, 2010; Rafael, 1995). Familiarity with an Americanized model of nurse education. Idealization of an Americanized model of nurse education is another condition compelling nurses to seek overseas employment. Historian Catherine Choy (2006) who has written a detailed analysis of Philippine nurse migration to the US argues that contemporary international migration of Philippine nurses is inextricably linked to early 20thcentury US colonialism in the Philippines. In her master?s thesis, Ronquillo (2010) also argues that colonial relations between the Philippines and the US continue to shape experiences of nurses educated in the Philippines as they transition into the Canadian workforce. In addition to the development of an Americanized education system in the Philippines under President McKinley?s ?benevolent assimilation proclamation? strategy, the creation of an Americanized training hospital system that included the promotion of English language fluency and the establishment of gendered notions of nursing as women?s work, during the US colonial period helped to lay the foundation for the eventual mass nurse migrations in the second half of the 20th century (Choy, 2006).  It is also proposed that the Philippine government?s support for the establishment of a large number of private nursing schools20 to produce nurses qualified to compete for overseas                                                  20The number of schools in the Philippines grew from 63 in the 1970s to 370 nursing schools in 2004 and most of these were private institutions (Kingma, 2006). 32  employment, is a factor contributing to nurse migration (Guevarra, 2010; International Labour Office, 2005; Kingma, 2006; WHO, 2006). As many as 200 applications for new nursing programmes were submitted for the 2004-05 school year alone (International Labour Office, 2005) and there are approximately 460 nursing colleges that offer BSN programs and graduate approximately 20,000 nurses annually (Lorenzo et al., 2007). To put the number of nursing graduates per year in the Philippines into perspective, in 2010 there were roughly 179,000 examinees taking the board exam in the Philippines (ABS-CBN News, 2011) while in Canada with a population roughly one-third of the Philippines, during the same year, there were  approximately 10,500 examinees taking the CRNE, or approximately one-seventeenth of the examinees in the Philippines (CNA, 2011a; CNA, 2011b).  Enticements from recruitment agencies. In a competitive labour market, the international migration of nurses offers endless opportunities for related business ventures (Castles & Miller, 2009; Kingma, 2006). For example, nurse recruiters, travel agencies, banks and telephone companies, in addition to nursing schools, have turned nurse migration into profitable businesses (Kingma, 2006). It is reported that nurse recruitment generates approximately three trillion dollars per year in the Organization for Economic Cooperation and Development (OECD) countries (Kingma, 2006). Statistics from a London based survey indicate that 96 percent of respondents from the Philippines reported that a recruitment agency had been involved in their move and that the agency was based in their home country (Buchan et al., 2005). Although, we do not know the number of Philippine educated nurses residing in Canada who have sought the services of recruitment agencies, it can be anticipated that many have visited the numerous websites that offer online services encouraging IENs to migrate for Canada. Further, it is known that in 2008 33  the province of Saskatchewan recruited 108 nurses from the Philippines (Saskatoon Health Region, 2008) and the same year a provincial recruitment team from Manitoba made conditional offers of employment to a group of 131 nurses from the Philippines (Recruitment Canada, 2008).  In BC, Health Match BC, a free health care recruitment service funded by the Government of BC, claims to have successfully recruited thousands of Canadian and internationally educated health care professionals (including RNs) on behalf of facilities around the province since its inception in 1999 (Health Match BC, 2012). However, though they send nurse recruiters to attend career fairs or nursing conferences in Canada, the UK, and the US they refrain from actively recruiting health care professionals from developing countries. But they take the position that individuals have the right to migrate globally to advance their careers and lives and consequently do not deny health professionals from a developing country any  recruitment information (Health Match BC, 2012). Financial incentives. Limited opportunities for employment and poor working conditions and salaries at home are commonly cited as factors promoting Philippine nurse migration (Lorenzo et al., 2007). Based on a production and domestic demand model, the Philippines has a net surplus of RNs: of the total number of nurses registered in the Philippines in 2003, only 58 percent were employed as nurses either in the Philippines or internationally and the majority (84.75 percent) were working abroad (Lorenzo et al., 2007). While it appears that the Philippines are overproducing nurses, there are also reports that they are underutilizing them. In 2003, it was estimated that funding shortages contributed to an estimated 30,000 unfilled nursing positions (Bach, 2003). Thus, there are many nurses in the Philippines professionally qualified but without employment (Kingma, 2006). In her comprehensive analysis of nurse migration, Nurses on the Move, Kingma 34  (2006) refers to this as a modern paradox: nurses willing to work but refused positions by national health systems unable to absorb them, not for lack of need but for lack of funds and/or sector reform restrictions.  Additionally, the disparity between salaries in the Philippines and those abroad makes overseas employment an attractive alternative for many. For instance, while the average monthly salary in 2005 for a professional nurse in the Philippines was 144 US dollars (Worldsalaries, 2005) the hourly wage rate for a new RN graduate in BC is approximately 31 US dollars (HEABC, 2012). Thus, working abroad is viewed by many not only as an opportunity for employment, but as an opportunity to vastly improve their standard and their family?s standard of living (Hefti, 2003; Parrenas, 2001). A desire for a better future for their families. In her analysis of the difficulties of family separation and re-unification among domestic workers in BC, many of whom are RNs educated in the Philippines, Geraldine Pratt (2012) draws attention to the fact that hopes for brighter futures for their children were central to many women?s narratives. Despite the fact that Philippine society constructs women as wives and mothers, concerns for a better future for their family inspire many to seek employment abroad (Lorenzo et al., 2007; Pratt, 2012). Indeed, migration offers many migrants from the Philippines and their families an opportunity to escape poverty and advance their social status (Parrenas, 2001). It is estimated that nurses from the Philippines working abroad remit more than 800 million dollars annually to their families (Jeans et al., 2005) and statistics from a London based survey indicate that three-quarters of respondents from the Philippines regularly remit money, while respondents from other countries are less inclined to do so (Buchan et al., 2005). 35  Additionally, migration of one family member may be viewed by some families as a means to facilitate their own migration (McKay, 2002).  Encouragement from social networks. While nurses may be subject to pressures at home to migrate, they also may be encouraged by social networks, in the form of families, friends, and colleagues, living abroad. It is not uncommon for nurses from the Philippines to emigrate in cohorts or to go where relatives or friends live (Choy, 2006). It is suggested that such networks can be important sources of support and identity and can reduce costs and risks associated with migration (Bach, 2003).  Rafael (1997) offers further insight into how those working overseas have become catalysts for migration. He describes how the Marcos regime in 1973, as part of its plan to improve the economy, offered incentives to balikbayans, or those living abroad as permanent residents primarily in the US, to return to the Philippines as tourists. Rafael puts forward that balikbayans were treated with the deference usually accorded foreigners and encouraged to be consumers. As such, balikbayans have come to symbolize to those who remain in the Philippines the fulfillment of desires realizable only outside of the Philippines.  Thus migration is a social issue. It rarely involves isolated social beings making a decision to migrate; rather, it is about individuals within the context of families and other social networks deciding to migrate (Foner, 2003; Glick Schiller, 2003). Moreover, in the case of the Philippines, migration has become a way of life; one that defines aspirations and is seldom absent from the everyday experiences of a large proportion of the population (Choy, 2006; Guevarra, 2010; Kelly, 2000; Pratt, 2010; Rafael, 1997; Ronquillo, Boschma, Wong, & Quiney, 2011). It is this ?culture of migration? that underpins the desire for nurses to seek work abroad (Choy, 2006; Guevarra, 2010). 36  Implications for nurse migration experiences. While the literature offers insights into a variety of conditions that compel nurses educated in the Philippines to seek employment abroad, it also reveals that these same conditions influence a nurse?s capacity to gain overseas employment and the nature of employment ultimately attained; shape social and financial status; and may inadvertently alter family  relationships. Job opportunities and reception in destination countries. Guevarra (2010) suggests that the Philippine neo-liberal framework for managing labour migration that encourages workers to become national economic heroes renders them vulnerable to exploitation both in the Philippines and overseas. For instance, she claims that this strategy instils a determination in workers to succeed at all costs. She also argues that the ?added export value? assigned to nurses educated in the Philippines makes them vulnerable as it generates a standard upon which foreign employers determine their expectations and measure nurse performance (p. 127). As well, she contends that nurses educated in the Philippines may be more likely to tolerate unpleasant working conditions because they may believe their overseas employment opportunity is the only means to their survival.  It is also suggested that the commercialization of nursing education poses a threat to the quality and reputation of Philippine nurses (Buchan et al., 2005; Lorenzo et al., 2007; Xu, 2007). Kingma (2006) proposes that as the educational sector in the Philippines forges more business ties, boundaries between scholarship and commerce are at risk of becoming blurred. Brush and Sochalski (2007) report that many of the new nursing schools in the Philippines are administered by portable deans (deans with administration responsibilities across a number of schools); have ghost faculties (faculties who are listed as faculty but are never seen or available to students); 37  and have inadequate curricula. It is speculated that such conditions caused the government to close 23 nursing in 2004 (Brush & Sochalski, 2007). It is further revealed that an increase in nursing schools has been accompanied by a corresponding decline in the number of nurses who pass the Philippine national nurse licensure examination (Brush & Sochalski, 2007). Between 2001 and 2004 only 45 to 54 percent of the nurse registration applicants passed the exam compared to a national pass rate of 85 percent in the 1970s and 1980s (Brush & Sochalski, 2007). More recent reports indicate that the national nurse licensure examination pass rate continues to be low, with a pass rate of 41.4 percent in July 2010 and 35.25 percent in December 2010 (ABS-CBN News, 2011). In 2006 it was again reported that the national regulatory body of the Philippines had difficulty enforcing and maintaining educational standards, consequently compromising students? performances on licensing exams and ultimately their opportunities for  international employment (Kingma, 2006). After disclosure in June 2006 that questions for the national examination had been leaked to hundreds of applicants, officials and industry officials warned that the country?s status as a top worldwide source of nurses could be jeopardized (New York Times, 2006). Recruitment agencies or large scale recruitment campaigns may also influence overseas RN employment experiences and there is increasing concern that these services place IENs at risk of exploitation and abuse (ICN, 2007a). Although I am unable to find literature that addresses the impact that recruitment services may have on nurse migration experiences in Canada, a study conducted in the UK by Smith et al. (2007) is of comparative interest. It reveals that recruitment and employment patterns can shape migration experiences both positively and negatively. For instance, active recruitment of nurses in a group may facilitate the establishment 38  of strong social networks and ultimately enhance social adjustment but it also may interfere with career progression (Smith et al., 2007). It is speculated that members of a group tend to avoid advancement for the sake of  group solidarity (Smith et al., 2007). For those who individually secure the use of a recruitment agency, it is reported that they are at risk of being hired under false pretences, may be misled about employment conditions, or are charged excessive recruitment fees (Smith et al., 2007). While exploitation by recruitment agencies was avoided by those who sought employment directly from overseas employers, these nurses were at risk of  encountering underemployment in care homes (Smith et al., 2007). Such problems were less likely to occur if employment was sought once the nurses were already located in the UK (Smith et al., 2007).  Family relationships. It is also reported that nurse migration experiences are both shaped by family relationships and shape such relationships (Pratt, 2003, 2012).  For instance, some migrants feel that they are under pressure from their families to migrate and, moreover, to keep remitting money (Hefti, 2003; Kingma, 2006; Macan-Markar, 2003; Parrenas, 2001; Pratt, 2003, 2012). Additionally, they may have financial responsibilities associated with paying off debts incurred in migrating, as well as saving to sponsor family members from abroad (McKay, 2002). It is reported that single migrant women, due to cultural expectations imposed on single daughters, feel especially burdened with responsibilities to provide financial assistance, particularly for the purposes of sponsoring the education of  younger siblings (Lan, 2003). As well, migrant women often remain burdened with gendered responsibilities linked to  having children or husbands in the Philippines (Lan, 2003; Parrenas, 2008; Pratt, 2012). Though women are socially defined as the primary caregivers, migration forces many female migrant 39  workers to rely on extended family members, husbands, or hired help to care for their children (Lan, 2003; Parrenas, 2001, 2008). Consequently, migration may place a considerable  emotional strain on mothers who leave their children behind, and for many there is a need to distinguish their transnational motherhood from an act of child abandonment (Lan, 2003). Moreover, it is reported that migrant mothers may become "dollar mommies" with little personal closeness to their offspring (Hefti, 2003). Long term absences or staggered migration processes can also result in changes in family relationships and can contribute to family breakdown (Hefti, 2003; Kingma, 2006; Lan, 2003; Parrenas, 2001; Pratt, 2012). For instance, husbands may feel inferior or ashamed that their wives are working abroad to support the family (Lan, 2003). If the family eventually re-unites overseas, there is a risk that conflict between traditional societal values may evolve (George, 2005; Hefti, 2003; Kingma, 2006; Parrenas, 2001; Pratt, 2003). Further, Rafael (1997) points out that for those who do acquire permanent residence abroad there is a risk that they will come to occupy an ambiguous position when they return to visit the Philippines: ?Neither inside nor wholly outside the nation-state, they hover on the edges of its consciousness, rendering its boundaries porous with their dollar driven comings and goings? (p. 269).  On a positive side, it is speculated that migration may be an empowering experience for women who seek overseas employment without their families as it liberates them from traditional duties as daughters, or provides them with an acceptable method of escaping an unsatisfactory relationship or the impoverishment of single motherhood (Parrenas, 2001). Further, it may provide them with an opportunity to participate in the economic development of both their country of destination and their own country. As such, it is argued by some that women from the Philippines are not just passive victims of international commodification, but 40  are active agents in their decision to migrate (Parrenas, 2001; Sarvasy & Longo, 2004; UN, 2006). It has also been reported that new technology such as text messaging permitting constant contact between family members helps to maintain long-distance emotional connections (Mckay, 2007). In contrast, however, it is argued that transnational communication does not provide full intimacy to the family and ironically has become a means of retaining gender norms or reinforcing the myth of the female homemaker (Parrenas, 2008). Structures Influencing Entry into Professional Nursing Practice in Canada Once nurses from the Philippines decide to re-locate to Canada conditions embedded within social, economic, political, and historical contexts influence their ability to secure RN licensure and employment. The literature suggests that these conditions may take the form of immigration policies and professional credential assessment and recognition procedures. As well, support offered to ease integration experiences and approaches to health human resource planning may shape experiences and influence ability to secure Canadian RN licensure and employment. Immigration processes. One of the first challenges confronting IENs seeking RN employment in Canada is the task of navigating through Canadian immigration policies. Although it is frequently assumed in the literature that nurses are actively recruited to work in Canada as temporary foreign workers (TFWs) under the TFWP, most come to Canada as federal skilled workers (FSWs) or permanent residents under the FSWP (Blythe et al., 2009). However, many also enter Canada as live-in caregivers through the LCP (Health Match BC, personal communication, March 31, 2009). Each of these pathways has implications for RN licensure and future employment. 41  Federal skilled workers (FSWs). Skilled workers are economic immigrants, a category of permanent residents21, selected for their ability to participate in the labour market and to establish themselves economically in Canada (CIC, 2007a). Prior to 1967 it is contended that immigrants to Canada were selected largely on the basis of their race (Gogia & Slade, 2011). For instance, in the early 1900s black farmers were often deemed unsuitable for the Canadian climate by immigration officials and later in the 1920s race-based immigration restrictions were intensified against the Chinese, Japanese, and South Asians (Gogia & Slade, 2011). On the other hand, during the same period the federal government created measures to increase the number of British immigrants by offering transportation assistance and other immigration incentives. Although immigration restrictions were gradually removed following the Second World War, immigration from Britain, the US, and northern European countries continued to be preferred (Gogia & Slade, 2011). With the introduction in 1967 of a point-based system to recruit skilled workers, it is suggested that that overt race-based restrictions were finally removed (Gogia & Slade, 2011).  Although there have been numerous amendments to the point system over the years the general objective has remained constant: applicants are assessed for their overall capacity to adapt to Canada?s labour market (CIC, 2012e). Initially points were allocated in nine categories: education; occupation; professional skill; age; arranged employment; personal characteristics;                                                  21Skilled workers are selected to come to Canada as permanent residents. Permanent residence status gives a non-Canadian the right to live in Canada. However, permanent residents must comply with certain residency obligations to maintain their status. Aside from a few exceptional situations, they must be physically present in Canada for at least 2 years within a five-year period. It is necessary to have permanent residence status to be eligible for Canadian citizenship (Government of Canada, 2013).  42  language proficiency; existing relatives in Canada; and intended settlement location (Gogia & Slade, 2011). In  2002 the point system was reconfigured and applicants were assessed on the basis of six selection criteria: education; official language ability; work experience; age; arranged employment in Canada; and overall adaptability (e.g. previous work experience in Canada, spouse?s education and relatives in Canada) (CIC, 2011a). These changes meant that points were no longer assigned for intended settlement locations in Canada and currently Canada does not have a policy that dictates skilled workers seek employment opportunities in certain regions within Canada (Success Immigration Services, 2007). Consequently, IENs who enter Canada as skilled workers can settle in any Canadian jurisdiction regardless of the demand for qualified RNs in that jurisdiction. In 2008 further changes to the FSWP had significant implications for IENs desiring to immigrate to Canada as nursing became one of the 38 occupations that was assigned priority immigration status. Citizenship and Immigration Canada (CIC) announced that in addition to meeting the selection criteria, applicants had to have an arranged employment offer with a Canadian employer; or, evidence of one year continuous full-time (or full-time equivalent) work experience in one of 38 priority occupations; or be legally residing in Canada as a student or temporary foreign worker (CIC, 2012h). As a consequence of these changes nurses destined for  Canada under the FSWP could expect to have their application for immigration expedited and processed within six to 12 months of receipt (CIC, 2012e). Between 2008 and 2010 there was no limit placed on the numbers of IENs who could immigrate to Canada. As long as they met the selection criteria and had either an employment offer or evidence of one year continuous full-time (or full-time equivalent) work experience they 43  could settle in any Canadian jurisdiction. However, in 2010 CIC capped the number of new FSW applications to be processed at 20,000, not including applications with an arranged employment offer (CIC, 2013c). As well it reduced the eligibility list to 29 priority occupations and each of the occupations was capped at 1000 (CIC, 2013c). Therefore, although nursing was still considered a priority occupation, under the FSWP, the Canadian government restricted the number of nurses who could enter Canada that year.  Then, effective July 2011 another CIC amendment further limited the intake of new FSW applications by lowering the cap to 10,000, with caps for each of the 29 priority occupations set at 500 (CIC, 2013c). Consequently in 2011 there were only 500 nurses entering Canada under the FSWP and again, in accordance with CIC policy, these nurses could seek employment opportunities in any location in Canada. On July 1, 2012 on the grounds that time was needed to manage inventory pressures and to align the application process with the implementation of proposed regulatory changes to the FSW class, CIC temporarily stopped accepting any new FSW applications aside from those with a qualifying offer of arranged employment or those eligible for a PhD program (CIC, 2013c). Most recently in December 2012, CIC announced that the new selection system for the FSWP will take effect on May 4, 2013 at which time the program will re-open for applications (CIC, 2012g)22.  Gogia and Slade (2011) argue that although the introduction of the point system eliminated race as a criterion for immigration selection, current immigration practices and policies continue to be highly selective. By privileging education and work experience the                                                  22 As mentioned in Chapter One, on April 18, 2013 CIC announced that the list of 24 occupations eligible under the FSWP when it re-opens on May 4, 2013 will not include nurses. However, nurses will still be eligible to apply to enter Canada under the FSWP if they have a qualifying offer of arranged employment or they are in the PhD stream (CIC, 2013d).   44  selection system targets those deemed to be the ?best and the brightest? (Gogia & Slade, 2011 p.57).  Concerned that many highly competent newcomers to Canada remain underemployed, the Government of Canada funded the Association of Canadian Community Colleges (ACCC) to begin offering orientation services in the Philippines, China and India on a pilot basis in early 2007 (CIIP, 2013). Canadian Immigration Integration Program (CIIP) is now a three-year program (2010-2013) that is funded by CIC to provide free pre-departure orientation to FSWs, Provincial Nominees, their spouses and adult dependents, while they are still overseas during the final stages of the immigration process. CIIP offices are located in China, India, Philippines and the UK. Live-in caregivers. In the 1960s and 1970s when individuals from the Philippines started immigrating to Canada, the majority were RNs who had been recruited by hospitals and health institutions (McKay, 2002). However, in the 1980s with the initiation of the  Canadian Foreign Domestic Movement Program (FDM, many nurses from the Philippines began entering Canada as domestic workers (McKay, 2002). This program, which was re-named the Live-in Caregiver program in 1992 (McKay, 2002), brings temporary foreign workers to Canada as live-in employees to work in private households caring for children, seniors, or people with disabilities (CIC, 2007a). It is estimated that between 3000 and 4000 domestic workers, mostly from the Philippines, enter Canada each year (Pratt, 2010). To be eligible for the LCP applicants need a positive Labour Market Opinion from an employer in Canada (to show that there is a need for the foreign worker to fill the job offer and that there is no Canadian worker available to do the job); a written contract with an employer; successful completion of the equivalent of a Canadian 45  secondary school education; at least six months? training or at least one year of full-time paid work experience as a caregiver or in a related field or occupation (including six months with one employer) in the past three years; good knowledge of English or French; and a work permit before entering Canada (CIC, 2012c). Despite these minimal requirements, most registered in the LCP have postsecondary education and many are nurses (Pratt, 1999, 2010). Live-in caregivers may apply to become permanent residents after they have worked full-time for at least 24 months or a total of 3,900 hours of full-time employment within the four years immediately following their entry into Canada under the LCP (CIC, 2012a). While working under the terms of their contract they can take non-credit special interest courses, but these courses must be less than six months in duration (CIC, 2012b).They are entitled to a salary that meets at least the minimum wage; extra pay for overtime; statutory holidays; and days off each week. Employment Insurance premiums, income taxes, and Canada Pension Plan contributions are deducted from their pay and room charges may also be deducted depending on the conditions of the employment contract  (CIC, 2011b). Temporary foreign workers (TFWs). Those who enter Canada as TFWs must obtain a work permit for work in Canada and a job offer before they emigrate. The permit may include certain conditions, such as the type of work they can do; the employers they can work for; and the length of time they are eligible to work (CIC, 2007b).  Before being considered eligible by a provincial or territorial regulatory body to practice nursing, however, they must have their credentials assessed and recognized by a professional regulatory body in Canada (Dumont et al., 2008). Once in Canada, TFWs can apply for permanent resident status and most provinces, including BC, have a Provincial Nominee Program to expedite this process (Baumann et al., 46  2006). The BC PNP is administered on behalf of the Province of BC in collaboration with CIC. It accelerates the Permanent Resident application process for immigrants who want to settle in BC permanently (Government of British Columbia, 2013a). It is an option that is available for business immigrants and individuals who work in one of the Strategic Occupations (e.g., nursing). The Strategic Occupations component of PNP is intended to help BC employers recruit or retain qualified foreign workers to help meet current and future labour needs. Nominee applicants under the Strategic Occupations component must have been recruited by provincial and regional health authorities administered through Health Match BC (Government of British Columbia, 2013b).Under this program employers can nominate immigrants who have the skills, education, and work experience needed to make an immediate economic contribution. It permits nurses to work in Canada for a specific employer for up to three years; it is renewable; and it also allows spouses to apply for work in Canada. Professional credential assessment and recognition procedures. Although CIC may recognize an IEN?s education and skills, RN employment in Canada is not guaranteed. Unlike immigration, RN credential regulation is a provincial or territorial responsibility, not a federal one (Dumont et al., 2008; Government of British Columbia, 2013a). Currently, regardless of their immigration pathway all IENs seeking RN licensure in Canada must have their RN credentials assessed by a professional regulatory body23 before they are eligible to write the CRNE and in BC acquire full CRNBC practising registration (CRNBC, 2011). Since credential assessment and recognition processes are a provincial and territorial                                                  23The purpose of professional regulation is to serve and protect the public and the mandate of professional regulatory bodies is to ensure that the Canadian public receives safe and ethical nursing care from competent, qualified registered nurses. Although professional regulatory bodies have the authority to self-regulate, legislated acts ensure that they remain accountable to governments and to the public (CNA, 2007a). 47  responsibility, these procedures are subject to variation. However, most provinces and territories share a number of similarities (Dumont et al., 2008). In BC the regulatory college cautions applicants that the entire registration process could take from three months to three years to complete and cost approximately 1600 dollars, excluding educational fees (see Pathway to RN Licensure in BC for IENs, Appendix A) (CRNBC, 2011). In the 2005 CNA study mentioned earlier in this chapter it is estimated that the overall application process could cost an IEN as much as 20,000 dollars (Jeans et al., 2005). To initiate the process IENs must submit documentation that verifies their English proficiency24, basic nursing education, and competency to practice nursing to determine eligibility for registration (CRNBC, 2011).  Eligibility for RN registration in BC is also determined by a credential assessment process, the Substantially Equivalent Competency (SEC) Assessment. This assessment can take up to five days to complete and uses four strategies to evaluate the competencies of IENs: a written diagnostic exam (including both multiple choice and short answer questions) to test the general nursing knowledge required of professional nurses in BC; an assessment interview to test problem solving and critical thinking skills; a clinical judgment assessment; and a clinical evaluation in a lab setting (Kwantlen Polytechnic University, 2013b).  If gaps in knowledge, skills and abilities are identified applicants may be required to take targeted educational upgrading (CRNBC, 2009). This may take the form of a short term RN qualifying course or a one year full-time RN re-entry program. The objectives of this latter program are to prepare IENs to practice within the Canadian health care setting; to renew and                                                  24 Since 2007, as part of a CRNBC initiative to ensure a more efficient registration process, English language fluency has had to be demonstrated at the time of application for RN registration, rather than later in the process (Brunke, 2007).  48  enhance previously acquired nursing knowledge and skills; to identify and address individual needs; to ensure graduates meet the professional practice requirements; to foster effective communication skills in the workplace; and to prepare graduates to be eligible to write the CRNE (Kwantlen Polytechnic University, 2013a). In addition to theory, students must complete 500 clinical practice hours (GNIE Re-entry Program, Kwantlen Polytechnic University, personal communication, May 2012). Applications to this program are only accepted from Canadian citizens and permanent residents (Kwantlen Polytechnic University, 2013a). Additionally, applicants must complete a monitored Canadian work experience (CRNBC, 2011)25. Unlike the SEC Assessment, this new addition to the registration process for IENs is relatively unique to BC. It is the only jurisdiction in Canada that requires a monitored Canadian work experience, aside from Newfoundland and Labrador which require a minimum of 400 hours with a Newfoundland and Labrador employer and a satisfactory employer reference before being granted permission to write the CRNE (ARNNL, 2013). The final step in the registration process in BC is writing the CRNE (CRNBC, 2009). The CRNE consists of 180 ? 200 multiple-choice questions and candidates are given four hours to complete the test (CNA, 2007b) and three attempts to pass this examination (CRNBC, 2012a). Upon successful completion of the CRNE and a satisfactory reference from an employer following the 250 hour monitored Canadian work experience, an IEN may be granted full CRNBC practising registration (CRNBC, 2011).                                                   25 As mentioned in Chapter One, on March 13, 2013 the RN regulatory college of BC announced that it was removing the requirement for a Canadian reference following 250 hours of practice as a professionally registered nurse and that the change will be implemented over time (CRNBC, 2013c).  49  Supports to ease integration. A review of policies and reports from numerous provincial organizations revealed numerous provisions to ease the integration of IENs into the Canadian workplace after arrival in Canada. Although they do not appear coordinated, a range of support services are available to IENs, including those offered by the provincial regulatory college, trade unions, immigrant serving organizations, and professional support groups.    The provincial regulatory college. An inspection of the BC regulatory college?s website, Registration for International Nurses (CRNBC, 2013d) reveals various sources of support for IENs. For instance the website includes a link to an online self-assessment for readiness to apply for registration; an outline of the registration process for foreign applicants (Occupational Fact Sheet for Internationally-educated Nurses); fact sheets related to English tests, the SEC Assessment, and the criminal record check; CRNE resources; workplace environments in BC; and provincial resources for new immigrants. Additionally, the website alerts IEN applicants to monthly information sessions held at the college to assist with better understanding the credential assessment and recognition procedures, English requirements, and the CRNE.  Trade unions. Although traditionally trade unions have had a protectionist and exclusionary stance towards migrant workers with the dominant concern being erosion of  wages and working conditions, they now recognize that immigration is an inevitable component of a more globalized economy (Bach, 2003; Gordon, 2005). Consequently, they have shifted their focus towards a more open and inclusionary approach to internationally educated professionals and are beginning to draw migrants into union membership (Bach, 2003). This shift in perspective is reflected in 50  the information provided for IENs at the British Columbia Nurses? Union (BCNU) website (BCNU, 2012). BCNU claims that it recognized that establishing a practice in a new health care context can be challenging and that it is committed to working with IENs to help them understand the regulatory steps to getting RN licensure in BC.  As well, BCNU funds and delivers a communication course to assist IENs to better succeed in the Canadian practice environment.   Immigrant serving organizations. As part of its immigration and integration policies Canada offers a variety of  provincial and federal programs and initiatives that are designed to facilitate the inclusion of migrants into society (Scmidtke, 2007). Indeed, it is reported that there are over 235 immigrant serving organizations actively involved in facilitating the settlement and labour market integration of immigrants in Canada (The Alliance of Sector Councils: Gateway Potential, 2013).  In BC the Skills Connect for Immigrants Program is a province?wide program designed to help skilled immigrants connect to jobs in BC that build on their pre-arrival skills, training, knowledge, and experience (Work BC Employment Services Centre, 2012). It is intended to assist those with intermediate level of English language proficiency who have become permanent residents of Canada within the last 5 years and who are unemployed or under employed. More specifically, the program provides customized services that include: qualifications assessments; career counselling; job seeking skills and support; training funds for upgrading or job specific skills training; assistance with regulating bodies or certification; and  networking opportunities (Work BC Employment Services Centre, 2012).  S.U.C.C.E.S.S. is another immigrant serving organization in BC that receives provincial and federal funding to provide settlement and integration services to immigrants and their 51  families. It reaches out to permanent residents, live-in caregivers, refugee claimants and others (S.U.C.C.E.S.S., 2013). The Multicultural Helping House Society? Newcomers Resource Center (MHHS?NRC) is another non-profit society and charitable organization in Vancouver dedicated to helping newcomers to Canada (individuals and families) integrate into the community (MHHS, 2012). Professional support groups. In Canada, the Philippine Nurses Association of Manitoba (PNAM) has been instrumental in assisting foreign trained nurses in obtaining Manitoba Nursing Registration and offering scholarships to Filipino-Canadian nursing students. Each year, PNAM has organized a one-day workshop focusing on various health topics (Philippine Nurses Association of Manitoba, 2010). In BC IENs from the Philippines who enter Canada as domestic workers may receive professional support from the Filipino Nurses Support Group (FNSG). This group assists registered nurses from the Philippines who are doing domestic work in Canada. The group seeks to facilitate its members? accreditation and support their personal and professional development by advancing their rights, dignity, and welfare in the Canadian workplace (Filipino Nurses Support Group, 2012). Health human resource planning. While not specific to nurses from the Philippines, the Creating Access to Regulated Employment (CARE) Centre for IENs is a program funded by the Province of Ontario to enable IENs to practice and excel in their profession (CARE, 2013). A visit to the program?s website reveals that it was initiated in the late 1990s by a partnership of health and social service agencies concerned with the high number of IENs immigrating to Ontario who were unable to practice their profession due to significant barriers in meeting regulatory requirements. Funded 52  by the Province of Ontario, CARE Centre continues to be a multi-partner initiative that invents, coordinates and delivers flexible, client focused education and support services, such as communication courses, networking, observational job shadowing, CRNE preparation, and professional nursing workshops. Since the fall of 2001, it has served over 1,000 IENs representing more than 140 countries. Although the CARE Centre continues to evolve and adapt to the needs of these nurses and is now located in five major cities in Ontario, it is not available in other Canadian provinces or territories.  The increasing global shortage of nurses and the globalization of labour markets have ignited the interest and concern of a large variety of stakeholders at international, national, and local levels (WHO, 2006). At the international level, organizations such as the ICN, the WHO, the International Centre on Nurse Migration (ICNM), the United Nations (UN), and the OECD, have developed numerous policies and initiatives to address these issues.  Recognizing that combined pressures of an increased demand and a decreased supply have led to heightened competition for nurses and that quality health care depends on qualified nursing personnel, the ICN and its member national nurse associations, including the CNA, has been committed to establishing policy and strategies key to ensuring an adequate supply of nurses and to meeting nurses? individual needs (ICN, 2007b). In its Position Statement, Nurse Migration and Retention, ICN (2007b) asserts that the retention of nurses plays a critical role in the migration of nurses and calls on governments, employers and nurses to promote positive practice environments. It also argues that nurses have the right to migrate as a function of choice and acknowledges the potential benefits of migration, including learning opportunities and the rewards of multicultural practice. However, the ICN recognizes that international migration may have an adverse effect on the health care of source countries and that nurses who do migrate may 53  be particularly vulnerable according to  the employment situation in a receiving country. Therefore, to support its position on migration and retention ICN (2007b) makes numerous recommendations including: promoting the important link between positive practice environments and nurse retention; developing appropriate human resources planning and ethical recruitment strategies; providing orientation for migrant nurses on the local cultural, social and political values, and on the health system and national language of the country; ensuring that migrant nurses have conditions of employment as favourable as those holding similar positions; and ensuring that distinctions not be made among migrant nurses from different countries.   Conscious of the global shortage of health personnel and recognizing that an adequate and accessible health workforce is fundamental to an integrated and effective health system, the WHO adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel (WHO, 2010). Similar to the ICN, the WHO cautions member states and other stakeholders to take measures that  ensure all migrant health personnel are offered appropriate orientation programs enabling them to operate safely and effectively within the health system of the destination country and that they receive treatment equivalent to domestically trained health workers (WHO, 2010). At the national level the CNA has been active in seeking greater clarity in understanding issues related to nurse shortages and nurse migration and in developing measures to enhance IEN integration (Little, 2007). Although it repeatedly calls for measures to retain nurses in the workplace and to increase the domestic production of nurses, the CNA also recognizes the right of individuals to migrate (Little, 2007). As such, it has developed a line of support products under the title of LeaRN to help nurses make informed decisions before coming to Canada (Little, 2007). The CNA also spearheaded a project to understand issues related to the increasing 54  number of IEN applicants and their integration into the workplace. The report emanating from this project, Navigating to become a nurse in Canada: Assessment of international nurse applicants, reveals a lack of communication or coordination between regulators, employers, unions, educators, government and community agencies. Further, it offers numerous recommendations, including: the establishment of a national IEN assessment service; development of nationally standardized, flexible bridging programs to ensure IENs are competent to meet Canadian nursing standards; and a principled, comprehensive, and collaborative approach to ethical recruitment practices (Jeans et al., 2005). However, the report also acknowledges that recruitment of IENs as a solution to the shortage of nurses in Canada has not been well received by everyone (Jeans et al., 2005). Those opposed to IEN recruitment argue that it is symptomatic of a failure to address underlying domestic recruitment and retention issues and that it is not a cost-effective solution to Canadian nurse shortages (Jeans et al., 2005). Indeed, it is estimated that the cost of recruiting one IEN could be approximately 20,000 dollars, once costs pertaining to recruiter salaries, credential assessment and recognition procedures, and educational upgrading are taken into consideration (Jeans et al., 2005).  Another  noteworthy report, Building the Future: an integrated strategy for nursing human resources in Canada, published by the Nursing Sector Study Corporation, examines the nursing workforce and related human resource issues for all three regulated nursing professions in Canada (Licensed Practical Nurses (LPNs); RNs; and Registered Psychiatric Nurses (RPNs) (Baumann, Blythe, Kolotylo, & Underwood, 2004). In addition to strategies to enhance nurse retention, the report lays out recommendations to facilitate the integration of IENs into Canadian society. For example, it suggests that transition planning, licensure, and educational standards be 55  implemented and that efforts are made to prohibit unethical ?poaching? of nurses from developing countries.  More recently, in 2009, the CNA prepared a study that further addresses efforts to promote self-sufficiency and reduce dependence on international recruitment. Although it is predicted there will be a shortage of approximately 60,000 nurses by 2022, it is also argued that this shortage could be eliminated if Canada reduces dependence on IENs by 50 percent and makes an effort to increase RN productivity, reduce RN absenteeism and attrition, and increase enrolment in RN education programs (Murphy et al., 2009). It is recognized, however, that a move toward self-sufficiency may have negative as well as positive implications for IENs. From a negative perspective, self-sufficiency may reduce opportunities for foreign employment and consequently the potential for professional advancement and improved standards of living; from a positive perspective it may result in the creation of better working conditions for those who migrate (Little & Buchan, 2007). Implications for nurse migration experiences. A review of the literature suggests that the complexity of processes that confront nurses educated in the Philippines when they arrive in Canada may both facilitate and impede their ability to acquire a Canadian RN credential. Indeed, Canadian immigration processes, professional credential assessment and recognition procedures, support services, and health human resource planning strategies appear to intersect at various levels to shape nurse migration experiences. Immigration processes. Reports from the literature suggest that immigration policies may significantly influence migration experiences in a variety of ways. For instance, Canadian policies dictating that  federal 56  skilled workers  have a year of continuous full-time paid work experience may place a particular burden on nurses from the Philippines who often are faced with  working for little or no money following nursing graduation due to high unemployment rates (Iredale, 2001). Consequently many need to seek work experience in Southeast Asia and the Middle East prior to emigrating to Canada to build their nursing skills and credentials (Kingma, 2007). It is also argued that Canadian immigration policy that assigns points for education and work experience may create unrealistic expectations for nurses regarding their eligibility to practice their profession on arrival in Canada (Barry, 2002). That is, when nurses come to Canada under the FSWP, they enter on the basis of an immigration assessment not a credential assessment by a Canadian regulatory college. Consequently they face a lengthy regulatory review which may deem  their competence to practice is not equivalent to that  required of Canadian RNs (Barry, 2002). Indeed, ICN cautions that nurse associations must alert nurses to the fact that diplomas, qualifications or degrees earned in one country may not be recognised in another (ICN, 2007b). However, it is also reported that Canadian initiatives abroad may lack accurate information about nursing in Canada (Jeans et al., 2005). As well, Canadian immigration policy has implications for those who arrive in Canada under the LCP. Restrictions preventing domestic workers from participating in educational activities or pursuing RN employment during their LCP contract cause many to abandon nursing (Blythe et al., 2009; Jeans et al., 2005; McKay, 2002; Pratt, 1999). Consequently, many are at risk of becoming ghettoized within marginal occupations (McKay, 2002; Pratt, 2003). The frustration associated with this situation is exemplified by a comment from one domestic worker in a Vancouver based research project who remarked that though she was still an RN in Canada, in Philippines she had been a ?Registered Nurse? while now she was a ?Registered Nanny? 57  (Pratt, 1999, p.233). However, it is also suggested  that the risk of becoming deskilled may be related to a commitment to send remittances to families in the Philippines or to sponsor their immigration (Pratt, 2010). In addition to being at risk of underemployment, it is also argued that LCP regulations stipulating that domestic workers must complete their live-in caregiver responsibilities before obtaining permanent resident status and family reunification put many at risk of exploitation, and family breakdown (Pratt, 1999, 2003,2012). Professional credential assessment and recognition procedures. Professional credential assessment and recognition procedures can also profoundly affect nurse migration experiences. In many countries acquiring the necessary credentials for professional nursing practice can be a lengthy and costly process (Bach, 2003). Canada is no exception and as mentioned earlier in this chapter, a significant number of IENs never become registered (Jeans et al., 2005). Challenges interfering with registration include: problems related to locating information from regulatory bodies; lack of standardization of credential assessments between provinces or regulatory bodies26; credentialing expenses; navigating bewildering sets of licensure requirements; acquiring necessary documentation from nurse education programs; finding a space in a RN bridging program; and passing language tests and the CRNE (Jeans et al., 2005). Many IENs also report that they find the culturally based nature of the exam and its multiple-choice format particularly challenging (Jeans et al., 2005).  Statistics gathered from the CNA (2008) regarding CRNE pass rates appear to support the findings in nursing studies. In 2007 approximately 71 percent of IENs passed the CRNE on                                                  26In Canada there are 25 regulatory bodies and applicants can apply to more than one regulatory body at the same time. That is, they may apply for licensure and registration with regulatory bodies for RNs, LPNs, and registered psychiatric nurses (RPNs) located in different provinces and territories (Jeans et al., 2005). Each has different credentialing requirements that necessitate different assessment procedures (Jeans et al., 2005). 58  their first attempt, compared with approximately 95 percent of Canadian-educated first-time CRNE writers.The failure rate, however, appears to fluctuate according to country of education. For example, IENs from countries such as the Philippines and India have traditionally higher initial failure rates than IENs from countries like the US and the UK, which have the same language and a similar health care system and nursing role as Canada (Little, 2007). More recent statistics indicate that IENs continue to do poorly on the national exam compared to Canadian educated nurses. In 2011 only approximately 50 percent of internationally educated first time CRNE writers passed the exam, compared to about  87 percent of Canadian educated first time writers (CNA, 2012b).  In the 2006 study of IENs residing in Ontario (Baumann et al., 2006; Baumann, Blythe, & Ross, 2010; Blythe et al., 2009) it is also noted that IENs experience numerous credentialing challenges. For instance, it is reported that IENs lack adequate access to support resources and to information at each stage of the migration process. Many nurses claim they would have been able to prepare documentation prior to emigration if they had understood national licensing processes in advance (Baumann et al., 2006; Blythe et al., 2009). Cost of language tests may be a deterrent for IENs who are unemployed or working in low-paying jobs. Further, the study suggests that the urban location and temporary nature of bridging programs make accessibility problematic (Baumann et al., 2006; Blythe et al., 2009).  Expense associated with credential assessment and recognition requirements was also a constraint noted by Pratt (2003, 2012) among domestic workers seeking Canadian RN licensure. As she noted, following completion of their LCP responsibilities, women have little money and often work multiple, insecure jobs in order to save enough to bring their families to Canada or to meet their financial obligations at home in the Philippines. Another Canadian study that focuses 59  on the experiences of skilled professional women from China, and not on the experiences of IENs in particular, found that costs associated with re-certification are an obstacle interfering with professional accreditation in Canada (Man, 2004).  The latter study also suggests that inadequate daycare services and lack of childcare subsidies make it difficult for women to engage in full-time positions or to enrol in English language or re-certification programs (Man, 2004). A further study that explores the experiences of IENs in their efforts to gain entry to practice as RNs in Ontario, suggests that IENs progress through a three-phase journey in their quest for registration (Sochan & Singh, 2007). These phases include: (1) hope ? wanting the Canadian dream of becoming an RN; (2) disillusionment ? discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment ? living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications (Sochan & Singh, 2007). One study participant stated that ?becoming a nurse in Canada is something like a ?big mountain is in front of me?. It?s like an obstacle. Always I fear some difficulties? (Sochan & Singh, 2007, p.134).   Acknowledging that there are significant challenges associated with foreign credential assessment, Barry and Ghebrehiwet (2012), ICN consultants, nevertheless recommend numerous strategies to reduce barriers to migrating nurses. For instance, they put forth that regulators need to ensure that information pertaining to regulatory requirements, policies, and processes be clear, accessible, efficient, and transparent. Additionally, they contend that to reduce the likelihood of governments intervening in regulation, regulators must be able to articulate the rationale for regulatory requirements to applicants, employers, governments, and the public. Further, they argue that regulatory colleges provide IENs with sufficient information on the expectations of 60  practice and that employers and colleagues offer IENs ample support during their integration into the new practice setting.  Entry into the workplace. There is growing recognition that nurse migration is becoming more prevalent as higher income countries, such as Canada, struggle to fill vacancies created by nurse shortages (Buchan, 2002; Kingma, 2007; WHO, 2006). In contrast, there is a dearth of nursing literature addressing the ease with which these nurses find employment in destination countries.  As noted earlier, although the ICN (2007b) supports the right of nurses to pursue professional achievement and attempt to better their living and working circumstances, it also cautions that career moves may negatively affect nurses? lives. It describes how the absence of international recognition of nursing diplomas, post-basic studies, or degrees can be a source of frustration and that many internationally recruited nurses have reported that they would have preferred to remain at home in their own culture, close to family and friends. Bauman (2006) suggests that the ease of entry into the Canadian workplace is in part dependent on the state of the job market. However, literature pertaining to skilled immigrants in general reveals that job opportunities may also be shaped by systemic inequities such as employer preference for Canadian education, training and experience. Preferences that some argue are forms of systemic racism that unfairly constructs immigrants as unskilled labour (Creese & Wiebe, 2009). As a consequence, skilled workers are denied access to the occupations they previously held; are forced to switch careers; and experience loss of social status (Bauder, 2003). Further, such preferences create an unjust division between Canadian-born and immigrant labour (Bauder, 2003) and ultimately put new arrivals at detrimental risk of economic, social, 61  and health consequences (Beiser, 2005; Creese & Wiebe, 2009; Gogia & Slade, 2011; Shields, Kelly, Park, Prier, & Fang, 2011).  Reflections on the Literature While the Canadian nursing literature illuminates many challenges associated with acquiring Canadian RN credentials and employment, it appears to be deficient in a number of areas. First, analyses typically focus on economic and health policy issues and the voices of nurses themselves are often overlooked. Indeed, the statistical and impersonal nature of many of the reports contributes to the objectification of IENs. As well, the literature mostly groups IENs together, regardless of their source country, and thus renders unique needs and characteristics invisible. Additionally, nursing reports and studies tend to focus on IEN transition and integration issues in Canada and do not address the broader context of nurse migration. Also, the interplay between structure and agency (e.g., how nurses may both resist and be constrained by structures and also contribute to the very oppressions that shape their experiences) is typically disregarded. Finally, studies that explore the power inequities embedded in nurse migration experiences that have been reported in US and UK literature tend to be missing from the Canadian nursing literature. In contrast, numerous studies in the social sciences are helpful in depicting how social relations, such as gender, race, and class, intersect within broader contexts to shape migration experiences of women domestic workers (many of whom are RNs) from the Philippines residing in Canada and raise ethical concerns related to the marginalization and exploitation of these women (McKay, 2002; Pratt, 1999, 2003, 2010, 2012). However, these studies do not specifically address experiences related to the acquisition of a Canadian RN credential. I will 62  return to the literature again in Chapter Nine and expand on some key elements outlined in this chapter.  Chapter Summary In this chapter I have drawn on literature from the nursing sciences as well as from the social sciences to enrich my understanding of nurse migration experiences. I have also turned to the nursing literature in other countries, most notably the US and the UK, and have expanded my review to include insights from the experiences of migrants other than nurses. I have learned that nurses? experiences in Canada may already be shaped by structures in the Philippines or in other countries prior to arrival in Canada; structures such as the prevalence of private nursing programs; Americanized nursing curricula; labour export policies; and acceptance of a neo-liberal market economy. As well, the literature revealed numerous structures at the national level in Canada (e.g., immigration policies and a nursing licensure exam), at the provincial level (e.g., provincial regulatory requirements and immigrant serving organizations), and at the local level, (e.g., education programs and the job market) that can also influence experiences once in Canada. I have also learned that experiences for those seeking RN licensure in Canada can be shaped by social relations such as class, race, and gender both in the Philippines and in Canada. Moreover, the literature suggests that IENs in general are at risk of becoming deskilled and remaining underemployed in Canada. In the next chapter I present the theoretical framework I used to address my research question. I will argue that the perspectives of postcolonial feminism and relational ethical theory helped me to achieve a deeper understanding of the complexity of nurse migration. While the former provided a theoretical lens to unmask taken-for-granted processes that structured experiences of study participants, the latter prompted me to explore the context of decision-63  making related to migration and RN licensure experiences and to raise ethical questions such as whose interests are being served by nurse migration to Canada and whose may be harmed?  64  Chapter Three: Surveying the Theoretical Terrain This chapter provides an overview of the theoretical lens I used to pursue my research question as delineated in Chapter One (How do social, political, economic, and historical contexts mediated by the intersection of social relations, such as gender, race, and class, come to shape the everyday experiences of nurses educated in the Philippine as they seek RN licensure and employment in Canada?). In selecting an interpretive lens I reflected on four issues. First, I acknowledged that conditions coordinating everyday experiences of study participants may not necessarily be visible to them or to me. Second, I considered that nurse migration is a multi-dimensional phenomenon, embedded in broader social, economic, political, and historical contexts, and mediated by intersecting social relations, such as gender, race, and class. Third, I speculated that such complex conditions may constrain the ability of IENs to exercise autonomy over their own nurse migration trajectory. Fourth, I viewed my work as a catalyst for social change. To address these issues, I located the meta-theoretical context for this study within the critical theory paradigm, in particular, within postcolonial and feminist scholarship. Toward this end I drew on traditions of postcolonial feminism and relational ethical theory.  To situate my theoretical position I will commence with a brief discussion of critical theory followed by an overview of postcolonial and feminist theory.  I will then turn my attention to postcolonial feminism, within the context of post-colonialism and intersectional theory, and consider how it can inform a critical and gendered analysis of Philippine nurses? experiences in Canada. Finally, I will examine relational ethical theory and deliberate on how it directed me to pay attention to the context that shapes decision-making for nurses from the Philippines as they progress along a trajectory towards RN licensure and employment in Canada. 65  However, to lend additional support to my argument for selecting this framework, I begin by reflecting further on the complexity of nurse migration.  The Complexity of Nurse Migration I argue that numerous conditions support adopting both a gendered, racialized, and classed perspective on nurse migration and situating it within a relational ethics framework. To begin, nursing in Canada is a female-dominated profession (93.4  percent of the Canadian RN workforce is female (CIHI, 2012) and Canada relies heavily on women from lower income countries, especially the Philippines, to meet the demand created by its nurse shortages. These nurses possess particular class affiliations in the Philippines: they are predominantly from middle-class backgrounds and hold certain privileges that have been granted to migrants in their home country (Glick Schiller et al., 1992). However, if unable to meet Canadian professional credentialing requirements they are at risk of working in marginalized jobs in Canadian society and losing their middle-class status (Pratt, 1999, 2002, 2012). It is also worth considering that these women may be filling positions that Canadian educated nurses are unwilling or unable to fill. That is, positions that may be vacant as a consequence of an underinvestment in Canadian nursing education programs or in workplace environments. It also warrants consideration that such an underinvestment may be related to the low status assigned to nurses, or indeed to women, in many countries (Buchan, 2002, 2006). Thus, as Canada turns towards lower income countries (such as the Philippines) to address the demand created by its nurse shortages, it warrants examining whether gendered oppression is being transferred from one group of women in Canadian society to another, who happen to be from the global South. Further, it is worth examining the nature of the conditions that compel nurses to leave their country and seek work abroad. As mentioned earlier in this dissertation, contemporary 66  international migration of Philippine nurses appears to be greatly influenced by American colonialism and American values related to nursing education and overseas employment. However, opportunities to work in the US or in other higher income countries may come at an emotional cost. The literature from the UK suggests that recruitment agencies, intense recruitment campaigns, or future employers may render these women vulnerable to exploitation and discrimination. As well, IENs may be susceptible to policies that discriminate against certain types of immigration visas or make it more difficult for nurses from some countries to gain RN licensure and employment. Further, while working abroad many nurses have to submit to pressures to maintain gendered responsibilities associated with parenting or supporting extended family members left behind. It is also important to note that migration may not be a matter of choice, but rather something imposed on nurses. Indeed, conditions creating a demand for nurses in higher income countries such as Canada and those compelling nurses from lower income countries to migrate remind us to query how much control IENs have over their own actions and, as I mentioned in Chapter One, to raise ethical questions such as ?whose interests are served and whose are harmed by the traditional ways of structuring thought and practice? (Sherwin, 2000, p. 76). Further, challenges encountered along the way with respect to credential assessment and recognition caution us to consider whether IENs are making informed decisions about migration.  Thus, the complex nature of nurse migration appears to necessitate an examination of nurse migration, not as an isolated phenomenon, but rather as one embedded within broader social and historical contexts that overlap at international, national, and local levels. Moreover, it seems apparent that researchers must seek ways to understand how power and oppression shape the everyday lives of nurses who migrate. For these reasons, I turned to the critical paradigm and 67  more specifically to postcolonial feminism and relational ethical theory. I contend that as the complexity of nurse migration began to unfold these theoretical perspectives gave rise to an in-depth understanding about how or why nurses decided to migrate to Canada, challenges confronting them upon arrival in Canada, and about how they addressed such challenges. The Critical Theory Paradigm Certain beliefs shape how the researcher views the world and acts in it. Such belief systems are referred to as paradigms. Paradigms are the starting points of an inquiry, determining what inquiry is and how it is to be practiced (Guba, 1990). However, because paradigms are human constructions and subject to change they are often difficult to describe, with different theorists using different conceptualizations. For the purpose of this study, I have elected to use Guba?s (1990) method of delineating paradigms. He differentiates four paradigms on the basis of how the researcher views the nature of reality (ontology); the relationship between the knower and the known (epistemology); and how knowledge is gained about the world (methodology). He refers to these paradigms as positivism, postpositivism, constructivism, and critical theory. Further, Guba (1990) contends that each paradigm has its own merits and each ultimately produces a different type of knowledge, with one not being superior to the other.   According to Guba (1990) positivism refers to a set of beliefs that is embedded in a realist ontology (reality exists ?out there?); a dualist/objectivist epistemology (it is possible and necessary for the researcher to be able to view nature without altering it in any way); and an experimental/manipulative methodology (hypotheses are stated in advance, subjected to empirical testing and controlled conditions). With respect to postpositivsm, Guba (1990) suggests that it is a modified version of positivism and, as such, has a critical realist ontology (reality exists but can never be fully apprehended); a modified objectivist epistemology 68  (objectivity can only be approximated); and a modified experimental/manipulative methodology (findings should be based on as many sources as possible, including qualitative inquiry). In stark contrast to positivism and postpositivism, constructivists believe in a relativist ontology (reality exists in the form of multiple mental constructions); a subjectivist epistemology (findings are the construction of the interaction between the knower (inquirer) and the known (inquired); and a hermeneutic, dialectic methodology (individual constructions of knowledge are elicited and refined, compared and contrasted in order to reconstruct the ?world?) (Guba, 1990).  Finally, Guba (1990) suggests that the critical theory paradigm, similar to postpositivism, has a critical realist ontology27 (a ?true consciousness? exists and that values and meanings extending beyond peoples? consciousness permeate the world, empowering some, while disempowering others); a subjectivist epistemology (values mediate inquiry); and a dialectic, transformative methodology (the task of the critical theorist is to eliminate a ?false consciousness? or, to raise people from oppressive situations to a level of ?true consciousness?, whereby they can begin to realize the extent of their oppression and can act to ?transform? the world) (Guba, 1990). However, Guba (1990) also challenges these stances, suggesting that a disjuncture exists between the realist posture maintained by critical theorists and their subjective approach to uncovering meaning. He contends that a ?real? reality demands an objective epistemological approach. This notion is disputed by other theorists. For instance, Schwandt (1990), citing Bernstein (1976) argues that a ?false consciousness? does not presuppose a ?true consciousness?. Further, Schwandt (1990) citing Giroux (1988, pp., 192? 93), contends there is a need ?to ?move beyond the language of critique and domination? to develop a ?language of                                                  27In contrast to postpositivists, critical theorists tend to locate reality in specific historical, economic, racial, and social infrastructures of oppression (Guba, 1990). 69  possibility?? (p. 274). My own theoretical position coincides with that set forth by Schwandt. Although I attach importance to lifting false consciousness, I do not foresee the attainment of a true consciousness as a possibility.   Although a single critical theory does not exist and the critical condition is always evolving in light of new theoretical insights (Kincheloe & McLaren, 2005), all such theories possess ?the power to affect progress in or transform human life? (Schwandt, 1990, p.274) Indeed, Guba (1990) argues that critical inquiry is a political act and reasons that if values enter inquiry then the choice of a particular value system has the potential to empower some while disempowering others. Thus, critical theorists are not only seeking knowledge, but they view their work as a catalyst for social change (Kincheloe & McLaren, 2005).  Beliefs underpinning the critical paradigm influenced all aspects of my study, such as ?... the problem selected for study, the paradigm which to study it, the instruments and the analytic modes used, and the interpretations, conclusions, and recommendations made? (Guba, 1990, p.23). As a theoretical perspective concerned with issues of social injustice and oppression, critical theory prompted me to explore oppressions shaping migration experiences for Philippine nurses.  Indeed, as a form of praxis28, it extended my gaze beyond the individual to reflect on broader social and political problems of injustice; caused me to query how these situations came to be and how they could be different; and stimulated me to uncover alternate possibilities for change and to attempt to make change happen (Chinn & Kramer, 2011). Therefore, as a critical theorist, I was not only interested in critiquing how unequal power relations based on assumptions about gender, race, and class intersected to shape nurse migration experiences, but I                                                  28Praxis implies a dialectical relationship between theory and practice, with each informing the other in the direction of emancipatory social change (McCormick & Roussy, 1997). 70  hoped that as the study unfolded study participants would become more aware of their oppressive situations and inspired to work towards change. As well, it was my intention that the research findings would encourage policy makers, Canadian educated nurses, nurse educators, administrators, IENs in general, and other internationally educated professionals to work towards change for the better.  Postcolonial theory. Like many critical theories, postcolonialism is highly eclectic and difficult to define (Quayson, 2000). However, Quayson (2000) offers a possible working definition, suggesting that postcolonialism ?involves a studied engagement with the experience of colonialism and its past and present effects, both at the local level of ex-colonial societies as well as at the level of more general global developments thought to be the after-effects of empire?(p 2). Cashmore (1996) tells us that:  postcolonial discourse concerns itself not only with the former colonies that gained independence during World War II, but with the experiences of people descended from inhabitants of those territories and their experiences in the metropolitan centers of the ?first world? colonial powers ? the Diaspora (p. 285).  It is Edward Said?s (1994) work, however, that provided me with the greatest insight into the nature of postcolonial theory. Said?s (2003) book Orientalism is said to have ?paved the way for postcolonial studies by forcing academics in the West to re-think the relationship between the Orient and the Occident? (Ashcroft, Griffiths, & Tiffin, 2006b, p.10). Said?s (2003) main thesis is that the Western academic discipline of Orientalism was a means by which the Orient was produced as a figment of the Western imagination for purposes of consumption in the West and colonial domination (Quayson, 2000). However, not only was the ?non-Western Other? constructed through contrasting images to the West and determined to be different from the Occident, the ?non-Western Other? was constructed as inferior (Anderson, 2004). Drawing on 71  the work of Michel Foucault, Said (2003) inserted a poststructuralist problematic into the study of colonialism and used discourse analysis to discern issues of power, domination, and complex hegemony embedded in the Occident/Orient relationship (Said, 2006). Said?s (2003) work helped establish what was later to be known as colonial discourse analysis and the words ?Orientalism? and ?Orientalist? have come to mean attitudes of knowing the Third World that are meant to serve Western interests (Quayson, 2000). As stated by Joan Anderson (2000b): ?postcolonial scholars keep reminding us of centuries of colonization, diaspora, and exploitation.? (p. 145). Thus, postcolonial discourse analysis provides a method of interrupting the essentializing discourses that classify people according to racial categories; classifications that are now understood to be socially constructed in order to define and organize relations between dominant and subordinate groups (Anderson, 2002; Reimer Kirkham & Anderson, 2002). It has become a means for uncovering how conceptions of the racialized ?Other?, ?race?, ethnicity, fluid identities, and hybrid cultures, have been constructed within particular historical and colonial contexts (Anderson, 2002; Anderson, Reimer Kirkham, Browne, & Lynam, 2007; Reimer Kirkham & Anderson, 2002). Accordingly, postcolonial theory cautioned me to be mindful that images and conceptualizations about nurses from the Philippines may have been developed and sustained to serve the interests of higher income countries, such as Canada, and that such conceptualizations may well cast these nurses as inferior.  As an interpretive lens postcolonial theory helped to unpack the complexity embedded in Philippine nurse migration to higher income countries such as Canada. For instance, it extended my gaze beyond local challenges encountered by nurses from the Philippines to explore how dominant ideologies shape everyday experiences of marginalization (Anderson, 2002; Anderson 72  et al., 2007; Reimer Kirkham & Anderson, 2002). Indeed, Philippine postcolonial theorists contend that the oppression of subaltern nations by the West continues to shape the lives of people in the Philippines (Rafael, 1993; San Juan, 2000). For instance, as noted in Chapter Two, contemporary international migration of nurses from the Philippines is inextricably linked to early 20th century American colonialism in the Philippines (Choy, 2006). In a similar vein, it is suggested  that conditions of economic underemployment and national debt (repercussions of American colonization) are major forces driving Philippine domestic workers to migrate to Canada and that a study of migrant workers is a study of the processes that create global inequality (Pratt, 2004). Further, contemporary postcolonial scholars from the Philippines contend that one of their major challenges is to disrupt dominant discourse  sustaining the notion that migrants from the Philippines are the natural domestic servants of the world (San Juan, 2000). Not only are such scholars concerned with exposing oppressions that shape the experiences of migrant workers from the Philippines, they also want to raise awareness of how these individuals contribute to the very oppressions that dominate their everyday world (San Juan, 2000). In this regard, postcolonial theory directed me to explore how nurses educated in the Philippines may contribute to the oppressions that hinder RN licensure and employment in Canada. Without underestimating its significant contributions, it is important to note, however, that postcolonial theory has been criticized on several grounds. For instance, some argue that the discussion of gender is muted in the mainstream postcolonial narrative (Anderson et al., 2007; Gandhi, 1998; Reimer Kirkham & Anderson, 2002). Gandhi (1998) points out that postcolonial theory approaches epistemological questions in a universal manner, using colonialism as a principle organizing category. She contends that the all-inclusive idea of ?colonialism? fails to 73  account for the similarities between cultures, or societies, which do not share the experience of colonialism, and that such a perspective fails to account for differences in forms of colonization and anti-colonial struggles. Spivak (2006) is also critical of what she sees as a persistent essentialism underlying postcolonialism and argues that for ?the ?true? subaltern29 group, whose identify is its difference; there is no unrepresentable subaltern subject that can know and speak itself? (p. 32). Further, in response to critiques of essentialism, Homi Bhabha (2006) extends thinking about culture to include the notion that culture is partial and he introduces the conception of cultural hybridity. That is, when cultures come together (as in the colonizer and the colonized), a third, or hybrid, space is created and the ?colonized? become active agents in negotiating and constructing new meanings (Anderson et al., 2007; Bhabha, 1994).This perception of culture reminded me that the meanings constructed by study participants about their migration experiences are not static; that their understanding of events may shift and new meanings emerge as they become more entrenched in the processes of acquiring RN licensure or employment in Canada, or indeed, as they actively participated in the research study. As I progressed with my research, these concerns about postcolonialism reminded me that if I focus on oppressions related to colonization to the exclusion of other oppressions, such as sexism or classism, I could risk oversimplifying migration experiences. As well, they cautioned me about the hazard of essentializing nurse migration experiences and to be mindful of the differences that emerge from different accounts. For instance, I could not assume that all nurses educated the Philippines were subjected to similar colonial injustices or that they had reacted or were reacting to injustices in a similar fashion.                                                   29I am using the term ?subaltern? as adopted by Antonio Gramsci to refer to those groups in society who are subject to the hegemony of the ruling classes (Ashcroft, Griffiths, & Tiffin, 2008).  74  Feminist theory. To further untangle the complexity of nurse migration experiences and to position nurses from the Philippines at the centre of my study, I turned to feminist theory. Although there are many variations of feminist theory within the critical paradigm, as critical perspectives they are all political insofar as they offer new visions for social change (Anderson, 1991a; Harding, 1987b). For instance, Anderson (1991a), citing McPherson (1983), contends that feminist theories serve two functions: ?They offer descriptions of women?s oppression, and prescriptions for eliminating it? (p.1).  In an early attempt to reconcile the social and political nature of feminist research Harding (1987a) outlined three general types of feminist inquiry: feminist empiricism, standpoint theory, and postmodernism. According to Harding (1987a) each offers a more reliable and objective approach to inquiry than that offered by traditional science30. She argues that feminist empiricism stresses the continuities between traditional justifications of scientific research and feminist ones, but unlike scientists engaged in traditional practices feminist empiricists recognize the influence of social values on science (Harding, 1987a). Feminist standpoint theorists offer another approach to justifying the results of feminist inquiry. They contend that since traditional social scientists only raise questions that appear problematic within experiences characteristic for men (white, middle-class Western men), research findings are distorted and partial (Harding, 1987a). Thus, these theorists maintain that women should have an equal say in defining what is in need of scientific explanation and that problematics should be generated from the perspective of women?s experiences (Harding, 1987a). Therefore, both feminist empiricists and standpoint                                                  30I am using the term ?traditional science? in this paper to refer to the traditions of positivism and postpositivism. 75  theorists are attempting to ground accounts of the social world which are less partial and distorted than traditional ones.  Postmodern feminists, however, negate claims  advanced by both feminist empiricists and standpoint theorists that feminist struggles can tell ?one true story? about ?the world?(Harding, 1987a). Harding (1987a) contends that there are at least two origins of scepticism about the epistemological project within which postmodern feminists are engaged. One source of criticism arises from feminists who are sceptical of any universalizing claims. These feminists argue that women do not have a unified voice; rather, many different ?subjugated knowledges? exist and conflict with, and are never reflected in, the dominant stories that depict social life (Harding, 1987a). Another group of critics, according to Harding (1987a), emerges from women of colour. For instance, bell hooks (2003) argues that since there can never be one unified feminist standpoint, the commonality that binds feminists is their struggle to end sexist oppression.  While some postmodernists may be sceptical of a feminist science, others contend that postmodern feminism can advance the cause of feminism. For instance, Flax (1990) contends that postmodernism can facilitate analysis of gender relations, which she argues is the fundamental goal of feminist theory. She reasons that since postmodernism fosters scepticism about beliefs concerning knowledge, power, the self, and language, it has the potential to encourage feminist theorists to tolerate and interpret ambivalence, ambiguity, and multiplicity, as well as to expose roots of oppression.  Fraser and Nicholson (1990) also maintain that a feminist lens, embedded within postmodern scepticism, will yield the sort of theory that would be useful for contemporary feminist political practice. Addressing the tension between postmodernism and feminism, they 76  argue that both have complementary strengths and weaknesses: while postmodernism offers persuasive criticisms of foundationalism and essentialism, its conceptions of social criticism is weak; and feminism, while contributing to social criticism, tends to lapse into essentialism (Fraser & Nicholson, 1990). Further, these authors contend that the major advantage of a postmodern feminist perspective is that it recognizes that a single theory cannot adequately address the diversity of women?s needs and experiences (Fraser & Nicholson, 1990).  As I proceeded with my own analysis of the experiences of Philippine nurses seeking RN licensure and employment in Canada, postmodern feminism offered a means of gaining a more in-depth understanding of the oppressions shaping these women?s experiences. It directed me to place the nurses at the centre of my study; to explore the roots of their oppression; to deconstruct universals and meta-narratives that are intended to define them (e.g., that IENs from the Philippines are national heroes); and to focus on understanding multiple meanings of nurse migration. As a critical perspective it also directed me to query how situations could be different and to seek to uncover and introduce alternate possibilities for change.  Postcolonial feminist theory. In an attempt to bring a gendered analysis to postcolonialism and to speak from the perspective of the postcolonial ?Other? situated in countries of the North (i.e., rich countries), some feminists have turned to postcolonial feminist scholarship (Anderson, 2002; Browne, Smye, & Varcoe, 2008). Such scholarship arises from the convergence of black31 feminist standpoint theory and postcolonial theory (Anderson, 2002).                                                  31In accordance with Anderson (2002) in this study I am using the term ?black? to refer to ?people of different shades of skin colour in a show of solidarity and coalition to resist labels such as ?visible minority? which, unwittingly, designate people as marginal with minority status and, therefore, inferior? (Anderson, 2002, p. 15). 77  To add clarity to postcolonial feminism and to explicate how such a theory advanced understanding of nurse migration experiences, I begin with an overview of black feminist scholarship, in particular intersectional theory. Intersectional theory. Intersectionality ?provides a lens to address how ?race?, gender and class relations intersect to shape material existence and the social conditions of women?s everyday lives? (Anderson, 2002, p. 11). As a theory, it offers a means of viewing how various socially and culturally constructed categories interact on multiple levels to produce social injustice (Collins, 2000; McCall, 2005; Varcoe, Hankivsky, & Morrow, 2007). Fundamental to the development of intersectionality has been the criticism put forth by black feminists that feminist scholarship has failed to address the lived experiences of black women at points of intersecting oppressions. Similar to a postmodernist criticism that feminist scholarship has a tendency towards modernity and meta-narratives, feminists of colour criticize feminism for its homogeneous categories that strive to uncover a common essence of all women (McCall, 2005; Racine, 2002). The primary philosophical consequence of such critiques has been for many feminists of colour to render the use of categories such as gender, race, and class suspect, arguing that not only do they fail to address the lived experiences of black women at points of intersecting oppressions, but they also have no foundation in reality, as they are categories that have been created by discourse (McCall, 2005). 78  Like other standpoint feminists, Collins32 (2000) adheres to the premise that all knowledge claims are socially situated and that some social locations are better than others as starting points for the development of knowledge. She argues for the necessity to place black women?s experiences at the centre of analysis: Oppressed groups are frequently placed in the situation of being listened to only if we frame our ideas in the language that is familiar to and comfortable for a dominant group. This requirement often changes the meaning of our ideas and works to elevate the ideas of dominant groups (p. ix).  Moreover, Collins (2000) contends that the standpoint of black women provides a means for the ?outsider-within? location to foster new insights into how a variety of oppressions mutually construct one another and create different kinds of lived experiences and social realities. That is, an outsider?s social location may illuminate contradictions that are not readily apparent to white people. However, she acknowledges diversity within black women?s thought and notes that not all black women will respond to encounters in the same manner (Collins, 2000).  Intersectional theory, as set forth by Collins (2000), provided a means of learning new insights into oppressions which might otherwise have been overlooked. Currently the voices of nurses from the Philippines appear to be missing from nursing policy and education initiatives in Canada. By positioning these nurses at the centre of my study and shifting my analysis from a singular form of oppression to intersecting forms of oppression embedded within institutions (such as regulatory procedures or recruitment policies), I was able to offer new insights to the challenges encountered by IENs as they seek RN licensure or employment in Canada.                                                    32While numerous black feminists have offered insights into intersectionality (for example, Bannerji (2000) and Brewer (1993)) at this point in my research I am drawing more heavily on notions put forth by Patricia Hill Collins (2000). However, as I progress with my research I will also want to learn from others. 79  The convergence of postcolonial and intersectional theory. While black feminist scholars often focus on how social relations such as gender, class, and race intersect to create social injustices and postcolonial scholars tend to focus on the construction of ?race? and racialization33 and cultural identity (Anderson, 2002), a convergence of the two theories offers a perspective that brings a gendered analysis to postcolonial theory (Anderson, 2000a; Anderson, 2002). Postcolonial feminism, or, the convergence of these two theories, contributed in numerous ways to my research. First, as mentioned above, it directed me to begin my inquiry from the perspective of nurses educated in the Philippines. As well, it directed my gaze to multiple forms of oppression such as exploitation and marginalization embedded in a complex of processes at local, national, and international levels, including American colonization of the Philippines, neo-liberal economic trends, immigration policies, and professional credentialing procedures. It presented a way of situating and historicizing difference by studying the way in which exclusions have been legitimized in Western practices. It also offered insight into how issues that are often considered cultural (e.g., the act of making regular remittances) might be better understood as partial and dynamic implications of broader social inequities. Additionally, it prompted me to explore the tensions between agency and structural constraints and, as a critical perspective, it encouraged me to move beyond descriptions of what ?is? to what ?ought? to be and to work to make change possible (Reimer Kirkham & Anderson, 2002).                                                    33I use the term racialization as it used by Ahmad cited in Anderson (2000a). Racialization assumes that race is the primary, natural, and neutral way of categorizing individuals and groups as distinct and different. Anderson argues that racialization is neither a neutral nor a benign process and that it can result in the silencing of some groups and their exclusion from positions and privilege (p. 223).   80  Relational ethical theory. In light of findings in the literature that migration may not be a matter of choice for some nurses, but rather something imposed on them, I also elected to incorporate ethical theory into my theoretical lens. Indeed, to broaden our understanding of the nature of autonomy it is suggested that we turn to the study of ethics, or to moral theory that is concerned with value related questions about human conduct (Sherwin, 1992). While traditional ethical perspectives tend to view agency as enacted by self-determining individuals, a relational approach to ethics regards agency as enacted through relationships in particular contexts (Rodney, Kadyschuk et al., 2013).  One of the principle tasks of ethical theory is to explain the basis for making sound moral claims. However, it is argued that traditional approaches to ethics often reflect moral decisions as logical outcomes of rational negotiation conducted among autonomous, self-interested individuals (Sherwin, 1992). Further, it is held that such perspectives ?do not constitute the objective, impartial theories that they are claimed to be; rather, most theories reflect and support explicitly gender-biased and often blatantly misogynist values? (Sherwin, 1992, p. 43). Consequently, some feminists claim that traditional approaches to ethics must be revised if they are to effectively address how issues of dominance and oppression affect women (Sherwin, 1992).  Accordingly, a relational approach to ethics views individuals as rooted in an interconnected dynamic web of social relationships and affinities with others; not as isolated, social units fixed in time (Rodney, Burgess et al., 2013; Sherwin, 2000). Individuals are perceived as relational because their identities are constituted by elements of the social and historical contexts in which they are embedded  (Rodney, Burgess et al., 2013). Such an 81  approach to ethics recognizes the importance that relationships and context have on shaping each person?s identity, development, and aspirations (Sherwin, 2000). The relational ethical theory that I draw from, however, does not refer only to personal relationships; rather, it also refers to political relationships of power and powerlessness. In this regard, relational theory accounts for how forces of oppression can interfere with someone?s ability to exercise autonomy (Rodney, Burgess et al., 2013; Sherwin, 2000). Sherwin (2000) cautions that we need to distinguish between agency and autonomy. She argues that exercising agency implies exercising reasonable choice, whereas exercising autonomy implies resisting oppression. She contends that the dominant perspective that agency equates with autonomy overlooks the context of prevailing social arrangements that may in fact perpetuate oppression. That is, although individuals may appear capable of making reasonable decisions or appear to be free of direct coercion, they may not be autonomous free agents. For instance, they may be functioning within an oppressive framework, or they may have access to only a few choices. Citing Michel Foucault (1979), Sherwin (2000) explains that in modern societies the illusion of choice can be part of the mechanism for controlling behaviour and if we limit our analysis to the quality of an individual?s choice under existing conditions, we have the potential to overlook the significance of wider oppressive forces. Sherwin (2000) suggests that in order to ensure that we recognize and address the restrictions that oppression places on peoples? choice, we need to adopt a broader conception of autonomy one, that will allow us to distinguish autonomous behaviour from mere acts of rational agency. As a feminist perspective, relational ethical theory, like postcolonial feminism, is also concerned with the oppression of women. As well, similar to postcolonial feminism, such a perspective views individuals as socially constructed complex beings with historical roots 82  (Sherwin, 1992). However, I envisage postcolonial feminist and relational ethical theories to be complementary. While postcolonial feminism is concerned with the means by which everyday experiences are shaped by multiple forms of intersecting oppressions embedded in a complex of historical, social, and cultural processes, relational ethical theory accounts for how forces of oppression can interfere with the ability to exercise autonomy (Rodney, Burgess et al., 2013; Sherwin, 2000).  As I examined the experiences of nurses educated in the Philippines and the intersecting oppressions that shaped their experiences relational ethical theory directed me to examine how wider oppressions influenced their agency: that is, it inspired me to extend my gaze beyond individual decision-making to social, political, economic, and historical contexts within which decision-making occurred. Consequently, I had an analytical lens to address questions about whose interests are being served when nurses from the Philippines seek work abroad and to query how much control IENs have over their own actions. It prompted me to consider the consequences of such choices and to remember that relationships (personal and political) both influence and are influenced by choices. It helped me to theorize about why participants decided to seek employment in Canada; why they engaged in RN licensure and credentialing procedures despite daunting challenges; and why they stayed in Canada rather than return to the Philippines.  Chapter Summary In this chapter I have described the theoretical lenses I used to pursue my research question. I have argued that a postcolonial feminist perspective offered an opportunity to place the experiences of nurses educated in the Philippines at the centre of my analysis and from there explored how intersecting oppressions of racism, sexism, and classism embedded within social and historical contexts overlapped at international, national, and local levels to shape migration 83  experiences. I have also contended that as a critical perspective, postcolonial feminism prompted me to query how these migration experiences could be different and to uncover possibilities for change. As well, I have indicated how relational ethical theory further enriched my study as it provided an interpretive lens to explore how power inequities, embedded within a broader complex of social and historical conditions, shaped the ability of IENs to exercise autonomy over their own nurse migration trajectory. In the next chapter I will sketch out how I operationalized these theories towards answering my research question. 84  Chapter Four: Implementing the Study Crotty (1998) suggests that as a starting point in the development of a research proposal, researchers need to consider two questions: 1) What strategy of inquiry34 and methods35 will we employ in our research project? and 2) How do we justify this choice? However, he contends that the answer to the second question is dependent upon whether the strategy of inquiry and the methods are capable of fulfilling the purpose of the research and answering the research question. Further, he argues that it is the theoretical perspective which provides the context for the research process and grounds its logic and criteria (Crotty, 1998).   In answer to the first question posed by Crotty (1998), I used a qualitative design inspired by ethnographic inquiry as my strategy of inquiry. Ethnography had the potential for capturing, in some depth, the lived experiences of nurses from the Philippines striving to continue their nursing practice in Canada, and for examining the structures that shaped these experiences. The inquiry was grounded in assumptions underlying postcolonial feminist theory, and as such illuminated the tensions between the agency of these nurses and the structural constraints embedded within social and historical contexts. In response to Crotty?s (1998) second question, I used in-depth interviews, observations of people?s behaviour, document analysis, and extensive field notes to gather my data. Such a variety of methods offered an opportunity to generate deeper understanding of factors shaping nurse migration experiences. In this chapter, I                                                  34Crotty (1998) defines a methodology ?as the strategy, plan of action, process or design lying behind the choice and use of particular methods and linking the choice and use of methods to the desired outcomes? (p.7). So far in this paper I have used the term ?methodology? in accordance with Guba?s (1990) definition, to imply a philosophical assumption underlying a paradigm of inquiry about how knowledge is gained about the world. So as to not confuse the two terms, I have decided to refer to the plan of action lying behind the choice and use of particular methods as my ?strategy of inquiry?. 35Crotty (1998) defines methods as the ?techniques or procedures used to gather and analyse data related to some research question or hypothesis? (p.6). 85  will elaborate on these approaches and justify my choices. Toward this end, I begin with an overview of ethnographic traditions of research. Understanding Ethnographic Traditions Ethnography had its beginning in the discipline of anthropology in the early 20th century and usually involved living with a group of people for extended periods in a society different from one?s own, in an attempt to document and interpret a distinctive way of life (Hammersley & Atkinson, 2007; Vidich & Stanford, 1994). The philosophic perspective underlying this early stance included an emphasis on the positivist approach to science, with its assumptions that there is something ?real? out there that can be captured by objective, accurate observations (Hammersley & Atkinson, 2007). Since these early beginnings, however, the philosophic perspective underlying ethnography has shifted to include multiple paradigms including feminism, critical theory and constructivism/interpretivism, and has been adopted by a host of disciplines such as sociology, human geography and nursing (Hammersley & Atkinson, 2007; Muecke, 1994). Indeed, there is no standard way of viewing ethnography and many variations exist. Regardless, a hallmark of ethnographic inquiry is that it immerses researchers in the midst of whatever it is they study, allowing them to examine various phenomena as perceived by the study participants (Berg, 2007).  Hammersley and Atkinson (2007) suggest that the nature of ethnography can perhaps best be portrayed by paying attention to what ethnographers actually do and considering the sorts of data they collect and how they handle the data. As such, they have outlined five features that commonly characterize ethnographic work. First, people?s actions and accounts are studied in everyday contexts (i.e. in the ?field?) rather than under contrived structures and usually over an extended period of time. Second, data is often collected from a range of sources, including 86  documentary evidence of various kinds, participant observations, and informal interviews. Third, data collection is usually relatively unstructured in the sense that it does not involve following a fixed design determined at the start of the inquiry; and, further, categories used for interpreting the data are not built into the data collection process but are generated during the analysis of the data. Fourth, the focus of the inquiry is typically centered on a few cases to facilitate in-depth study. Fifth, the analysis of the data involves interpretation of the meanings, functions, and consequences of human behaviour and institutional practices and how these are implicated in broader social contexts. Commonly such an analysis generates verbal descriptions, explanations and theories. LeCompte and Schensul (1999) also shed light on the nature of ethnographic research. These scholars maintain that an ethnographic approach to research is ideal for addressing problems that are complex and embedded in multiple structures; for revealing multiple perspectives; and for addressing questions that do not have simple solutions. As such, ethnographic researchers often seek extreme, typical, and unique cases to determine patterns of difference between members of a population. Similar to Hammersley and Atkinson (2007), they stipulate that ethnographic research frames all elements under study as existing within a context.  Indeed, they argue that from an ethnographic standpoint, the behaviour and beliefs of individuals or organizations ??can never be understood completely without understanding the social, political, cultural, economic kinship and even personal matrices in which they are embedded...? (LeCompte & Schensul, 1999, p. 19). However, these scholars also maintain that though ethnographers generally strive to conduct research in natural settings where people interact with one another (e.g., in homes or schools) they frequently need to manipulate or create settings 87  within which to elicit data. For instance, researchers may need to bring study participants together in a single location for the purposes of conducting focus group interviews.  Although my intention was never to conduct a full-blown ethnography whereby I immersed myself for extended periods of time in the lives of nurses from the Philippines seeking RN licensure and employment in Canada, I nevertheless drew on ethnographic traditions to examine the social and historical context of nurse migration as perceived by study participants. Over the course of a year that I spent in the field, developing relationships with stakeholders, engaged in individual and focus group interviews, observing nurses describe their experiences in Canada, and examining documents related to nurse regulation, education, and employment and immigration policy, I became increasingly familiar with issues confronting study participants. An opportunity to present my preliminary findings and participate in an international nursing conference in the Philippines also provided rich insights about structures influencing migration experiences. For instance, I learned about the social status assigned to working abroad, an issue I will refer to later in this chapter. Spending a year in the field also permitted time to note the shifting context of nurse migration and integration experiences. For instance, during the course of the year the nursing labour market was in a state of flux; new immigration and regulatory policies were introduced; and private colleges were expanding to include programs targeting the needs of new immigrant nurses.  Conceptualizing an Ethnographic Approach Informed by Postcolonial Feminism Although an ethnographic approach provided the framework for my research study, postcolonial feminism and relational ethical theory determined the context for the research process. While relational ethical theory was a helpful analytical lens, postcolonial feminism guided my overall research design, informing my decisions about data collection and analysis, 88  methods and research outcomes (Crotty, 1998). In the following sections I will comment on three defining features of a postcolonial feminist perspective that influenced all aspects of my study: starting from the standpoint of those at the margins; engaging in a multi-layered analysis of intersecting relations of power that influence and are influenced by everyday experiences; and extending analysis beyond generating a description of ?what is? to providing a prescription for ?what ought to be? (Reimer Kirkham & Anderson, 2002).  Beginning from the standpoint of those at the margins. A central tenet of postcolonial feminist methodology is that research begins with the experiences of marginalized women who have been subjected to intersecting forms of oppression embedded within a complex of historical and social processes (Anderson, 2002; Reimer Kirkham & Anderson, 2002). It is put forth that to make knowledge more representative, the perspectives of oppressed groups must be heard as these groups are more likely to perceive certain types of problematic assumptions that support their continuing oppression (Bhabha, 2006; Reimer Kirkham & Anderson, 2002; Sherwin, 2001; Smith, 1999, 2006). Inspired by feminist standpoint theory as set forth by Dorothy Smith, Anderson (2002) asserts that by beginning with people?s everyday experiences researchers can reflect back and link these experiences with social forces that structure and are structured by them. To make such connections, the researcher ?critiques taken-for-granted assumptions, analyzes discourses and structures that support the status quo, and turns a critical eye upon self (self-reflexivity)? (Reimer-Kirkham & Anderson, 2010, p.199). However, postcolonial feminists do not suggest that those at the margins are passive agents. Rather, a postcolonial feminist perspective directs researchers to explore tensions between human agency and structural constraints located in histories of colonization (Reimer Kirkham & Anderson, 2002; Reimer-Kirkham & Anderson, 89  2010; San Juan, 2000). For instance, researchers need to question how individuals may both resist oppression and be actively engaged in producing the same oppressions that shape their experiences. My time in the field facilitated an understanding of the participants? perspectives and inspired me to challenge taken-for-granted assumptions that underpin nurse migration issues locally, nationally and in the Philippines. I became increasingly aware of broader social/historical structures and power relations that shape and are shaped by their experiences. For instance, I became cognizant of structures that put these nurses at risk of exploitation as they prepared to leave the Philippines and as they settled in Canada and I became conscious of their capacity to both resist and contribute to these very structures that aim to exploit them.  While standpoint theory has much to offer postcolonial feminism, it is not without criticism. For instance, some argue that Dorothy Smith?s notion of standpoint is an essentialist view that overlooks questions of difference as it suggests there is only one way of knowing a socially constructed world (Wolfe, 1996). However, as Wolfe (1996) puts it, the discussion has broadened to include ?standpoints? as there clearly is no single standpoint for women with diverse class, racial, and ethnic backgrounds. Indeed, as I proceeded with data collection and analysis I became cognizant of the varied experiences of study participants. They represented a wide range of social locations, perspectives, and oppressions and clearly there was no single standpoint. While some complained at how marginalized they felt by the regulatory process, others conceded that they thought it was fair.  In a similar vein, another criticism of standpoint theory is that it implies that one?s positionality as a woman is crucial to gaining knowledge of other women and thus raises concerns about epistemic privilege, or whether one has to have lived an experience to understand 90  it (Wolfe, 1996). Indeed, a nagging concern that I had as I entered this research study was whether as an ?outsider? I would be able to capture the viewpoints put forth by study participants. This concern was highlighted at an Advisory Group meeting toward the end of my data collection when I commented that I had not heard study members refer explicitly to acts of discrimination. In response, a member of the Group cautioned me that as someone who had never experienced discrimination I would not be able to detect it.  Though this comment was well-meaning, it alerted me to my privilege and filled me with self-doubt. However, it was gratifying to see that a member of the Advisory Group was willing to challenge my insights. Later, I was somewhat reassured when I came across the notion set forth by feminist scholar Narayan Uma, cited in Wolfe (1996, p. 14), that although shared positionalities as members of an oppressed group may create a greater probability of sharing and understanding, it is possible for those with a different social location to also gain understanding. As well, Reimer and Anderson (2002) argue that Dorothy Smith?s notion of standpoint does not privilege the knower but instead it is a means of understanding the socially organized nature of knowledge, or how everyday experiences are shaped by social relations. Accounting for intersectionality. As mentioned in Chapter Three, intersectional theory provides important insights for postcolonial feminism and has become a key component of such scholarship (Reimer Kirkham & Anderson, 2002). Intersectionality brings to the forefront diversity among individuals. It directs the researcher to move beyond recognizing difference to critically examining it as historicized within colonial relations of power and to analyzing how assumptions underlying difference contribute to social inequities (Anderson, 2002; Reimer Kirkham & Anderson, 2002). More specifically, it disrupts the history of  categorizing  people according to their presumed race and 91  guards against Othering or essentializing groups of individuals for the purpose of reproducing the status quo inequities (Anderson, 2002; Reimer Kirkham & Anderson, 2002).   Intersectionality prompted me to be cautious about how participants may be ?Othered?, or deemed different for purposes of maintaining the current state of affairs in BC. It also caused me to critically reflect on the complex context of nurse migration experiences and refrain from searching for simple explanations. As well, it directed me to account for the fluid nature of power (Reimer Kirkham & Anderson, 2002). That is, it shed light on the fact that a participant could have multiple identities (e.g., I noted that while study participants frequently implied they were proud of their ability to navigate the immigration process in Canada, they also alluded to feeling marginalized by their inability to meet RN regulatory requirements) and could be contemporaneously both oppressor and oppressed  (e.g., one participant of a focus group who had come to Canada as a live-in caregiver revealed that she felt marginalized by those who came under the FSWP and yet this latter group of nurses expressed that they in turn felt marginalized by RN regulatory processes in BC).   Orienting towards praxis. As a critical perspective and a form of praxis, an ethnographic approach informed by postcolonial feminism offers an opportunity to raise people from oppressive situations to a level of awareness whereby they can begin to realize the extent of their oppression and make efforts to address it (Chinn & Kramer, 2011; Guba, 1990; Lather, 1991). Indeed MacPherson (1983) argues that feminist theories have a dual function:  ?they offer descriptions of women?s oppression and prescriptions for eliminating it. They are empirical insofar as they examine women?s experience in the world, but they are political insofar as they characterize certain features of that experience as oppressive and offer new visions of justice and freedom for women (p. 19).  92   As well, Lather (1991) contends that the goal of critical or emancipatory research is to encourage praxis, as much as it is to generate empirically grounded theoretical knowledge. Starzomski and Rodney (1997) suggest that to integrate praxis into the process of the project the researcher must consider how to connect research to political activism and social transformation. They suggest that, ?critical perspectives are able to take us from the ?is? to the ?ought? and thereby provide normative direction for change? (Starzomski & Rodney, 1997, p. 225). Thus, critical theorists are not only seeking knowledge, but they view their work as a catalyst for social change (Kincheloe & McLaren, 2005). Accordingly, I view my work as a form of praxis; inspired by postcolonial feminism I entered the field with the aim of extending my gaze beyond critiquing issues of social injustice to laying out a plan for action. To produce transformative knowledge, or knowledge about what ought to be, Anderson (2002) contends that the researcher must be ?mindful of the principles and processes that underpin rigorous critical theory? (p. 20). Drawing on Lather (1991), Anderson states that researchers engaging in postcolonial feminist inquiry need to be cognizant of three interrelated issues: the need for reflexivity; the need for reciprocity; and dialectical theory-building.  Adopting a reflexive stance.  Sandelowski and Barroso (2002) assert that, ? Reflexivity implies the ability to reflect inward toward oneself as an inquirer; outward to the cultural, historical, linguistic, political, and other forces that shape everything about inquiry; and, in between researcher and participant to the social interaction they share (p. 222). Lather (1991) argues that ?if illuminating and resonant theory grounded in trustworthy data is desired, we must formulate self-corrective techniques that 93  check the credibility of data and minimize the distorting effect of personal bias upon the logic of evidence? (p. 66). That is, to produce credible and reliable knowledge, critical ethnographers need to continuously explore their value orientation at every step of the research process (Carspecken, 1996). Shedding further light on the issue of reflexivity and its significance for a praxis-oriented research project, Reimer Kirkham and Anderson (2002) suggest that such a project:  ... begins with the researcher as he or she engages in reflexive critique of the research process itself (e.g., the relationships formed with participants, the influence of the researcher?s positionality, and the dynamics of power at work) and the nature of the knowledge being constructed (p. 14). However, adopting a reflexive stance about the dynamics of power that pervade a research project can be a daunting task. Said (1994) reminds us, ?Politics is everywhere; there can be no escape into the realms of pure art and thought?? (p.16). For Wolfe (1996), the most central dilemma for contemporary feminists in fieldwork is power and the unequal hierarchies or levels of control that permeate all aspects of the research process. Noting that knowledge is always situated, or that the production of knowledge is always shaped by the dynamics of where we are located and positioned, she contends that feminist researchers must bring their own location (historical, national, generational) and positionality (race, gender, and class) into the research.  Bringing my own location and position into the research. I can therefore say that I am a second generation Canadian with mixed English and Scottish ethnic origins. Further, I am a middle-class and middle-aged white, heterosexual, married woman with four adult children and two grandchildren. I also am a practicing registrant with the CRNBC and have more than twenty years of experience working with nurses from the Philippines in both clinical and classroom settings. Indeed, as I acknowledged at the outset of 94  this dissertation, it is the relationships I developed with nurses educated in the Philippines while working as a nurse educator in various IEN transition programs in BC and as a tutor for the CRNE that inspired me to initiate this project. Experience as an administrator for a nurse transition program for practical nurses also heightened my appreciation for the complexity of regulatory procedures and the interconnectedness of regulation, education, and practise. I also have a Teacher of English to Speakers of Other Languages (TESOL) diploma and experience teaching English to internationally educated students in health sciences programs. On two occasions I have visited the Philippines: first in 2006 in the capacity of a nurse educator from a local nursing college in Vancouver and second, in 2011 as a nurse researcher and PhD candidate. On the first occasion my aim was to determine the feasibility of establishing a partnership with a nursing program in the Philippines; in the second, I presented preliminary findings from this research study at an international nursing forum, 1st Cebu International Nursing Conference. Both experiences provided insights into Philippine culture. For instance, I was struck by the depth of desire to work abroad expressed by nurses I met along the way. Typically, during introductions, nurses would explain to me that they would like to relocate to Canada, or were in the process of completing Canadian immigration procedures, or that a family member was working abroad. I also learned that nursing is highly regarded in the Philippines. During his welcome address at the nursing conference, the Mayor of Cebu City stated, ?The best work of life is service to humanity? and then added, ?Life will only be meaningful if you can touch the heart of somebody else?. Throughout the course of this study I tried to remain sensitive to my privilege and aware of the effects it had on each phase of the research, from gaining access to the field, to collecting, interpreting, and disseminating data. Four interrelated concerns haunted me throughout the 95  process: the research endeavour could perpetuate colonizing relationships; my research findings could further essentialize and marginalize nurses from the Philippines; I could be advancing my own position of power in relation to study participants; and my position of privilege could distance me from the participants, limiting my ability to access their insights.  With respect to the first concern, I feared that as a white researcher in a high income country studying nurses of colour from a developing country I could be reproducing the very power imbalances that define relationships between colonizers and the colonized, specifically, the relationships that a postcolonial feminist inquiry strives to eradicate (Diaz, 2003; Reimer-Kirkham & Anderson, 2010; Wolfe, 1996). For instance, the very notion that an objective of postcolonial feminism theory is an engagement with voices that have not been listened to could be interpreted as the researcher wielding hegemonic power to allow these women to speak  and, further, that they are unable to speak for themselves (Spivak, 2006). Both issues were disconcerting and surfaced early in my research endeavor when a fellow researcher, who was from the Philippines, informed me that nurses from the Philippines were quite capable of speaking for themselves (i.e., ?They don?t need your help?). His comment underscored my need to be mindful that my purpose was not to speak for, or represent, study participants but to learn from them and make nursing knowledge more representative (Reimer-Kirkham & Anderson, 2010). As Homi Bhabha (2006) suggests, ??it is from those who have suffered the sentence of history ? subjugation, domination, diaspora, displacement ? that we learn our most endearing lessons for living and thinking? (p. 246).  Further, as Reimer-Kirkham and Anderson (2010) remind us, although the goal of postcolonial feminism is to promote social justice, social justice does not inherently mean ?speaking for? a particular group. Rather, through the process of 96  engaging with study participants in reflexive discourse oppressive structures shaping their experiences can be explicated and strategies developed to address them. In a similar vein, I also worried that the study findings might foster Othering, or a situation in which nurses educated in the Philippines would be viewed as different and inferior to those educated in Canada (Reimer Kirkham & Anderson, 2002). That is, I was fearful that findings might reinforce existing power inequities and contribute to a West versus non-West binary notion of nursing; one that overlooks the possibility of the merging of cultures described by Homi Bhabha and referred to in Chapter Three. I was also uneasy that the research project could advance my position of privilege in relation to study participants. Although my stated intent in proceeding with my research was to achieve social justice for nurses educated in the Philippines, I realized that I was undoubtedly empowering myself in the pursuit of this goal. Not only did the research process give me access to knowledge that I might otherwise not have been privy to, I could eventually earn a PhD from the endeavor. Clearly this research study constituted unequal power relations; a proposition that made me more sensitive to ways of equalizing the power between myself and participants. A further concern was that participants may not be willing to share their concerns because I was not a member of their community. As I will explain later in this chapter, I initially had experienced difficulty recruiting participants and even with those who agreed to participate, I often sensed a degree of reluctance or nervousness. For example, sometimes a potential participant would cancel the interview at the last minute or arrive with a friend. In one situation, two participants who had arrived together at the designated meeting place confessed that they were fearful that participation in the study was a violation of their live-in-caregiver contract. Although I assured them otherwise and once again reviewed the terms of the Consent Form with 97  them, I remained conscious of how vulnerable this study group felt and how much courage it took for some to step forward.  To address these aforementioned concerns and to minimize biases or preconceptions I took a self-reflexive stance. I regularly examined and documented the values and ideas that I brought to the study. For instance, I stayed mindful of how my background experience as nurse educator influenced my perspective about re-entry nursing programs and how my years of working with nurses educated in the Philippines in the clinical setting shaped my expectations. Incorporating reciprocity. Reciprocity or the dialectical process of negotiating meaning and power is another valuable aspect of fieldwork in a praxis-oriented research project. From a feminist perspective, not only does it empower women but it guards against theoretical imposition (imposing meaning on situations) and reification (treating abstractions as if they are realities) and fosters rich data (Lather, 1991). Accordingly, throughout my time in the field I tried to incorporate numerous acts of reciprocity into the research process. Reimer-Kirkham and Anderson (2010) argue that ?...empowerment comes through the processes of finding one?s voice, articulating one?s perspectives, and engaging as a person of equal worth with those who have been privileged by their social location? (p. 204). Lather (1991) adds that a researcher/ participant relationship can be strengthened by conducting interviews in an interactive dialogic manner that includes incorporating self-reflection and elements of self-disclosure into the exchange. Thus, during the course of an interview I often revealed that I had been to the Philippines; or that my daughter had spent time working in the Philippines; or that a preceptor during my own nurse refresher program had been educated in the Philippines. I also was candid about my struggle to understand their motivation in leaving their own country or my 98  difficulty in comprehending the complexity of immigration or RN regulatory processes. Such disclosures seemed to reduce the distance between myself and participants, break down hierarchies of power, and foster trusting relationships. However, reluctantly in the end I accepted that this could not offset the inequality that remained (Wolfe, 1996).  Anderson (1991b) contends that for a praxis-oriented research project that aims to empower women, the process begins within the actual research encounter. She suggests that sharing information with participants helps them take control over their lives. Although the consent form alerted participants that the purpose of the research project was to provide an opportunity to discuss experiences and locate sites for potential change, I often felt they wanted something more when they committed to the study. For instance, I wondered if they hoped that as a nurse educator familiar with the registration process, I could offer them guidance and support in becoming a RN in Canada, or even advocate on their behalf. Following one focus group interview I received an email from a participant stating:  I?m sorry for venting out some of my frustrations with regards to the Canadian system [during the focus group discussion]. I know you?re only asking for a feedback. I hope this [interview] help[ed]. Thank you very much for your case study. In a way, you are our angel (Focus group 1213). I was not sure if this participant was expressing gratitude for being listened to or whether she was hopeful that I could help her along with her colleagues to acquire licensure. Indeed, during or following interview sessions participants often approached me with questions or to express concern about their inability to move forward with their registration plans. They clearly appreciated any guidance I could provide (e.g., I told them about monthly information sessions at the CRNBC and about a new program at a local community college in Vancouver that offered free English preparation classes for IENs); a factor that alerted me to how much these nurses craved support.  99  However, as a novice researcher I sometimes worried that I was crossing the boundary between researcher and advisor or that I was perpetuating the power imbalance that existed in the research process. Although I had difficulty reconciling these concerns, I discussed them with my supervisor and felt that it would be morally unjust to withhold information or support. As well, I reminded myself that I was not the only person to offer information; rather we were all learning from each other. Collectively we were assembling the pieces of what seemed to be a gigantic and, at times, impossible, puzzle. Further, I sometimes questioned whether my motive in helping was to assuage my guilt over my privilege in relation to study participants. However, I think in the end my desire to offer assistance had more to do with a genuine concern for the well-being of the participants and the sense of gratitude for their commitment to the study.  Lather (1991) also suggests that in praxis-oriented research the researcher needs to help participants move beyond ?articulating what they know?, to ?theorizing about what they know?. Toward this end she recommends that the researcher encourage participants to critique ideologies, or taken-for-granted beliefs. Accordingly, I frequently used communication strategies, such as summarizing and reflection, to seek clarification and stimulate further discussion. I aimed to challenge their thinking, although at times I worried that I pushed them beyond their comfort zone. For example, on one occasion I stated, ?What strikes me is that people come here in order to have a better life? but in reality is that what?s happening?? (Focus group 1213). In response to this question, there was some laughter and while one participant quickly responded, ?yes?, others said ?that gives us something to think about?. Such strategies raised discussions to a new level as participants tried to make sense of their experiences. Inspired by focus group discussions, one participant created a website to provide a means for participants to exchange information and offer encouragement. As she explained to me in an email,  100  It is my way of getting in touch with my fellow nurses and [to] give them positive thoughts....This is the only thing I can share with them with much conviction that our situation right now will eventually turn into our advantage. And if there would be a chance to be a catalyst for a better and more effective means to get back to our profession? well may[be] this little contribution [might] play a significant role for us and the future of the nursing profession in Canada (Email exchange July 13, 2011, Focus group 1213).  I also used my preliminary findings to stimulate conversation in follow-up interviews. Not only did they provide a starting point for further discussion but also a means of verifying that I was on the right track.  Engaging in dialectical theory-building. In addressing the issue of dialectical theory-building, Lather (1991) holds that ?data must be allowed to generate propositions in a dialectal manner that permits use of a priori theoretical frameworks, but which keeps a particular framework from becoming the container into which the data must be poured? (Lather, 1991, p. 62). Although I remained cognizant of the assumptions underlying postcolonial feminism and relational ethical theory, I tried to remain receptive to the notion that data might not support these assumptions. For example, I did not want to fall into the trap of thinking that women who left their children at home in the Philippines, often for several years at a time while they worked in Canada, were always oppressed. Thus, I tried to bracket, or set aside my natural assumptions, to remain open to what participants were telling me, and to allow myself to be surprised.  The Process of Research: Constructing Meaning and Knowledge In this section I provide an overview of processes used for constructing and analyzing data and measures taken to foster scientific credibility and maintain ethical standards. Although I discuss data collection and analysis in a linear fashion, as if they were two separate entities, in fact they occurred simultaneously. Indeed, data collection and analysis was an 101  iterative process, each informing the other (Hammersley & Atkinson, 2007; LeCompte & Schensul, 1999).  Constructing data. During the process of constructing meaning and knowledge it is imperative to ensure methodological integrity; that data collection strategies be congruent with the philosophical assumptions underlying the research design (Crotty, 1998). Accordingly, I will present strategies employed with respect to negotiating access to the field and recruiting participants, creating a sample, and collecting and managing data. I begin, however, with an overview of my rationale for forming an Advisory Group and its ensuing benefits. Forming an Advisory Group. Recognizing that as a white middle-class professional woman I may experience challenges with all aspects of the study, I established a voluntary Advisory Group of nurses from the local Filipino community. I sought members who would be able to advise me on strategies for fostering interest in the study and recruiting participants, inspiring dialogue during interview sessions, interpreting the data, and disseminating research findings. Since I wanted to learn from study participants with diverse backgrounds, such as different immigration pathways and at various stages of the RN regulatory process, as well those who had elected not to pursue an RN pathway in Canada, I sent invitations to participate in the Advisory Group to nurses who represented different segments of the community. Ultimately, I was able to form a group which consisted of five female Philippine nurses: four who had been educated as nurses in the Philippines and one who had been educated as a nurse in Canada. Of the five, three were currently employed as RNs (one had only just acquired her practising license), one was currently working as a practical nurse, and one was seeking RN registration. Of those who were educated 102  in the Philippines, one was a Canadian citizen who had returned to the Philippines as an adolescent; another had come to Canada under the LCP, another had immigrated under the FSWP, and one had come with her family under the Family Class category.  Our first Advisory meeting was held shortly after I received ethics approval to proceed with the study. As with subsequent meetings, the date, time and location of the meeting were determined by the members. After signing confidentiality agreements and introducing each other, I presented a detailed overview of the research project and reviewed my expectations regarding group participation (attend a minimum of three group meetings, each lasting approximately one to two hours, over the course of the project). After some useful discussion, the Group felt that we would probably need to meet at least once during each of the different phases of the project: recruitment, data collection, data interpretation, and data dissemination.  Since my first objective in moving forward with the study was recruitment of participants, much of this initial meeting centered on recruitment strategies. I provided members with copies of the recruitment letter and advertisement that had been approved by the Behavioural Research Ethics Board (BREB) and sought advice on how to distribute them. While the Group agreed that it would be helpful if they forwarded the letter to their friends and colleagues, they also suggested posting the advertisement in various community settings frequented by Filipinos (e.g., community centres and restaurants).  During the first meeting I also raised concerns related to data collection. For instance, I wondered about the practicality of assigning participants to specific focus groups according to their position on the RN regulatory/employment trajectory, a strategy that I had contemplated during earlier conceptualizations of the study. Although the Advisory acknowledged that such a tactic might generate useful discussion, they concluded that it would be logistically problematic 103  since the composition of focus groups would probably be determined by the availability of participants. On reflection, this was valuable advice. As I would soon find out, it was often challenging to recruit participants and, regardless of the participants position on the RN trajectory, focus group discussions often evolved into problem solving sessions with participants appreciating feedback from those who were at different stages of the regulatory process. Additionally, conversations were not confined to regulation, rather encompassed socio-political and economic concerns experienced by nurses prior to arrival and after arrival in Canada (e.g., immigration challenges, locating ?survival jobs, and family responsibilities).  Moreover, I sought the Advisory Group?s opinion on the utility of hiring a research assistant, such as a Filipino RN or graduate student, to participate in some capacity during focus group interviews. I suggested that participants might be more forthcoming with information if a Filipino research assistant was present or that observations captured by an assistant would enhance the quality of the data. Interestingly, the Advisory was opposed to this on several counts. First, they argued that I would not have any problems generating discussion since Filipinos tend to be very talkative (they proved to be correct). Second, they seemed confident that they had the capacity to assist me with challenges I might encounter with data interpretation (again, they were correct). Finally, they raised the concern that an assistant might not be able to make objective observations and further, might upset the group dynamics (a factor reminiscent of the influence that a researcher?s location has on the study and also of ethnicity being both a liability and an asset). As with subsequent Advisory Group meetings, I found this first session extremely helpful. The members? familiarity with the Filipino community and their diverse perspectives and experiences provided rich insights. Further, their interest in the research study was gratifying 104  and inspirational. However, unlike the first meeting which was attended by all, follow-up sessions were often only attended by one or two at a time since I had difficulty coordinating  work schedules. Consequently, to keep everybody in the loop, I often resorted to sending email updates and scheduling meetings with members individually.  During our second meeting, several months later, I summarized my recruitment activities to date (I had interviewed seven participants by this time) and described my frustration that on several occasions individuals who had originally expressed an interest in participating, had not followed through. Members suggested that it may have been difficult for some to find time to commit to an interview, since many worked long hours and had numerous other responsibilities. Also, it was suggested that since the community of people I was drawing from was a marginalized group, they perhaps lacked confidence to step forward. As well, they speculated that as new immigrants in Canada, some may have felt they had little to contribute to the study; that they were unfamiliar with Canadian culture or regulatory and employment processes in Canada. Although I think I anticipated these recruitment issues before I ?entered the field?, these reminders and the Group?s encouragement were appreciated. The next several meetings with the Advisory Group occurred towards the end of my data collection as I began to formalize some preliminary findings. As always feedback was helpful, offering a range of insights into the nurse migration phenomenon. As an example during one session, a report of the findings inspired a discussion about discriminatory regulatory practices in BC, and the comment that as a white person I would not notice these practices, a point that I alluded to earlier in this chapter. Such comments reminded me of the situated nature of knowledge and that numerous interpretations of data were possible (a factor that speaks to the complexity of the research topic). As well their feedback cautioned me to examine data in more 105  detail, to listen carefully to what participants were saying, and to cast a more critical eye on structures shaping nurse migration and integration experiences. The Advisory Group also directed me to references in the literature that ultimately helped to advance my appreciation for challenges expressed by study participants. Negotiating access to the field and recruiting participants. Even prior to seeking ethics approval to proceed with my research, I began meeting with community members (see Field Work Calendar, Appendix B). For example, I had informal discussions with members of a Filipino nurse support group, a nurse recruiter, immigration counselors, English language teachers, nurse educators and administrators for nurse bridging programs, and representatives of the local nurse?s union and nursing regulatory bodies. Not only was my intent to raise awareness about my study but, also, to learn from these individuals, to gain a broader contextual understanding of migration and integration issues; knowledge that would eventually serve me well during data collection and analysis. Additionally, during these encounters I was mindful of prospective Advisory Group members and study participants. I also became a volunteer at two immigrant serving organizations and subsequently a mentor for IENs pursuing RN licensure in BC. People generally seemed receptive to meet with me and I could not help but think my nursing background was paving the way for my research endeavor. Not only did I already know some of the people but there seemed to be a credibility assigned to my role of nurse educator. When I initially introduced myself to people I always explained that I was PhD nursing student and that I was meeting with them in the capacity of a student. However, during the course of discussions I also revealed my personal interest in the research and my position as a nurse educator.   106   Once I had gained approval from the BREB and established an Advisory Group I began recruitment in earnest, posting recruitment advertisements and engaging the Advisory Group and professional colleagues to disseminate recruitment letters. Prospective participants were invited to participate in two to three focus group interviews and/or individual interviews, each lasting one to two hours, over a period of six months. They were also informed they would receive a 10 dollar Gift Card for a local grocery store for each interview attended to compensate for transportation expenses.  Although I was told by one member of the Filipino community that as an ?outsider? I might have better luck than an ?insider? recruiting participants due to the fractious nature of the Filipino community, my initial attempts at recruitment were disappointing. Despite following my Advisory?s advice to post recruitment advertisements at specific locations frequented by Filipino nurses, including Vancouver Community College (VCC) and Kwantlen Polytechnic University36, I never had a response to these efforts. Further, many of the prospective participants identified by the Advisory Group were reluctant to come forward (e.g., half of the participants who contacted me, either never followed up with their initial interest or cancelled interview sessions before we were able to meet).  Though I had been forewarned that prospective participants, as members of a disenfranchised population, might be reluctant to participate, I do not think I fully appreciated reasons for their reluctance until I became more immersed in the field. As mentioned earlier, on one occasion a nurse commented that she worried that participation would put her at risk of                                                  36Since both VCC and Kwantlen Polytechnic University offered programs for IENs, I had acquired ethical approval to recruit from their student populations.  107  violating her contract as a live-in caregiver. Others expressed fear that I may not be able to understand their English. Still others implied they did not have the necessary time to commit to a research study. Despite initial difficulties, individuals gradually did come forward. Some also encouraged their friends to contact me and consequently after three months of recruitment I had interviewed eight nurses. While engaging in these early interviews and waiting for responses from further recruitment efforts, I continued to establish relationships with stakeholders and to present my research proposal at various local conferences. My most significant breakthrough with respect to recruitment, however, came after I made contact with counselors from three different immigrant serving organizations in the Greater Vancouver Region. These individuals expressed an interest in my study, largely in part, I think, because they hoped that their clients, many of whom were nurses educated in the Philippines, would benefit from the support offered by focus group discussions. While they agreed to disseminate recruitment letters, they speculated that interest in participation would more likely be achieved if their clients had an opportunity to meet with me first. Subsequently I was invited by four different immigrant serving organizations to be a guest speaker and provide an overview of steps required for RN licensure in BC. My experience as a nurse educator in a BSN program and as a tutor for the CRNE prepared me for these presentations. I referred attendees to the CRNBC Occupational Fact Sheet for Internationally-educated Nurses (2011) for information and explained I was not an ?expert? but was willing to work with them to try to understand the process. Thus, sessions became interactive and attendees were often forthcoming with their own registration experiences, which was appreciated by everyone. The sessions also helped to advance my own understanding of how many perceived the regulatory process in BC and it gave me an opportunity to observe 108  interactions between nurses, many of whom were educated in the Philippines. Following these presentations I gave a very brief overview of my research study and invited attendees to participate at a later date in either a focus group or individual interview. The result was the formation of three focus groups and three individual interviews; factors that alerted me to both the advantage of face-to-face recruitment over solicitation by advertisement and the benefit of having the study acknowledged in advance by a person or a group that has the confidence of prospective participants (Polit & Beck, 2004). I always remained cognizant of the need for objectivity in my research intentions when I met with prospective study participants. However, because my reputation as a nurse educator familiar with the RN regulatory process usually preceded me, I worried that I might unwittingly position myself as an ?advocate?, or somebody who could speak on their behalf or enable them to meet the criteria for licensure. I also was concerned that I might be generating an expectation that research findings would alleviate their problems (Reimer-Kirkham & Anderson, 2010). Such concerns cautioned me to be vigilant about how I was presenting myself to participants. My literature review suggested gaining access to the field could be time consuming (Hammersley & Atkinson, 2007; Mulhall, 2002), however, I do not think I anticipated that it would exceed the time spent in the field collecting data. For many months I had a steady engagement with both stakeholders and study participants. Stakeholders sometimes contacted me to inform me about changes to nurse migration or integration processes and participants often emailed me with further questions about issues they were struggling with or to discuss ideas that had come to them after we had met. Despite the extra time involved, relationship building was the part of the research process that I relished the most. It provided an opportunity to become 109  connected with an array of interesting individuals who generously offered me their time and invaluable insights. Creating a sample. Ethnographic researchers usually select study participants because  of their ability to inform the researcher about the nature of the experience being explored (LeCompte & Schensul, 1999). Accordingly, they often seek extreme, typical, and unique cases to determine patterns of difference between members of a population (LeCompte & Schensul, 1999). To answer the study?s overarching research question (How do social, political, economic, and historical contexts mediated by intersecting oppressions come to shape the everyday experiences of nurses educated in the Philippines as they seek RN licensure in BC?) I used purposive sampling to identify nurses educated in the Philippines who had sought or had considered seeking Canadian RN licensure and/or employment within the past 10 years, who could converse comfortably in English, and who would be willing to talk about their experiences. Although my focus was on female nurses as they make up the greatest percentage of RNs from the Philippines, to further illuminate their experiences I extended an invitation to male nurses educated in the Philippines. To reflect the complexity of nurse migration, I also deliberately selected those who represented a mix of social identities, such as different ages and different employment and immigration histories.  As patterns and themes emerged from the initial phases of data collection and analysis, I turned to theoretical sampling to refine my understanding of the impact of varying immigration pathways on nursing experiences in Canada. In particular I wanted to learn how experiences of nurses coming to Canada as TFWs varied from those with other immigration pathways. I also solicited insights from an immigration counselor; three nurse educators; two Philippine nurses 110  who were not nurses on arrival in Canada but who later pursued a Canadian nursing degree; and one nurse educated in the Philippines who immigrated in the 1970s. This latter group of participants advanced my understanding of issues that were raised by primary participants. and were considered secondary study participants.  While there does not appear to be any set of hard rules about an adequate sample size in qualitative research, several researchers offer helpful suggestions. Morse (2000) puts forth that important considerations include the scope of the study, the nature of the topic, and the quality of the data obtained. For instance, a larger sample is generally required if studies have a broad scope; address complex issues; or if the participants have difficulty expressing themselves (Morse, 2000). Sandelowski (1995) also maintains that the adequacy of a sample is relative to the intended purpose of the research project and to the research method. She asserts that typically an acceptable sample size in qualitative research is one that is small enough to permit deep analysis, but large enough to allow for a new and richly textured understanding of experience (Sandelowski, 1995). Thorne (2008) concurs, and, further, advises that the best way to justify a sample size is to offer a rationale that demonstrates how the research problem can reasonably be tackled with the anticipated exposure. Prior to data collection I had anticipated I would require a sample of approximately 30 participants to reflect a mix of social identities, professional backgrounds, and migration challenges and to capture the complexity of nurse migration issues. However, since organizers at immigrant serving organizations extended open-invitations to participate in focus group discussions, numbers swelled beyond my expectations. In total I interviewed 47 primary participants (see Table of Participants, Appendix C). They ranged from 21 to 57 years, with the mean age being 37 years. There was a mix of single and married participants, some had brought 111  children with them to Canada and others had left children in the Philippines. Thirty-five were female and 12 were male. Twenty-eight had been in Canada for less than one year, 17 less than five years,; and two more than 10 years. Thirty-five came to Canada under the FSWP, two under the Family Class provision, eight with the LCP, and two came as TFWs to work as RNs. Two had acquired their RN status in Canada, 18 had not yet started the RN application process, 21 were at various steps along the RN trajectory (e.g., waiting to do the SEC Assessment or the CRNE, enrolled in RN upgrading courses, or seeking the 250 hour supervised work experience), three had pursued the practical nurse pathway in Canada,; and another three were unaccounted for. Of those who had begun the RN application process, seven said they had started the process prior to arrival in Canada. As well, the sample represented a range of previous RN work experience: from a minimal amount of volunteer nurse experience in the Philippines to almost 20 years of experience in the Middle East. Some had held nursing positions in critical care (e.g., ICU, ER, OR); others in medical-surgical, obstetrics, or community health nursing; and still others had been teachers and administrators. At least three had been physicians in the Philippines prior to earning their nursing degree.  In retrospect I feel that the sample was large enough to provide rich data and foster understanding of nurse migration issues. Though I would have preferred to have interviewed more nurses who had come to Canada as TFWs, time constraints, the scarcity of these nurses, and the reluctance of some to come forward, made it impossible to do so. However, it is a topic that can be taken up in future research endeavors. Collecting data. In keeping with the traditions of an ethnographic approach to qualitative research I collected data from a range of sources. These included individual and focus group interviews, 112  participant observations, and documentary evidence. As well, I used ongoing journaling to help keep track of my thoughts and sort out my ideas and impressions as I progressed with data analysis. Conducting interviews. Constructing meaning and knowledge for an ethnographic study informed by postcolonial feminism, demands ?...an engagement with voices that have not been listened to, to bring these voices to the forefront? (Reimer-Kirkham & Anderson, 2010, p. 203). Toward this end I drew upon in-depth individual and focus group audio-taped interviews. Reflecting on my position of privilege discussed earlier in this chapter, I paid particular attention to how I presented myself to research participants during interview sessions. I aimed to maintain professional boundaries and at the same time demonstrate respect and an eagerness to learn from them. As with nurse/client relationships, the needs of the research participant were foremost in the relationship. I aimed to remain courteous and available; uphold confidentiality; and engage in communicated understanding (e.g., I would give participants my full attention, and use strategies such summarization or reflection to clarify that I understood their message). I also remained cognizant of the fact that English was not their first language and refrained from complex English. Where possible I adopted expressions that were familiar to the participants, such as ?show money? and ?survival jobs?. As I reflect on these interviews it seems that my nursing background prepared me well for the role of researcher. Not only did it help me to recognize professional boundaries and engage in communicated understanding, my years of teaching nurses from the Philippines and working alongside them in the hospital familiarized me with their communication patterns. 113  However, though I had been confident about my interviewing skills when I first began interviewing participants, I quickly became aware of my shortcomings. During the process of transcribing audio-tapes I had time to critically examine my style and note my errors. In particular, I noticed that I often left insufficient time for participants to speak; that is, I would move onto another question without fully exploring what they might be meaning. Indeed, it was humbling to listen and analyze these conversations. Nevertheless, since the acts of interviewing and transcribing took place in close succession, I was able to learn from these mistakes and hone my skills for the next interview.  In addition to maintaining professional and respectful relationships with study participants, I was cognizant of my theoretical commitment to postcolonial feminism and engaged in methods that fostered reciprocity described earlier in this chapter. I aimed to conduct interviews in an interactive dialogic manner that included self-reflection and elements of self-disclosure. Additionally, I readily shared information with participants and encouraged them to critique taken-for-granted beliefs (e.g., I commonly prompted participants to reflect on how life was better for them and their families in Canada).  Initial conceptualizations of the study included a plan to begin data collection with a series of focus group interviews and then to extend invitations to participants that had unique experiences. However, accessibility to participants overruled my intentions and data collection began as soon as individuals volunteered to participate. Ultimately, I did recruit several members of focus groups to expand on their insights in individual interviews. For example, I had a revealing interview with one participant who had declared during a focus group that she thought Philippine nurses were ?willing victims?. I also had a more in-depth interview with a participant 114  who had worked as a RN in the US before returning to the Philippines and then migrating to Canada.   In total I held 17 audio-taped individual interviews37 and six audio-taped focus group interviews. Each interview, regardless of whether it was an individual or a focus group, lasted from one to two hours which seemed sufficient for interactive exchanges and self-disclosure. I began each by reviewing the Consent Form (see Appendix D), assigning a participation number, and asking participants to complete the Data Sheet (see Appendix E).  My Interview Guide (see Appendix F) consisted of seven open-ended questions and because I was interested in learning about experiences prior to arrival in Canada, as well as after, and about plans for the future, questions began with ?Can you tell me how you came to decide to immigrate to Canada??, and concluded with, ?What are your thoughts about your future??. Although questions often flowed in this chronological order, I did not necessarily adhere to this sequence of questioning nor confine my inquiry to the questions in the Interview Guide. Rather, after the initial question, I pursued cues elicited by participants and explored the subject matter they perceived most relevant. Also, answers did not necessarily emerge as a direct response to a question. For example, although I asked how life had changed since arriving in Canada, answers might emerge indirectly during an exchange involving plans for the future. However, during the course of the interview I tried to ensure that each participant had an opportunity to reflect on the entire set of interview questions.  While individual interviews offered an opportunity to explore in greater detail various individual attitudes, opinions, and experiences, and revealed insights that may not have been                                                  37Although the term individual interviews suggests a one-to one researcher/study participant interaction, out of 17 individuals interviews, five were attended by participants who brought along a friend or sometimes a prospective participant. 115  gleaned from a group interview (e.g., despair associated with not being eligible for RN status in Canada), comments exchanged between members of focus groups often generated animated debates and yielded a greater breadth of understanding. As well, focus groups provided a means for participants to draw strength from one another (e.g., participants began to see that many of the challenges they faced seeking RN registration were not the result of individual deficiencies but were related to inherent barriers and inequities of existing structures) and to examine strategies for change.  Even though it may have been beneficial for participants to engage in individual interviews rather than, or, in addition to, focus group interviews (e.g., they provided an opportunity to expand on their situation in relative privacy), they appeared to be anxiety producing encounters for many. As mentioned earlier, participants arriving for these interviews sometimes appeared unexpectedly with a friend or another prospective participant. Though initially I had been unprepared for this eventuality, I quickly realized its benefits and began explicitly offering this option to other participants. Having the support of a friend appeared to mitigate nervousness. Also, the fact that I engaged in acts of self-disclosure and sharing of information seemed to lessen anxiety, as did respecting preferences for interview locations. We often met in social spaces such as public libraries, cafes, college cafeterias, and shopping malls. Additionally, rather than immediately jumping into my prepared set of research questions, I opened by offering refreshments and engaging in what I believed was non-threatening social interaction.  In contrast to those participating in individual interviews, those in focus groups generally seemed relaxed. They often appeared to enjoy socializing with other members and exchanging contact information. Unlike individual interviews, where participants determined the time and 116  location of the meeting, the organizers at the immigrant serving organizations made the arrangements.  Although I had envisaged that a focus group of four to six members was a manageable size, they ultimately ranged from three to nine participants. Further, since I did not know in advance how many to expect I had to prepare for any number. I remember my surprise when nine showed up at my first focus group interview. I adhered to my initial plan, however, and assigned each with an identity number, had each sign a Confidentiality Agreement (see Appendix G), complete the Data Sheet (see Appendix E), and then, following introductions, extended an invitation to comment on how they had decided to migrate to Canada. Though lively discussion usually ensued during these interviews there was always a tendency for some to dominate and frequently I had to tactfully seek opinions from less assertive members. Another problem I encountered with large focus groups was keeping track of which participant was speaking, as participants frequently interrupted one another and it was not uncommon for more than one to speak at a time. I usually concluded each session by inviting participants to make a closing remark; a strategy that worked well as it provided each participant with a final word and offered insight into issues deemed significant. I anticipated I would need a sequence of two or three individual interviews to produce sufficient depth and breadth of understanding (Polkinghorne, 2005) but in most situations this was not feasible. The population under study had numerous time constraints, with many needing to balance jobs or the pursuit of employment with family responsibilities and educational upgrading activities. As well, in most cases, a single interview seemed sufficient for learning from the participant and clarifying my perceptions. However, I did schedule follow-up focus 117  group interviews. Due to the volume of ideas generated from these sessions, I found it helpful to meet a second time to clarify and reflect on my preliminary understandings.  Utilizing observations. My immersion in the field offered many occasions to observe nurses educated in the Philippines in their pursuit of RN licensure and to consequently advance my understanding of structures shaping their experiences. I began entering my observations in an electronic journal on February 13, 2010, following my first meeting with a group of nurses attending a FNSG meeting. At the time I was waiting for my BREB certificate of approval and was establishing relationships with nurses in the community to develop awareness about my study. My first entry began: There was a group of about 10 nurses. I was so keen to meet these women and excited to finally be in the ?field? after having spent so long planning and in the ?literature?. But I also felt nervous. I felt like an ?outsider?, or an ?intruder? and the power point presentation seemed too formal. I wonder if I?ll ever earn their trust?  I continued to make notes in my journal on a regular basis. I kept track of thoughts and ideas that occurred to me before and after meetings with my Advisory Group, my committee, and community members or when I came across something of interest in the literature. Journaling or maintaining an ongoing reflexive analysis of my work and my thoughts as I progressed with my research helped me to achieve greater understanding of how my values and attitudes were shaping my data collection and analysis.  I also kept notes about my observations during interview sessions. I referred to these notes as my field notes. Immediately following each interview I would audiotape and later transcribe them. These notes provided the context for each interview and I filed them with the transcription in a single folder. I usually began by reflecting on how the interview session went 118  in general. For example, the following field note dictated after a focus group interview captures my enthusiasm and my respect for the agency exercised by study participants. This research is helping me uncover the stories beneath the surface?the backgrounds to the students I meet in the classroom. Now I can see that each student is like the tip of an iceberg?there is so much that I hadn?t noticed or paid attention to before?the educational, regulatory, immigration, and work related hoops that they have gone through to get where I see them today... sitting in the classroom, or working in the lab. It is truly amazing. I also included specific details about what I learned from participants. For example, I paid particular attention to comments or exchanges that surprised or upset me. In one case I noted my surprise on learning that some participants, who had arrived in Canada under the FSWP, were relying on financial assistance from family members back home. I also recorded emotions that I had observed during exchanges, such as grief or despair when talking about an unsuccessful attempt at an English proficiency test or the gratitude expressed when somebody learned something new about navigating the regulatory process. I also recorded observations about the way in which participants responded to each other during group interviews. For instance, I entered a field note that participants frequently shared contact information and on one occasion offered to accompany each other in search of information. I found such insights helpful in understanding the meanings participants attached to their experiences. That is, these notes offered a glimpse into structures that constrained agency and strategies employed to negotiate such constraints.  According to Hammersley and Atkinson (2007) writing field notes enables ethnographers to move beyond mere data collection to developing ideas that will illuminate data. Indeed, this seemed to be the case. Ideas generated from field notes became a foundation for further insights. I would often discuss my notes with my committee supervisor and together we would explore how they were informing my theorizing. Additionally, they became a means for communicating 119  my interpretations with my Advisory Group. On one occasion when I expressed my dismay to an Advisory Group member that participants seemed to sacrifice so much to come to Canada, she helped me understand that migration was a ?way of life?, that the West is perceived as a land of opportunity, that soap operas and movies feature families going abroad, and, further, it is a childhood dream to leave the Philippines. Insights gleaned from these exchanges were then tested with further data. The process of recording and transcribing field notes, and then reading, reflecting, and sharing them with others, informed my ongoing analysis. Employing documentary evidence. Beginning from the standpoint of participants I also conducted a document review to examine in detail how the domains of RN regulation, employment, education, and immigration intersected to shape experiences. This review led to questioning whether institutional practices at local, national, and international levels may have inadvertently contributed to marginalization and exploitation of this sample of nurses. As well, it directed my attention toward broader structures such as neo-liberalism, neo-colonialism and globalization, and caused me to query how they in turn contribute to oppressive practices and to explore whose interests these practices serve.  My analysis, therefore, moved beyond the micropolitics of everyday experiences, to a deeper and more profound exploration of root causes of social and economic inequities. Managing data. Data management is concerned with protecting, organizing, and tracking the construction of data to ensure that it takes a form that can be readily accessed and used throughout data collection and analysis (Thorne, 2008). To safeguard confidentiality I assigned an identification (ID) number to each participant; attached the ID number to the actual data; and maintained identifying information in a locked file. Further, as I transcribed the tapes I took precautions to 120  ensure that any identifying information was removed. I used NVivo 8, a data management software program, to organize my data for ease of retrieval. Analyzing data. Analysis permits ethnographers to make sense of the information they have assembled. It is an iterative process and begins upon entering the field with the first set of field notes and experiences and continues until a fully developed and well-supported interpretation emerges (Hammersley & Atkinson, 2007; LeCompte & Schensul, 1999). Thus, to understand what they are observing, ethnographers must engage in several levels of analysis since the overall picture is not immediately apparent.   From the beginning I had an ongoing engagement with my data, continually comparing and contrasting findings and expanding upon conceptualizations. I found the following set of questions adapted from the writings of Emerson, Fretz and Shaw (1995) helpful: ?How do participants talk about, characterize and understand what is going on??; ?What assumptions are they making??; ?What do you see going on??;  and ?What did you learn from this??(p. 146). Such questions helped me to develop interpretations rather than causal explanations of the data; to focus on the ordinary and taken for granted as well as on the unusual events and situations; and to elicit the meanings and points of view of those under study (Emerson, Fretz, & Shaw, 1995). As I read and re-read data and field-notes and considered these questions I produced memos which gave rise to codes and eventually to themes. Thus I moved from the particular to capture a more general theoretical dimension of nurse migration to Canada. Organizing data. As mentioned earlier, interview data was in the form of transcriptions from audio-tapes and as soon as possible following each interview I transcribed these recordings. Doing my own 121  transcriptions provided a lengthy engagement with the data and a familiarity that served me well once I began to code it. Listening and transcribing each interview, I was able to explore the data in a reflexive manner; to raise the questions posed by Emerson et al. (1995); to enter memos on the transcripts; and to reflect and re-consider my interpretations. Insights gleaned from this process often directed me to areas for further consideration (e.g., to explore structures that marginalized participants in Canadian society). Another advantage to doing my own transcriptions was that I learned to recognize voices and recall the sequence in which participants spoke.  This helped to assign the correct code to the speaker. In some cases, however, due to the large number of participants and the fact they frequently interrupted each other, this was not possible. Here I simply had to assign ?other? to the participant descriptor. As mentioned, after completing each transcription I uploaded it to NVivo 8.  To provide a pragmatic means of organizing data and making it readily accessible, I began sorting it according to pre and post-arrival experiences and further, according to the general questions outlined in my Interview Guide (e.g., ?How has life changed for you??). However, I had to resign myself to the fact that not all the data could be organized along pre-configured headings. For example, family reunification issues and efforts to settle did not necessarily fit under ?How has life changed for you?? As I became more familiar with the data, I noted a disjuncture amongst the accounts of participants who came to Canada along different immigration pathways. For instance, those who came under the FSWP often shared stories about difficulties finding employment in Canada, while live-in caregivers were typically pre-occupied with completing their live-in work contract, and TFWs largely focused on licensure experiences and integration into the RN workplace. 122  Consequently, I further grouped data according to participants? entry visas. It was now easier to manage my large data set and to make comparisons and contrasts within and across groups. Open coding. As I read each transcript line by line, I paid attention to what participants were saying and I tried to bracket, or set aside my natural assumptions, and remain open to their narratives. By remaining flexible and permitting the element of surprise, I was able to identify events and situations that were significant to the participants (e.g., passing an English assessment test or failing the CRNE); recognize relationships between structures and experiences (e.g., between the type of immigration visa and the ease with which participants pursued RN licensure); and notice incongruence arising from experiences (e.g., participants becoming deskilled in Canada while waiting to enter a re-entry program). This open approach to coding fostered a wide range of new ideas, linkages, and connections. Focused coding. Through an iterative process of coding, reflecting, and memoing, and discussing my interpretations with my Advisory Group and my committee supervisor, my initial codes were refined and my approach became more focused. I selected core themes used by study participants to describe their experiences. Themes such as ?we created a story?, ?they don?t accept us?, and ?the countdown? captured participants? sentiments and were broad and theoretical in nature. They helped me to cluster experiences and conceptualize them as temporal sequences on a journey that began in the Philippines and progressed to Canada. Clustering data in this manner directed me to the interconnectedness of structures and mediating oppressions at local, national and international levels and to relationships between structure and agency. Additionally, it helped me to understand the nature of decisions that 123  participants made at various points of their journey, to note narratives constructed to support decision-making or justify actions, and to reflect on power dynamics at play. As one example, I started to explore in more depth how particular kinds of stories were used to justify decisions to migrate to Canada (e.g., for the future of their children) and to consider if these stories served participants well. Fostering Scientific Credibility It is widely acknowledged that the measure of credibility of scientific statements in qualitative research rests on the degree to which the researcher follows methodologically sound principles (Crotty, 1998; Schultz & Meleis, 2004; Thorne, 1997). In this section I outline the measures I took to ensure the scientific rigor of this qualitative research project. However, since my goal as a critical researcher was to encourage praxis, as much as it was to generate empirically grounded theoretical knowledge, in the final chapter of this thesis I will also put forward recommendations for promoting social transformation. Each qualitative tradition has distinct guidelines by which it may be judged methodologically sound. Thorne (2008) suggests, however, that the rigor and credibility of any qualitative project is grounded in a set of general principles: epistemological integrity (the research question must be consistent with the epistemological standpoint and the methodological strategies); interpretive authority (researcher interpretations are trustworthy and account for the reactivity, or bias, that occurs within the research process); representative credibility (theoretical claims need to be consistent with the manner in which the phenomenon are sampled); and analytic logic (the logic of the research process must be apparent).  124  Epistemological integrity.  I contend the study had epistemological integrity. Knowledge claims arising from the data appeared compatible with the underlying assumptions of an ethnographic inquiry informed by postcolonial feminism. As well, the strategy of inquiry was an appropriate fit for the research question. It helped me to produce idiographic knowledge, or knowledge of the particular, about the context of the participants? experiences. Additionally, data collection methods fit with the purpose of the research project. Interpretive authority. Interpretive authority is about assuring the reader that the researcher?s interpretations of the data are trustworthy; that there is some truth to the findings beyond the researcher?s own bias or experience and knowledge gleaned about the particular is credible (Thorne, 2008). To achieve trustworthy data, Patterson (1994) argues that it is necessary to account for the reactivity (the response of the researcher and the research participants to each other) that naturally occurs during the research process. However, she adds that accounting for reactivity is more than simply acknowledging the subjectivity of data collection; rather, it includes identifying how the researcher?s values, behaviours, attitudes and experiences inform the collection and interpretation of research data. As described earlier in this chapter, I consistently tried to incorporate reflexivity into the research project.  Representative credibility. To achieve representative credibility I took measures to ensure that my theoretical claims were consistent with the manner in which I sampled the phenomenon under study (Thorne, 2008). As one example, I avoided making inferences from my study that apply to all nurses educated in the Philippines or to different ethnic groups of IENs; rather, I acknowledged that my 125  findings reflected the social processes associated with the specific group of IENs from the Philippines whom I sampled. Analytic logic. To illustrate my inductive line of reasoning and to clarify the logic behind my interpretations, I used numerous examples of verbatim accounts from the data in support of my claims. As well, I tried to demonstrate why or how I had selected such exchanges to underscore a point. I drew heavily on my journal entries and field notes and findings in the literature to help with these interpretations and tried to communicate to the reader how I arrived at a particular decision.  Attending to Research Ethics To protect participants' rights and eliminate researchers? biases, proposed research plans normally are subjected to institutional review (Polit & Beck, 2004). Prior to undertaking my research plan this type of ethical review was obtained from UBC, BREB and from sites I used for recruiting participants, the Research Ethics Review Board at VCC  and the Research Ethics Board at Kwantlen Polytechnic University. However, ethical issues in ethnographic research can be complex and solutions not always straight forward (Hammersley & Atkinson, 2007) and attention needs to be paid to ethical considerations throughout each phase of the research process (Goodwin, Pope, Mort, & Smith, 2003). Accordingly, from the outset of the research project I tried to anticipate ethical problems that might arise and in addition to obtaining the aforementioned ethical approvals, I implemented numerous measures to ensure that ethical considerations were properly addressed.  First, in addition to providing participants with information about the study prior to participation (see Appendices H and I) and providing them with time to review the Consent 126  Form (see Appendix D) in advance of the interview session, I reviewed the Consent Form with them to prevent any misunderstandings. Also, recognizing that qualitative research consent is often viewed as an ongoing, transactional process (Polit & Beck, 2004), I continuously checked participants? willingness to participate with each new interaction. Additionally, for those participating in interviews with other participants I discussed measures to ensure confidentiality and had each participant sign a Confidentiality Agreement (see Appendix G) prior to participation.  Another important consideration to promote the safety and well-being of participants is to ensure that the research project is free of any sort of coercion, or any explicit or implicit threat of penalty from failing to participate in a study, or excessive rewards from agreeing to participate (Polit & Beck, 2004). It is recognized that the issue of coercion may require special attention when the researcher is in a position of authority, control, or influence over a potential participant (e.g., a teacher/student relationship) (Polit & Beck, 2004). Therefore, I did not engage my students as research participants. However, in consultation with my Advisory Group, on one occasion, invitations to participate in the study were extended to a former cohort of students. I also was mindful that participants might see me as someone who was in a position of authority to advocate to the regulatory body, to an educator, or to an employer on their behalf. Since my research role was to learn from participants not to advocate for them, I needed to be consistently self-reflexive: not only about how my values and experiences shaped my interpretations but also how I was presenting myself and the research to participants.  Aware that discussions related to migration and integration experiences might be upsetting, I took several precautions to minimize harm to participants. For example, I assured participants that, if necessary, I could direct them to counselling services. Further, I reminded 127  them at the beginning of interview sessions that they could refrain from answering a question, discontinue the interview, and ask to have the audio recorder stopped at any time during the interview. I also was sensitive to their verbal and nonverbal reactions to questions and if they appeared anxious about a matter, I ceased pursuing the subject. Though several participants cried during interviews and I turned off the audio recorder during these times, no one wanted to discontinue an interview or seek counselling. I did follow up with these individuals, however, after the interview session to check on their condition.   Although I understood that my research role was not to advocate on behalf of participants I found myself in the uncomfortable position during the course of data collection in which I felt obliged to notify the regulatory body of ethical concerns arising from the data. In particular, I was concerned about reports from participants about difficulties encountered while trying to meet the requirement for the 250 hour monitored Canadian work experience. Before presenting my findings at an international nursing conference I wanted to alert the regulatory body of these results and clarify my interpretation of the requirement. Therefore in consultation with my committee supervisor, I sent a draft of my preliminary findings to the regulatory body and met to follow up with my concerns. They appeared receptive to my feedback and explained an administrative particular about the requirement.  Disseminating Data In compliance with the social responsibility assigned to critical ethnographers to produce transformative knowledge for action, I engaged in strategies to disseminate my findings in an ongoing process throughout my engagement with the study (see Fieldwork Calendar, Appendix B). I gave numerous formal and informal presentations of my research findings at international, national, and local conferences and symposiums. In addition, I discussed my findings with those 128  in positions to influence change at the provincial and local level (e.g., I initiated a meeting with educators, employers, and regulators to discuss strategies to support for IENs striving for RN licensure) and I plan to continue these efforts following completion of the study. I will also be sending participants a summary of the results; presenting findings to ISOs, educational programs, the regulatory college, the union, and nursing conferences; and publishing my work.  Chapter Summary In this chapter I have offered a description of an ethnographic informed by postcolonial feminism and relational ethical theory that I used to pursue my research project. Further, I explained how I constructed data and accounted for strategies used to gain access to the field, recruit participants, and address sampling and data collection. I also accounted for how I managed and analyzed data and I outlined efforts for ensuring scientific credibility. Finally, I provided an overview of the ethical issues I encountered as the research project unfolded and illustrated methods taken to disseminate findings. In the next four chapters I will present the results of the study. Consistent with an ethnographic approach informed by postcolonial feminism, each chapter of results is grounded in the experiences of the study participants. Further, each chapter represents a temporal sequence of a journey that begins in the Philippines and progresses to Canada; each influenced by and influencing the other (see Appendix J: The Journey to RN Licensure in Canada).The first chapter of results, Chapter Five, addresses experiences of nurses before arrival in Canada. Whereas, the focus of Chapter Six and Seven is experiences after arrival in Canada and in Chapter Eight I attend to thoughts about the future. 129  Chapter Five: Beginning the Journey - Seeking ?Greener Pastures? As Chapter Two depicts, the migration of nurses does not commence with arrival in Canada, rather the phenomenon begins with the decision to migrate. Accordingly, to understand the structures and processes shaping participants? experiences pursuing RN licensure in Canada, I begin analysis with a detailed exploration of pre-arrival experiences. In particular, I examine findings arising from the two interview questions: ?Can you tell me how you came to decide to migrate to Canada?? and ?How did you prepare to come to Canada?? The major themes constructed from responses to these questions, ??We created a story that Canada is a green pasture??and ?Using ?stepping stones??, though interrelated, are separated for analytical purposes. Together, they comprise the first segment of a journey that starts in the Philippines and progresses toward RN licensure in Canada. As I reflected on interview responses and field observations I was frequently impressed by their resemblance to those reported in the literature and presented in Chapter Two. They also often reflected what I had learned from students while teaching in nurse bridging programs. Therefore, as I present what I learned from participants in the next four chapters, I will also compare the findings to the literature and offer comments about similarities and differences.  Deciding to Migrate:  ?We Created a Story?   Participants expressed numerous reasons for migrating to Canada, but their rationale was typically linked to the notion of hopefulness. When asked, ?Can you tell me how you came to decide to migrate to Canada?? most responded without hesitation, ?for a better future?, and in particular, ?for a better future for my children?. For many this was a dream or a magical story they created about re-locating to Canada; one that would have a happy ending for themselves and their families. One telling reflection was, ?We created a story that Canada is a green pasture? 130  (Focus group 1213). I was interested in learning the origin of their ?green pasture? characterization of Canada and, further, comprehending their compulsion to seek these ?green pastures?. Thus I begin with an analysis of the substance of their dreams. Their dreams: ?Land of milk and honey?.   During numerous conversations with participants I learned that a better future for most meant a better economic status. One explained, ?...number one priority, the number one reason, it?s economic. That?s why you come here? (Focus group 0126 follow-up). The significance of money was highlighted during one focus group interaction when participants discussed family expectations upon a return visit to the Philippines.  P381: It?s so hard to go back if you don?t have money; attained a certain thing. P2: If you go back you?re expected to spend?everybody gets [something]?so when you go home?you?re like up there [emphasis added]. R: You have status when you go home? P1: They expect something from you. P2: Even though you?re like a cleaner here, or just cleaning somebody?s house, it doesn?t matter. As long as you?re abroad, you?re [respected]. P1: They don?t care about the status [in Canada]; they care about your money (Focus group 0210).  For this group money appeared to trump all; that is, life would be better, regardless of where they re-located, as long as they were able to earn money. I was not surprised to learn this from participants as it was frequently reported in the literature that the economy in the Philippines is dependent on remittances from abroad (Buchan, 2006; Choy, 2006). Moreover, I recall Rafael (1997) discussing that migrants have historically been treated with the deference usually                                                  38The designation of P indicates a study participant. The designation of R indicates the researcher. Following each excerpt, the participant code appears in parenthesis. If the exchange occurred during a focus group interview the code number for the focus group appears in parenthesis and the different members of the group are distinguished by the subscript 1, 2, etc. Occasionally ?individual? interviews involved a second or third participant and in these situations participants are distinguished by letters A, B, C. The code for the interview also occurs in parenthesis at the end of the exchange. If the exchange occurred during a follow-up interview, the term, ?follow-up?, is included in the description. 131  accorded foreigners when they return home and encouraged to be consumers; a factor he states reflects both the neo-liberal market economy of the Philippines and the legacy of American colonialism. The destination country may have been irrelevant for some, but for others an opportunity to live in Canada was the realization of a childhood dream. One nurse, who had previously worked as a RN in both the UK and Australia and had come to Canada with a temporary work permit to work in an acute care RN position, expressed how he felt when he stepped off the airplane in Vancouver: ?This is my dream; I?ve fulfilled my childhood dream?. To further illuminate the substance of participants? dreams, I turn to an exchange amongst FSWs:  P1: It?s a status symbol being successful in a certain land. P2: Yes. R: What?s a status symbol? P1: It?s a status, like a certain land like here in Canada. Successful nurse, successful doctor successful here. P3: Going abroad is the greatest achievement. R: Oh, going abroad is the status? P2: Yeah. P1: It?s like a status symbol. Only the richest and the most famous people can go to a certain country. R: Would Canada be considered one of those countries? P2: Yeah? it?s part of North America; it?s America (Focus group 0210).  The foregoing revealed the social status attached to going abroad particularly to a North American destination, such as Canada. As well, it drew attention to the fact that one?s economic position (?only the richest can go?) in the Philippines shapes ability to migrate, a factor that I will expand on later in this chapter. However, it also introduced the notion that the highest social status is derived from practicing as a nurse or a physician in Canada, or living the dream. Another nurse, who had recently arrived in Canada under the FSWP, echoed a similar sentiment:  132  P: The goal is still there?the star is still there.  R: Which is the star? P: To become a RN in Canada. Because when we finished college after a few months we started working already ...and so being a RN was our life. That?s all we know?caring for people (P1012 B).  For this nurse, her dream meant employment not merely residence in Canada.  Themes such as money and status commonly surfaced during interview sessions, but this next example shows not everyone shared the same motivation. This federal skilled worker stated, ?Like money, it?s not a big deal ??? we were making?I mean we were doing okay back home?. Later, offering further insight into his economic situation he added:   ?Cause we had a good practice back home?we?re both actually general physicians back home as well as nurses. I was going on duty as a nurse and I had my own clinic, so we?re debating to go or not. But then we decided okay let?s do it for the kids, ?cause we wanted to have a better future, you know, a better education, stuff like that?.so we decided to come (P0203).  For this participant, in contrast to most, money was not a major element of his dream; he and his wife, both physicians and nurses, appeared more concerned that their children have a better future. Indeed, for those with children the notion of striving for a better future in Canada seemed to include a better future for their children. One mother who had migrated to Canada as a live-in caregiver three years previously, left behind her one year old son: ?I want to give? my son a better future? (P0213A). However, I had difficulty ascertaining just what a better future might involve for this mother and because she looked sad and lowered her tone at the mention of her son, I shied away from the topic. During another interview, I tried once more to gain a better appreciation for what a better future for children might mean: R: I hear that a lot of people say ?for the future of my children?, but can you tell me more about that? As far as education? P1: Education and opportunities. 133  R: Opportunities for...? P2: For having a job and maybe a good life here (Focus group 1213).  Indeed, a desire for a better future for their children in Canada often included the hope employment opportunities.  Frequently discussions did not progress beyond this point and I was left wondering whether participants were deliberately withholding information or felt that the answer was so obvious that explanation was superfluous. At other times, however, participants were more forthcoming. For example, one nurse who had left her children behind to come to Canada as a live-in caregiver informed me that she had migrated chiefly for her children?s, ?future immigration purposes? (P1028B). In contrast, another who had re-located with her children to Canada as a skilled worker mentioned that she had hoped Canada could offer an opportunity to spend more time with her children; in the Philippines she had to work long hours to support them. Another who had also immigrated as a skilled worker with his family offered that Canada granted his children an opportunity to get what they deserved in life; a prospect that was not possible in the Philippines. Actually for me it?s not that we have a lower education back in the Philippines because modesty aside I could send my children to good schools ..., it is the political economic situation like even if they graduate from a good school they cannot earn the amount that is, you know, that they deserve (Focus group 1213).  His comment reflected hopelessness about life in the Philippines, another factor that is well recognized in the literature (Choy, 2006; Guevarra, 2010; Parrenas, 2008; Rafael, 1995,1997). In addition to immigrating for economic reasons, social status, or their children?s future, I discovered a wide range of other motivations to migrate, specifically to a higher income country such as Canada. Freedom from political oppression was one example. This notion surfaced when 134  one participant attempted to clarify why he and his wife selected Canada rather than the Middle East as their destination of choice. He declared:  P: We?d heard bad stories about the Middle East so that?s why we didn?t want to go there. R: What sort of bad stories? P: Like, you know, all the women that are being oppressed and the culture is quite different than what we we?re used to. My wife believes in women freedoms; and the rights are so oppressed over there so she didn?t want to go there (P0203).  For this couple life in Canada promised greater liberty and a tolerant society.  This next example also linked the notion of freedom with migration to Canada, but freedom of a different sort. During one focus group interview several younger participants who had immigrated under the FSWP reflected that a key component of their dream involved freedom from family constraints: Like we actually were talking about it. We were going out the other day and we were just talking about ?why we decided to come here. Then suddenly it just came to us, ???cause we?re both the youngest in the family and we just found out that it?s one of the best reasons for us?to be away from our families? (Focus group 0210).  This recent self-discovery of motive  reminded me once again of references in the literature to  migration  becoming  a way of life in the Philippines (Choy, 2006; Guevarra, 2010; Pratt, 2010; Rafael, 1997; Ronquillo et al., 2011); that drivers of  migration may be taken for granted or relatively invisible to  individuals.  Yet another motivation was revealed by a participant who had worked in the Middle East for approximately ten years prior to immigrating to Canada as a skilled worker. She raised the point that she had come to Canada for health reasons:  For my asthma I had a lot of medications for this thing. I took Ventolin, I took Symbicort puffer. The environment is not good [in the Philippines]. When I tried to see a specialist then he advised me if you have the chance to go to Canada then, ?this the right place for you, for your health? (P101). 135   This participant also shared at various points in the interview that she hoped Canada could offer a better education for her daughter, improve her economic status, and provide her with an opportunity for a professional RN career. The diversity of motives alerted me to the fact that there was no single driving force compelling these nurses to seek greener pastures in Canada. Analyzing the commonalities across the data thus far, it appeared that the dream of migration to Canada provided hope: about their future and that of their children. The specific elements of the dreams, though different, usually included the ideas of improved economics and better educational prospects for their children. Additional elements were living in a fair country, RN employment, and increased social status in the Philippines. I now turn my attention in search of some possible origins of these dreams.  Structures shaping their dreams: ?So I?ll go there?. As I proceed with analysis I attempt to expose underlying structures compelling participants to search for ?greener pastures?. Further, I aim to examine how such structures limited  or empowered participants? decision- making or their agency to move forward with migration, and to speculate on who may benefit by these dreams. ?The salary is just too small for a family?. Participants commonly cited limited opportunities for employment in the Philippines and low incomes as incentives for migration. One stated, ?Because there is a lot of unemployment now there. Those who are unemployed are already university graduates there? (P1028). In other interviews the suggestion arose that the economic situation in the Philippines was dismal even for those with jobs. One nurse explained, ?Like salary wise. A month?s salary in the Philippines is just one day salary here? (Focus group 0210). Further, one nurse said  there was no will on the 136  part of the government to rectify the situation: ??the Philippines they are not doing anything about the wages of nurses so it?s kinda like they can?t really complain why people leave?(P1012). Listening to these exchanges reminded me of the notion of ?forced migration?? that Pratt (2012, p. 144) alludes to in her description of the migration experiences of domestic workers. Similar to findings by Pratt, these participants recognized that the economic situation in the Philippines left them with no choice but to seek overseas employment.   Another nurse put the economic situation into perspective when she offered, ?Well first of all I worked in the community in the Philippines and um you know in the Philippines you know the salary is just too small for a family? (P0213A). Shedding further light on why prospects  were bleak, another pointed to the Philippines? private education and health care systems as contributing factors and explained, ?Expenses are majority from out of pocket in health and education where the private sector always offer better and quality services because of the meagre government investment in health and education?(P0705). In another discussion two live-in caregivers, were quick to draw attention to the government?s lack of investment in education as a factor compelling them to migrate:  PC: You tend to give your children to private schools because if they go to public schools they will not learn anything because of the number of [students]. PB: Too much over-populated. R: And so to get a better education in the high school years you need to pay to go to a private school? PC: Yes. PB: And also university. PC: And usually for us to have a job there, you have to be a university graduate?and you have to go to ? PB: It?s politics.  PC: Go to well-known, I mean very good schools, and that costs a lot and of course because of the unemployment parents tend to send their children to the good schools so that they will have employment after college (P1028).  137  Citing the government?s limited investment in health as the main factor that compelled her to migrate as a temporary foreign worker and leave her family in the Philippines, one stated: I will tell you the reason why I came abroad?..so my daughter got really sick. We have to stay in the ICU for 2 months. We have to spend everything that we earned?sell properties just to come up with the millions of pesos she needs for the hospital. So we are bankrupt, we are totally bankrupt. That?s the reason I came abroad. If I am not bankrupt because of my daughter?s condition I would prefer to stay in my country (P0801). For this participant, although she had nursing employment in the Philippines, remaining there was not an option. An underinvestment in a public health care system had driven her to look for greener pastures abroad. Another informed me that though it was her family?s tradition to help each other, it was also a necessity, as the government could not be relied on for financial assistance:   That?s the way it is. So, I?m the first and so I decided in order for me to help my parents for my two sisters, they?re still in university at that time, so I decided to go here in Canada,?it?s our tradition  in our family that we have to help each other. ...we don?t have loans there, for student loans; we don?t have funds from the government. If you?re gonna send your children to university it?s from your own pocket (P1116).  In this foregoing example the need to migrate seemed to be fostered by a tradition of interdependency among family members, in addition to limited financial support from the Philippine government. Again, remaining in the Philippines was not an option for this participant. One participant who had been both a doctor and a nurse shed further light on the economic climate in the Philippines when she explained why she and her husband had at one time contemplated re-locating to Bangladesh to work as domestic helpers:  You can see the mindset of Filipinos going out to sustain their families in the Philippines. So it?s anywhere. Because really the economy cannot support and the government already embraced the fact that to sustain this economy it just has to continue exporting its people to the labor market (P0705). 138   Similar to findings put forth by Guevarra (2010), this nurse?s comment indicated that nurses educated in the Philippines have limited autonomy with respect to decisions to work overseas; that they have become a commodity39 for export and are being exploited40 by the Philippine government. During another discussion when a participant who had come to Canada as a live-in caregiver was lamenting the difficulty of acquiring RN licensure in Canada, I asked if she thought rigorous Canadian regulatory requirements would deter future nurses from re-locating to Canada. She replied that nurses would migrate regardless and provided the following rationale: P: ?cause back home we?re really overpopulated, it?s more than 90 million, and then a lot of nursing graduates are unemployed. And so they still want to come. R: Because? P: It?s a passport. R: It?s still a better option? P: Yeah, rather than staying back home unemployed (P0120). From the perspective of this participant, underemployment in Canada was more appealing than unemployment in the Philippines.  ?Everybody was going away?. While political and economic situations in the Philippines may have been key factors compelling study participants to seek RN employment abroad, encouragement from family and friends was another. One RN who had come to Canada under the LCP stated:  I decided to come to Canada, through the regular encouragement of my siblings, who entered here as immigrants. ?they used to tell me ?you are staying long in Saudi Arabia, what about your immigration status? Just think of the future of your children? (P1028B).                                                  39I use the term commodity to refer to a service for sale in the market place (Coburn, 2010). 40I am drawing on Iris Marion Young (2011) to use the concept of exploitation to describe oppression that occurs through the process of transferring the results of the labour of one social group to benefit another. 139  Whether encouragement came from family members living abroad or at home, it seemed to be a significant factor shaping migration decisions and in some cases, it constrained agency. For example, in this next excerpt, parents in the Philippines along with a family member in Canada were driving forces behind this nurse?s migration plans: I came here because I have a sister here who?s living already two years?so my parents really wanted me to come here, for me to have a better future?. Yeah, I?m enjoying life here. I chose Vancouver because my sister is here, and I have no choice. And that?s it. I just need to accept the fact that I need to be with my sister (Focus group 0210).  Although it is impossible to discern her parents? underlying motives, it is clear that migration for some may be considered an honorable endeavor. This point was illustrated by another participant: ?But really it?s [going abroad to work] Filipino, I mean our families, they look up to us if we get out of the Philippines? (P0705). The next example further illuminated the extent to which family pressure may have constrained decision-making. In this circumstance a nurse described how she had let her mother down when she failed to meet immigration requirements to work in the Middle East:  That?s why my mum is so mad with me. I had just graduated and got my license and she was counting on me to ?be of help with them in their schooling knowing that I already have my RN license. And then for sure I can go overseas to work and then earn big money (P0120).  Additionally, this foregoing scenario underscored the interconnectedness between gendered responsibility associated with caregiving in the Philippines and decisions to migrate, a relationship that is well described in the literature (Parrenas, 2008).  In addition to encouragement from family members to migrate, peers may have an influential role. One study participant illustrated this point stating: ?? everybody was going away to different countries and we were like, ?Oh my gosh, I?ve got to get out of here? ?cause 140  everybody was going away. So that?s what drove me to apply to Canada? (P1012). For this nurse the notion of migration seemed entrenched in her everyday life. It was a societal expectation that required little reflection.  ?So you?ve got to make a sacrifice?. Discussions related to how decisions about going abroad were also frequently couched in terms of self-sacrifice and moral responsibility. Even those who had claimed that the decision to migrate was their own would often add that it was intended to serve the interest of others (i.e. family member(s). One nurse who had come to Canada with his wife and young family under the FSWP explained:  R: Was there pressure perhaps from family to migrate? P: Not at all. It was totally our decision. They were holding us back. They wanted us to stay back home?because we had patients, we had stuff going on and so they just wanted us to stay. But we decided to go because of, we were thinking of the children (P0203). From this participant?s perspective, although he and his wife felt the decision to migrate was made independently, the sake of their children was a factor. He seemed proud of his sacrifice.  The same sentiment arose during other interview sessions. One male nurse who had migrated with his family under the FSWP confided that he had sacrificed his medical practice and a good income in the Philippines for the future of his children, ?I would like to explain to them that I migrated here with my children because I wanted to give them a better future. Actually it?s a big sacrifice for me. I left my profession, fairly lucrative practice? (Focus group 1213 follow-up). In another instance a nurse coming to Canada as a live-in caregiver described enduring a lengthy separation from her family for the sake of her children?s future: R: How long have you been apart from your family? P: Here in Canada, 4 years. Plus 9 years in Saudi Arabia. R: Wow, it?s a long time  P: It?s a challenge (I think she is smiling). I need to be away from my kids 141  because of their education?that?s my main reason I had to leave the Philippines?They have to continue with their college?and education in the Philippines is so expensive and so you?ve got to make a sacrifice (P1028B).  Again, staying in the Philippines had not been an option for this nurse; rather, she seemed to accept that making sacrifices for family, such as enduring lengthy separations, was a necessary even noble sacrifice. Another commented that people from the Philippines are ?willing victims?. When I asked her if she could expand on this idea she replied, ?You know what the consequences are, you know it is unknown out there but any place other than the Philippines is a better choice. ?So I?ll go there. I go there?? (P0705). So, from her perspective, despite the prospect of further unknown challenges, she was willing to take the chance.  Shedding further light on their inspiration to make sacrifices for their family, one participant explained:  Because we?Asians, not just Filipinos, feel that we have a moral responsibility to care for our parents when they grow old?like they took care of us when we were a child. I don?t know what you Europeans or Americans feel about it? (Focus group 0210).  While some felt empowered by such self-sacrifice, it is also possible that the moral responsibility associated with going abroad may have constrained decision-making. In the next scenario a nurse recalled how she had been coerced to serve the needs of her family members living in Canada: It wasn?t actually my plan to come here. I was trying to process my papers to go to, like any other nurse, they would prefer to go to the US?but then my relatives who, ?cause I do have relatives here, and they would want me to come here and live with them for like to stay with them like a caregiver.?And so I have to come here as a live in caregiver. And so I have no choice but to come here (P1219).  142  In this case, familial responsibility intersecting with moral and perhaps gendered responsibility contributed to her sense of powerlessness41. ?I?m sorta westernized in the American system?. A familiarity with the West may also have inspired dreams of greener pastures that many alluded to at various points throughout the interviews; a familiarity that Choy (2006) argues is a legacy or a consequence of American/Philippine colonial relations during the first half of the 20th century. For instance, one nurse provided the following rationale to explain her interest in immigrating to the US: ?cause Philippines has [American base], at that time we were under Americans, for how many years? And so I?m sorta westernized in the American system?we?re used to the American system?because?the US base was there? a long time (P1116).  For this nurse the presence of American military in the Philippines fostered a sense of American identity. As well, participants often made reference to the fact that they felt comfortable conversing in English; another example that Choy (2006) contends is a remnant of their colonial past: You know, I have been taught English since I was in grade one and I have been using English until I become a doctor. In every conferences we use English, the newspapers we read are in English, the books are in English. The movies that we watch, the news television that we watch, CNN, BBC, are in English (Focus group 1213).  Others told me that Philippine movies often featured families going abroad to the US. Another participant said  that it is common for people in the Philippines to hold childhood dreams of                                                  41Drawing from Iris Marion Young (2011) once again, I am using the term powe