Aligning nursing practices in the Philippines with those of the mainland made the empire run smoother. But it has also had a profound unintended consequence. Once standards are firmly established, they are hard to dislodge, and the Philippines has remained, even after independence, extraordinarily U.S.-centric in its nursing practices. So, as the U.S. population has aged, requiring more health care, and as the Philippine economy has faltered, more and more nurses from the Philippines have left to work in the United States. Today, a massive pipeline carries tens of thousands of Filipino nurses
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