This paper examines the nursing profession in Mexico from its historical roots to its present-day challenges. It traces the global history of nursing from church-based care through Florence Nightingale's reforms, then focuses on Mexico's acute shortage of qualified nurses, the low social prestige of the profession, inadequate salaries, and underdeveloped training infrastructure. The paper also analyzes US recruitment of Mexican nurses, the role of institutions such as the American British Cowdray School of Nursing, emergency medicine training programs like PACEMD, and professional associations including the New Mexico Nurses Association. A concluding section addresses the critical importance of bilingual and transcultural nursing care for the growing Hispanic population in the United States.
In ancient times, the sick and the unwell were generally cared for in temples or other houses of worship. This tradition continued until the early Christian era, when certain women of the Church took up the care of the sick and diseased, sometimes extending their services to patients' homes as well. These women had no formal training, but they were experienced, and that was what mattered in those times. They were extremely skilled in the use of various herbs and medicinal substances, and they began to gain fame as informal "physicians" of their era. In later centuries, nursing duties were undertaken by relatively uneducated women, until the seventeenth century, when St. Vincent de Paul began to stress that these women must undergo some form of training if they were to nurse the sick and the ailing (Nursing, Medicine).
It was in 1846 that a formal Training School for Nursing was established in Kaiserwerth, Germany. This is the institution where Florence Nightingale received her training, which subsequently enabled her to establish her own school for training nurses at St. Thomas's Hospital in London. Similar schools were soon established in New York and Boston. Nursing thereafter became a very important profession for women, until the beginnings of the feminist movement in the 1950s and 1960s. Eventually, the late twentieth century saw the beginning of a nursing shortage, driven by a variety of factors: salaries remained stagnant, workloads increased, and a broader range of professional opportunities opened up for women. As a result, enrollment in nursing programs declined, and that trend has continued into the present day (Nursing, Medicine).
In an article published by CBS News on June 29, 2004, it was reported that because of the shortage of nurses in the United States, the US government had been sending recruiters to Mexico and other developing countries to draft trained nurses into the American healthcare workforce. The article noted that this kind of international recruitment could place an even greater financial strain on the already stressed healthcare systems of the developing world. US authorities had issued repeated warnings that the country could fall short of approximately 275,000 nurses by the end of 2010 if the situation were not reversed, due in large part to the growing burden placed on the healthcare system by an aging population (Foreign Nurses Sought to Fill Void).
US recruiters had long found a source of nursing talent in the Philippines, where schools were established specifically to train nurses for eventual work in America. Health care personnel from India, South Korea, and Nigeria were similarly being recruited. However, by the early 2000s, the primary focus had shifted to Mexican nurses, who would be particularly valuable in serving the rapidly growing Hispanic population in the United States. A Mexican nurse would not only speak the same language as Latin American patients but would also share cultural familiarity, offering a significant advantage for both patient and family. Mexican nurses working in America could earn approximately ten times what they would earn in Mexico — a powerful incentive. One nurse, Sanjuana Sanchez, who earned about $350 a month on the night shift, expressed her motivation plainly: "My motivation, more than anything, is economic," and added, "My goal is to get to the United States for the salaries." She had already begun studying English in preparation.
Despite these incentives, the actual recruitment of Mexican nurses into the US had not yet gained the expected momentum. Statistics showed it was still in its very early stages: only 58 nurses sat the US Nurse Licensing Exam in 2002, according to the National Council of State Boards of Nursing. Of those 58, only about 28% — approximately 16 individuals — passed, a figure well below the average pass rate for nurses from non-English-speaking countries, which generally perform better on the exam. Nevertheless, this had not discouraged Mexican nurses from studying and preparing to pursue opportunities in the United States (Foreign Nurses Sought to Fill Void).
Allison Squires, MSN, RM, BC, a student at a US School of Nursing, offered a perspective on the nursing profession in Mexico. She argued that nurses studying in countries with well-developed nursing systems have both a professional and a social responsibility to support their peers in other countries who are struggling amid large-scale healthcare challenges. Squires's interest in nursing in Mexico stemmed from her own undergraduate experience, during which she traveled to Oaxaca, Mexico, and encountered first-hand the realities of international healthcare. That experience, she said, helped her discover her "nursing niche" (Allison Squires: School of Nursing, Admissions).
The health service disparities evident in the developing world were a formative experience for her. Living and working within an international healthcare system made her appreciate the struggles that immigrant patients face when navigating an unfamiliar system and attempting to communicate in an unknown language. This is the essence of what is known as "transcultural" nursing — a model in which teams of nurses are sent to developing countries such as Mexico to learn first-hand about healthcare realities outside their own borders. The experience is considered enriching for all participants and offers nurses a broader, more globally informed understanding of their profession (Transcultural Nursing, the Mexican Experience).
In Mexico, fundraising for any purpose — even for non-profit organizations — is a complicated undertaking. Fundraising has never been widely practiced or popular in Mexico, and there is both a restrictive legal framework and a restrictive tax framework that inhibit such activities. According to the American British Cowdray School of Nursing (ABCSN), a non-profit institution affiliated with a local Mexican hospital and university, the subject of fundraising is virtually ignored in Mexico, compounded by a lack of basic knowledge about how to conduct it effectively. The ABCSN was founded in 1956 to support the professional training of nurses in Mexico, particularly for the ABC Medical Center, and it is considered one of the best nursing schools in the country (Case Study of the American British School of Nursing, ABCSN).
The field of nursing in Mexico is currently under considerable stress for many reasons. The basic qualification for a general nurse is a middle school education, known as secundaria, extending through to the ninth grade, after which a three-year practical training program is required — though standards are gradually becoming more stringent. According to Elisa Quintero Ramirez, Director of Nursing at the ABCSN, there is today a severe shortage of nurses in Mexico. Fewer than 10% of practicing nurses have completed a Bachelor's degree in Nursing, and only 2% hold a Master's degree. Most nursing duties are in fact performed by nursing trainees — known as "para nurses" or nurse auxiliaries — who have completed only the ninth grade and one year of training (Case Study of the American British School of Nursing, ABCSN).
Director Ramirez emphasizes that even these novice nurses are in short supply, and that the shortage of qualified nurses represents a growing crisis that is worsening rather than improving. Recent statistics indicate that while approximately 70,000 students are currently studying to become medical doctors, only a small fraction of that number are enrolled in nursing programs. During the 1980s, nursing enrollment fell so sharply that the ABCSN was forced to close its general nursing training program, as it was no longer financially viable. Of every 1,000 students who enroll in nursing school, only about 40 actually graduate; the rest drop out or move into other service sector jobs. The ABCSN Board accordingly decided to focus exclusively on providing specialized training for nurses who had already obtained their nursing degrees elsewhere. One popular offering is the Nursing Diploma in Oncology, delivered through a two-month continuing education course held two days per week (Case Study of the American British School of Nursing, ABCSN).
According to experts, the troubled state of nursing in Mexico stems from several causes. Chief among them is that nursing is considered a low-prestige profession — one suited to those who lack access to higher education or prefer not to study further. It is also widely regarded as a profession for women rather than men. Since women are traditionally considered second-class citizens in much of Mexican society, the profession itself is devalued by association. Consequently, nurses' salaries are very low: in 2000, nurses in Mexico earned between 75,000 and 110,000 pesos annually (approximately US$8,000–$11,000, plus benefits). Many nurses must hold two or more jobs to survive (Case Study of the American British School of Nursing, ABCSN).
Director Ramirez also notes that many trained nurses leave the profession after only a short time due to low pay, while those who remain for more than ten years are frequently recruited away by pharmaceutical companies, which offer significantly higher salaries and better benefits. This leaves hospitals dependent on inexperienced new graduates. Compounding the problem, nearly all physicians in Mexico treat nurses as little more than servants — an attitude that has persisted for centuries — further demoralizing the profession and making it unattractive to prospective students. Ramirez herself, as director of one of Mexico's largest hospitals, does not belong to any national or international professional organization, nor do most of her colleagues attend workshops or conferences. Of Mexico's 120,000 nurses in 1990, only about 800 belonged to the Mexican affiliate of the International Council of Nurses — a membership rate of approximately 0.7%, compared with 25,000 to 50,000 or more members in countries such as Germany, Finland, and Japan, where eligible nurse membership can reach 50% (Case Study of the American British School of Nursing, ABCSN).
To address this isolation, the ABCSN offers post-basic nursing and specialization courses, health care management programs, and intensive care internships. On average, the school reaches approximately 1,500 nurses annually through its programs and free workshops. The Director reports directly to the Board of Directors of the ABC Medical Center, which provides smooth institutional alignment and free access to the Center's expertise and resources. A potential disadvantage, however, is that the Board must divide its attention between the School and the other units of the Center (Case Study of the American British School of Nursing, ABCSN).
Nursing and midwifery practitioners constitute the largest group of healthcare providers in Mexico, and they have influenced changes in the basic healthcare system in several important ways. Their working environment, scope of practice, and relationships with other healthcare providers are all shifting. However, very little formal emergency room training is available to nurses in Mexico, and most nurses working in critical care have little or no specialty training. Even emergency room physicians are often insufficiently trained for their roles (PACEMD Nursing Activities, Trauma Nurse Core Curriculum).
"PACEMD program and gaps in emergency nursing training"
"Nursing associations supporting Mexican nurses locally and abroad"
"Language barriers and the case for bilingual nursing care"
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