Describing Professional Nursing in Five Words

Hi everyone welcome to the Lefora Talk Show. My name is Holly Musselwhite, and I'm pleased you're joining us for season five and episode seven. We're going to be joined by a wonderful guest today, and our topic is really all around professional nursing. So I think it's going to have a lot of relevant details to share with you that hopefully you take to heart and find encouraging and something to look forward to. So we're going to be talking about describing professional nursing in five words. Believe me, there are a million more, but we're going to stick to just five today, and hopefully the information is something that you find really meaningful. Please make sure that in the chat, if you have questions, you go ahead and put those in there. And we'll also be looking at where you guys are signing in from. We'd love to see all the interesting places across the globe where we have healthcare professionals joining us from. So I'll start out, let's see looking at where are you from? Let's see we have Muhammad signing in from Bangladesh, and Ahmed from the UAE, and Sarah has already got questions, why no available opportunities for direct hire nowadays, there are opportunities, Sarah.  

So if you're interested in applying to us, I will put the link up there for you to take a look at in a little bit. And let's see Zane has signed in. Sarah, another question, when did you? So you submitted your application already, and you're looking for a response, okay, we can work with our recruitment team to see that someone gets back with you. Let's see Sakina from Bangladesh, Raquel from the UAE. Jasmine says hello. So it's great to see all of you. Please keep signing typing in where you're from. Previous is from Zimbabwe, awesome. Alright, so we have lot of countries and regions represented already. Fundo from Botswana. Thanks for signing in, alright, so before we go any further, with one more Jennifer from the Philippines, Alright, so we've got representation from the Philippines as well. Okay, before we go any further, let's also introduce our guest. So she's joined us once before, and we had a great show. I think we'll have the same thing again today. Lemone Brady, good to see you. 

Hi, Holly, how are you? I'm doing great. It's Tuesday it's beautiful, sunny here, and I'm awake. I don't know that my coffee is quite kicked in yet. So bear with me let's see so Lemone, would you introduce yourself and tell a little bit about your background, and then we'll dive a little deeper later on. Okay, so morning, everybody. Hi, I am Lemone Russell I am a night education resource specialist. I also hold, as you can see, on screen, I’m MBA as well as an MSN in leadership. And I'm a certified cardiovascular board nurse as well. I was an international nurse, so much like you, I transitioned here to the US approximately 10 years ago, and I'm currently in education and absolutely loving it awesome. So it sounds like you've done a lot of different nursing roles in the States as well as maybe some different things before you moved here. So with these five terms that we are going to talk about I'm sure we want to kind of dive a little deeper, but I kind of want to give people the general gist of what we're covering today.  

So, autonomy, trust, expertise, advocate and learning. So it's not an acronym or anything fancy, but these five terms are ones that I think really impact the experience, the clinical transition experience of nurses who have not worked in this country and are coming and starting their careers here. So for those in the audience who are thinking about coming to the US, or you're already on the track to come to the US. The idea is to start to understand before you get here. You won't see it play out very often in the circumstances you're in prior to arrival, but when you get here and you start to see some of it, you can think back and go that's what was happening. That's what she was talking about. That's what I thought it might be, but it's those are things we want to kind of prepare you for. And for those of you who are here, maybe this will demystify some of the things that you're seeing. If you're in your initial months and you're going, Why? So hopefully it connects regardless of what part of the timeline you're in. 

All right, so Lemone, let me I'm just rearranging things a little bit here when it comes to these five terms, autonomy, trust, expertise at. Advocate and learning which term connects the most for you in terms of your experience as a professional here in the US, I would you gotta pick some autonomy. Autonomy would probably be my most relatable. And not just autonomy for your clinical practice, but also autonomy for your professional practice. And by that, I mean autonomy, as we all know it, is being a self starter, you know, starting things to your patient, asking those hard questions. You know, doing things without being prompted, but also within your scope. And of course, we all understand that. I think for me, coming here, the professional autonomy was something that was a little bit different for me, because you had to determine, okay, I'm doing med surg, it's been three years. What do I want to do? Where do I see myself in five years? How do I, you know, get more proficient at typing? How do I get involved in E charting? How do I get into committees? What does it mean to be an APRN? And so being able to do that research yourself, being able to identify this is what I do want to do. How do I get there? What's a pathway that I use to get to getting to this professional goal? Those were some of the things that I think I was familiar with. And so I learned a whole new take on autonomy, what that meant for me clinically as well as professionally? Yeah, I would agree. I think that that's the part that at first, when you get here, you're not quite realizing how much autonomy you're going to have.  

And sometimes I will have nurses say, I feel like I have so much power now, I have so much influence. And you're like, Yeah, it's pretty awesome. It's also a lot of responsibility. So this actually, and that kind of leads perfectly into the discussion about that first term. So it's something that many nurses, autonomy is considered to be that thing that gives a lot of us meaning and importance in our work. So you're, you know, you're going to be making decisions day in and day out throughout your shift that influence the outcome for the patient, whether that's from just an experience perspective, whether they, you know, obviously when people are sick, they're at their most vulnerable, they can be their personalities can be very strong. And they can, you know, express fear in many different ways, sometimes ways that in your current country of practice you are not expecting to see. And when you see it here, you're like, oh my goodness. I learned very early on that the sort of like the worst of your personality can come out when you're sick, and nobody here, really says shame on you or anything like that, unless, of course, it's truly inappropriate. But people are ill, they're scared, and nurses are heavily influencing whether we can calm that fear, help them understand the things that they don't understand. I had someone who was sharing last week that they didn't realize how much the they would be doing and explaining to the patient here that oversees, a physician does that like, all the way, and here it's like the physician is in and out.  

They see them for like, less than two minutes, write up their note, and they're off to the next unit, and you don't see them again. And so it really falls to us and we can really make a difference. That's the power part of this. I guess that's really encouraging for a lot of nurses. So how, when you changed from, you know prior work, to coming to the US and you're in your starting in your first nursing job here, how did that autonomy aspect really come into play for you at first. Do you remember it's been so long, right? 10 years? You kind of have to, or just, you know, in general, you know, maybe you've seen nurses who are kind of as they realize that how that sort of comes into play for them, right? So prior practice, I feel, for want of a better word, we were spoon fed a little bit more. So, you know, you started as a new grad, even if you had had experience, you're starting the ICU, or labor and delivery, or, you know, you start in the pack, you had these lines of this is your preceptor. Doesn't matter how long you're going to take to come up. We're going to show you how to do a dressing again. We're going to show you how to feed the babies again. You'd never held a baby. We're going to show you. And so we really started with really showing you the basics and building on that. 

A contrast to America, it is like you already have experience in med search, okay. Well, this is what you need to know for ICU, very different. So you have now the responsibility to come into ICU being prepared. Like, okay, mentally, I'm going to hit the road running. I need to know what my labs look like? What are my determinants? What are the common things? What does a ventilator look like? What am I doing? You're the expectation of coming in knowing that you have done your homework. Very different in America. My prior practice it was, you're coming in, you're having doctors rounds, where doctors are there teaching for an hour. You know, you're writing notes. You're like I've never heard of this before. They're explaining all these things, and so you're being spoon fed this valuable information in order to care for your patient today. Very different in America  that was a big change for me. Another thing was realizing that where I was before we had paper charting, so you'd make, you know, maybe write two lines for the night. You had a lot of time to spend with your patients, that one on one care, doing, you know, talking, finding the background story fast forward to America. Very different.  

You've got to be that self starter. Okay, what's your health history? What's causing this what's causing this behavior? Did they have a prior experience, what are some of the questions that you need to ask your doctor? Because they will always have that you know, questions that you know that they're supposed to ask, that they don't ask until the doctor is gone. You have got to be the person that is like, okay, so when the doctor comes in, remember, we need to ask him these three things, because, as you said earlier, Holly, they're going to be in and out two minutes in and out. So being that person that is advocating that is, you know, being, you know, autonomous in like, okay, these are the things that are crucial for my patient today. They may or may not say it, but I need, as soon as that doctor comes in, I'm using that time, because if that doesn't happen, like you said, Holly, you know, things go away. Patients don't remember. They're afraid to ask. And so the nurse has to step in to be that autonomous person who has done the background, has done the research, has pulled up the chart, know what levels are out, know what orders we need for today. And that was a big change for me like I said, having the doctors come on round, they are the ones who typically do that.  

And so when I came here. That was a big change for me. So those two areas, I think, were just really for the biggest things that I really had to assert my autonomy and really step in and do that background work before the patient had any on towards effect or any plan for the day. And that was a big change, absolutely, and I think that's very common where nurses today, if they're thinking about how their day works and how much the physicians are involved in everything, it may seem a little scary the most important thing, and you probably heard it come through in what Lemone is saying, is that you're seeking out that information. So the autonomy to go and ask the questions and dig for the information and explore what it is you need to know when you think some of you have done the NCLEX. So you may have realized this already, that when you approach an NCLEX scenario, you see a lot more where you're like, well, there's an option to refer to the physician. And you know, if you've looked at the materials 99 out of 100 times. That's not the right answer. You can steer clear, because the nurse has so much autonomy and the scope is so different.  

So what we look for when as US nurses? I've been a preceptor of many international nurses, and of course, in the roles I've had with the companies I've worked with, with international nurses, it's been very obvious that it's a total, total switch to how you get information, because you become the primary person seeking that out. You have to be curious. Now, the cool thing is, you have experience already, so while you're maybe thinking, Well, I don't know this sometimes, once you sort of take a deep breath and you start to think, I have a patient with CHF that's here in this hospital. Have I ever taken care of CHF before? Yeah, have I had physicians tell me what's going on with the patient? Yeah do I kind of know what orders I'm probably going to get from that doctor based on my private prior experience? Yeah, there's a lot that you know, and now it's just a matter of you have to start taking that initiative, to go and ask to look. And if you do that with a preceptor, if you're actually vocalizing, I guess I need to go look at those labs, or I think I need to go now they're not trying to read your mind and wonder if you're actually processing all of this, and you can start actually doing it while you still have the preceptor as a guide for you.  

So I'm going to switch over for just a minute and look at some of the comments that are coming through. Let's see here, gotta just a second little hard to see these. Come on there they go, alright, so scrolling along here, wow, we got a lot of comments and some more people telling us where they're from. So, Hadija is joining from Namibia. Juan from Abu Dhabi. Anyango from British Indian Ocean Territory. So Jamal from, yeah, that's different. Jasmine is an RN from India. Has a priority date from December and a DQ date February, 2024, congratulations. How many days waiting for interview for USCIS please answer me. Well, unfortunately, I am not an immigration expert, but we can, we can probably get some additional information for you. And as you probably know, if you've been on our shows before, if you've watched our shows before at least for AMN, which is the organization that I work with. Amn international hosts an onwards and upward show every month about immigration and current updates, and it's up now on our Facebook and YouTube channel, so you can see the one that we had when the latest visa bulletin came out. Take a look at that information, and that will also kind of get you up to speed on where things are with immigration priority dates and some of those projections. Just in general, your specific question, Jasmine I'll have to tap into my immigration experts to get more info. 

So let's see OJ is signing in from the Philippines. I hope it's OJ, but if it's OJ, I apologize. Hopefully I got one of those right. Julianne from our Julianne is mentioning some folks names, I guess she wants you guys to tune in. And Melanes is apparently enjoying the show already. Zane is from Pakistan, final year Bachelor of Nursing Student willing to shift my journey from bedside to freelance medical writing. What are your suggestions about it? What is the scope and opportunities and last How do I get started in this career? Well, so Lemone is going to share a little bit about what she's currently doing with her, all her lovely credentials and experience. However, I'm going to talk to you, just in general, about experience for coming to the US. So if you are looking to immigrate here with a bachelor's degree and you don't have bedside experience that's fairly fresh, that can make it extremely difficult for you to find a sponsor to begin a career here.  

And so if you're looking at taking the pathway to come here and be a nurse here and get recognized for those credentials, you would have to a have bedside experience where you are in most cases, especially now, it's highly competitive for those positions that are available those hospitals. If they have the choice between sponsoring someone with fresh, relevant clinical experience or someone who's maybe got a great degree but no bedside experience, they're going to go with the candidate that has the bedside experience over the one that does not, and certainly the one that has aspirations outside of the bedside, doesn't really make sense for them to select that type of candidate. So those are things you want to think about. And then, if you'll stay tuned, Lemone is going to share a little bit about her own writing that she's done, so let me just scroll through here. Continue to put your questions in. If I can answer them, I will, and if I can't, I'll try and see if I can get a resource who can help us out and get those for you. Anson is from Kenya, signed with another agency, and we're educative. Good applause for the good job, and you passed your NCLEX congratulations. That is such a huge, amazing milestone. So I bet you're floating on a cloud right now. We probably Lemone do you remember when you passed your NCLEX? 

Yes, it's been a while for me. So let's see, I was actually calculating the other day. So 24 years ago, I passed my NCLEX, and that memory of pulling the results and then calling my mom, who's a nurse, and saying, I passed, and she went, I knew it, and I'm like, but I didn't so strong. Congratulations. Yes, congrats, Anson. And for those of you who are not yet, who have not yet done your NCLEX, this is the time to get it done. So if you're like retrogression, and the visas are slow, and why should I do it again? Visas are still being filed, people are still being given offers. So if you are working on a plan for yourself, and you haven't yet taken your NCLEX get it done, get moving in that direction towards getting that offer and getting filed. Gifty is signing in from Ghana. Thanks for joining us. Gifty and Sarah sending an email to the recruiter. She said she doesn't have available opportunities. Okay, and you're okay, they're going to look at something through O'Grady, but you're interested in Connetics. So yes, we are all part of AMN. And so the O'Grady Peyton is the staffing, which is actually what Lemone came through all those years ago and had a very positive experience.  

I from what I've heard, yeah, and we have lots of Connetics nurses who also join our shows and share that they've had a positive experience. So we certainly will look for what we can find to accommodate your needs. But I do know that, depending on your experience, where there are openings at this point in time, etc, you may find that there is an opportunity that's going to work for you. So it's worth exploring, in my view, so that you know what your options are. But I will, I will also ask that your recruiter take a look and follow up with you. So let's see previous my question, apart from nurses, you don't take healthcare, or is it only nurses? So we do work with some allied professionals, and we are also expanding that right now. We do have med tech applicants that we file and bring to us locations as well. So if that's a discipline you're part of, or there may be some others that are in more of the lab type of arena worth applying. 

Let's see, are we hiring, even if not yet, an NCLEX passer? So the majority of our applicants are actually going to be NCLEX passers, so that we can get them moving forward and file for their visas ASAP. So that's kind of where things are right now, if you are close to having your NCLEX done, it may be a good time to talk to a recruiter about what your plans are and when you're going to be taking your exam. All right, one more question slash comment, and then we're going to get back to our topic for the day. If someone completed a BSN in Bangladesh, will it be accepted as a bachelor in the USA? Ah, this is a good question. So here's what you need to know. Every single degree and school and year has to be evaluated by a credentialing service for a couple of reasons, number one for licensure. So if you apply to take the NCLEX with your degree overseas, you will be tasked with presenting your transcripts to a credentialing body. Very few states will do the credentialing themselves. There's a couple, but most of the time, they want to report from a credentialing service like CGFNS and they will evaluate not just what country and what degree you got there, but actually what classes went into that how many hours to make sure that it is equivalent to the general US nursing degree requirements for a bachelor's now, that being said, every state also has requirements.  

So for instance, some states may require more hours in a certain topic, like maternity than others. So again, what may work for one state might not work for another state. And so there's also, you know, the focus that comes in for I want, I want to get a visa. I want to have an equivalent degree. That's important, but you're also going to have your licensure review. The visa requires you to go through the visa screen, and so with the visa screen, you will present your credentials, your education, for review, to look at the that standard as well, and they'll come up with a statement of whether it's substantially equivalent to a Bachelor's of nursing degree here. So I can't say specifically for any person, just because I know what they had in their country of education, what degree it was designated as, that it would match what we would be looking for here. Sorry, but hopefully that helps to clarify that a little bit. All right, everyone. So we're going to shift gears and go back to the second term in that list of terms that we talked about earlier, which is trust. So annual surveys for the last 22 years done by Gallup, I believe, so well recognized survey organization. They surveyed. 

Nationally, so across the US and nursing is the most trusted profession. Does that surprise you? Over physicians? Of course, think about what we talked about earlier. You are going to be sharing a lot of information and knowledge with your patients that today might be the responsibility of the physician that builds trust and rapport, but it also means your communication skills, they have to be good. Matter of fact, they probably need to be really good, because if they're not, that's where you can actually lose trust, if you're not able to articulate information easily and explain things to someone who's very scared and wants to understand at least what's happening and what their options are. And a lot of times nurses are helping connect those dots. So Lem, what do you think is the biggest reason why the public would see nurses as the most trusted profession here? 

A lot of times we're the go between. You know, and that's what we talked about earlier. A lot of patients are intimidated by the doctors and they will come in, like you said, two minutes they're in and out. So they really give this air of this is my time. I don't have a lot of time to waste. Like, please get it done. And we love our doctors, but the reality is, they are seeing a lot more patients. And so for us, our nurse to patient ratios are smaller. And so we find that patients tend to confide in us. Or, you know, nurse, can you ask my doctor about this? Nurse, can you ask my doctor about that? Or the doctor comes in says something, and they don't understand the word, but they're nodding. And so afterwards, we have to translate from doctors, speak to patients, speak and you know they tend to trust us to do those things. You know we are the hand holders. You know we are the ones that they trust. You know, with a curtain pulled and so you will find often times, and it's such a hallowed space to be in when a patient trust when a patient trusts you to ask those hard questions for not only for themselves, but for their family member. You know, my mom was worried about this, and it wasn't sure if it's okay to ask the doctor.  

And so they're asking you to advocate for them. And when you have somebody who knows Nurse lamb or nurse Gifty is somebody who has my back, that is how they see you. That is such a hallowed space to be, so always make sure that I always say establish that trust, let your patient know. Hey, these are the concerns that I saw that was brought up for you from the other nurse. Is that, what's happening, you know, checking into them, not just seeing them as a number or a name or a door this is patient room 501. Mrs. Brown, what's happening today? Get that first hand knowledge, because then they realize that you're here for Mrs. Brown or Miss Mary. And these are things that Nurse Jane told me about it. You're verifying those things, and you're wanting to know what is really happening with them, so that you can establish that trust. You can ask those questions. You can find out what's happening. Oh, you haven't eaten since 12 o'clock last night. We were supposed to have surgery this morning. Let me find out what's happening. You can do that extra and it sounds like an extra step, but that's so important with that nurse patient relationship. It really builds stress. And patients really, really come back to us for that they you have a much better night. I can tell you when they realize that you are in their corner, and it really just goes smoothly for the whole interaction. 

Absolutely. So have you ever had a situation where you were like, this patient, very obviously, doesn't trust me? How am I going to turn that around? Like, because we can't just ignore them. So have you ever experienced that? I have, thankfully, not very often, but I remember that you talk about this, and I come one, one situation comes to mind. We had this older gentleman, and he had a younger wife, and would go in and say, hey Mister Ray, let's say, how's it going? He's fine he had a rough day. You know, a lot of you know aggressiveness in the tone, and you know, this very dismissive tone we'd ask, do you need someone to know already had some in fact, you could get me some ice, you know, that kind of stuff. And I was like alright we are starting off out the gate this morning, you know. So I continue to be as pleasant and patient as I can. You know, this is my name. This is our pain plan for the day. Are there any questions that you would have? Is there anything that doctor explained that, you know, we, you know, those kind of things again, still meeting with that gruffness continue to persist. And as ask a little bit about how was your morning this morning? I kind of took the focus of the patient and took it more to the wife. How was your morning this morning? And did you get breakfast? Because they have a cafeteria downstairs. 

Turn into balling. A whole balling session come. To find out, you know, she had a daughter that was sick. She had come from Thailand, and her daughter was there. She couldn't get back. There was an issue with the visa. And so all of these issues that weren't related to the patient, weren't related to the care that she was getting wasn't related to any of us, was in the background. And so they had these issues that were going on. There were financial issues. So a whole 45 minutes later, after she had divulged what was happening, she now felt that this was somebody who was here for her. This was not something that I had done, that the staff had done, and it really just reset the whole day. So you said, you know, we were able to help her to get some social help as well. Referral for that, we were able to care for the patient himself and those issues and again, sometimes, you know, people have so many things that are happening. And just like Holly said earlier, we don't know what people are going through, and we have to, I know it is difficult because we are human. Have to make sure that we aren't taking those things personally, they have so many things happening, and when you're, you know, that is the worst time to be nice. So as nurses, we do have that element of, you know, caring and nurturing, but sometimes we have to dig deep, because when we have those hard patients, it really erodes that trust.  

When we could have been like well, she's going to be one of those days, one of those day today, and you will reflect that, you know, project that onto her, because we have no idea what she's going through. And so we're like this is a difficult patient. I am not in the mood today for this foolishness, you know, and it just erodes trust, patience. Concerns get swept under the rug. They don't bring those issues forward, and we can't help them because they are not helping us. So sometimes we do have to go with that soft approach and kind of try to get behind the scenes of what's really happening, to break down those barriers and see what the true issue is. And sometimes you find it's such a simple thing, they haven't eaten since yesterday, they didn't get let back in last night, and their dogs are at home, and they're worried about their dogs. But sometimes it just takes that extra element to really establish that trust and find out what's happening behind the curtain. And I find in the one or two situations that I have been in that has really been the Isida, extenuating factors that have nothing to do with us, and once we have addressed those, is the one they've once they've even talked and bawled about it, it's so much better, and the environment is much more amicable. 

And I'm so glad you mentioned the label of the difficult patient. Yes, that is something I learned, actually, probably very early in my career, that if you were getting a handoff and you were kind of warned that someone is difficult, put that away, yes, and walk in and start that relationship fresh, because you don't as to your point. You don't know what they went through. You don't know what things are playing into, how they feel, what their fears really are. And we see that sometimes staff, you know, they reflect that. So they're very abrupt, or they don't want to talk to them at all. They're like, I guess I just won't talk to them, and I'm like, that's going to make it worse. It actually does destroys that potential. And once I started walking into rooms going, I have not heard that, it's going to be a new day, and I'm going to have to try and get them to relate to me. They don't have to like me, but I want them to know I have their back. Yes, it changes the game, but you have to. 

You want to separate how you're feeling personally about how they're behaving. Yes, hardest when you're new because you're like, absolutely, is it because I'm new? Is it because I'm not from around here? Do they not trust me? And if you let that cycle get into your thought process, you actually will self defeat and that opportunity to build that rapport totally lost. I used to I don't have any more, but absolutely, I had the baby face. You know, those nurses that walk in the room and the patient's like, you're not my nurse. You're not old enough to be my nurse. And I had that a lot when I was first starting, and it really frustrated me, because I'm like, you know, I've worked so hard to get where I am. There are many reasons why people may see the outward of you, or that initial interaction, as we know, we form opinions based on very quick interactions. If you want them to give you the opportunity to be that nurse that you know you are, it will take a little work on your part for some of these folks. Unfortunately, it will, it will. And those biases, like you said, Holly, are so varied. It could be like you said, the baby face, or your skin color or your tone being aware of those things when you interact with people, just in general, but more so people that. 

Are sometimes facing death, sometimes facing true financial issues, like they have just been to the ER and they paid $800 that they were going to pay on rent, you know? And some of those things come into play. And like I said it really does take that extra element of okay, I'm going to peel back my layer today and try to put my best foot forward, but putting that best foot forward every time, regardless of what people may think of you or have that first opinion, and I'm sorry, I'm an underdog, I love to prove you wrong, because if you think I'm baby faced, and her tone is that, let's undo that, because today, we're going to have a great day, just having that attitude really have to change patients perspective without them even realized, oh my god, that was actually the best day I ever had. So going forth with that and not defeating yourself out the gate like Holly rightly said, really goes a far way. 

You just go in and say, well, you never know, I might be your favorite nurse by the end of this shift. So stay tuned, correct? Yeah, exactly you're going to love me, you're going to love me, and I am going to take the best care of you. So absolutely, give me a chance. Little humor goes a long way. Exactly, it really does. And you know, sometimes being the sunshine in the midst of a storm is what you're really doing. Realize, realize that, you know, they're really in a storm for all the reasons that Lemone mentioned and more. Okay, so we're also experts at a lot of different stuff. So the more expertise we have, the more comfortable we are with autonomy, with building trust. But that expertise, you know, there, of course, there's studies on all aspects of nursing, but they show that this expertise that we have, this clinical nursing expertise, has a really high significant impact on the quality of the care delivered. So let's think about this. In the United States, many times people who haven't experienced our health care system before and go into experience that having been in another country, regardless of whether they live, their work there, whatever, they're surprised. They're like wow. So this person is this old and they're still getting this amazing cancer treatment.  

Or, wait, you got diagnosed just a week or so ago and you're already coming in for surgery to get this taken care of. So there are sometimes surprises to what is done and how it's done. Are there frustrations? Yes, there are frustrations with our healthcare system like any other. So there's pros and cons, but with our as we learn about how our healthcare system works, what are the things that are available, even for people who don't have health insurance and things like that, the standard of care that's expected for them. It means that nurses have to really understand how the clinical aspect works. You know, patho, pathophysiology, microbiology, how the healthcare system works, how the equipment works. And of course, what today, tomorrow, there's some new thing. So I spoke to a nurse from the Philippines this past week, and he said, I know how to take care of this condition. I think it was some maybe DKA. I know how to take care of this condition, but I'm here in orientation, and we get this patient, and I thought, I'm really going to be confident on this. And they brought up all these different labs that they were going to be checking. And he said, immediately, I went, I don't know about these.  

That's okay sometimes that learning and that excitement to understand is all we're really looking for. You don't have to know it all, but you have to be willing to recognize what you don't know and take autonomous action to research. In the meantime, you're building your expertise constantly. Yeah so the expertise varies, though. So we have, like, what you got trained in, we have what you learn as you go through your clinical experiences as a nurse, and that's where that relevant work experience comes in, pre us arrival, when you're like you know, I'm thinking, maybe I'll leave the bedside and go do blah, blah, blah. The further you are away from that bedside care, the more you're losing in terms of that relevant knowledge of that patient's condition. What are the things that we typically do for patients you know, in a very timely fashion, to manage this condition, to prevent it from worsening, to improve it, to cure it, whatever it is, the further you are. Way from the bedside, the less relevant that experience that you had becomes. So if you tell me, Holly, I'm an ER nurse, and I'm like, Great, let's see your resume and what you did, and we find out the last time you were in an ER was five years ago. 

Guess what? Your specialty is probably going to have to change because er, that's five years ago is not fresh enough for you to transition appropriately here and use that knowledge to get a foothold. It's very, very difficult, and we're already talking about just the basics of current er experience and transitioning here. So your expertise is valuable. Your experience is valuable. It may be a little frustrating to continue in those types of bedside roles, but it's also extremely frustrating to get here and realize how much your expertise is the start and you're going to have to build very rapidly the expertise that you need to be a trusted professional here, and you can't do that without having being a self starter, I would say so. Lem, what was the most significant type of expertise that you felt like you needed to acquire to be that confident nurse? Again? Because you know, when you first get here, you're like, What did I do? At some point that hits most, most nurses, what did I do? But at some point you also feel like, Ah. So for you, what was that like? 

I think I was, I was happy with the training that I got because my training was primarily, I want to say, in terms of specialties, was critical care. So I came to the US as a critical care nurse, having ICU experience, pacu experience, and that's what I transition as I'd had prior experience with NICU and pediatrics and obstetrics and mid search, but I transitioned specifically into critical care. And that really was a great base for me, like you said, Holly, every system differs, not only as a country differ, but within the US. There are different systems within systems, within systems. And so for me, I was happy that I had that clinical base on that bedside experience, because it was easier to transition into know my assessments, like critical care is critical care, patient assessment, those are similar all you know, on all platforms. But for me, my challenge was now everything was in the computer, patient history, my data, my labs, everything was in the computer, and I had to write my patient that I'm looking at. Okay, I did my assessment. How do I put it into this computer? What am I looking at in terms of history? How do I correlate the two? And how do I give the patient, this patient, the best care, just like you talked about earlier, a DKA patient, some of those labs I'd never seen before. The good thing was, I realized real quickly that the computer was my friend.  

What am I looking for? And so your computer would help me to understand, why is it that we're looking at this? The doctor's orders would explain. So learning that the computer helps you to understand your plan of care and how to explain to your patient, what are you doing for your own self knowledge? What am I doing? The patho what I'm doing, the doctors not look at that. I started to put pieces together my bedside knowledge, this new knowledge that I'm getting using you're up to date, your legitimate websites, a lot of a lot of hospitals have, I want to say, data base, like a database search that you can look through to see what it is that I'm looking at, and how does this policy relate? What is the procedure for this? And so learning those pieces built my expertise. I also wanted to do more cardiovascular stuff, because we had a lot of cardiovascular patients coming in, and I was like, You know what? I want to do a certification that really looks at the intricacies of cardiovascular nursing. And so I did that again. You talk about autonomous, really, if you're, you know, a progressive care nurse, there's a, there's a certification for that, your main surge nurses education for that. Do I want to really go into education? 

To go into ICU. What does that look like? What do I need to do to really set myself up for success there? What are the categories I want to do with an advanced degree? And a lot of these questions were things that I struggled with, and like Holly mentioned earlier, we eventually put it in a book, which I'm sure Holly has on there, called Dear nurse, and it really goes into behind the scenes. Look at various arms of nursing, common arms of nursing. So let's say you as a perinatal nurse, there is a behind the scenes look of, how do I transition? How do I make this something that is a part of me? How do we how do I become an expert if I'm going to be an NP. A lot of people come and they want to become an NP nurse practitioner. What do I do to successfully become an NP? What are the things that I should do as an international nurse? How do we self starter? How do I do research, things that will send me and so some of those things are things into this book to really help you become an expert in your area, where you really handle your own you can do a certification, you can do an advanced degree. You can join an ebp. You can do a course in you know how evidence based research? How do I become a researcher? And even if I don't want to become a researcher.  

How do I get more involved these committees that look at look at patient outcome, look at these patient estimates of care and really help determinants that help my patient do better. Or how do I look at engagement for my staff? What does that look like as a new leader? I want to be a new leader. What does pathway look like? So putting all those pieces together really helps to build your expertise and really renders you somebody who knows what they're doing. And so when somebody comes to you, whether it's a patient, a doctor, you know, a quality person, analyst, you know what you're talking about because you've looked at all those things, you've done your research, you've done your certification, you've done your post grad things, you've done your advanced degree, and all that really comes together to really build you into an expert. 

There's so much good information in what you just said. So thank you so much for sharing all of those thoughts. I think that a lot of the nurses who are here may be doing things practice wise, that look different here. So you mentioned, like, evidence based nursing and getting up to speed on some of the different things. And I think almost from the beginning, you're going to see things that you're like we didn't do it that way at home, or where I used to work. And so be careful of using that verbiage, but also be eager to yes and say, you know this, this lab is new for me, so I want to learn more or this procedure or that I see that machine over there. What does that do? And when do you use it, rather than waiting for all of that stuff to come to you when you see or hear unfamiliar things, just start looking, start digging, getting to know the topic, or the or that thing. And I love what you said earlier about the computer, that it's your friend, so sometimes it's a love hate relationship, but it serves a lot of purpose for quick information. I when we first, when I first came into nursing, we were just introducing our computer system into the hospital that I was at. So it's a while back, and I loved paper. Check a few boxes, write that quick note, 

transitioning into the computer system. All those things are kind of at your fingertips, and also you don't have to fight to find a chart. So if there's three different you know, physicians who need it and you need it and the PharmD needs it, you can all be in that chart altogether on different devices and get what you need without having that slow down. So I like that part of it, too. All right so advocate. We've actually mentioned a couple times about being an advocate. Nurses advocate for patients in so many aspects of their care, they help them understand what's happening, why it's happening, what are the options for treatment? Because remember, your patient gets to choose whether they want to participate and agree with the plan of care that the team is putting together for their review so an educated patient makes a decision that they can feel more comfortable with as an individual, and that will come back to how well you advocate for them. You may be guiding them through the healthcare system. You may be the one going and speaking to the physician, like limbs example earlier, where you're saying so doctor, the daughter came up and asked whether this patient could be discharged to go and attend a funeral tomorrow and then come back. I mean, sometimes the questions are very, very strange, and you're like, I don't even know what can be done. I will tell you the other important thing that I'm sure, Lem. 

Has also experienced is nurses are not alone, so we have teams around us that typically include social workers, case managers, nutritionists, Chaplain services, Grief counselors or life you know, people who have that more psychology style of degree and can help with some of those challenges that aren't maybe they're more about grieving than about mental health disorders and things. So we've got resources, and sometimes, until you need them, you may not realize exactly what they do. But if you speak with your team, you'll also realize that part of being an advocate is not about knowing everything. It's about saying, If I don't know, I need to see what's out there. I need to ask the question. And so that is probably critical to any part of this role. If you don't know, don't assume that it isn't out there or that it doesn't exist, because there's a lot of amazing resources that you may discover with just a few questions. 

We want to protect our patients. I have to underscore that. Holly, yes, please remember I'm that was one of the things I was very excited about when I was coming to America. I was like, what? There's a whole RT that extubates patients and dead blood gasses. What that is amazing. So hold on, you have a whole dietitian that does the whole care plan, like, I don't have to worry about that. Yes, there are a lot of resources and a lot of what we call an interdisciplinary team. There are a lot of people within that team that can address issues for your patients. So please don't think that you have to go it alone, that you have to have all the answers. In fact, it's better that you refer them to those people, because they are experts in their area. You're telling your patient, you know, trying to explain how diabetes works and these changes that they'll have to do, and how food works and what they can choose. Please don't go it alone. There's a whole dietitian or diabetes educator that's available for that. It just depends on your system, but knowing what is available is the key thing. Please don't go it alone, because you put yourself in a professional at a professional disadvantage, and you also put your patient at a professional disadvantage, because this is not something that you're an expert in. So please make sure that you're using those resources because they are available for them, absolutely, and we have seen that usually, the nurses who take that to heart use that advice, are the ones that it doesn't make it easy, but it's what allows them to advance at a pace that's reasonable for them and for the team that's going to be training them. 

So Lem, have you ever had an experience? I know I have, but I want to hear from you. Have you ever had a family member who was attempting to maybe speak for the patient when the patient was perfectly able, they may have been older, but they were able to speak for themselves, and yet this family member was like, I'm going to I'm going to control the show. And how did you handle that? Unfortunately, in my experience, and again, thankfully, I haven't had a lot of those experiences, but I remember specifically we had a patient that was not doing well. Patient could still speak for himself and could still make decisions. But at the time of admission, unfortunately, we hadn't quite determined who was who specifically, but he had a partner there who kept saying, Oh no, we're not doing that. He doesn't want that. We don't want that, you know, before the patient could say anything, you know, we would talk to the patient, which wasn't there, and the patient would be like, Yes, this is what we need. And she'd come back in after lunch. I was like, oh, no, we are not doing that. We're not doing that at all. And so we had to find out.  

Okay, let's, let's go back a little bit. Let's roll back the tape a little bit. Who is this person? Because we had been taking directives really well, not, directly, taken directly, but we were siding with, Okay, well, the wife says, you know this title of well, the wife said the patient was really coherent, even though he was more mild mannered. He was like, you know, he would differ. Like, yeah, you know, it's okay. Forget what I said. We'll just go with what she said. Came to find out it wasn't even the wife, it was a living girlfriend of a year, and the power of attorney was actually the wife. So we could have gotten ourselves in a lot of legal issues and a lot of legal ramifications, had we not stepped back and realized, okay, let's find out who is really in charge of this person's regal affairs, health decisions. The patient comes first, and there's a whole list, and I'm not sure Holly will go into that a little bit more of who is legally responsible for this patient. This patient is once they are coherent, oriented, knows what's happening, they have the legal right to decide what's happening. Yes, you may have an overbearing spouse or an overbearing family member, but that patient. 

First of all, has the right to make those decisions, and we have to defer to that. If that person is not, then we have to go to the next available person. Who is that person? Again, it will your hospital will determine who is that person, who is a power of attorney, if it's a spouse, if it's a legal person, that will that's where you know your people, who from chaplaincy, come in, they will determine who exactly legal might have to come in there, ethics might have to come in there, and again, using your interdisciplinary team to determine if this patient cannot make these decisions, who is responsible legal if you're making that decision, those are the things that come into play. But your patients want their once. Once that patient is oriented, they know what's happening. They are the person who really should determine what health decisions really need to be made. And we have to remember that, because we can get cost cut, you know, caught up in the Oh my gosh. I don't want to get the wife angry or the girlfriend angry. That is just not a legal stance that we can make. And we have to make sure that our professional practice really matches our clinical practice, and that you're also protecting your license as well, because it really can come down to that. 

So that advocacy role is not just something that you do when it's comfortable more when it's uncomfortable, both for us and sometimes for the patient, especially if they're used to letting someone else speak for them. If they're if they are legally competent, then the decisions that are made are ones that they have to be able to make and vocalize. They sign their consent forms as legally competent. Patients and they make informed consent decisions. So, yeah, so our last aspect, and then I want to jump to a couple questions. We've only got about three minutes, but this one's kind of, we've kind of hit it a little bit already. So learning nurses are lifelong learners. What you and I know today, if you talk to us in two years, not a very long time. There are many things that will change for us, for our clinical knowledge, our expertise, our understanding, the way certain nursing roles function in certain departments, the tasks that we may have to do, the equipment we may have to use. It's all about learning. So Lem, do you have anything that comes to mind when you think I came in knowing x, and now I've, I've had, you know, maybe it's an evidence based practice change or something that your team decided to change because it was better for the patients. Is there anything where you can say this is something I learned that I totally didn't expect to change. 

Like you said, there are a lot of sacred cows that you bring from your old life to your new life, and not only not your not your own life. Like you said, things change within two years. You know, last year ICU, we're talking about, okay, this is bundle that we're going to use when we have catheter, because we want to take these catheters as soon as you know, as soon as we can take them out, we're going to make sure, oh, there's no loops. We're going to make sure we're cleaning them within six months. Completely change, completely different bundle. We're using new techniques, entirely based on evidence based practice, and now we're not doing a lot of those things. So the you know, so many things change so often, and it's just not with procedures. It is with policy, with how you're admitting the patient. We're no longer using this system. This is a new system we're adapting. But I think the bottom line is always being open and aware those policy changes, making sure you're up to date with what's happening, what's changing your hospital system, what's changing your clinic is so key, because data information just nullifies so quickly. It gets out of out of date, and you have got to be aware of that, because things change so quickly. A lot of things are evidence based, and that's what's going to happen.  

That is the best advice I can give you, with regards to always keeping abreast of learning, because there are always changes. Keep an open mind, being aware of what those changes are. And if you don't know, ask somebody who's reliable. Always check for yourself in black and white. Look at your policies, alright? And I do want to go back. We mentioned earlier that someone was looking at medical writing. That's not quite what you do, but you did mention your book, and so I wanted to know a little bit more about that. I think you've probably shared some other nuggets of wisdom in there, in addition to what you're talked about here. So tell us a little bit about the writing that you've done. 

So I penned a book. It's called Dear nurse. It's love letters to nurses, things I wish I knew at any point in my nursing journey. So it is looks at different arms of nursing, your perinatal nurse, your night nurse, your IC. Nurse, a new grad nurse, and these are things that I wish I knew as international nurse coming in. As you can see, it's all over. I get emails all different people from India. They have used it to navigate behind the scenes. How do I navigate this role where I'm at? How do I use this to get the next professional step in life? How do I become an educator? How do I become, you know, a CRNA, I'm a med, surg, nurse. What can I do now with where I am to go to my next step. I'm an ER nurse. What am I? What do I expect in the US, especially as an ER nurse, how do I navigate that? What are the pros and cons of going into an ER sometimes you come up and you're a med surg, like, oh my gosh, I always wanted to go into or nursing. How do I do that? How do I transition? And so this really looks behind the scenes of how to do that. What steps do you take practically to do that? And all of that is just combined with a bunch of nurses with everything from CNOs to new grads to residents to fellows, and we've put it all in one simple book where you can go behind the scenes and find out, dear nurse, it's on Amazon. You can get it in kindle. You can get a copy.  

We ship everywhere, and we specifically put it on Amazon because we wanted to pay it for with our nurses. And had I had something like this when I came and a lot of nurses tell me the same thing, even before I came here, they're giving it to new grad nurses, to nurses in nursing school to help them navigate their career to be successful. And I feel like this is my way of paying it forward. You know, a lot of nurses voices have gone into this, and so we have put this in a condensed area where you can use that as a reference material to really navigate be that autonomous self, self starter, who wants lifelong nursing, and who wants to make a successful career out of nursing? And this, we've put it in there so that you can find those key things that can help you do just that. And our director also posted the link, so if you're interested, you can check it out on Amazon, as she mentioned. So I think you're very inspiring. You have obviously done a lot in your professional career, you're a published author, and you're giving, you're giving of that expertise to others in so many different ways, including appearing on these, on these web shows to share live, and your book, and I think a lot of other things I heard through The Grapevine. You just got a DAISY Award. 

Yes, yes. I was just nominated as a daisy regional. It's the first one for educators. So out of five regions, I was chosen as the recipient. Very, very deeply honored. And, you know, it just, it just been a wonderful year. I was one of the top 25 nurses in Texas recognized by the Texas Nurses Association. And so, you know, I guess it's a measure of success, they say. But I want to pour back into my nurses, and I specifically have a soft spot for my international nurses, because I've been down this road, and you know when covid happened, that's when dear nurse was written, and so we want to pay it forward to our nurses to see, how do I really navigate and take control of my professional career? Because we don't spoon feed in America, unfortunately, and it's a pro and a con, right? But these are things that we want to pay it forward to you guys to see, how can I really get this experience of these people who have done this and have done it, you know? And so that's what we're trying to do with dear nurse. So we're, we're happy to pay it forward, and I'm going to answer one last question really quickly. So it says, can a nurse refer a patient to interdisciplinary team member I think you're asking, or is it the physician? So it depends a little bit on what that interdisciplinary team member is, and a lot of times you want to let the physician know that this is part of what you recommend.  

So you don't want to leave them out of it, even if it's within your scope to recommend that someone come in from that team. So for instance, chaplains, we don't need a physician order to ask for a chaplain service to come in, or a priest or something to come and see that patient, but letting the physician know that you are looking at this patient holistically and thinking they need this. Remember, mind, body, spirit connection is very powerful. So when we're working as that advocate for the patient, part of what we're doing is, even if we don't need the order for that, we may need the order for consulting some sort of, definitely, a specialist physician. Because here's roles that require that, because of what that person is going to do for that patient.  

So and again, you will not know all the services and options that are available. So asking the question, is there someone in the hospital who looks at this or deals with this, or helps with this? A lot of times, that's when it'll come because you'll hear it sometimes during orientation, but it's just in one ear and out the other. On that note, I'm going to have our director pop up the information about some upcoming shows and things, and I'm going to say thank you to Lemone for joining us our next onwards and upwards on September 27 So Friday of this week, why pass your IELTS before December? This sounds like good information for you to know if you're pending English or if you're going to have to redo your English in order to keep it current. So please join us for that. And then on October 15, we're back with another Lefora Talk Show. So if you want drop in the comments, what things you'd like to learn more about, and we'll see if maybe we can add to our topic for October 15. Thanks again Lemone, as always, appreciate your time and your expertise. Thank you