How Do Doctors and Nurses Work Together

Good morning everybody and welcome to Lefora Talk Show season 5 episode 1. Wow, I can't believe we're in season 5 episode 1 we've been doing this for a long time. If my face is looking a little bit familiar, you might recognize my last name Danielle Freedman. My mother is Tanya Freedman, the former CEO of Connetics USA nursing job agency, which is now a part of AMN Healthcare, where we have staffing under O'Grady Peyton and direct hire under Connetics. We are so excited to have you here today, we are going to be talking all about working with physicians in the USA. This is a very important topic and a very exciting, although I'm sure a very anxious topic for a lot of nurses. So we are going to give you all of the good tips and tricks and all the inside info that you need to know about working with physicians in the United States. Please let us know in the comments where you're watching from we love to see where our viewers are watching from around the world. And let us know if you have any questions our esteemed panel are going to come on they're going to give all of their experience. And they're going to be here taking xuestions, so please share your questions. Before we get started I just wanted to share a map of where AMN International is currently hiring. So we have positions all over the United States so let's pull up that map. Let's show where our opportunities are. As you can see we have opportunities all over so if you want to come with direct hire with Connetics or if you want to come with staffing with O'Grady Peyton, our recruiters are on hand ready and waiting. You can apply at amnhealthcare.com/international and our recruiters are ready to help you reach your American dream. All right, so let's get started this morning let's bring on our experts. Good morning, everybody there we go. I see Cynara and Jose good morning so excited to have you guys on today. Why don't we take a quick moment and do some introductions. Jose, shall we start with you first?

Yes hi, everyone. My name is Jose and I'm currently stationed at Houston, Texas.

Okay, great. Well, we're very excited to hear all about you and your journey. And I'm sure a lot of nurses are very excited to hear about Houston, Texas. I know that's a very hot spot for a lot of international nurses. All right so let's turn to you Cynara.

Okay, my name is Cynara. I'm originally from Brazil and I'm placed in Chamberlain, South Dakota.

Okay, great. Well, we are very excited I know there's a lot of active recruiting in South Dakota. So I'm sure you can give some good insights, who are nurses who are watching right now all about life in South Dakota and what it's like working there. All right and last but certainly not least, Miss Holly.

Good morning, Danielle, good morning, everybody. My name is Holly Musselwhite. I am a nurse and I've worked with nurses from all over the world who come to build a career here in the States for about 10 years. Maybe a little more I'm happy to be joining everyone today.

Okay, well, Holly's been working with our lot of our international nurses for many years. So she knows a lot about all of the different challenges and different things that international nurses might experience. So we're going to hear all from Holly. Okay, so let's get started. So Jose, I would like to start with you. Can you tell our viewers a little bit more about your journey to get here? How long you've been in the US? And just anything you want to share with our viewers about your journey, please?

Yes, sure I mean, I moved here to the US in first quarter of 2022. And I've lived in Abu Dhabi in the United Arab Emirates for 19 years and I've practiced nursing there since 2003. And it was quite an interesting journey for me with O'Grady Peyton. There were some it was very well guided it was very well structured. So I was I was very appreciative of that and it was all facilitated by O'Grady Peyton very well.

Okay, well, we're glad to hear that Jose sounds like you've had quite a long career. I'm sure you've had some very interesting experiences practicing in different countries. So we're very excited to hear a little bit more about that. Okay, Cynara you want to go next.

Okay. I've been a nurse in Brazil since 2019. I worked during the pandemic, so was a quiet experience working in a hospital during COVID. And then I started my process to become a nurse in US all facilitated by Connetics, which I was well, I had all the support necessary to be here. Now, I've been working for several health in Chamberlain, South Dakota, med surg, which I strongly recommend, because it's a great opportunity to learn about everything. And I'm all also training to become a year nurse.

Okay, very interesting. Well, sounds like you both had quite an interesting path. Jose, can you tell us a little bit more about where you're living now? What's the city like? What's your favorite thing to do there? You've been there for about two years now, which is actually a pretty good amount of time. So you probably got your bearings. What do you like most about Houston?

First and foremost, the weather. Because it's very similar to a very tropical, I feel so and it's very close to the coast. I often go to Galveston, which is the nearest coast from Houston. So I can go the beach to the beach and have a really good time there. I live very close to where my assignment is so it's a very short five minute drive. So that I would say I'm lucky factoring in that Houston is such a big city, and it's infamous for being for its traffic.

Okay, very nice. Yeah, that is a very lucky commute for a big city. I actually live in Los Angeles, California. And my commute before the pandemic was 40 minutes, which was pretty normal. So I think in a big city, you are used to usually having a longer commute so having a five minute commute is very lucky. But sounds like you are loving your life in Texas, which is great to hear. So Cynara you want to go next tell us a little bit about what it's like to live in South Dakota.

Okay, I've been in Chamberlain since April last year, April 2023. So next month, actually next month me is going to be one year that I arrived me in west. And in April It's been one year that I've been working for Sanford Health. Chamberlain is a small town It's a beautiful town across the river, which is amazing, beautiful. So the main thing that Jim, South Dakota has to offer our outdoor activities, fishing, hunting. Some outdoor museums, for example, my free time I like to go to forests hiking or to visit places. Some months ago I went to Mount Rushmore Badlands National Park, those are just gorgeous the nature and everything else. Just like her said, I'm all I also live very close to my work is a four minutes drive. Which is really, really good. Because sometimes I already forgot things at home. So I came back home so quickly and I still arrive at work on time. And that is a plus for sure I love working close to my job. And people just have the code is being so welcome to me. I never had an issue of being welcome there. That's amazing this is my favorite spot in Chamberlain. Behind you guys can see the river is just very nice places small town people are very welcome. I live close to the reservation, which means close to Native Americans. So who has interesting on learning more about the culture of the Native Americans. That's an amazing place to be.

Wow, that sounds like a really, really interesting experience and sounds like you're having a really amazing time there. I love seeing that picture of you in the snow, you look like you're having a lot of fun standing across from the Missouri River, and you're going to Mount Rushmore and hiking and doing all kinds of things. So sounds like yeah, definitely a nice place.

That's amazing and so nice to hear that it's a welcoming place. I'm sure for a lot of our nurses they feel a little bit anxious about coming to the US, as I'm sure you both did, too. So it sounds like it's you're both in a nice landing place, which is great. So our show today is focused on working with physicians, which I know can be quite a scary part for international nurses to come to the US because practices are different sometimes in your home country versus in the US. Did either of you do anything to prepare for that transition? Jose will turn to you first.

Yeah, I am lucky in the sense that the UAE is very diverse in its residents and the people I work with. So it's very similar to my situation here in Houston, specifically, because you Stan is very diverse as well. So you get to meet a lot of professionals in with different backgrounds, and more specifically with a physician. So they're very diverse. So it's just a matter of, I guess going up, setting up professional rapport with them, whenever you're at work. Ah, okay, so sounds like you had a little bit of experience kind of going through this in Abu Dhabi in another country, and experiencing diversity and experiencing how to work with physicians in another country. So you had a little bit of experience with this? Yes, okay great. Okay well, I look forward to hearing a little bit more. What about you Cynara? Did you do anything to prepare for that transition?

Well, in Brazil, some things are similar. But some other things are very different here from my previous practice. Something that helped me was during those courses that was assigned for me before arriving here. Some of them used to talk about how to communicate with the team, including physicians, but not just then. And that helped me to prepare myself about how to communicate with them, like, should I call Should I text them? Should I use the private secure chat, how to do that, and also used to have a group of other international nurses coming to Brazil, some of them was already here. And I also had a mentor. So they we used to talk about these things about how to do so talking with other people that were already here helped me to prepare to be here about what to expect and how to communicate effectively with other colleagues at work.

So I'm sure that was really helpful to hear from your other colleagues who are already going through it or who are going through it at the same time and hearing all about their experience. Okay, I see you nodding your head I could see you agree. All right so before we turn to a couple more questions, I see we have so much chatter in the in the chat of where everybody's watching from. I love to see where everybody's watching from our viewers watch from all over the world. We have fires watching from Jordan, Lennie watching from Saudi Arabia, Abu watching from Qatar. So it's nice to see everybody watching, thank you for joining us. Again, we are on the Lefora Talk Show today. And we are talking about working with physicians. So that's what I love about the Lefora Talk Show. It's all about nurses helping nurses and we're helping share all of the information that nurses have learned, and that our clinical educator has learned and we love sharing with everybody. So please feel free to put your questions in the chat if you have any questions for our experts today. So Holly, I want to turn to you. Can you talk a little bit about the relationship between RNs and Physicians in the United States?

Yeah, it's a very close one. It's built on trust and usually a good degree of mutual respect. And the nurses that are coming here are a lot of times surprised at how much physicians really rely on what the nurse has assessed. She is sharing and updating them about so there's a lot of dialogue and the clinical observations that nurse has are highly valued when they're communicating with physicians. So we find that some nurses are shocked by that. And they feel a sense of importance that maybe they didn't experience before because they're they have a voice and science or use the word colleague. And that is really what it comes down to is physicians or nurses, colleagues, you're part of a team. And it really is great to be a part of that team. And when you're working very cohesively together is when you get great patient outcomes. So that's what I'm interested to hear more about from Cynara and Jose today to.

Okay, well, thank you, Holly, thank you for sharing that some good basic insight for us, and to hearing about working with physicians as nurses who are new to the USA. So Jose, how did your initial orientation training go? Was there a lot on in your orientation about working with suppositions?

Yes, because it has given me a really great overview or that I could see or to firsthand account on how the dynamics of working with physicians here in the States, how we, how they interact, how information is being shared between both roles. We the ultimate goal of having a cohesive approach to patient care.

Okay, I love that. So you said cohesive approach Holly, and Cynara are I mentioned colleagues having a voice? So it sounds like when you're working with physicians in the US, you're definitely a collaborative team, which may or may not be different from your home countries practice. Cynara what about you? Did you learn during orientation, how to effectively communicate with physicians or any takeaways that you can share about your orientation?

Absolutely. My orientation process was really good. First of all, I had a very patients nurse to help me in a very similar age than me. So that helped a lot because I was just a fun fact, I was the first international nurse arriving in this hospital in South Dakota. So everything was new included for my colleagues. And I was very, very welcome. During my orientation process, the nurse that was helping me, they help each how to communicate with the physicians on that facility. I know there are some differences between facilities to facility, but I work in a small facility where everyone knows everyone. So she kind of gave me I realize, hey, this one likes that he called him and update him very often. This one prefers to, to like this and that helped me a lot. My, so my transition was very smooth I did not have any issues communicating with them. And something that I think Polly said they really trust on us. That's very true, because what I have on my mind is that is not the patient, the patient is not the physician. If something happened with a patient's not the physician, it's going to be the team. The team is taking care of the patient. So he's part of everyone, everyone takes care of him. So that's why they really rely on us and I've been having very good experiences with the physicians that work with me, or never work together. Yes, I did not have any issues so far.

Good. Well, that's really good to hear and I'm sure was so helpful to get from your other colleagues, some insights about what physicians like or don't like, or what specific physicians like or don't like, because that was able to help you do better and understand how to work with your physicians. So I'm sure that was very helpful. Holly, what do you usually see as some of the main differences of working with physicians in the US versus for a lot of nurses in their home countries?

So in my role as a Senior Clinical Manager for AMN Healthcare and the other roles where I've done similar support with international nurses, there's a lot of common things that they report, they may struggle to initially feel confident when they have to give updates, they may be unsure, like Cynara said, what does the physician want I've heard some people say, I don't want to bother the physician, and you're like, okay, but you have to look at this from a different angle, you're not bothering them, you're reaching out to a colleague and a team member on behalf of a patient. And it's about safety, both for the patient and for the rest of the team when it comes to preventing negative outcomes. So we see international nurses, some are not used to that type of dialogue, they are surprised when they have to suggest things to the physician. So instead of saying, doctor, something has changed, can you come and look at this patient, they may not be able to come in look, they may not be in the hospital there. So now you're the eyes and ears for the physician and you're relaying what you've seen. And then on top of that, you're gonna say, oh, and I would like to get orders for this, and this and this and this. And then the doctors expect that they don't expect a more passive type of conversation, they want very good active dialogue. And they can disagree with what the nurse might be saying or suggesting, but they expect that with the level of skill and knowledge that we have, we will articulate that and be those eyes and ears to kind of paint a very good picture for them if they're not able to see the patient themselves, and make some well informed decisions about what may be the next steps.

Okay, thank you, Holly. So I think that was a good sum up of what some nurses might be struggling with. It sounds like generally having a lot more autonomy, a lot more of a voice, a lot more of the team, which is probably very exciting, but also probably a little bit scary. If that's not something that you're used to experiencing, I see everybody kind of going like this. So I think everybody's agreeing I see we have a question from Lenny, Lenny says, how do you cope and learn with some physicians with an accent or terms that they often use in the hospital that are difficult to understand? So Lenny's talking about another different struggle that some of our international nurses might experience with different terms or different accents. So Jose, have you had any experience with this in your hospital? Yes, well, definitely. I guess you can remedy that by stating clearly that you needed to hear the information one more time. So just to make sure that the information is received, and on the receiving end well, so you just asked for them to repeat the information. And there's totally nothing wrong with that.

That's good advice. Jose, I'm sure some nurses probably feel a little bit nervous to do that, and nervous to speak up. But it's important to speak up, it's important to use your voice to make sure that you fully understand what's being requested of you, and to advocate for yourself. And the only way to do that is to really have a conversation, and make sure that you are fully understanding the request. So I think that's really good advice. What about you Cynara? Have you experienced anything like that? And how did you deal with it?

I haven't experienced with accent yet. But with terms for sure when strategy that I've been using to communicate with physicians, is before I call them because I also had that insecure. I used to just reveal everything that I need to talk but then if I need to take vitals one more time, if I need to see the patient one more time to make sure that I'm giving them the right information. And we use the is bar communication strategy. I'm not sure if someone's familiar with that is very effective communication. So they also use this bar communication with us, which helps when we have this accent or terms. And when I don't understand the term when I don't understand something. I just say hey, I'm sorry, I didn't understand this term. What does that mean? Because we cannot assume they are saying something if they are saying something different, because my part the patient's danger, the patient in risk. Especially if they are giving us an order by the phone, and we need to play the order in the computer. So the only advice that I give is, if you're not sure what they are saying, feel free to ask questions. Hey, I didn't understand. Can you repeat that for me? And in the end, I just repeat what they're saying to confirm. Okay, so just go for and while you're saying, you want me to do this, and this and this, and this? Is that what you're saying? They say yes okay, if they say no okay, so you're going to understand this one more time, because it's your patient life than you're talking about.

I think that's a really good way to put its INR at the end there where you said, it's a patient's life that we're talking about. So, it's a big deal and you want to make sure that you are understanding what's being asked to view what terms are being used. And I think using your autonomy and asking questions, and making sure that you get to get the answers that you need is a very good strategy. Holly, do you have any thoughts on this or any advice for nurses who might be anxious about the same thing?

My advice is what I would give any nurse that's coming into this type of role. And what Jose and Cynara are shared are very relevant, very accurate things to try and do a couple of things that I would maybe add, never be afraid to ask someone to repeat themselves. Ask them to speak more slowly. I've been on the phone with people from similar regions and said, I don't understand you, maybe it's how you're holding the phone, can you reposition it because it's muffled. So it all comes back to patient safety. And at the end of the day, if you don't speak up, you may end up doing something unsafe for a patient, or making a lot more phone calls, trying to clarify and be sure that you know, and Cynara. And I mentioned the S bar and she also said repeat back. And those are two things that usually across different hospital systems and in our healthcare culture, are very much recognizable tools, there may be some difference with the S bar. Some people have an AI s bar and some people have maybe something tacked on other ways. But that acronym of situation background assessment and recommendation for the nurse is a very common structure for communication that other healthcare professionals should recognize and be patient for that to be verbalized. It's not fun to be on the phone for a long period of time. But it's a lot less fun if you have to keep repeating things because you didn't get it the first time you made that phone call, and now you're sending other messages or you're calling back again you realize that the information just wasn't complete. So take the time to have a quality conversation, especially over the phone, before you hang up. And using that repeat back option is huge, important way of ensuring that the conversation from both the giver and the receiver was well understood.

Okay, thank you, Holly. I think that's such good advice for our nurses who might be watching and thinking, how am I going to handle these challenges? What am I going to do? Do you have any suggestions of different things that nurses can look at beforehand, you mentioned some communication strategies, Is there anywhere that they can go to learn more before they arrive in the US?

Cynara mentioned the modules, some training that she did beforehand. And there are a lot of times communication tools and information in those modules. So if you're working with an organization that gives you access to training before you get here, make the most of it to kind of get that baseline up a little more familiar with certain things. I also find that there's a there's a program from AHRQ, called team steps. If you look it up, you'll see there's a lot of great communication strategies there. And maybe we can post a link a little bit later in the chat where you can take a look at that. But it goes through things like s bar and some other structured communication strategies that all team members can use to be effective when they're giving a debrief when you're in a team huddle when you're calling about a problem. And it seems like the person on the other end is not understanding how serious your update is. There's tips and techniques in video format and examples that you can use from there. So in addition to those modules, that's maybe another site that might be helpful, but there's tons of stuff all over the web. about communication in healthcare. And so the S bar, very widely known even overseas, but if you're not using it consistently, start practicing using it now, so that when you get here, it's less of a leap to integrate that into your conversation.

Okay, Holly, some great advice. Definitely some good insights, and some good thoughts for nurses who are thinking, what can I even do now to prepare myself for working with physicians in the US, Holly, how long have you been working with international nurses?

I've been a nurse for 23 years. And after my first year, as a nurse, I began as a preceptor orienting internationals. And so I've never stopped working with them. But I've had different roles that I've played in my career working with them. So I love hearing about things like Cynara, asked saying that she had a preceptor who took the time to point out which physicians preferred what type of communication or frequency and things like that, because that tells me that's a preceptor who really gets how important communication is, and sharing those things without prompting is really exciting to hear. So if you don't have a preceptor who is actively sharing those things, it doesn't mean that they don't care, but it does mean you may have to ask, so getting tips from them on practical ways that they have integrated good communication with the physician so that you can learn from their experience is really important. So for me, every time I hear that a nurse is completing orientation and moving forward to be more independent, I know what a significant milestone that is. And it's really exciting when we as a team can help each other to be better communicators and better team members from the get go. But there's a lot you're going to learn only once you're here. So please take these tips and keep them in mind start practicing them where you can, and then you'll polish them once you're here.

Okay, thank you, Holly some great insights, Holly has been doing this for a long time a frequent guest on this show. So she has got a lot of experience. So thank you for sharing, Callie. So Jose Cynara you've both been in the US now for respectively, about two years and about a year. What's one aspect of working a physician that with a physician that surprised you or challenged you when you came to the US? Jose will turn to you first?

Yeah funny, because I would say mood swings, there are some physicians who somehow they portray, like their own character, characteristic as to that's why you have to fine tune as to what approach are you going to use do in trying to communicate with them? Like some physicians would rather have? You send them a short, secure chat message, rather than a phone call? Wiles of others would prefer a straight up phone call than sending secure chat messages. So it's a matter of knowing and yes, we have to ask and for tips from our colleagues at work.

That makes sense and was that something that you were used to dealing with when you were working abroad? Or was it more standardized abroad?

I would say it's pretty much the same. With regards to the individuality of the doctors that I've worked with, since it's very diverse, the doctors whom I've worked with, that makes sense, and that probably is going to happen in almost every industry or aspect of your life where you're going to get different personalities, different ways that people like to communicate with each other. And it's all about like you said, learning from your colleagues, learning what you can about those physicians how they like to best communicate what works best for them for you to figure out, what's going to be your best way to move forward. Thank you, Jose, very interesting. Cynara what about you? Was there any aspects that you thought were challenging or surprising about working with physicians?

From my experience, from my previous experience in Brazil, I think was more surprising in a good way. I think now they have much more trust on our work that I had in Brazil, for example. In the appreciation for when we do something that's good they say hey that was a very good move. Thank you because I had the two experiences, we have some physicians, they already know, all the patients and they kind of, they've been there for a while. So they know the patients almost basically since they was born so for then, I don't have much to say usually, I learned with them. And some others I already had physicians that arrived in nurse's station, say, hey, how is my patient wrong? This row oh, okay your patient is like this. There's this if you don't mind, I implement this order. Because the patient was an example his oxygen was dropping. So I, I took delivery to put an oxygen, and I also put the patient continuous monitoring. Now the patient's like days and days and days, we plan to titrate there, but Allah. Oh, perfect thank you. So that's the I think it's more like a colleague relationship, for looking for the best outcome for the patient, looking for a well discharge for our patient. Or I had a very recently situation with a physician, just exemplifying about what I said about the appreciation. I had a patient during rip report on emergency room. And the patient just started not being good anymore, was the situation was not good. And the physician was about to implement an order. And I remember something that happened before. And I said, no, just a second. And I did something else. And what I did my attitude, have to save the patient. Because he was forgetting something that happened before. So the next day, he arrived to me and said, hey, thank you very much for what you did yesterday that was very good. You save the patient and this kind of thing that I was not used to it, and was a good surprise for me. So these appreciation, and also, I'm someone that I asked questions when I'm not sure of it. Another day, the same in the yard as well the physician prescribing medication for one patient and I said, hey, I prescribed this medication for this patient. Are you sure you want this medications said, oh no, I want this medication for another patient. Thank you so that's what about I say about the teamwork about looking for the best outcome for the patient? Don't be afraid of to ask questions. So my surprise here was good.

Wow, that's amazing that's awesome to hear. And really I see Holly's clapping I'm clapping too. That's so great to hear. So for you, one aspect of working with physicians in the US that was surprising was actually a really good one. Because you experienced more appreciation and kudos to you for speaking up and saving that patient. At the end of the day, I think everybody's goal is to give better health care provide providing and be a better, you know, health care provider, make sure that patients are safe. So that is a very, very interesting aspect of for you. So thank you Cynara for sharing that. So I want to ask you both I know working abroad, it sounds like there are some things that physicians do that nurses don't do. And now you've come to the US and nurses have more autonomy. Can you talk a little bit about your experience with that? Have you found that to be true? Jose, you want to go first?

Yes with this specific example, like the clinical assessments I find is more devolved towards the RNs firsthand. I guess simply because we are at the frontline. You know, we get a massive amount of time to interact with the patients. And so our assessments are really deemed as very valuable. So I would say that the responsibility of the assessments are devolved towards the nurses.

Is that has that been your experience as well? Do you have anything to add to that?

Yes is basically my experience, I think we have more autonomy here, with autonomy comes more responsibility, of course. But that's my biggest difference from my previous experience for sure.

Okay, so thank you, Jose, and Cynara, for sharing your experience. If you're just joining us, we're on the Lefora Talk Show. And we are talking about working with physicians in the United States. So although this is one clinical aspect of moving to the United States, I think it is very helpful for a not a lot of nurses who are watching around the world, to have a better understanding, there's going to be a lot of different factors that play into your transition into the US, Jose and Cynara talked about their colleagues the where they live, and how that affects the transition. But we found that nurses that have more preparedness, when they come to the US seem to do a little better. So we are very happy to be here nurses helping nurses talking about working with physicians in the US. So Holly, I'm going to turn to you, how do you prepare nurses to work with physicians in the US?

In some part, it is going back to those modules and trying to give them examples. But I do and have done for many years, some clinical conversations with nurses as well. And a lot of times, I will ask them the question that you just asked, which is what do you do? And like day to day, what are some of the tasks that you're responsible for? And if I'm hearing them talk about things that are not part of their wouldn't be part of their role here, then I want to talk about those things. So assessment, if I hear the nurse say I do an assessment, I'll ask them to give me detail. And if they say, well, I'm looking at that, but I don't hear listening, then I say okay, what about a stethoscope? Do you have one? Do you use it to listen to lung sounds and heart sounds, because here, you will have to listen, you will have to identify abnormal sounds, you will have to document those usually at a minimum once a shift. And it's the whole set It's all body systems, not just what we call a focused assessment. So practicing those things, even if you're not allowed to practice it at work, practice it with your family, get a stethoscope while you're overseas, and start listening to lung sounds and heart sounds. There are websites that can give you examples of abnormal sounds. And we'll pop those into the chat in a minute but the idea is to begin to tune your skills in those areas. So that when you walk into a patient room, you have got the one piece of your uniform that today you may not have. But here a part of our uniform is our stethoscope, our personal one. So having that with you being ready to assess a patient, important blood draws, some of you say only the doctor draws blood. Well, here the doctors don't draw blood, I'd be shocked if I saw one in in a unit nursing unit draw blood, not to say that they're not able. But that's typically not something they're doing the nurse or a lab technician even may be doing that. Using central lines for blood draws and things like that the nurses do that. Versus overseas, I hear a lot of times I don't do that the doctor is the one who does that. Inserting nasal gastric tubes, they may have a nurse do it in an emergency situation where they currently work. And yet here, it's no big deal for a nurse to be the one doing that. And I very rarely see a physician on the nursing unit doing that. And even in some other areas not going to be doing that so it's good to explore your what we call practicing at the top of your scope. And in a legal sense It's going to be different here, what the top of your scope is versus what it might have been overseas and the more you can prepare ahead of time, like maybe you're allowed to do it. But typically you don't try and get some practice in. If you're auscultation at work and you're trying to fine tune your listening skills. Then I would tell you go look at the physician's notes and see if what they heard when they assess the patient is what you're hearing and ask them for tips and suggestions say hey, I want to be more comfortable doing this. Can you give me some ideas on how to listen or how to describe this or whatever else, so you have to start to think about what kind of preparation you can do this not just watching videos, or attending our shows, but also where you can try to put it into practice, or continue to watch and learn more and more, instead of just, I watched a video on that, good note, you got to start practicing and continuing to watch other resources as well.

Some good advice there. Holly, I like what you said about fine tuning your skills I'm sure some of those things like drawing blood or putting into herbs where it's not something that you're used to doing can sound very scary for an international nurse who is coming to the US and having to do some of these things for the first time. I see Jose kind of nodding his head like this so I think he agrees yeah well, culturally.

Holly, so what can nurses do to build their comfort levels in working with physicians in the United States

my biggest piece of advice is run towards it instead of away from it. So I've had and I'm sure we all have had interactions with physicians that weren't so positive. And from those we learn, and we grow, but we don't learn or grow if we run away from it. So I've had nurses who get so scared and nervous in those first few weeks and months that they are like, adding the phone to the Preceptor going, you do the goal. Don't do that practice, like Cynara said, rehearse, you can do roleplay, you can say, okay, preceptor, I'm going to call Dr. Smith. And I have to tell him about this thing that happened with the patient. And this is what I'm going to say, and this is what information I have. And this is what I'm going to recommend, am I missing anything and they can reinforce? Yeah, you're on the right track. Or they can say, I think you should maybe add this or change this wording or whatever. And those help you build your skills much faster than if you go, you do the call. And I'm just going to listen, that does not giving you the skills that you're going to need. And it takes you then more time to reach a point of feeling halfway comfortable. So sometimes you might be so afraid of using the wrong word that you just don't want to speak up at all, because you don't want to seem like you're not knowing what you need to know. But that also hinders your progress. So even if you're afraid, you've got to use some of the techniques that we're talking about, to try and grow that and also be a little bit vulnerable. So we've talked about this on other shows before, the doctors that you work with, some of them may come from other countries as well, they may have practiced, their profession overseas, or gained some insight in what that's like. And so sharing a little bit about yourself and your journey when you have the time rather than going that's Dr. So and so I he doesn't like me, because I made a real mess of this, that actually makes it worse. So as scary as it sounds, it's so important in those early days and weeks, introduce yourself, share a little bit about where you're from, get to know them as a person as a as a person first as a colleague and a team member next, so that you build that rapport with the physicians and the other, nurse practitioners and physician's assistants who may be you need to partner with very closely and have a good working relationship. If you don't, it'll come eventually, but it takes a lot longer. And it's actually a lot harder.

Good advice there. Holly, I think for all of our nurses who are watching might feel a little bit fearful about the new roles and responsibilities that they're going to be taking on when they come to the US. The best advice that I'm hearing from the show is to speak up, ask your questions, make sure you're fully understanding Jose, Cynara. And Holly all kind of said along the same lines, make sure that you are using your voice. So fine tune your skills, make sure you're using your voice I think that's all very good advice. So Jose, I know we are coming into a close on our show. But I have just one more question I wanted to ask both you and Cynara or a couple more questions. But I wanted to ask you, let's see how much we can get in. Jose, I wanted to ask you, how have you adapted to this these new responsibilities that you're taking on that were formerly you know, a physician's responsibilities abroad? Has that been a difficult change for you? How are you adapting to that?

I adapted to it by really working on or brushing up on my assessments skills, because that's basically what they want from us. Our ends is that how credible our assessment findings are. So there's one way for you to, the only way for you to do is really brushing up on those skills, making sure that we've discussed it earlier with regards to auscultation. So you have to be able to identify breath sounds, say, for example, and what are the things that you have to look out for. So, yeah, brushing up on your skills, that's, that's, that's really a must. And if you do that, it gives you self confidence. So it takes care about the fear of reaching out to the physicians or the fear of relaying pertinent information to them. And it takes care of the hesitation, I would say so.

Good advice Jose, I think for all of our viewers who are watching, that's some good insights coming from a nurse who's now been working in the US for two years. So you have a lot of good experience and good insight to share with our viewers. Cynara what about you?

I completely agree with Jose, when he said about the about our assessment skills, that's a must. I used to say that our body speaks for us. And another thing that I use is, usually the system has tools to help us to make decisions. So don't be afraid of using those tools. Oh, should I give this medication that's in there or not? Okay, probably have a tool to use and help us to decide if even though you don't, I'm not sure about what to do. I always have a charge nurse, I'm more experienced nurse that I can discuss the case and give something to the patient with more safety.

Okay, so good advice from Jose good advice from Cynara about using the tools brushing up on your skills. And that's how you are going to best adapt to the new responsibilities that you'll be taking on as a nurse. So I see we have a couple of questions in the chat. We're going to try and get to them before we close our show. So Anje says hi direct hire or agency. So if you are just joining us, we are here from AMN Healthcare International, where we have direct hire and staffing. So we have both options for you that's amnhealthcare.com/international. We have our wonderful nurses from both our direct hire and our staffing routes, who have both had good experiences both prospering now in the US and sharing their experience. So we're very grateful for them giving up some time, I'm sure you are both very busy. So thank you for being on today. And if you're watching, let's pull up that opportunities map, where we have opportunities all over the US, Jose's in Texas and Arez in the South Dakota, but as you can see, there are 48 Other states that you could be going to so opportunities in every state, whether you want to go with direct hire or you want to go the staffing route, AMN Healthcare International has opportunities on both paths, and our recruiters are on hand ready and waiting to help you find your perfect match. amnhealthcare.com/international. And we have got our link posted in the chat if you need it there. So let's see. We have another question from Lenny. Lenny, thank you for sharing so many questions. We're so happy about that. So Lenny says is there by chance that you've experienced bullying or harassment from physicians? How do you deal with that? So Jose or Cynara? Have either of you experienced bullying or harassment from physicians? Or maybe even not bullying, harassment? Maybe just a little bit of intimidation? Which I'm sure you know, there's a hierarchy when it comes to hospitals. Maybe you've experienced something like that.

Yeah, not maybe, but intimidation. Yes, both a perceived intimidation or intimidation by their own will. So, I would say my how I deal with that is that I would express to them how competent I am in what I do, and how sure I am. Of the things that I have to say or the responsibilities that I need to tackle. I just showed them what I can do. And they would sit, they would somehow, you know, ease up.

That's some good advice, Jose, I'm sure that probably happens a pretty decent amount where maybe you get questioned, or you're kind of second guessed. And in that case, it's good to have confidence in your answer, assuming you are confidence in your answer, but making sure that you are showing what your competence and doing and showing that you have strength and ability as well. So that's very good advice. Holly, do you have any words of wisdom for any nurses who might be scared about bullying or harassment and how they should deal with that?

Well similar to what I said earlier, don't run away. I've learned just in life and in this culture, that if there is anyone who is maybe being overbearing bullying, harassment, if not that I've experienced harassment, I will say intimidation, yeah, I found that the more I sort of shrunk into myself and became more timid, that personality type usually finds more reason to disrespect. And so on a personal level, I've realized that I need to be confident in what I know. And know that I'm doing it for the right reason, the things that I do and say, are on behalf of the patient. And sometimes, I may be in a difficult situation where someone maybe makes me feel bad about what I'm doing or what I'm saying. But at the end of the day, I'm trying to do the right thing and use my best clinical judgment. So when I avoided some of those team members, be it a physician or somebody else who was maybe not the most collegial. That was where I found that those relationships actually got more and more strained over time. It's kind of like we have a joke in nursing, that when you have like, you guys may know what Joint Commission is. But when Joint Commission comes, you've always got those nurses who are like I have to go the restroom when they see the surveyors coming It's the same idea. If you're running away, it's actually gonna make it worse. So that's really important to me. The other thing is, if you are experiencing bullying, harassment, any kind of inappropriate behavior, your employer has their own set of expectations and standards for behavior for everyone who is working in that facility. And so they are there to support you as well. If you don't disclose, if you don't speak out, you can't get help. And sometimes those individuals who are not being appropriate, they need help, too. So if nobody says anything, to confront the issue and say, this person is not being professional, they are maybe they're being a bully, or they're harassing me, and I'm uncomfortable, and I don't know what to do about it, but there's got to be a resource there are. And unfortunately, the longer that goes on, the worse it can become. So really facing it, using resources that you have. And also not running away is really important.

Okay, so some good advice from Holly for you there and Lenny on how to deal with bullying or harassment head on. So some good words there so we are almost at the close of our show. I want to give everybody one quick opportunity to share any one piece of final advice for nurses who are watching how to best prepare for their transition to the US and working with physicians. Jose will go to you first.

Yeah, I would say just increase your knowledge and be prepared. Study in advance, know where you're going to be assigned. Expect the issues or the 10 challenges that you're going to tackle. Yes, those are the points that you nurses who want to ensure transition here in the states would really folk need to focus on.

Thank you, Jose, for sharing and thank you. I love seeing all of those pictures of you having fun in the US in your scrubs at the hospital. So thank you so much for being on and sharing all about your experience. I'm sure it was very helpful for our nurses. Cynara any final piece of advice?

Well, before arriving the rest, I would recommend a person to identify your weakness is your weakness communication is English. So work on that there is always a room for improvement. After arriving here, I will do the same. Identify your weakness is an assessment is a communication is the English, work on that, and do not be afraid of asking questions.

Thank you Cynara great advice for our nurses watching around the world. And I see Evans we had a question about accents. If you scroll back in our show, we actually talked about accents and different terms. So you can see all of our advice on how to break that barrier. But I just saw Cynara touched on the English and I thought we would just quickly address that question. So thank you Cynara, some good advice, love soothing seeing those pictures of you exploring the US living your best life living the American dream. So thank you for coming on and inspiring our nurses. And last but certainly not least, Holly, any one piece of final advice.

I think make sure that you remember why you went to become a nurse in the first place. So most of us even if we have a good living, or we enjoy doing something highly technical or something like that, that purpose, ultimately we are using to benefit others. And when we look at the healthcare culture here and the opportunity that we have to be autonomous, and to practice at the top of our scope, and work with physicians, as colleagues, if we focus on that as our purpose, all of the other things do come together because we're pushing towards the same goal. So you're going to be a patient advocate, you're going to be a gatekeeper, you're going to be a team member, you're going to be a clinical expert. And you're going to bring all of those things to bear for patients to have better outcomes. And for you to have a solid clinical career here in the US. So prepare for that as best you can. And when you get here, look for those opportunities, seek them out, don't wait for them to come to you. And that will help you make that transition happen a lot more timely, and more effectively.

I think that is a great place for us to end some good words of advice from our clinical nurse educator who has been with us and been working with international nurses for almost two decades. It sounded like so a lot of experience there. So thank you so much, Holly for being on thank you to Cynara thank you to Jose, if you were inspired as I was by any of our esteemed panel today, and you would like to come to the US and reach your American dream. You can apply at amnhealthcare.com/international . Our recruiters are on hand ready and waiting to take your applications ready to help you with direct hire or staffing placements. And then is the only company that has both opportunities available for you. So we are excited and ready to help you. So before we go, we're going to take a look at our show schedule on the admin healthcare page and the love for top show page. So we have upcoming shows at 7am Pacific Standard Time on our AMN Healthcare International page. We have March 1 Career Day, we are going to be showcasing different employers around the US. It's their chance to sell themselves to you. On March 22 we have our monthly Q&A with our esteemed legal experts. So bring any questions you have about immigration retrogression, whatever it may be. And on March 12, we are back here for the Lefora Talk Show. We are going to be talking all about the met for international RNs. So we look very forward to that, we also have our AMN Academy which are upcoming shows every Monday at 5am Pacific Standard Time on the AMN Healthcare International page with our partners IPass Swoosh, 9.0 Niner and Aspire RN. So those are free classes for you to take and avail yourself of on our page. So thank you so much to our panel for being with us today for inspiring our nurses for sharing your experience and just wish you both well wish you well Holly and thank you all for being here today. Onwards and Upwards everybody until we see you next time bye bye.