Med-Surg Nursing in the USA

Hello Leforans and fellow nurses. How are you this evening or this morning? Depending on where you are in the world, my name is Holly Musselwhite. I am the clinical nurse educator for Connetics USA. And I'm so glad that you're joining us for this session on med surg differences, clinical differences between nursing internationally and the US. So we have a couple of experts here with us today. I'll introduce them in just a moment. They're popping up on the screen now. So a good morning to the two of you. I know you guys are in the US. So Mark Jones is joining us from am International. And Carl DeLa Santos joins us from Missouri. And he is a Filipino educated med surg nurse who's also had some UK experience, but I'm gonna let both of them take a moment and introduce themselves to you. So, Mark, we'll start with you.

Thanks, Holly. And happy to be here with everyone today. As mentioned, my name is Mark Jones. I'm one of the clinical managers here in the offices at O'Grady Payton International, worked closely with our nurses as they transition here to the US and get used to those clinical practice differences. And I'm very excited that Carl has joined us today. So curl lets you give a quick introduction about yourself as well. Hello, good morning, everybody. My name is Karla Santas. I was educated back in the Philippines. After graduation, I was hired as a clinical instructor in one of the universities in our region. And then I worked in St. Luke's Medical Center coronary care unit for over two years before I moved in UK, where I spent 15 years of my nursing career. I worked in general surgery, vascular surgery. And when the dedicated infectious disease unit open up at the Royal Sussex County Hospital where I was working, was one of the new nurses who started that word until 2021. We move in America July 2021. And started working as a med surg nurse, Mercy south here in St. Louis, Missouri.

Awesome. Thank you, Carl, I appreciate you sharing that with us. It sounds like you've got a lot of great experience. And so I know your input is going to be really helpful. I should mention I am also a med surg nurse by practice. So I understand a little bit of where you're coming from as well. So those of you who are joining us today, if you want to share in the comments, any questions you might have or where you're signing in from and watching from today. We'd appreciate that. Again, thank you to everybody who's joining us. So now that we've introduced ourselves, and we've let everybody know that we're going to talk about med surg nursing. Carl, you mentioned you were an instructor in the Philippines. But did you have any experience in helping nurses who maybe were going to go to work or train in med surg? And what was that experience like in the Philippines for you? And then if you'll share a little about the UK with us, that'd be great.

Sure. To start with the curriculum of Philippine nurses is almost comparable is almost the same with Americans. So we have a 444 year course a bachelor's degree. And we it's also a didactic course willing to say it's both a combination of classroom manage a classroom lecture and a hospital exposure. In the UK, it's a shorter course they do it two to three years. So like, like the American setting, we study everything from med surg, from adult to pediatrics to psychiatry. And like in the UK, when you start your nursing career, you determined straightaway, what do you want? Do you want to be an adult nurse, then you only study adult nursing, you want to be a psychiatric nurse, you only study psychiatric nursing, or whatever. So nurses in the Philippines are put through a rigorous training. So I can say that probably one of the reasons why. Most some Filipino nurses are beloved and nurses they say are well versed when it comes to their skills and attitude. Caring is already part of our culture. So they skills is we learned it a lot during our exposure to all different hospitals. And of course, the setup in the classroom.

That's great information. So yes, we see Filipino nurses coming out with a very well rounded training. You see the same textbooks that US nurses are seeing when they're training, although arguably from a different time period, depending on when you became a nurse. But you know, we all read Good knows those authors, because they continue to update their texts, and we continue to use most of those popular well known ones. So um, what about orientation? Well, actually, we'll get to orientation in just a minute. What are some of the things that you see different in working in the USA versus your experience overseas? Are there some like glaringly obvious things that you've experienced that you've had to adapt to?

Yeah, when I left in the Philippines, I worked at St. Luke's Medical Center, they provided us with a 10 weeks course of orientation. It is coupled with six weeks lecture and four weeks on the floor exposure. When I moved in England, it's a different story. So they provided us we the bridging program, it's a six month Bridging Program. However, after the six month Bridging Program, once they issued us our personal identification number by the Nursing and Midwifery Council, they the hospital only gave us a couple of weeks orientation and pretty much you're on your own. In contrast, with the orientation I got from the hospital, where I'm working now, it's also it's comparable to the orientation I got from Philippines, which is almost eight weeks orientation. So it is coupled with an online courses, which is very popular right now. And of course, face some face to face training when because I came here almost Adama. Me they start at the middle of the Omicron variant when it's kicking in. So we still pretty much tight when it comes to lockdowns in May and then yeah, slowly.

And then it's a proactive orientation where the manager is always in constant contact with us in asking us how are we doing? Do we need more time, things like that. But because of my extensive experience in the past? It's, I professionally tell them that I'm almost ready because the only thing that hinders me or slows me down was the electronic. Electronic medical records we because in the UK, it's a do I spend a lot of time in UK we it's still much paper base, it's half. It's a hybrid system that we use there. Unlike here, everything is done online. So it was a major obstacle for me. But then Well, as we notice, we always say a web provides. So we have to make our own way to get through it. That's absolutely correct. Yeah, changes the only constant. Mark, from your experience. Why is orientation so important when it comes to the nurses transition and training here to the US? Yeah, I think you know, as Carl kind of mentioned, their orientation is crucial as you transition here in your journey to the US because there are going to be so many different practice differences, different equipment, different policies, procedures, or culturally there may be some items or interventions that you were not allowed to complete as a nurse in the country you're currently working.

And then when you come here in the US, it may be, you know, a basic expectation of your nursing care. So that's where we really focus our time and efforts in your orientation process both pre arrival to the US. And once you've begun working here in the US, we want to make sure you know both the Connetics and OTP teams that were getting you that support that you need. If you have questions or concerns that you're reaching out with us, if you want some extra resources on a particular item that you let us know, and we can get you videos or reading materials, or sometimes even do a one on one teaching session with you. And all at all, your orientation should last quite a few weeks. You know, we want to make sure that you're getting a thorough orientation. And if you feel like you're not getting that orientation and your current work setting here in the US, then that's where we can jump in and help advocate for you. If you know we think we need a little bit more time. Or maybe we can do some help and teaching with you to help you feel a little bit more comfortable coming off of orientation. I'm sure Carl, you can probably back this up. There's always a little bit of fear as you're coming off orientation for the first time, right? So everything's new, you're finally on your own you were probably an expert in your previous setting and now you're feeling a little bit more novice than the role. So we want to make sure that you have that support that you need and get you those resources over to you as well.

Thanks Mark. So I do see we have nurses from all different locations. We have Gina signing in from England and Jessica is from Jamaica, but currently living and working in Canada. So she's a bit of a traveler as well. Christine is joining us from Davao City in the Philippines haven't had a chance to get out that far yet. But hope things are going well for you this evening. And thank you for joining us. And if EMA says he's she's glad to be on the forum. And we're glad you're here with us. So thank you so much. Mildred is joining us from Dubai. So we got quite a variety of locations joining us today. Um, so mark in follow up. What should a nurse expect on average of four and orientation in a med surg setting here in the US, and then, Carl, if you have anything to add, we'll jump to you after Mark shares just sort of the general information. So every hospital is different here in the US in every unit, we even within the hospitals are different here in the US, your orientation should be tailored to your to your needs, you know, your learning style, different practice differences that you may have been coming from that you need to pick up and learn now here in the US as a nursing responsibility. As a general rule of thumb, though, you know, what you can anticipate, especially as a med surg nurse, ideally, around four to six weeks of orientation potentially longer.

That four to six week recommendation is kind of what we give to the different hospitals we work with as a best practice as a minimum timeframe for orientation. But once again, your practice setting may vary vastly from another international nurse that you're working alongside of at your new hospital. So perhaps, you know, you're coming from a very well equipped hospital in the UAE, that you've already been there, you'd have a lot of us type equipment, you have Cerner epic that you're using as an EMR. But maybe you're maybe a nurse coming directly from the Philippines where you're still kind of more accustomed to that paper charting. you're calculating your drip factors, you don't have an IV infusion pump for your basic medications on the medical surgical floor. So that's why there's not a hard and fast rule of your orientation has to be a set amount of length. But that is why it's crucial for you to have that open communication and open dialogue when you are working with your preceptors. And managers and educators here in the US, really letting them know what you need help with, but also showing your confidence and where you have great skills already.

You know, if you're confident in a particular intervention or particular skill, there's no need to ask, you know, two or three additional clarifying questions on that item, when you know what you're doing. You want to make sure you're coming off competent in those areas, but being sure to speak up and do ask questions and those areas you're a little bit more unsure of. So I think that's my key advice for that particular type of situation and orientation as it comes up. And then knowing that you should have several weeks, at least at a minimum as you work your orientation. Now, Carl, I'm sure the hospital that you're working at, I know that is probably a little bit different. And I think you got a little bit more timeframe, if you kind of want to elaborate a little bit of like, what your orientation looked like here in the US. Yeah, my orientation here, yeah, as you I think it's six or seven weeks, so and it because my most of the equipment here that I was shown here are pretty much familiar with, I wasn't pretty much familiar with it. So he, it took me a while it didn't took me long to adjust. It was only through the epic that I really struggled. But Epic is just like a Facebook where you will find your own your own way through it.

So what else and of course, the policies differ from one organization to another. So it is our professional duty towards ourself, towards our patients who are our clients to be familiar with all these policies. Because if we are familiar with all these policies, it makes things easier for us. And of course, I always tell it to my colleagues who are from other countries because back in England, I was a band six nurse, so I was looking after Junior nurses. And some of the Filipino new nurses also comes there. I always tell them to bat themselves engaged with other culture because by engaging with other culture, it will make things easier for them to transition to another country. The tendency of Filipinos and other nationalities in Japan's like the Ghania's they tend to clump to each other they tend to stick to each other. And I always tell them in the long run, it's not going to help you justice because you will you will not be working with them most of the time or all the time so you will need to be engaging with the others. Because if you don't know how to operate a certain equipment and you're working with only the agents if you don't know how to communicate with them, then you're stuck.

So you should be able to understand Under culture, be able to communicate with them professionally and properly because that will make your things life easier. Another one is communicate in a professional manner. Because though we have different cultures, we need to be very sensitive how we communicate with others, because some cultures, they tend to speak louder. Some cultures, these tend to be more reserved, like as Filipinos we are more reserved. So you can only achieve all these things and you can make your time things life easier, especially during orientation. If you are more proactive, rather than being receptive, you need to be productive you need, you need to dance on your own dance floor. That's what I'm telling them. You need to show what you've got. But you need to be sensitive not to be too cocky as well. Thank you, Carl. That's really good advice. And I think that you mentioned that cultures tend to gravitate towards similar cultures. And that's very true. It's our comfort zone. But I also know that the Filipino culture is very warm and welcoming towards other cultures. So it's good to kind of have that balance where you say, Okay, I know someone who may have gone through what I'm going through or come from my home. And that's, that's great.

But you're right, reaching out is really, really important. So I do have a couple of questions that have come up around. How can you apply? Or how do we recruit. So whether you're a med tech, looking at maybe transitioning to the US or a nurse, regardless of where you're trained from, you can go to Conneticsusa.com/application, and submit an application, we can look at your qualifications reach out to you if we need more information, and then, you know, see what we can do to partner with you or give you some suggestions for how you can move forward. So, again, the website is also posted in the comments, and it will pop it up here occasionally throughout the discussion. I see SIAC is joining us from I hope I say this right les take Philippines. Maybe Carl, you can correct me on my pronunciation. Yes, that's right. Yeah. Okay, good.

I try. So, um, anyway, one of the things that you mentioned was you were a band, six nurse in, in the UK. And actually, that comes up quite often that in many countries where nurses are practicing, they're practicing where there's a little bit of a hierarchy or levels, if you will, senior nurses, Junior nurses bands in the UK. And actually, sometimes that's a little bit of a surprise when they get here. And when they come off of orientation, there really aren't layers. There's you as the primary nurse. So can you talk a little bit about that, Carl and your experience? Yeah, in the UK, that that we have in every word there is the general manager and then under the manager, there is the band six nurses, which are the juniors, some call them the charge nurse. Some call them in the traditional way Junior sisters. So basically, you help in the daily running of the of the war. So you do the allocation, you make sure the right, patients are allocated to the correct skilled nurses, things like that. Unlike here, everyday does the most senior nurses are always elected to become the charge nurse for the shift.

However, the primary nurse for every patient issue, so everything that happens to your patient, from lab result to your assessment, to your proper committee and proper and timely communication to your doctor, it's basically you as the nurse now, technologies are provided with us to properly communicate everything to the proper doctors and the proper clinicians. The hospital where I'm working, we are provided with a zebra phone where it is basically a pocket phone, a pocket computer, it's a phone as well. So anybody doctors who are looking after your patients or any team members can directly communicate to you. It is also your handheld computer. You can scan your patients respond you can give meds via that phone. You can read notes or put notes via that phone so everything is our within that within that simple it's like an iPhone size. So what else so yeah, you do everything you do your assessment. For those Filipino nurses there I'm always telling them, familiarize yourself with the assessment because assessment from head to toe is basic here in America. auscultation is a must. So you need to familiarize yourself I know you're doing it already. So invest well in the stethoscope. That's the only thing I can say. Yes, all my life here in all my nursing career life here in the US, we've always kind of parented something similar, which is, the stethoscope is part of your uniform. And it's not just meant to be sitting on your shoulders, you're expected to use it and be very skilled in using it. Mark, what are some of the other responsibilities that a med surg nurse should expect to have, in addition to what Carl has already shared with us?

You know, those are all great tips. And I definitely can't reiterate enough, you know, that auscultation piece that head to toe assessment piece, you know, we know that many of our nurses that are coming here to the US, you're doing those skills in some aspect, either regularly or sometimes not as regularly depending on the ratios in the setting that you're working in previously. So you definitely need to know that when you're coming here to the US, that's an expectation for every single patient, every single shift, doesn't matter how many times you've had that patients for how many days in a row, you still have to document that you've completed that head to toe assessment with auscultation, even if the auscultation is normal, or within normal limits or normal parameters. You know, I think some of the other aspects to keep in mind as a med surg nurse here as you transition to the US is the autonomy that you're going to have to make decisions to really critical think in, you know, call the physician, sometimes you're gonna call those physicians in the middle of the night, if you're especially working at night shift. And you're gonna say, you know, here's the situation.

Here's the background, here is my assessment. And here's my recommendation on what you need to take as far as the maybe a medication suggestion or an intervention suggestion. So you may call a physician in the middle of the night, they're going to ask you Well, what do you want for the patient. So it's up to you to have that autonomy as the nurse, regardless of your setting, it doesn't have to be med surg, this could be labor and delivery, it could be ICU emergency department, you know, you want to make sure you feel confident in those skills. And that once again, goes back to that orientation period where you need to be confident and building those skills with your preceptor and your educator. Some of the other differences that you may have, you know, for example, you may be coming from a setting where it wasn't your responsibility to insert nasal gastric tube, or maybe it was not your responsibility as a female nurse to insert a male Foley catheter, that is definitely going to be your responsibility here in the US. So some of these little practice differences that might come up, obviously, you know, depending on your setting, there's going to be a number of them. But I think the keys are your basic assessment skills, your auscultation, as Carl mentioned, your autonomy, your willingness to be a patient advocate. And you know, your willingness to make those decisions in collaboration with your physician, or your advanced practice providers, rather than waiting for those advanced practice providers to tell you what actions to take.

Right. And I think the other thing that you may, I don't know, Carl, if you saw this as a something different or not, but some nurses are surprised that the physicians are primarily going to be someone that you call versus having them maybe sitting at the nurse's station are a little more accessible and hands on. And that's part of the reason that those assessment skills that the nurse has, and uses are so important is because you become the eyes and ears for the physician and you've got to be able to articulate those things, those high points really quickly, you know, I don't know that they hand out a lot of skill focus in med school on patients. And I do mean like being a patient person rather than a patient in need of care. But it's really important to be prepared that you are going to have to use a phone system and other messaging systems that hospitals may have. So a couple you mentioned, there's a small phone that that you carry around the size of kind of an iPhone, and that kind of is a one stop shop for a lot of different things that you're doing. Some hospitals don't have those. But they do have other technologies available, including instant messaging to physicians through secure portals and things like that might be used. So it's, it's just really important to kind of mentally prepare yourself. But if you're feeling nervous about making phone calls to physicians, what are some of the things Carl that you might do to prepare for making that first one or two phone calls and relaying information to the doctor?

There is this system. It's a beautiful system that has been developed by clinicians. It's called the S bar. Where it is stands for Situation background assessment and then recommendations. So you need to have before you call in any doctor, you need to know what's the situation, what's the background of the patient, and what's your assessment and then you do your record recommendations. You just don't pick up the phone and call the Doctor at the middle of the night with all incomplete details because otherwise, they might get upset some clinicians are proactive. Filipinos Filipino nurses back home that our culture is we are receptive with the doctors. So it's mostly a doctor given Dr. Dre driven show. However, moving to a Western country, both UK and here in USA, we nurses are more productive. It's just like the saying, for every good doctor beside is a good nurse. So we are apart, we are very clear, crucial when it comes to the decision making on what will be the plan for the nurse for our patients. So we work actively in conjunction with doctors it's not it's a two way process. So when you call a doctor, make sure you have all the data in front of you so that when you make your recommendations, and then you have a strong standpoint.

Thanks, Carl. And Mohammed, I see you're joining us from Bangladesh. Glad you're with us today. Amy is very appreciative of the information about orientation and medical surgical skills checks. She says what is the standard immigration wait time after your documentary qualified? So I'm not the immigration expert, I can tell you that. You know, there's kind of an average of I think around seven months or so six to seven months from DQ. Carl, did you did you have a similar experience? Or was it a little different? It was almost similar because I pre start processing my paper 2019 But then March when COVID arrived in UK, so we have a very the hardest lockdown in the whole world. So it took me just over 16 months, the process just over 16 months. Yeah. So um, we do have some information available on the Connetics USA nurses recruitment agency website about the immigration process. And there's also a resource that we can maybe drop into the chat that's a booklet about immigration and the process and the steps. I see webby, you you've mentioned, med techs and lab tech. So again, you can apply to Conneticsusa.com/application and get more information. We pop the web address up there again, we do have a program for med techs and so may find it something that will work for you. Thank you for asking. Jessica says how do you find communication between doctors and nurses in Jamaica? The doctor nurse relationship is very poor, important communication is open and easy. And as far as used and Carl, you and Mark actually highlighted some of those communication tips and skills. Is there anything else you want to add? Here? Are you think we've done a pretty good summary for Jessica?

Yeah, I think we've given it a good summary there. Jessica, I think the best thing to keep in mind is knowing your communication style, a verse knowing what the communication style of your work setting is like, yes, for example, as Carl mentioned, sometimes our Filipino nurses a little bit more reserved in their communication style. Sometimes our Jamaican nurses a little bit more direct, as I'm sure you can attest to as well. So you want to make sure that you understand the person that you are talking to not just the information that you are giving. And I think that will help your communication. And one thing I would probably mention and Carl, I think you've kind of started going towards it is you must be the one who drives the care here in the US. You know it? Yes, it is a collaborative approach. It is teamwork approach multidisciplinary in nature in terms of caring for the patients that as they nurse, you are the driver of that care. If you see that something's not going right, you need to speak up and mention it to the providers. Or if you're having trouble with those providers, then you follow that chain of command and you escalate up to your charge nurse or your manager whoever you need to, to make sure that you were advocating appropriately for that patient.

Thanks, Mark. That's really good advice. We also have a couple of nurses joining us from KSA or Saudi Arabia, Moshe and Dennis, thank you for joining us and we hope you have a great day as well. Raffaele says Hi there. Do you have any advice for nurses who've been away from the bedside for 10 years and are considering I think you've been returning to the practice? Raffaele So you're watching from Vancouver but you're a Philippine educated nurse. So I don't know the ins and outs for Canada if you were to look to go into practice there to return to nursing practice. What I can tell you is that if you're interested in coming to the US to work as a nurse and If you're looking at what's desirable for hospitals here, they absolutely like to see that you have one to two years of experience in a hospital setting that's current, that's desirable. We do see some hospitals and other settings now will who will consider nurses who may not have recent experience, but that can impact what they may be able to offer you. And it can also make your transition to practice here in the US that much harder. So it is pretty important to try and get back into to nursing practice, preferably for most hospitals that you actually have that in the hospital. med surg nursing is highly desirable, as are all other profession settings right now for nursing. So I'll say that, as advice, I don't know if there's anything else mark or Carl would like to add?

Yeah, definitely need to make sure you're getting the acute care experience coming back to the US doing a one to two years minimum. As Holly mentioned, you know, there may be some different programs between Connetics and overdue Peyton that you could potentially explore. But it's going to be a harder transition. And you may not necessarily qualify for those minimum recruitment standards. So definitely would encourage you to practice as a registered nurse in an acute care setting, you know, make sure it's a good hospital, you know, one that would qualify for either program. Carl, I don't know if you have anything else to add there? Yeah, definitely, you need a little more experience, because it's not just for it's your professional duty towards yourself and your professional duty towards your clients. So you need to be able to equip yourself with the right attitude, knowledge and skills.

Absolutely. And so the other thing is, some of you may know someone who is looking to make the transition to practice in the US. And if you do know, a nurse who has passed the NCLEX Connetics, currently has a $1,000 referral bonus details for that can be found at Conneticsusa.com/referral. And that information is also in the chat if you're interested. So just keep in mind that if it's you or somebody else who's interested, we do have a way to reach out to you and connect with you. If you go to the website. As Mark mentioned, sometimes there are certain opportunities for people who don't have recent clinical experience, but those are very limited. So again, get back into it, get some acute care, spirit experience, that's, that's probably going to help shape your experience when you do transition to the US for the better. Alright, so Jessica, you mentioned in Canada, you've seen in practice, doctors are often annoyed by you. As far as a no. How do you find communication in the US? Our doctor? Nurse relationships? Good. So Mark, I'm actually going to have you answer that one for us, please.

Yeah, let's get I would say, you have to build relationships with anyone that you're working here in the US, yes, there's a certain level of respect that comes baseline in terms of communication. But I personally would say that the interactions that you have are great with your physicians when you work as a team. So you want to get want to be kind of mindful of the way you're speaking. You know, Carl mentioned that, you know, knowing what you're talking about, when you're going to them, you know, you want to show that you're a subject matter expert on your patient. That is your patient, you should know the most about that patient at that time. So when you show that, you know, those baseline fundamentals that we would consider here in the US that really helps improve that relationship. And it helps build that trust between provider and nursing staff. And once you have that trust, the communication becomes way easier.

Absolutely. So the other thing is we kind of mentioned layers of nurses. But in the US the  interdisciplinary team here is a little bit flatter by structure. We see physicians relying on nurses to bring their A game and their input. And there are also other members of the team who may have things to share that when you do huddles with the interdisciplinary team, or you're receiving, you know, some information maybe from someone who's not a nurse or who is who is not at the physician level, that that input is still considered very valuable. Carl, do you work with any, any other team members in the interdisciplinary team who are you know, bringing you information about your patients that you're wanting to use and make sure that you kind of take that into account? Yeah, we work with respect authority therapists, for posts of patients, we work with the physical therapist and the occupational therapist as well. What else there's some like wound care team, IV teams, so you need to be able to communicate with them properly.

What else. And as we have mentioned while ago, you need to know your patients well, so that when you communicate to a doctor, say when a doctor orders two bags of food, or pack RBC to be given overnight, and if you know your patient will be because you read well, the history that this patient had congestive heart failure, things like that with a poor renal function, then straightaway that you will be asking for a standing order for a lay a 10 milligram to be on site in case the patient is start developing congestion. Because if you fail to pick that up, and then at the middle of the night, you're giving your bloods you will end up calling the physician will be like just for a 10 milligram Lasix, then, of course, sudden patients are not going to be very happy. You should have picked it up earlier. But of course, but the facility where I'm working right now, they have these virtual nurses, it's an extra pair of eyes and ears for us nurses who are on the floor, who picks up things that needs to be considered. And when they pick up something, they always make suggestions to you and for junior nurses or newly qualified nurses is very helpful because it gives them I said, an extra pair of eyes and ears and it all it's very helpful because yeah, when it gives you direction on how to deal with the patients, so but not all facilities, I believe they have this virtual nurses who are kind of on the background, monitoring every abnormal lab results or, or any abnormal trends on a patient.

So that sounds like something unique, but could be very helpful and kind of keep you on top of things because you can't be everywhere all the time. So having those extra eyes and ears is important. Mark, I know some facilities also have nurse techs who are sometimes called nurse's aide and in some locations, so how do you see that role interacting with the nurse role here in the US? Yep, so that kind of goes back to that multidisciplinary team approach that we were speaking about. So you may hear called a tech nursing tech, a patient care assistant, PCA are lots of different acronyms kind of depending on their work setting in the client or the hospital that they are working for, in terms of what their official title is, that this person is here, you know, to help you with some of those activities of daily living, that, you know, they can get some vital signs for you. Pretty much you know, any of those non invasive procedures that they can help you with they can.

Now what I would say is usually there may only be one or two texts for a 30 or 40 bed unit. So their time may be split amongst all those beds. So kind of being mindful of how many asks of them, you know, is this something I can easily complete by myself right now? Or is this something that I should delegate out, because I really don't have the time, but I know that it is within their scope of practice to complete. So they can be a great asset to your team, you know, once again, building that trust and relationship with them as a collaborative approach to your patient care. You know, you may go in and you come in and you say, hey, you know, I am working with this tech today. Maria, can you come in and help me with the bath real quick, I think if we both do it, we can get it done in about five or 10 minutes rather than one of us taking 20 or 30 minutes to get it done. So you want to make sure you are talking to your techs early on in the shift that you are developing a plan of care for all of your patients and then understanding what other responsibilities that that Tech has as well to another nurse to another patient, that you need to be mindful of to make sure that they are completing all the items that they need to complete on their end. So it's kind of a collaborative approach.

Thanks, Mark. That's really good advice as well. Paul is joining us from Ghana and you are a Connetics nurse. So that's awesome. Paul, we're glad that you're with us today. Lovita says Hi, our NICU nurses also in demand in the US. Thanks. Yes. So there are you know, some areas of the US have a higher demand than others for some of those more specific specialties if you will like NICU, but we do find that there's very few settings that I can think of that aren't in high demand. So Lovita you know, we welcome your interest and hope that you'll keep moving forward to look for an opportunity here in the US. You NSF as a as a nurse communications important to deliver the best quality care to your clients needs, especially to doctors and nurses. If you're unsure about the procedure or the things you do, just don't hesitate to ask. That's a really, really important point, we're probably going to hammer this one pretty heavy today to asking or speaking up is so important if you feel nervous, uncertain. Carl, have you had experiences where you know, you had to think I'm not sure about this? And how did you handle it?

What as a band six nurse back in England, I always tell my the junior nurses before this, this is my ethos in life. If you're in doubt, do not ask. Resolve that out before you ask. That's the safest thing to do. If you're not sure of anything, always ask. You don't wait until you mess up or hurt somebody, we are not dealing here with paper you are dealing here with humans who can be hurt psychologically, physically, before you do something, if you are mature, it is always wise. And it's always nice to communicate and as somebody who had prior experience to this one. So that's why I'm always telling people to beat yourself with the other culture in get involved with the other culture, that's the best weapon you can have. There's no such thing as pure Americans, pure Filipinos right now, we are now living in a melting pot society. So that's the best way you can do.

Right? And there's a lot of great resources, probably know, some, some hospitals, actually most hospitals within their electronic medical record, they have certain things that you can reference, if you don't know what the medication is, you don't give it until you know, but how do you find that quickly? So there's usually some quick wit reference links and things like that. Do you have other resources that you have used to look up information or, you know, verify you're on the right track with things? Yeah, I'm in the in our Mar. There's the so called micro medics where if you are not sure of any medication, you just click it and it gives you all the information. And there is also this policy Tech where all the procedures are re are written or read our source of via Kaplan so Kaplan is our famous books in the nursing school. So when you click it, it's all the procedures are there. And it coincides with the hospital policy. And one thing good here in USA is they said, all the packs here are designed by nurses. So when you open say a catheterization pack, everything you need is there. And it is number with step by step, what procedure to do things like that until you finish it, which make things like easier for nurses.

So for those new nurses out there, everything here will be provided with you the easiest possible way. So don't be don't be don't be so scared. So what else? Say if you're going to give a certain medication, if the computer highlights everything, say when you give Metoprolol it will ask you whether did you take the heart rate, make sure you check it and you don't give it below 50, things like that. So there's always check and counter checks happening within the epic or within the computer system. So not unless you override it, then then something can go wrong. So you it makes you thinks critically all the time. So yeah, yeah, yeah, it's really even though it's an adjustment to get used to the electronic medical record. At the same time, it takes a lot of the guesswork out of it for some of those important parameters that you need to use when you're caring for the patient, or you're doing medication or a treatment. Jessica says how are patient rounds done? Is it done at the bedside with doctors and nurses? So Mark, you want to talk a little bit about that.

So I'll touch on it. And hopefully, Carl, you can confirm it's still done like this, since it's been a few years since I've been at the bedside now. But generally speaking, for the various specialties, various units, rounds are usually done about the same time every day. It's typically a team of care providers. So could be your physicians could be a nutrition expert. It could be you know, a social worker, case manager, you know, various team members rounding on the patients, they talk about that s bar once again, kind of going back to it. That's how it starts. You know, who is the patient was the situation, what's their history, like? What are our current assessments and what is our plan going forward? that is generally how the rounds go. If you familiarize yourself with that SBR process over and over again, participating in these rounds will be much easier. And I see your emphasis there, as it done with the doctors and nurses. Yes, the bedside nurses should be a part of the rounds for their patient.

Now, obviously, if you're in an urgent situation, and another patient's room, and the physicians or doctors or whoever are rounding on another patient, you tend to that urgent issue going on with your patient, your charge nurse or your colleague, you know, in the heads of the patient rooms next to you can kind of listen if they need to. But there should also be some notes within that EMR system on the patient rounds for the day that are published by the physician at some point, I would add that typically, the nursing notes and finish physician notes are completely separate. So that's once again, where it's important for you to be confident in your skills and your assessment skills. You know, the physician is not necessarily looking at your assessment skills to make their assessment skills and vice versa, you should not be looking at their assessment to make sure that matches yours. You want to make sure that what you were assessing and what you're looking for matches up with what it was for that previous nurse, are there any differences, and then that's where you bring those differences up in those rounds. So let's say that, you know, the patient was alert and oriented overnight. And this morning, you've noticed that there's some slight confusion, you want to make sure that you're bringing it up in rounds, if not communicating that to the physician a little bit sooner.

Thanks, Mark. Carl, similar experience for you and your facility. Yeah, definitely bedside report should be given because the patient should be able to participate during bedside report so that whatever your plan for the day you whatever you're planning for the night, the patient will be aware. So yeah, it's a it's a must. Yes. Thank you, Carl. So Marianne, is a Filipino joining us from Riyadh today, and Abby, is joining us from Ghana. I have another question. Let's see from Francis. Oh, are we are we going to do a session for accident and emergency or er, we actually did one of those previously. So I'll see if we can drop the link for that session into the chat here for you has some great information about er and the transition and some specific things. So yeah, you can tune into that. Most she wants to know the nurse patient ratio in the US. So I'll let Karl share his ratio in just a minute. But Moshe, one thing you need to keep in mind is like Mark said earlier, every hospital unit is different. So even if you have five med surg units and one hospital, you can see different ratios. You can also see sometimes ratios in the unit change based on the acuity of the patients that are there at that particular time or on that shift. So I've experienced the gamut of that. But, Carl, I'll let you share your personal experience with your med surg unit and your ratios and then mark, maybe you can add some about what you see in general with some of the nurses that we work with.

The main facility where I'm working right now is during the day we have one nurse is to find patients at night, it's one is to six. However, in the other hospital where I do my PRN job, it's one to five. So it depends really on the facility. And maybe some of the other resources that might be available and how the responsibilities are divvied up. So, Mark, you want to share what you're seeing with some of the nurses we work with? Yes, so it's kind of up on average air with a crossbow for our medical surgical wards. I would probably say right now you're going to be hard pressed to find a one to five ratio, it's usually about one to six most med surg, it could be one to seven, one to eight, depending on what the staffing for that particular hospital or that particular unit is like at that time, once again, medical surgical, your step down units here, your telemetry units, PCU units, those ideally should be a little bit lower, you know, a step down unit, maybe one to five, and then once again, in an ideal scenario PCU, one to three, one to four more likely one to four. Sometimes we are seeing some PCs right now that are going up, though, one to five, one to six, just because they're having such patients. And as we know, there's nursing shortages all over the world.

And obviously as you know an international nurse coming here to the US and working with us as staffing agencies, you know, you're coming going into a hospital that doesn't have perfect staffing, I think that's very important to understand as you come in, that your ratio is maybe a slightly higher than a hospital that is perfectly staffed here in the US, which seems like a dream scenario that I haven't quite heard of or found for anybody yet. Now ICU, you know, could be one to one, if the patient is incredibly sick, there's multiple people in the room, you're worried about them coding all shift long, more likely to be one to two in the ICU, or potentially up to one to three, at times. In the ICU here in the US. I know, sometimes that's a little bit of a shock, especially for nurses maybe coming from the Middle East, or the UK that are a little bit more accustomed to those one to one ratios, kind of be prepared for one to two, one to three at times in the US here.

And then accident emergency department, you know, maybe one to four, one to five, could be one to three, it just kind of depends on the area within the emergency department that you were working on, you know, your ratios in a resuscitation area, or trauma bay, as we may call it here in the US, will probably be a little bit lower than if you're just in the general part of the emergency department or the observation, part of the emergency department. And I think another key thing, who knows, sometimes we have behavioral health or psychiatric holds in our emergency departments as well, where the ratio is maybe slightly higher, because it's more of an observation patient, not necessarily acutely ill with a medical condition, more of a psychiatric behavioral health conditions with monitor.

Thanks, Mark. That's really good information for those who are maybe practicing in different specialties as well. So I appreciate you sharing all those details. So Francis, you're joining us from Kenya, and Glenda is joining us from Jeddah KSA. So thank you both for joining us. And I do see that we've dropped the information from the session for ER nursing into the chat. So you can take a look at that using that link. Okay, so I think all of us have faced burnout, especially in the last couple of years, given how healthcare challenges have just exploded with dealing with COVID and changes every other day on what we're supposed to do. But can you tell us, Carl, what are some of the things that you think might help or that you have used to help you deal with burnout, or one of the best practice that I was able to pick up in England working in England is where they encouraged us to pick to take a regular breaks. So in England breaks in the time that you take your break is allocated by the charge nurse, so you have to take your break at a certain time.

So you're allocated to do your break this time, so you really have to get off the floor, leave everything. And unlike here in America, I hate to say this, but break is encouraged. But then sometimes the work can be very busy. So you have to learn the art of multitasking that you're having a break. And then at the same time you're reading your lab values, so things like that, so you need Yeah, you need to go. When you come here in America, you need to explore your community, you need to get out there. You need to compartmentalize your personal life and your work life. So it's an art that you had to learn. So you need to get out. There's a lot of opportunities out there, go out and explore your area. Take a small travel one, two hours road trip like that. So anything that will maintain your balance and your sanity, if I may say yeah, absolutely. Mark, any other tips you would have for dealing with burnout?

Yeah, I think that's great honest tips and opinions. You know, just know coming here to the US. You know, as Carl mentioned, you do have to develop that work life balance. You know, if they are asking you to continuously to pick up that extra shift. Oh, the unit short, can you come in and work tonight? Can you come in for eight hours on Saturday? It's okay. If you say no from time to time, yes, we all love working that extra overtime, getting a little bit of extra money. The sense of pay may be involved, depending on the hospital you're working at. But it's not always worth it if it's affecting your emotional health in that work life balance as we talked about, so we want to make sure you're mindful of that and also know you know, as you know, coming over as an as an employee both now with Connetics with Amen.

Pretty paid with am and you have resources available to you to help you with that burnout, employee assistance programs, you know, counseling sessions, financial advice, you know, different things, you know, just Ask your team here of how we can get those resources over to you more than happy to help you know you have tons of support. And I think that's the biggest thing you need to build. Even if you are coming here to the US by yourself, you know, single nurse going to a city or a state where you don't know anybody else, you have to build those relationships with your support team. And sometimes your support team may be you know, myself or, you know, Holly or you know, one of the other nurses on the floor that you've just met. So, you know, don't be afraid to reach out and ask for help wherever you need it. That's the best way to kind of prevent that burnout from occurring.

Absolutely. So another question popped up in the chat. Kasim. Thanks for joining from KSA. And Mary Ann says, do we at least have UAPs and LPN so UAP is another term for nurse tech or patient care tech or nurse aide, depending on how your hospital may use that title. And all hospitals are different. So some will use them, but they will narrow their responsibilities to only certain tasks, others will maybe broaden it and give you more of that type of help. But the other thing we are seeing a trend with again, because of nursing shortages is hospitals that may not have had very many LPNs or LV Ian's are now reintroducing them. And we're seeing it sometimes it's a pilot program. So not every unit has them. And sometimes they're like full on. One thing I would advise is that if you're working with an LPN know their scope, understand that sometimes it's it can be advanced beyond what you've studied for the NCLEX. The NCLEX is very rigid. It's about what all LPNs can do. And so when you start to look at specific states, as well as specific hospitals that may offer some additional training to broaden that LPN scope, you may be surprised. Carl, do you work with any LPNs? at your hospital?

Yeah, the hospital where I'm working right now the story is, they just started reintroducing the LPN again. So yeah, most of the LPNs that we I work with, they're very proactive. And I'm also being productive because I'd never worked with the LPN. We don't have LPN back in England, so I asked them, so what's your scope of practice, and they're very proactive in saying this is, this is what we can do. And this is what we can do so and when I do my bedside assignment, so I always make sure that everybody everything is balanced with the work that they can do and the work that they can do and make sure that they handle the most disabled patients. So that they don't bother my nurses. So we're also looking after some acutely ill patients already. So yeah, yeah. So yeah, I think some nurses may look at LPNs and say, well, they don't have as much education as I do, because I'm an RN. And their license isn't as, you know, as high level as mine. The reality is, when you work with LPNs, in a team setting, it's very important to respect what they bring to the school, and to listen, sometimes they're going to pick up on things and you can't look at it as well. They're an LPN.

And I'm an RN. So I don't really know if I really want to listen to that you really want to take what they're sharing about the patients that you may be sharing responsibility for into account. Okay, so we just have a couple of minutes left. And I want to thank you both. Again, Mark, and Carl, for joining us today for this show. I think we've shared a ton of information. And I think we've answered most of the questions that were posted in the chat. So thank you for that. Let's see, if there. If, if we're talking about orientation, I want to circle back to that for just a second. And you are working with a preceptor and it just doesn't seem to be going well. It's not maybe what you expected. They seem maybe to not be the best match for what you're what you were expecting. Mark, what would you suggest that that nurse do to deal with that type of situation and hopefully resolve it in a positive way?

Yeah, you definitely have to advocate for yourself in that sort of situation. Because as we know, personalities are different. Even if you are very friendly with the person you're working with. They may not be the best preceptor for you. You know, especially as you're coming here and learning new practices, you want somebody who's patient who's willing to teach you let you be hands on, and I always give the story of I was a horrible priest. Just wanted to get in there and get everything done and and make sure that I was super clean. And now you know, seeing it on the other end of the spectrum, helping our international nurses we understand how important it is that you find that appropriate preceptor so if it's not working out, you have to speak up. Talk with your manager. Talk with your educator and unit talk with your support team, either Connetics or IGP, whoever you're working with, and even if you're not working with one of our agencies, whoever your support person is, let them know, Hey, I just don't think that it's working out with my preceptor. You know, I appreciate their time and efforts. However, I just don't know if I might learn better from somebody else, it's okay to change preceptors we would like that preceptor to stay consistent, you know, one or two people that you're consistently working with.

So you kind of have that repetition, and you understand what they expect. And they and you understand how you to perform certain tasks. Because as we know, working here in the US, there's multiple different ways you can do something to achieve a positive outcome. So understand your preceptor what they're looking for. And once again, if it's not working, speak up, talk to your manager, talk to your educator, or your support person within your agency. Absolutely, we are all here to make sure that you're set up for success. And so we want to make sure that the resources that you have access to you know what they are, and you use them, if you're not sure where to go, we can also help point you in the right direction. So there are more resources available on the Connetics college site, we have resources for other specialties, including the one we did for ICU, we have discussions about English exams, and so free sessions on that that you can join, as well as if you're preparing for the NCLEX. There are some sessions related to NCLEX topics. So please check those out on our website, Conneticsusa.com. And they're also posted, I believe on YouTube. So check those out.

We do have some upcoming shows available for you some NCLEX session, so they're popping up on the screen here now. On the 16th. We are going to talk about immigration. So if you have more immigration questions, that'll be an awesome opportunity. The 23rd of December, we have a special Christmas show. And then we have some best Oh new moments in 2022. And coming in January already. We have additional sessions available early January taxes in the USA. If you don't know how that works, you definitely want to tune in New Year New Plan in 2023. Goals for recruitment event and immigration Q&A will be on January 28. And on January 27, we have part two of our spousal support session. So please take a look at opportunities to attend some of those. And again, if you're interested in applying to Connetics and finding out if we have something that might work well for your needs, you can go to Conneticsusa.com/application. We are a part of AMN as we mentioned earlier, so we appreciate our other AMN partners mark from OGP. And Carl, who's joining us today. Thank you guys so much. We really appreciate your wisdom and look forward to future sessions. Have a great rest of your day. Thank you. Bye bye. Bye thanks