Navigating a New Team - Survival Tips For Nurses

Hello, everyone. Welcome to the Lefora Talk Show season 5 episode 4. We're happy that you're joining us today. My name is Holly Musselwhite I am the senior clinical manager at AMN International, hoping that some of our nurses I might recognize your names today if you're signing on to watch. Shawn is already saying hi. So how hi Shawn, thanks for joining us today. Hopefully those of you who are also joining can share with us where you're watching from, and we're excited to get topics discussed today that I think are going to be really, really helpful for you and maybe inspire you. If you're somewhere in the journey, in the process of coming to the US, and you need a little pick me up. There's going to be some great information shared today between our guests. So yeah, let us know where you're where you're signing in from. Rhonda is from England, watching from England. Thanks Rhonda for joining us today. Didn't say yet where he's from, so we'll have to check that out later. Alright, so today's topic is navigating a new team, and we want to give you some survival tips, and they're going to come from real life experience, so it's more practical in that sense.  

And I see Chanel is joining, also from England, and Serje from Manila, and Chamba from Zambia and Jihad from Jordan. So thank you so much for everybody who's joining. I might say some of these names wrong. So my apologies, But we love seeing all of these countries represented by professionals across the globe. Doddy is watching from the UAE. So we have a good representation of a lot of different a lot of different countries that you're living and working in. I know not all of you started in your careers in the country where you're currently working. So you've already gone through what might be the challenge of navigating a new team, or maybe you just moved hospitals and you were used to one team, and now you're dealing with another. I hope I'm saying that right I was watching from the Philippines. Thank you so much for joining us today we're glad y'all are here. Y'all like what we say in Tennessee. And Monica from Kenya, thank you, Monica, glad you're on today too.  

So as you think about navigating a new team, of course, the other aspect to think about is a new team with a new culture. So US culture as well as healthcare, culture differences and those all kind of play into how your experience is going to go those first few weeks and months. Many times you feel very, very confident in your skills and knowledge where you are today. You may be a senior nurse, a supervisor, a team lead, and yet, when you start your work here in the US, you may feel like a lot of that is missing, and the truth is, it's still there inside of you, but there's so many things that you're adjusting to and learning about and figuring out how to how to be successful in your new job, that for a while it's gonna feel like you're what we call a Fish Out of Water. All right, so I see Manuel is joining us from the Philippines, Mabuhay. I do know how to say that word, so, and I think now would be a great time to see if our guests are ready to join us, so I can introduce them.  

So here's Aaron and Mark and Aaron, there's your camera, alright, guys, I'm so glad you're here with us today. We're looking forward to hearing more information from you. Aaron, you are in South Carolina, correct? I mean, yeah, Mark, you're in Georgia, yep. Savannah, Georgia, yeah. So we've got the East Coast pretty well represented today, while Danielle normally does the West Coast representation. She's on maternity leave, but we're very pleased to be able to get together and share some great information with the nurses and any other professionals who join this show to watch today. So I do want to give you guys a chance to introduce yourselves, and I'm going to start with Aaron. So Aaron, if you would just give us a brief introduction, and we're going to delve into your story and experience a little further in the show.  

Okay, thank you very much, Holly. I hope you can all hear me clearly. My name is Aaron  I am a registered nurse. I immigrated to the US last year courtesy of OGP, excellent program from Kenya that is a country in East Africa, a country that is well known for long distance I came with my wife and two kids. My wife is equally a registered nurse practicing here in America already, and I work with Hilton Head Hospital, medical surgical unit, and I'm loving my workplace currently. I mean, it is also made of great, tremendous team, and with the preparation from the OGP team, I was so glad that my skill set and my contribution built up to the whole team that we're working currently so that is me. I practice for a year right now in America, but initially at practice in Kenya, as announced for the last 14 years. For 15 years. 

Wow, yeah, so you had a lot of strong experience before you got here, and you've been able to make that first year a successful one. It sounds like I can't wait to hear more. Mark, thank you, Mark, can you give us a little introduction as well? Yeah so hello everyone. My name is Mark Jones I am one of the clinical managers here with the O’Grady Peyton AMN International team. I've been here with our team since early 2019, so over five years now, been helping everyone as they go on their journeys, from, you know, other countries, here to the US, and a little background on myself. I was a critical care nurse for a number of years prior to taking this role in a contract nurse as well with Amn, did some travel nursing. So, tons of great experiences. I've seen a lot of different healthcare systems across the country, and now happy to be here helping all of you in your journeys here to the US. 

Thank you, Mark. Really appreciate you joining and I think you're traveling and seeing different parts of the United States. Sometimes it might feel like you're traveling to a different country when you go to certain areas. So you've got some good experience to share and that, and also working with nurses from all over the world, you kind of have that perspective. So before we delve into some of the more nuanced tips that we wanted to share today, Aaron, can you tell us a little more about your journey to the United States? You know, was it quick? Was it delayed sometimes? Just give us a little synopsis. 

Okay, I can't learn about OGP, like any many other companies that recruit international traders. So my wife herself and she started the process with OGP initially, and because of the pandemic, things on the application delayed a little bit, but in readiness for me being also a registered nurse in the US, I went ahead and prepared myself to sit for anchors on my own to be registered and I saw that when I come to America, I remain competitive in terms of joining the workforce. And in the process, I went ahead and did the preparation and for my NCLEX in South Africa. And that moment, I now learned about the OGP program of post NCLEX. Contract, and when I contacted them, the process really flowed so quickly. And maybe this the advice I'll give some notices outside there that I found the process post NCLEX passes was so thick on my end that took, like, a minimum, maximum of six months. And my case was like case complete.  

So initially, when I introduced myself to OGP and like and that contract that had some endless bonus test really went quickly. And I thank OGP in terms of schematic preparation of us in terms of the positive text. They gave me a flowchart that had like 12 steps, and in every step they were giving me the timelines, what it needs to be done from my end, and it involves things that also the company really did not have control over, in terms of securing an interview with the embassy after everything had been completed in terms of file complaints. So that was the waiting time that only we had no control of in the issue of submitting the files, the submitting the documentation, filling forms that was required. It was like files being said to me may fill in the details they require, and the steps move forward, but that part that really required me to get an embassy interview date with the US embassy in Nairobi was the only delay, if I have to call it that we had no control whatsoever. So. And it was coming at a time when there was post the covid pandemic, and there were a lot of backlogs in the US embassy in Nairobi.  

Currently, the US embassy in Nairobi is the biggest embassy, US Embassy within East Africa region. So it processes the visas, not only for Kenyans, but all the East African countries, Uganda, Tanzania, Rwanda, Burundi, so the backlog was severe, and this led to even the client hospital that I had the first interview with in Rock Hill postponing by like assignment for three months twice in the hope that I'll get the appointment at the US Embassy, but eventually they said, Because I done an interview with them, and they say they'd like to have me in their workforce, but because of the unforeseen delay in securing my interview at the embassy, they referred me now to their satellite facilities, which is now where I am right now Hilton Head hospital and another one called coastal that we need you, but we can now have you interview again with some of our plant satellite campuses in Hilton Head Island, and that's when I interviewed again with Hilton Head Island Hospital and got a contract and eventually got a visa embassy, the interview at the embassy, we got our visas, and after that, there's now process of being advised when to resign and preparing for eventual immigration and the date of starting employment.  

So from the time I contracted the OGP to the time that everything was ready, awaiting just appointment at the US Embassy, it took a record six months in a very quick wrapping moment. It's actually surprising, there was a bit of delay in securing the embassy appointment. But after that too, that process actually became again, quicker for me. And then the visa was valid for six months, but immediately we got the visa, were told we need to submit this resignation. We need to prepare to transition to the US within the first two months after the visa was issued. So as I said, the process, in total, for me, was smooth because of the preparation, because of excellent professional guides that we got from different team members from the OGP team. So in a nutshell, that is how, like, I got in contact with OGP at the stage where I'd already sat for my anchors. I know, for people who get prepared by OGP in terms of material, in terms of being sent to go and sit for their anchors, the process takes a little bit longer, but for me, that process became really shorter because I engage them after I done the NCLEX on my own. 

And NCLEX is such a big milestone for nurses. You know, sometimes that seems very stressful, and yeah, it opens up the door to so many opportunities once you've got it done, and then you want to work with a team that can be supportive and guide you through the process and answer your questions, and they have the expertise that that they can put to use on your behalf. So it sounds like you had a lot of support and guidance, and I'm really, really glad to hear that. I'm sure Mark is too. Yeah, yeah so Mark, can you tell us a little bit about your experience in navigating new teams with the travel that you've been doing or did?  

And yeah for everyone's reference, listening, and I did travel nursing here in the US for, you know, close to five years, and that was after I had already built up, you know, bedside experience and had those critical skills needed to be able to go on a short term travel contract. And I think the key important thing for everyone to know when you're a contract nurse, there are definitely differences as you get acclimated in so this will be kind of more towards our staffing model when you're joining a new team. I think the very first thing that you have to do is be a great listener. One you need to do a little bit of research yourself on the location, the hospital. You know what size possible this is a magnet facility. Is this a joint commission facility? Is it a stroke center or a Chest Pain Center, depending on the type of setting you're going into, but really the key once you are there, once you begin working, is listening, observing, seeing those different styles of people that you are interacting with you each part of the US, each region of the US, may have different communication styles.  

They may have different personalities. They may even have different types of culture in those areas. Some areas could be far more diverse than others. So as you listen and you learn those that you are working with, that's what gives you the tools to then acclimate successfully into that team. You see what people like, you see what people don't like. You see preferred communication styles. So I think for me, when joining a new team, that was one of the biggest keys, for me, is listening and then acting, and becoming a part of that team. Yeah, that's great advice for those who are listening today, and it looks like we've had more folks comment on where they're watching from so modeling is watching from Canada, and Larissa from the Philippines, and Shaheen from Bangladesh, Baba from Ghana, and Jeanette from Kuwait and Ritz from Ireland. So again, lots of great locations being represented by our attendees today, and we're so glad that you're here to hear some of the great information that mark and Aaron are going to share with us. So Aaron, now that you're working in a US facility, what are some of the things about getting used to the team that maybe took you by surprise back there in Kenya, we were trying to the facility I was working with.  

We were trying to have, like, digital documentation of you know, patient information. But unfortunately, it wasn't universal in all our department, so you will have some records done digital. But again, when you send patients for radiological imaging, when you send patients to get some samples in the lab. The results come in paper results. So you've got to maintain, like hybrid system, really, of documenting the part you can as a nurse on a digital person, but now you have this paper records, you have this ideological images, you have this consultation nurse for physicians that are in hard copy, so you had to maintain a physical folder of the patient. So now, when we came to the I came to the US here. I mean, the system was so totally digital, and this what I liked most. It was challenging for us to learn the Sana application. But the good thing is, the more you interact with the system, the more you work with it, the more you understand how to, you know, manipulate, how to put in orders, especially putting orders from the doctor's course, here we have an opportunity as nurses to contact doctors about a critical result or a diagnostic result that has become available, and tell them, Look, this is what I have blood causes grown positive for this type of bacteria.  

And they will examine and see that the patient is not maybe in the right regimen in terms of antibiotic. And they'll ask you to put in an order about something, about paid medication, about something to do. So this is where the digital platform for me was, like challenging, but in a very nice way for me, a platform for me to intervene from evidence based manner. I like the way that it gives me an opportunity to, like, intervene quickly. If a patient's blood results come out as hemoglobin, of let's say, critical value, be it creatinine, be it hemoglobin level, I'm able to shoot it immediately to a notification system to the medical doctor by calling and notifying the system, and the response of an order from the physician will be saying, put in an order for a unit of blood, and I'll put in an order for unit of blood. The lab will come with another notification for me to do some blood work to presented the lab for cross marching, and within 2030, minutes, we have a unit of blood for this particular patient to be confused. And for me, that is a very good turnaround of events in results and allowing me as a nurse to safely intervene and give that patient the appropriate medical care.  

If I have to compare that with how happened in Kenya, he could have been until I realized that this patient could be a navy I actually asked if it's appropriate for. Need to draw blood for this particular patient, to take the hemoglobin level, send it to the lab and maybe get a result a few hours later, or even maybe overnight. And then now, when you have the result, you have to call back the medical talk and say, I got this result. It is showing low hemoglobin level. What do I do? We need blood, and it's them to come and order, the blood is come, is for them now to come. And again, say how much of blood unit we did here the lab to prepare it at times of intervention could be transition after six, how transition after the shift? And you know, and you feel like personnel are frustrations, like it could have been early. It could have been sooner. So the systemic provision of the digital platform is whereby you get the results of the digital platform, you get the orders in there, and you get your own intervention applied within the shortest time possible. That gives me a lot of satisfaction. It gives me joy to say, things really work in a period that really safeguards the health of all patients, and you go home feeling like that was a good intervention.  

So Aaron, what I hear two kind of main concepts, differences from Kenya for you and your previous practice, technology that enables you as a nurse to intervene a lot more quickly, to figure out what's going on with your patient, very quickly, because you can get results. So everything's a lot more automated. And obviously, what's happening in the lab, we don't have to carry physical papers back and forth, and most of the time worry about printing and all of that. So that's really awesome. And then I also hear autonomy in what you're sharing. You have a lot more power as a nurse here to make things happen for your patients, because in large part, the technology helps facilitate that, but that also kind of that is actually follow up. Kind of question is, it sounds like there would need to be a good amount of training to prepare you for those things. Did you find that the team was supportive in helping you learn the systems and understand those differences? 

Yes, I had a very great team that really assisted me in the preceptory. They told me, as a registered nurse, is within our auspices to request orders. It gives me the voice to really advocate for what the patient needs to have as an interference at that point in time. At the same time, we really need to become open minded as international nurses. We really need to become confident in our competencies, first, our competence that I'm able to do this of course, during the preceptorship process, you ask this question, you ask your learners, you ask what needs to be done, and the support is doesn't end only in preceptorship. You still continue having colleagues working in daily shapes. You still have a charge nurse in a particular shape, so who you are able to run through, maybe a result or query your action like I want to request for this is this appropriate? I got this result, and I like mentioned to them, medical doctor. For me, I feel like this result, the patient is on. I feel fluid, but I feel like the patient has some chest congestion. The order is there to give a patient the fluid, but because you've postcode the patient's chest, you feel like it's no longer safe to continue having these fluids run through the patient, because you're thinking about pulmonary edema.  

So at that moment in time when you have that autonomy to call and advise and recommend and give the background information about this particular patient, it is always satisfying when the team works around to ensure the safety of this particular patient by saying, Okay, let's review this. The Creta lines were high. That's why we gave fluids. But right now, the nurse is talking about chest congestion, so it's about time maybe we review and see what needs to be done really make sure that we are not overcompensating on one area and causing a problem in another area. So the autonomy part, the clinical competency, the confidence, the seeking support and running through the colleagues that you have in any working shift, and at any point, there's always a house supervisor whose number is always displayed. It's within reach that you can shoot a question. You can call them for any support. For me that is helpful. It is helpful in our day to day management and service to officials, because you never know what you'll run through. In that particular shift when you have your passion. 

Yeah, so Mark, I think we want to turn to you for just a minute. And Aaron may want to add to this later, but when you're going like to meet a new team, what are some of the things that you experienced, like when you initially met your the teams, when you were going from hospital to hospital, was there some things you expected when you first got there? Or did it well, both to be to be honest with you. So there are always things as a nurse that are going to be universal, right? I mean, that's why we use that term, universal protocol. Sometimes, you know, hands on care is going to be the same. You know, your head to toe assessment is going to be the same, your auscultation, those sorts of things that they are kind of alluded to, those are always going to be similar in terms of your hands on skills. What's going to be different everywhere, though, is those policies and the procedures and, you know, physician preferences or co worker preferences.  

So that's why it's key to understand your new team and have that acclimation period with them and working with them. And I think for me, one of the things that I always did in, you know, as a as a short term travel nurse, you have far fewer days of orientation. You know, as a nurse coming from another country here to the US, you have a much longer orientation. I'm sure Aaron will be able to elaborate a little bit on that and a few but it's important when you're working with your preceptor, your educator, your manager to yes, you have that autonomy, but you also have responsibility as well. You are responsible for that autonomy, so you need to take the steps as the nurse to learn what is specific to your team. What are things that you need to take on to be a great teammate. So what I would do in each new setting is I would talk with my preceptor or a charge nurse, and I'd say, hey, you know, here's my plan for the day, here's what I'm going to take on.  

And then at the end of my shift, what I would do, I would go back to that same person and say, Okay, what did I do well today? And what do I need to improve on? What goals should I work towards so I can help, you know, the patients and help this team. So I think the more that you actively seek that real time feedback, the better you will be at contributing to that team, because here in the US culturally, sometimes that feedback is not always given in real time. So it is your responsibility as a new team member, as a newer nurse to the unit, to to actively seek that feedback, to actively go, okay, what can I do to better myself? Maybe my practices were different, maybe the way I went about my day was different, and I need to adjust that here for a new setting and a new team. 

Yeah, that's really important advice for anyone who's preparing to make that transition. And I, you know, in my experience, have seen the same thing. I wanted to go back for just a second to what you said about being responsible for that autonomy. And what came to mind is that nurses, a lot of times, they look at that preceptor and they think that's my bubble, that person is going to kind of protect me and my practice for that first, you know few weeks or months that I'm there when they actually often have a different view. They think that you know you're going to be sort of proving yourself and showing off your skills and acquiring new learning very quickly and eagerly seeking things out. So those two different perspectives sometimes collide into a lot of misunderstandings, and that's where you know what Aaron was saying about sort of checking to see what your progress is and where you need to you know, maybe focus on something else and not over or under.  

Focus on any area is important, but combining that with asking for real time and specific feedback helps to show the team that you're not just waiting for them to bring information to you, that you're not sort of what you know we want you to we have an expression here called leaning in that means you're very engaged in the process, versus leaning back and kind of waiting for things to come to you. And the leaning in is very important for moving through each of those orientation milestones in the way the team is hoping to see you do it? 

Yeah, absolutely. So I think Mark, I'll have you answer this first, but then we'll go to Aaron and get his thoughts. So what things have you experienced as a part of the healthcare team that make you as an individual feel like you're valued? You know, there's, there's a lot of different ways you know, to feel valued and to show value to your teammates as well. Once again, it kind of goes back to. To knowing communication styles of the new team you're on. And as I mentioned a little bit earlier, different parts of the US do have different ways that they show emotion, that the way they show value. Now, some of the obvious ways that you can get that as you know, a positive evaluation on file. You know, having a meeting at the end of your orientation where your manager says, hey, you did a great job. Those are kind of those, those more tangible ways to feel that value, to feel that appreciation. But I think the other thing you need to look for, especially as a new team member and as a new team member working in a new country, is some of those non verbal items that show you your value. So as you're progressing through orientation, or even as you you're off orientation, and you're progressing through your contract, or through your time working here in the US, you'll start noticing that they're giving me the harder patients. They're giving me the patient with CRR teeth today.  

So it it's not to say that they're giving you increased responsibility just because they want to put more work on you. That is them showing, hey, you're a good teammate. You're a solid, valuable team member. We trust you to take on these sick patients, these critical patients. So I think that that's one common misconception, is I'm getting a ton of work, but really it's man, they really trust me. They know I can take that on. So I think for me, that was always a great feeling, especially as a short term travel nurse, that if I got the sickest patient on the unit, hey, I'm probably doing something right here. Yeah, that's huge to feel that you've arrived and you've gone through enough of the adjustment to now get some of that responsibility, and it is big. Trust is something that I think as we gain experience and we're more senior in our time on an or on a unit or with an organization, we start to feel trusted. But that's a really good cue to look for, and I'm glad you mentioned it here.  

Aaron, what about you? Have, you experienced something that you can share, that made you feel like you were valued as a member of the new team, where you are, yes, absolutely. And I wanted just to add on what Mark rightfully said. At times, you really get your assignment, and it's the area you're in, a port that really has no difficult passion, but, like, it's heavy for you in terms of the procedures or what needs to be done in that corner. So what Mark said there is, like, the positive attitude that you approach with how the allocation has been done really determines your outcome. And I like that because it shows your confidence. It shows your confidence in terms of executing your excellent nursing care. And the most important for me in terms of how I feel valued, is the direct feedback for my patients.  

When my patients are really like thankful, my patients are telling me they're feeling relief, or they really feel like I know what I'm doing, inspiring that communication with our patients in a way that they really are trusting you. They really are like feeling you're on top of your game in terms of your nursing care really gives me the confidence and make me feel valued, the direct comments I get from my colleagues, my supervisors, after executing a procedure, or after, you know, a shift change, or after responding to A stroke a lot, or you finished a rapid response, and you have like a post mortem discussion, and you're given direct feedback, like you did well, here you caught it early. That was tremendous. This was a good eye to catch this result the way it was. That really makes you feel valued.  

I just did my I just received my one year performance evaluation to OGP, of course, and it was nice to see the comments coming in from the hospitality on the specific areas that provided feedback on and even the client hospital Management telling you, we hope you will stay beyond your traveler contract makes you feel like you're doing the right thing, and you feel valued that they really want you to have in that team for a longer, extended period, beyond just the contractual period. So that's how I feel valued. I get feedback daily basis, for a period of time, and most importantly, when I see that my patients are described with a massive. 

Yeah, that is really heartwarming to hear that you felt that way and you've had so many different. Instances to feel valued and acknowledged as a member of the team. And I like that you mentioned that those, those postmortems are what we sometimes call debriefs, were moments where you were recognized for doing something that made a difference by your by the team around you. And I think that's that immediate feedback, but it's also, Hey, good job. You're valued and we were glad you were here today. So that's really awesome. So what when you look at the team, one thing we haven't really talked about is nursing and physicians and the different roles, and we can do a whole another show on that. But one thing that I would like to ask you about Aron is what, what skills and interventions did physicians do overseas where you were working so you were in Kenya, that here you are responsible for? Can you give me like maybe three or four? 

I will say, the issue of having to put in order was absolutely a result of the physicians in Kenya, where they were the ones to prescribe what type of medication, the strength and everything for this particular patient, for every intervention, at no point were we in contact with a platform where we could put in order and here the systems have provided us, having provided that situation, background of the of the patient, the patient condition, and you're recommending that, I feel like this pain management for a patient currently is not meeting the is not controlling pain. They give you now that opportunity to put in an order of another drug. Of course, they've mentioned that if this person this and that, and that's the part I feel like we are now so actively doing the part of putting in orders after you've received that on conversation and reading back the orders with a particular patient.  

Another thing is like actively doing the head to toe assessment for your patient at any given time, achieved change at any moment, when a patient does run and say they not feeling comfortable, you are constantly assessing your patient and taking at those skills. Could it be a sign of struggle? Anything so that deeper assessment that you is constant awareness that I've got to assess my patient. I've got to detect any deterioration from the person on how you find your patient really weighs on us or nurses currently. And I will also say here, patients are more knowledgeable about their treatment. They are the regimen they are their pain management. So they actively request us, like while at home I was using this is not the strength I've been using.  

So being given that information from the patient, it now provides you an opportunity to seek verification or to recommend to the medical doctor that the patient has been using this at home, and we are now transferring their medical and reconciling, actually, their medical medications they've been using at home, you are the one responsible ton script that regiment have been at home to the medications they should be put on in a hospital setting so that the medical doctor can approve and make it available the home medication of the patient to continue as part of the regiment, on top of what the patient has been prescribed a new maybe IV antibiotics or things that the patient was not using at home. But as a nurse, you have the responsibility of exporting, if I have to say, home medication that the patient has been using to the system, so that the medical doctor can approve the same home medications to be continued, even in the hospital care. 

Wow so you gave us quite a few good examples. You know, putting orders into a computer system, which the physicians, of course, do as well being attentive to what their home medications are, confirming them and addressing any discrepancies, facilitating the communication from the patient about what they're looking for to those physicians to try and get orders that may work for what that patient's hoping for, if the physician's agreeable, the head to toe assessment. I was glad you mentioned that one, because I think that surprises a lot of people, a lot and Mark, I know you've worked with a lot of nurses, also from overseas. Is there anything that maybe Aron didn't touch on that you might add to that list. 

Yeah I think I would want to read and enforce head to toe assessments are key. If you are a nurse and you are pending coming here to the US to work here, go ahead and start researching and looking at videos on what does a US nursing head to toe assessment look like? And what I always encourage everyone to do in their current setting, if you can, obviously, don't break policies, don't break procedures, but if you can try to do that head to toe assessment for your for your patients, and get into the flow of that auscultation is a huge thing that is a physician responsibility in most countries, that is not currently a nursing responsibility in that country as well. Now maybe you complete it from time to from time to time if your patient has a new respiratory issue, but here in the US, that's something you are completing every single time, every single patient, every single shift. And it's key that you know that, because you know, as Aaron mentioned, you're eventually going to start putting in orders for a physician. You're going to start calling the physician and telling them, hey, here's an update of what's going on.  

And one of those practice differences is the physician is not going to come to the bedside and look at the patient. The physician is going to rely on your assessment as the nurse. What were your findings? What are their vital signs? What can you tell me about their cardiac rhythm even so, that's another great practice difference. Cardiac rhythm interpretation is 100% a nurse's responsibility here to interpret those rhythms in real time, watching the monitor, looking at it saying, hey, they went from normal sinus rhythm. Let me call the physician and let them know. Very first thing that physician's going to ask you, well, what did the rhythm change to? You can't just tell them that the rhythm changed. So those are a couple of the main ones. And then there's a few hands on practice differences that just come really with that, hands on experience here in the US, the IV insertion, maybe nasogastric tuber insertion, and especially for many of our nurses working maybe in some of our Middle Eastern countries, or some of our nurses working on those male only wards or the female only awards here in the US for urinary catheter insertion, you will insert for males and females, regardless of your gender, so that that's a key thing culturally to keep in mind as well. Unless the patient specifically asks you for a different gender caregiver to insert their urinary catheter, it is your responsibility, and even that situation doesn't come up as often as you would think.  

So some of those, those are the key practices. And then just getting used to the EMR, that technology aspect of it, you know, IV infusion pumps, feeding pumps, you're not going to be calculating drip factors anymore for your IV infusions, which is going to be a relief to many of you to not have to do that math. Now, everything goes through the IV infusion pump, so but a lot of those, those, some of those skills are more easily picked up in the orientation period with just time and repetition. But what I always, I can't emphasize it enough, practice your head to toe assessments, practice your auscultation, because there is no practice like doing it on a real patient. 

And I'll do a plug on that for owning your own stethoscope and feeling comfortable using it and bringing one with you when you come to work. They are part of our uniforms when we're working bedside here. So it and I have one, you know, at home with the job I do now, it still comes in handy. I check family blood pressures and friends who come because, of course, once people know you're a nurse, yeah, y'all know what happens, then everybody wants to talk to you about their medical stuff. So being able to assess a patient or a friend or a family member and say this is what I'm seeing. This is what it looks like that. You know, we really are trusted by physicians here, going back to trust. We're really trusted to bring a good assessment and even to potentially suggest what we think might be happening. So I think this patient might be experiencing signs of a UTI.  

You're not going to diagnose the patient. That doesn't happen with nurses, but you are. You are trusted to be able to start to connect the dots and critically think about what could be wrong based on your assessment. And from there, start to ask for orders for certain things. And in many countries, that's not normal to prompt a physician to say, Doctor, I'd like to get an order for this and this and this, and they're like what you wouldn't ask in most cases where you're practicing. Now, some of you might, but many nurses express a little bit of surprise when they realize how much more input they're going to have into figuring out what's wrong, what's changed, what to do about it, and once you get over the fear it's. Actually really exciting. And I think to Aaron's experience earlier that he was sharing, it's very fulfilling to be able to make that kind of a difference. To go home after your shift and be like, Wow, I did a lot today, and I helped in very significant ways to change, potentially to save somebody's life.  

So the other group that I wanted to talk about a little bit working with in the few minutes that we have left is working with nurse techs and nurse aides. That role is also different, and we want to acknowledge the value of that role within the team, but also to think about, how do we make them feel valued, and how do we work effectively with them? So Aron, have you do you currently work with nurse techs or nurse aides in your hospital where you are now? Yes, we work with our CNA’s, and they are very wonderful people that really complement the work that we do as registered nurses. Of course, we are deeply responsible for nursing responsibility that involves assessing our patients, evaluating them, and also the intervention that we feel like it's purely at the auspices of nurse and seeking advice from the doctors, but that those procedures like changing the patient, like cleaning up the patient, I assist in a patient to feed, taking vital signs, blood sugar, checks that the techs are really skilled and able to help in getting those vital signs, and they are able to run through us the vital signs that they find maybe a very low blood pressure or a very high blood pressure.  

And with that, if they were using like an automatic blood pressure machine, it's my responsibility for now to go and use maybe a manual blood pressure machine, and it is truly too high or too low, I'm able now to intervene by taking support or saying what needs to be done. So we really work together as a team, and in every ship, they are available to assist us do those routine things and just making our patients comfortable, and it saves us the time to really now do our assessment, pass our medication, and also now do the documentation in our staff course. If they weren't there, it could have been very difficult for us to have that quality nursing care, be able to do everything for patients at the same time, have the time to document, because work not documented is actually work not done.  

So they really, really are a very critical part in our healthcare system. And they are very great, competent people. Some of them really transition from the CNA’s and to become registered nurses, and that constant exposure in the hospital setting for them is a very encouraging moment for them, saying I'm able to do this, I'm able to actually get to be registered, as if they go ahead and like to study to be a registered nurse. So I really appreciate that provision in America, as Mark clearly mentioned our responsibility so expounding America assessments, intervention documentation, so it comes in handy when there's someone who is able to check for you that black sugar, there's someone is able to take that vital size for you. Somebody is able to empty that urinal for your patient, or someone just to change a canister. So there are lot of things that happen to just make our patients comfortable, that if it was where relying on us, it could have been difficult for us to achieve what you needed to achieve in a shift for a patient. 

Yeah, I think that you nailed it that being able to meet a patient's needs means you have to have a team there's so much that's going on. There are things that only the nurse can do, only the physician can do, and so having the role of the nurse tech or nurse aide, depending on the title that's being given, that person, becomes an integral part of that team to meet those patients needs. And so I found in my career and Mark, I'm sure you would echo this, that if you have a good rapport with your assigned partner in crime for that day, that your shift, even with all the crazy things that can happen, still feels like it went well because you have a team and you're effectively working together with them. And missing that component is really tough. So I do want to mention so we have a few others who've commented on where they're watching from today. So Jason from the Philippines, representing the Philippines today, Davina from Saudi and Nasis from Oman and Hannah, I think that's your name.  

So Hannah, you asked, do you still accept applicants who doesn't have current experience, though previously worked in the hospital, so we look at everyone's experience. And of course, the longer you're out of the hospital or bedside nursing, the harder it is for that transition that we're talking about, if you don't have fresh experience, at least in caring for patients where you are now, it can make it very challenging to try to adapt to the different things that you're going to see here, and it can take more time and orientation and Hospitals and Facilities, they know that, so they look to find nurses who do have more current experience. So I actually wanted to mention that today, because a lot of you are also potentially dealing with the effects of retrogression, and you may be thinking, I you know, I'll leave the bedside and I'll go back to it when things start moving again or whatever.  

Understand that bedside experience is a cornerstone of what you're going to build on for your US nursing career. And if you don't have it, or if it's Rusty, it can make it so difficult. And the last thing you want to do is get to this point of where Aaron is, you've immigrated, you've started your job, you're going through orientation, and it's just too overwhelming, and it's taking too much time. And that sends up a signal that you know, is it going to work out, and you want to know that you're setting yourself up for success here, as much as the hospital is looking to set you up for success. So I strongly encourage you get current bedside experience. Make sure it's consistent, regardless of whether you got a little slowed down in retrogression or not, which we'll touch on in just a minute, make sure it's robust experience. Try to get where there are hospitals that do have more equipment, even electronic medical record systems that are a little bit of a hybrid like Aron described earlier, it's still getting experience with computers and devices, so it's still valuable. Froy, you mentioned medication reconciliation, and that was the process Aron was describing earlier, about looking at the patient's home meds and then speaking with the physician to make sure there isn't a gap in what they're taking in the hospital.  

And we very much appreciate the opportunity to share what we know and what we've experienced with nurses that are still in the process and trying to prepare themselves mentally and emotionally and financially. We very much appreciate the opportunity to share this with you. So in the last little segment we have here Mark, I wanted to speak specifically to how working with a team can help with time management. Do you have any thoughts on how you can manage your time well, especially the first few weeks and months, it's a lot of pressure. Yeah, I think it's important for everyone to know your first few weeks, your first couple of months, it's going to be a little bit overwhelming. It's overwhelming for everyone. You're learning a new country, you're learning new coworkers, you're learning a new computer charting system, you're learning new policies, procedures. So it's normal to feel a little bit overwhelmed, but what I tell everyone is time and repetition really helps with that.  

You know, when if I call and I check in on you, you know, week three, week four, of your contractor of working here in the US, yeah, there's going to be some bumps in the road. There's going to be things that you're learning. And I always hear it's a lot of information, right? When I call and I check in with those same people, month four, month five, month six, working here, that's where we start hearing, okay, it's getting more comfortable. That's where we start getting requests from the facilities. Hey, is so and so allowed to be a charge nurse. Is so and so, allowed to precept somebody else. So in terms of the question there, I think your communication style, being assertive and being confident, will help with your time management. Ultimately, you'll get that time and repetition, like we said, throughout the orientation period, where you become more comfortable with the technology, the equipment, things of that nature, that slow you down at first.  

So that improves with time. But where you really start improving on your time management is having that open communication with your nursing techs. With your peers that are working beside you, with your charge nurse, hey, I'm going to give a bed bath at 3am you know, I'm going to go to lunch at 2am or 2pm you know, depending on which shift you're working. So as you open up your shift with that open communication of, hey, here's how I would like the shift to go. That is where you'll have better time management. Obviously, emergencies come up, you know, unfortunately, you know, a patient may code, or you may have a rapid response that you have to deal with right there in that situation, and that just throws a wrench into everything, but ultimately, you're caring for the patient in that moment. So I think those are kind of some of the key things to remember in terms of time management. Takes a little bit of time to get used to get used to time management, as silly as that sounds, and then clear communication really helps your own time management and your peers time management as well. 

So here, in the US, our team members that we work with often become like family. We tend to spend not just work time with them, but sometimes time outside of work, and so building that bond is kind of the last little tiny piece that I want to cover before we touch on retrogression for just a second. So hair, sorry. Aron, what? What have you done? Maybe just one or two things that have helped you kind of develop that bond with your team, either at work or outside of work. I will give an example of the Nurses Week that just happened recently, and I appreciate the nurses and it was like a hospital recommendation that nurses can come together and have, like a baking competition for a cake or something. And during that time, different skill sets of different people really came into play. Just going there as a man, I don't do much of cooking, but just, you know, going there, assisting in, like doing a few things from the colleague's point of view, instructing you, but not like in the clinical setting, but in the kitchen.  

For me, was a very warming moment to really have an experience with my colleagues from a non clinical setting. The birthday parties that people have here at the first day. What has came to the floor? There was someone specifically just asked me once your birthday, and she put it on her notebook. I didn't know why she was asking, but they really value it. They really like it. And what is your birthday? I mean, the floor will go, patients will know. And that moment the conference room, and there's food, there's egg, there is, a small balloon for you and for me, that strengthens that team. It really melts your heart when people think about you, when people celebrate you, not only from the basic clinical setup, but also, you know, participate in your life milestones. So there's those colleagues of viewers that you are, you know, you love football together. You love okay, and they tell you, I love soccer too. This weekend, it's a final or this particular tournament, you in town, so we can take it out in this particular place, and you extend now that personalized, you know, individual friendship, because you like common things, and overall, it becomes so satisfying. This a beautiful country.  

It has a lot of things from very big country, and during your night thoughts, during your free time, you're able to venture you're able to learn more things in terms of culture and explore places. And that energizes you. When you're coming for your next shift, you feel, you know, energized, and you feel so motivated to do more? So that's how I feel like dealing with my colleagues at a personalized, you know, personal time at some activities in our facility setting that is not purely clinical. Is always uplifting I love that. It sounds like you guys are really great group to work with, and you're finding ways to celebrate important milestones like birthdays. So yeah, if you get here and someone says, when's your birthday, Don't stress it. Yeah, they're actually wanting to celebrate with you on that note, thank you both for being on today and sharing such great information.  

I am going to switch gears a little bit, as I mentioned earlier, and we're going to talk for just a moment. Actually, I want to share a message about retrogression, given the fact that some of you are experiencing that. So this is a message of hope, and I hope that you find some. Positives and make the most of the time that you have when you get here, things go from zero to 100 so it may seem slow right now, there are still opportunities out there to enrich your skills and be prepared, and that way, when you do finally arrive, your transition is as positive as it can be. As someone who survived retrogression, I had to it almost 10 years to get to the United States, abandoned by employer back in 2014 when I was already current. By the way, my priority is 2008 amended by my employer, 2014 got recap for 2015 when I got recaptured, there was a retrogression guide for several years back, put back another two years, almost 10 years, to get here and leave the American Dream, the life that I wanted.  

Guys, do not stop at what you're doing. I have three take a key takeaways for you guys, for you nurses all over the world that are watching us today. The first one is continue with what you are doing with the process that you are doing, whether it is filing I-140 whether it is getting documentary qualified, whether taking your IELTS, reviewing for the NCLEX, or doing your visa screen, or whatever processes your employers or your lawyers are requiring from you. Keep doing that you want all of them in place for when the retrogression moves and it's time for you to be interviewed, you want all of them in place because the visa is numerically limited. Retrogression is a cycle it happens. It will happen, It will keep happening.  

The first one that gets into the consoles desk with all their papers and gets to go to the United States first, number two, do not make life changing decisions until you have your visa don't sell your houses. A lot of people made this mistake I've been an admin for Lefora for four years. I've been a nurse here in the States for six I survived retrogression for 10 years. Heard people sold their houses, quit their jobs, or quit their kids school, and then ending up having to have retrogression, and now they don't have visa because they're retrogressed for a year don't do that.  

Wait for your visa on your hand and you're you have a flight to the United States before you make any life changing decisions. And the last one is do something else while waiting. Go to Saudi, go to UK, go to Germany, stay in your country and improve your nursing skills, get more competent, try another unit and try specialty units, but do something to improve your career once you get here, trust me, it will be worth it. If I quit, I would not have lived the American Dream that I've always wanted when I was young. So that's it, guys. So that message from Paul, like I said, it's a message of hope and encouragement, and I thank you guys for being on today. Mark Aaron, hope the rest of your week goes well, and hope we may see you here again on the Lefora Talk Show. Thanks everyone.