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Clinical Assessments in US Nursing

Hello, welcome to onwards and upwards everything a global nurse needs to know to live and work in the United States. My name is Luciana Da Silva with Connetics USA. We are a direct hire company bringing nurses from all over the world to live and work in the United States. If you would like to achieve your American dream, please go to our website, and we want to help you live your dream and bring you and your family to the United States to work in American healthcare facilities. We have an amazing show for you today on onwards and upwards. We will be speaking about the RN clinical assessment. Before we get started with the show, we actually would like to announce our video and photo contest winners. The theme this time was show us your city and we would like to announce the winners now if we can get those pulled up here on the screen. In first place. We have med tech Ryan he's in front of the world's largest baseball bat in Louisville, Kentucky. He's saying Never let the fear of striking out keep you from playing the game. And in second place med tech Nico, in Memphis, Tennessee. It's actually a really cool video and we're gonna watch it here in a moment. And in third place, Nurse Eden is in New York City in front of the Brooklyn Bridge, the euphoric feeling between living and dreaming. There's New York, taken in the Brooklyn Bridge, my American dream, Nurse Eden. And as we said before med tech Nika who gave us a video from Memphis, Tennessee is our second prize winner, please turn up your volume and let's take a look at the video.

This is how this is halogens on legends This is how legends on. This is how legends are made. In America, anything is possible. Let's take a look at our Success Path really briefly so that you can see the process on coming to the United States with you and your family. The first thing you're going to do is take your NCLEX pass your NCLEX and then apply we also give a $1,000 referral fee if you refer an NCLEX nurse to our program. Once you are placed with the American health care facility, we'll help you out with the immigration, you'll get an EB three green card for you and your family from there. So the Get Ready game plan. Let's get you all set up to come to the United States. Make sure that you know everything that's happening, and everything that you can expect to get your life set up and for you to be successful. The Arrival sequence we'll be speaking about today actually is going to be a part of that the clinical part, the training, everything that a nurse needs to know in order to be successful with the clinical assessments. When you arrive in the United States you enjoy and prosper in your life and your American dream. Let's bring on our guests now. With no further ado, we have you This is Holly. She is actually no stranger to our onwards and upwards shove. We also have two nurses joining us to Connetics nurses, Jansen and Roy, please let's start out with Roy please introduce yourself to our audience.

Hi my name is Roy. They call me Roxy here in the United States. I am an inpatient dialysis nurse here in Sanford Medical Center and I am currently based in North Dakota. I am a Philippine registered nurse for eight years in the Philippines and I am also a board top nurturer. I am also a certified nephrology nurse. I am a top four in the Philippines and I am a United States registered nurse and currently I'm on my last set for my master's in medical surgical nursing. Thank you gratulations Wow, higher education and my messages once you got your talk about career growth congratulate Roy Jansen please introduce yourself to our audience. Thank you. Hi everyone. My name is Jansen. I'm working here in Sanford Bismarck as medical surgical nurse for one Northwest department. I graduated in 2020 08 and I worked in the Middle East for 12 years. And now I'm working here in North Dakota as a registered nurse. That's it.

Welcome to the USA and all of your success. Last but definitely not least, we have Holly Musselwhite, our clinical nurse Director here at Connetics USA, Holly, introduce yourself, please. Good morning. Good evening. Hello, everyone. My name is Holly Musselwhite. I am a nurse, bachelor's prepared nurse with a master's degree in business. So I've been with Connetics now. For September will be two years. But I've worked with international nurses since I started my career about 22 years ago. And I find that the differences between nursing here and across the globe. And the similarities are really fascinating. And I think this is going to be a great topic for us to share with everyone and hopefully gets give some insight to those who are preparing to come or thinking about what they can do to prepare. Thank you, Holly. And as Holly said 22 years of experience was quite the expert there. She has worked in direct hire, staffing, which Connetics USA, we're part of AMN healthcare, and we partner with O'Grady Peyton, who has staffing positions. So if you'd like to learn more, of course,

Our recruiters are waiting to speak with you. Let's get started here. I want to start with you. Right. Tell us about your journey to the United States. Why did you decide to come and live and work here it may sound cliche, but in the Philippines, I was a dialysis nurse there. And when I passed my Philippine licensure examination, I set my goals like I need to experience for five years here in the Philippines to serve my fellow countrymen. And when I finally had that experience, I am already eyeing for the United States of America, because that's my dream country to employ it with. And I am COVID hit the Philippines and although very work, and all over the world, and that time I need to recalibrate my goals in life. And so I started to review my NCLEX. And fortunately, I was able to pass it. And that time, I wasn't able to, to really choose whatever agency that I will be going in to or I will sign a contract with. So I went into the default page and I was able to see a lot of good, good opinion towards Connetics. And that time, I was really nervous because it's United States of America. And it's the dream destination of all nurses, and they Connetics process, my papers and every journey they are really there to help me to make my processing a lot easier. So they also pushed me to step out of my comfort zone and that time they asked me to do the IELTS and without me reviewing myself, so I only have like one week to prepare for my IELTS. And fortunately, I passed it. And I am so happy with the way my I'm nursing us. Step by step process was really easy. I only had like eight to nine months of waiting time because they are really half full and they expedite our own case, our own like case. So that's my USG it might be for others that It's so easy, but it's not. You have a lot of things to set aside like social life. I don't go out with my friends. Because I need to really eye on the prize that is to go in the US. So it's really, for me fulfilling all the sacrifices has been very fruitful.

Beautiful way. Yeah. What have you read seem so easy. That's really as you said, it's a difficult process. And we were actually talking about this last week, Holly, were saying that there's that quote from a movie, A League of Their Own. And it's set in World War Two. And there's a women's baseball team. And they're, you know, one woman is, what's the name of that actress Holly, Gina Davis, Nina Davis, and she's with Tom Hanks, and she just wants to quit and she's, she's just done. And he's the coach of the baseball team. And what he says is, it's supposed to be hard. If it wasn't hard, everyone would do it. The heart is what makes it great. Look at that. What an amazing piece of advice for anyone coming to the Mandalay? Absolutely, the heart is what makes it great and worthwhile. You just summed it up there, Roy. So it's wonderful to have you on the show today. Jenson, tell us about your journey to the United States and why you decided to come here. Oh, God, it's a long story. But I'll just try to make it brief. I got to eat in 2008. So before even going into college, I really wanted to go to work abroad. But during that time, nursing was really the number one course to take to go to the United States. So I finished my university in 2008, I passed my licensure exam in the Philippines. And then what? There? No, there were no visas being issued that time. So I set aside my dream, I worked in Saudi Arabia for four years. And in Qatar for eight years. Outside the field, I was in the medical insurance industry. So and then, I didn't know that there will be there was a chance for me to go back to nursing because first and foremost, I didn't ever practice it. But then I came across the floor, and then that dream came back. And then I took the exam, pass my IELTS pass my NCLEX and then tried applying for a lot of jobs, through agencies, and I got a lot of offers doing long term care, skilled nursing facilities and stuff like that. But then Connetics gave me a shot to be a medical surgical nurse and one of the magnet hospital in the United States, which is sad for toe. So I didn't think twice I signed up the offer.

And then my priority date was March one, I got my visa after four months. So my process was just four months. I got my visa, July 2021. No, I mean, July 2022. and flew to the United States. Last December. And then here I am now seven, seven months as a staff nurse in Sanford. The same thing occurred in North Dakota, congratulations. I loved that photo of you arriving like Hollywood. Here's the star. Here you come, ready to go. Absolutely love that and then you traveled to Fargo. It's absolutely wonderful story. So welcome to the United States. I want to ask everybody who's watching today, please put in the chat, your name where you're from, we'd love to say hello and see people from all over the world watching and we are going to be speaking about the clinical assessment. So please put your questions in the chat. We have nurses here we have the expert Holly to answer all of your questions live. So please take advantage of that. Right now. We have Allah DeSoto saying hello everyone. Moses is also saying Hi, Jeff Hi everyone, Annie is saying I love seeing two of my nurses doing this go real and Jansen looks like you have a Connetics cheerleader watching for you today. Whoo Roy, clap, clap, clap clap clap. Garang is saying hello, everyone. I'm from Nepal. Angela. Amazing story, Roy. Yes, fruitful and inspiring. Nona, just watching from the UK saying hello, Jenna is from the Philippines. Your stories are very inspiring. And that's why we do this show, because we want to take you onwards and upwards. Holly, first clinical assessment question for you, is an clinical assessment of a patient in the United States, the same as it is in other countries?

So it's kind of a yes and no, yes, in the sense that we as nurses are often trained in head to toe assessment during nursing school, we have textbooks overseas that may even be the same ones that are published here in the United States. And so the structure of head to toe assessment, and that expectation of knowing what that looks like happens for most nurses. What changes is that when you go into practice, as a nurse in many countries, you may not be expected to use those assessment skills on a day to day basis. So you'll see that I am wearing this and I currently not at the bedside, but this stays with me. In my home office. It's with me if I need to go even if one of my family members calls me and says, Hey, I'm not feeling good. Can you come check my blood pressure? Can you go. So this is my one of my things that I tell nurses from overseas, we are going to use this day in and day out in the United States. Whereas overseas, you may or may not have your own stethoscope. Here. It's part of a uniform from the time you're a student, nurse, and all the way through when you're doing bedside, when you're working in the doctor's office, wherever that may be our stethoscope and our ability to have that skill of assessing patients and then being the eyes and ears for the physicians is really critical. So training may be very similar. We're going to talk about that a little bit. But the actual execution day to day in bedside care may be different. And so some nurses are surprised when they get here. They're like, I didn't have to have my own stethoscope. I didn't have to be the one going in and assessing the patient before I even called the doctor, I would just call them and say we got a abnormal vital Can you come in my room and see this patient and so I'm not used to this. And it can be a real adjustment for some others may have a little bit more similar but typically that's if they're coming from places that are have a similar healthcare model to what the United States has. So we're going to talk further though.

Yes. And speaking of nurses all over the world wanting to learn more just shout outs more from the chat here. Janelle is saying hello from the Philippines. Rona. Hey, y'all from Houston, Texas. Looks like Rona is already learning some colloquialisms there. We also have Rona. Hello everyone. June from Cheshire Shire, the UK already here will be in Fargo by last week of August. See it there. So there's a new friend for you, Roy. And just the RT whenever she gets there. Make sure to say hello. Rolf is saying hi from Arkansas. Mona Lisa, what a beautiful name from Kuwait is watching. Alvin is from the from the Philippines. Someday I want to be a US RN. We're going to take you there of course Connetics forward slash apply so that you can start your American dream and live the beautiful lives that our guests are today. Let's go back to Roy,  ? How is that taught in the Philippines? What do you learn there? Give us an overview. I well in the Philippines is breathing the same when it comes to the assessment. We are taught to assess patients from proximal distal and Cephalon Caudal. That's meant head to toe assessment. The only difference is when we are saying are some somewhat lacking of the resources like stethoscope. It's really expensive to have like the Maxville and the most expensive things like weighing the difference is only the science and technology but it's probably the same If we aren't taught by us books also. So it's pretty insane.

That's really good to hear and probably comforting for so many of our nurses watching right now. Jansen tell us about the differences that you've noticed between your home country and, and here in the United States, whenever it comes to assessing patients. Well, just to give a history lesson, or just an FYI, well, the US was the one who brought nursing in the Philippines, they started building universities and hospitals. That's why Filipino nurses doesn't have to adjust too much to the nursing practice here in the US. But yeah, the difference will be the resources, as Roy said earlier, especially here in the US bow, everything is ideal, everything is available. But in the Philippines, you just have to be more resourceful with the things that you have. Other than that, it's the same. But what I noticed here in the US, we do clinical or assessment full assessment every day, every shift. But when I worked in the Philippines for a few months, I noticed that it's more of like, this is specific. And then other than that, that's it. We Filipino nurses have very good foundation, when it comes to assessment. Absolutely. And that's why so many Filipino nurses come to the United States, so successful as well, because you have that amazing education there that you've been able to, you know, to bring to your life and your work here in the United States. Holly, what are the elements of a basic clinical assessments in an acute hospital setting?

Sorry, I just had to unmute myself. So the basic elements are, as Roy mentioned, you're going to do a head to toe, proximal to distal, you're going to be assessing in terms of listening, looking palpating. So we have you know, formal words like auscultation and palpation. And the goal is to get a comprehensive assessment, as Jansen mentioned, every shift, so you have to learn to be really quick with that, because you'll have several patients that you're going to have to do that on each shift. And in some units, you may even have to do that more than once a shift, you may have to do it a couple of times. So you're going to have vital signs, you're going to have inspection of the patient just looking at them to see, you know, does their skin look like it's pale? Are they sweaty or diaphoretic? are they breathing really quickly, and you're going to count respiration. So of course, you'll get numbers out of that more objective data. But all of that information is also going to guide you into whether you do a more focused assessment. So Jansen mentioned that in the Philippines, you might have done a more disease specific assessment. And here, you might lead into that. If you actually notice something, when you're doing your head to toe assessment, you might want to dig deeper and see, you know, maybe I need to do more assessment more in depth with neurologic symptoms. So maybe the patient is presenting with a possible stroke. And knowing how to assess that and dive deeper into those things are part of what skill you need to be prepared to demonstrate, no one's going to tell you because the patient seems confused, you ought to maybe ask more neurological questions and assessment tools and things like that. Those are the things that you're going to have to know.

And then from there, as I said earlier, you're going to be their eyes and ears for the physicians. They're not as physically present as they may be in the places where you work now, or maybe they're the one that does have the stethoscope here. stethoscopes are not as financially significant of an expense as they may be overseas for some folks. Or it may be that, you know, the type of salary that you're earning here makes it seem less expensive. So I, the one that I have is actually very inexpensive. I think I spent about $20 for it. That's been a few years so inflation might have changed that but it's having the that is a resource having oftentimes hospitals will have vital signs machines, your patient might be hooked up to a telemetry monitor, on a consistent basis, be a monitor, patient and so those things actually Help us get more objective information. But knowing what to look for what to listen for how to interpret that, if you hear crackles in the lungs, if you hear rails if you hear wheezes, if you hear Strider, what does that mean for you to do next? What other things might you want to assess what things in the medical record Do you want to look for, and what things do you have to document. So basically, you've got to be able to look and listen and palpate and know what direction to do that in. And you also have to know how to talk to the patient about what you're going to do, and make sure that you're thinking about their experience. And the fact that patients in the United States like to be very informed. Before we lay hands on people, they want to be told, Hi, I'm Holly, I'm your nurse. And I'm going to, I would like to do an assessment. So I'm going to be listening to your lungs, listening to your heart, I want to look at your skin, look at your look at your circulation, etc. And just kind of explain that before you actually start doing your physical assessment.

And that's what's so important as well as that communication piece. Because Americans we will go into a hospital setting, just like all over the world. If I go I don't know very much about health care, I don't know what my lungs are supposed to sound like or anything like that. And so that communication with the patient, what to expect, here's what we're going to be doing. And that's where that's why you got to take those isles and PTE and OET English tests, right so that you can really get those communication skills in order to be successful. And of course, at Connetics USA Nursing Agency, we do have an English scholarship. So you can go ahead apply, we offer it to all of our nurses. I want to get back to Roy, tell us about how is a clinical assessment done in the Philippines. What does it entail? Well, um, clinical assessment in the Philippines is more on a specific way as what Johnson authored a while ago. It's just like more disease specific. Like if the patient has cellulitis, they will just go on in depth assessment with the skin. However, here in the United States of America, we are tasked to do general assessment like we do frequent turns in order for us to see if there are like blisters or sores that can also advance into bed sores. And so what I observed also in the Philippines is we tend to charge a lot of supplies. That's why patients sometimes don't abide to what the doctor has to offer or order because of the lack of financial resources. However, here in the United States of America, you can do all of the assessments kills with the use also of the proper equipment's, because it's always available. So it's already provided by their insurance company. So we are not really hard to do and to provide quality nursing care, especially with the clinical assessment skills. Jansen, you mentioned earlier about that one of the major differences was technology. What's that technology like in the Philippines and how is it compared here to the United States?

Well, one example is a cardiac monitor. Okay, every room here and in this in our hospital has a cardiac monitor. You just need to hook up the patient to the blood pressure cuff to the pulse oximeter. And then you will see the trend of the vibe, the blood pressure of the patient or the pulse oximetry, the heart rate on the monitor, even you're not inside the room of the patient. There is a monitor on the nursing station, where in you will be able to see if the patient is having a problem breathing or maybe the patient is having some increase in a blood pressure. In the Philippines. We don't have that because it's too expensive. So for you to be able to see the if the patient is having hypertension, you just you just need to go to the patient's room. and check it manually. Or let's say a patient is having an asthma attack and then having low oxygen saturation you will not be able to see that unless you go to the patient's room. So not like here in the US, you will see you will hear an alarm here and there from room 1200, the patient is having a problem breathing, so you know what to do just poke a hook him up into an oxygen to a nasal cannula or call a respiratory therapy to help in dealing with that situation. So and what else? Um, well, quickly what, you know, you were saying that people can monitor the situation from the nurse's station. So Holly, does that mean that you know, something like six people? Are there monitoring you? Or is it so one person I mean, talk about support?

Well, Roy mentioned respiratory therapy. So in a lot of hospitals, there are ancillary staff and allied staff members who may be part of that care team who will alert you if they hear something. And when he says monitor from the nurse's station. You know, alarm systems are often built in integrated were the type of problem can actually be transmitted to that central location at the station, which can then tell you what room you need to go to, and potentially what the concern is. So that technology is, you know, appearing more and more in hospitals. And even in long term care facilities, we're starting to see them be built and constructed with more technology around alarms. On the flip side, a lot of nurses that I work with will talk about the fact that there's so many alarms that they're trying to figure out, which one is it, you know, I'm hearing all of these different things, I can hear the IV machines beeping, I can hear this alarm in the room or down the hall or at the station. So it's integrating all of that information in a way that also now once you know what those alarms are using your skills to prioritize, but because you are the you are caring for the whole patient, so in many cultures, health care models and nursing models, the nurses may even be doing more functional nursing, still, we still hear that where they don't have like five patients, they have 15, or 20. And they're doing the vital signs for all of those patients, or they're doing the meds that day for all those patients or their knee.

So instead of the assessment, the medications, the vital signs, the treatments, the dressing changes, everything being done by one nurse for several patients. With a smaller number of patients, perhaps you have in some places, the care is being divided by task. And so a nurse is only doing one of those particular tasks. So those alarms, and those other technologies are built to help us with that. Sometimes at the nurse's station. If the patient has an EKG monitor on or a tele telemetry monitor on, you will see them at a station or even at a remote location. Watching those monitors. Sometimes it's a technician, sometimes it's a nurse, and they will actually be alerting the team as well if they see dangerous rhythms or significant changes. I have no other one, go for it. Another thing that about technology is what's good about the US we have this system, this computer system, which helps us not just to record the medication or what we do to the patient, but it helps us prevent errors. For example, I read one article which we use the same system, okay. Um B tried to enter the patient's medication, and since it's a wrong dosage, the computer said it's a wrong dosage. So we the prevented giving a wrong dose of medication to the patient because of that specific system. Here in Sanford, we use epic, which is a very user friendly software we're in you will see there. If the medication is wrong, you will see if the dosage is not correct. Or it's it's too early to give a pain medication, stuff like that. So technology really helps to make our work easier. And also, by simply just computing the correct flow rate of an IV, you don't have to do that here, you just need to put that on the Alerus. And then it will just put the medication name, it will automatically compute the flow rate on its own. So it's an easy, it's very easy to be to do things here because of technology.

And we're actually getting a lot of comments in the chat right now. If you want to tell us about the differences that you know about from your home country in the versus the United States. Please put it in the chat where I'm loving this right now Rolf is saying due to the increased number of patients or patient ratio is not real practice in the Philippines. We've been known nurses tend to do multitasking. That's why we clinical practice is not well implemented. And we do disease specific clinical assessment, Jolene, actually Jennsen you were just now talking about the IV. So IV infusion pump. That's what Jolene is saying for 100 bed hospital, only, maybe about 10 IV pumps are available. And Philippines has only just started with computer applications for nurses and doctors. Otherwise, we still use paper. Only. That brings me back to you. How does technology influence the clinical assessments tell us some you know, expand on that a little bit for us. So Jansen mentioned epic and Epic is one of the most well known electronic medical record systems here in the United States. There are a couple others that are that are used. But they do have some similarities in the fact that they are often customized to drive the nurse to follow up in certain ways and look at certain things. So for instance, let's say that you're going to assess lung sounds with your stethoscope, you're going to listen, you're going to be prompted what to document and then based on that sometimes there's even a follow up box that will pop up to put additional information or clarification in so you have that you also have this also plays back into Jansen comments when it comes to medication administration, and that barcode scanning process to prevent medical errors, or med errors.

The other thing that can be done is the systems can say, let's say there's a limitation on a medication being given based on someone's blood pressure or some other assessment information that you need. Those parameters can be plugged into the orders, and it can prompt the nurse to make sure that they actually record that information. Or at least assess it, if they're going to be giving that particular medication. So it's really built, in some ways it's built in make it so that it's more intuitive. And you don't have to sit there and think okay, what might I miss. And that's also why you're encouraged to usually have that EMR open at the bedside, so that you chart as real time as possible. And you use all of those prompts and elements within those systems to not miss anything. There are facilities that I've worked with that will even give you task reminders. So hey, this person has had a Foley catheter in for a certain period of time, it's time to assess the catheter, make sure that it's maybe not time to get an order to discontinue it because we don't want to leave a catheter inserted for too long. So the systems can be designed to help you have a thorough assessment to document thoroughly about it. And also to maybe help you not forget things and to recognize where there may be potential problems so that you catch them before your patient has a negative outcome or something that they are at risk for. Maybe they're at risk for a hospital acquired infection. And the system is built to remind the nurse or other members of the healthcare team of things they can do ahead of time to prevent that infection from happening. They didn't come in to get an infection. So the last thing we want to do is not manage that risk and the computer and the technologies that we have can help us do that.

Sure. Veronica is saying in the UAE we use epic Alaris physics some that's there it is. And those are all the same sort of software and programs and yep, so those are very common here in the US. I'd like to add up epic also prompts us if there were critical values when it comes to laboratory results. So ahead of time, we can really manage whatever the existing problem of the patient. And Lincoln is saying technology can bring us back to the real bedside patient care, click, click, click for a few minutes, then I can go back to my patient at bedside. That is also if nurse patient ratio is just right, of course. And that's something to always think about so that you can give the best care. Right, tell me in the United States, we were talking about this earlier that the doctors really rely more on the nurses than in other countries. How does that impact your responsibilities whenever you're performing these clinical assessments? Roy, are you there? It looks like Roy is having a little bit of some tech issues appears there she is. Why when you come back to that, okay, cool. There we go. Again, what's the question? Here in the United States and the physicians, the doctors really rely on the nurses more than in other countries? So just to ask, how does that impact your responsibilities during that clinical assessments?

Well, here in the US, you have the authority to have your own clinical assessment is just our profession here in the United States are more valued compared to the Philippines just as because they have the doctors here have more trust, trust in you, as a nurse, because you are not here just to be a maid or a slave to doctors, we are here to provide quality nursing care towards our patients. And that is also the thing that I love the most here because you have the authority and you can be an unrest, advocate for your patients. And that's the another important piece that nurses learn whenever they come to the United States is to speak up. They the doctors, they want your opinion, they're asking for your insights, and you're really more of a part of that team. Jansen, have you experienced that as well with your clinical assessments and working with the doctors? Definitely. Well, the first phrase that you said was like, physicians in the US rely on nurses a lot, well, that gives me a sense of that gives that gives me a strong sense of commitment to my to my career as a nurse and to give it gives me a drive to do my best all the time in doing the assessment. Well, there was one time when I got an admission a patient had was admitted due to weakness and then along the, during the chef, I noticed when I help her to go to the restroom, I saw some dark black stools.

So, my initial action was I conduct a message the doctor saying that the well we use the S bar of course, it means situation background assessment and recommendation. So I told the doctor patient X was admitted due to weakness. Um, went to the rest had the bowel movement and it was dark, it was black, tarry stools, can we do stool analysis and hemoglobin tests. So we, after the lab exam results went out, they figured out that the patient had low hemoglobin, so we had to transfuse blood. If not, if we did not do that right away. The patient could have had, you know, a more serious problem. So that's, that's a very important thing you know, To do your assessment all the time when you're with the patient. You mentioned about that documentation. Holly, I want to go back to you. So we have EMR, which is electronic medical records. And how does that work here in the United States? You mentioned earlier that that's one of the most important pieces of this puzzle. So it, I think that nurses who do have strong assessment skills can still sometimes struggle to integrate that into how do I put this into a machine? How do I make sure that I have the information recorded accurately, but we think of electronic medical record as also a communication device. So we're not just looking to document in that moment, and it's not useful for the future, we're also creating a record of what's happening at that moment as accurately as possible. Maybe the patient is very stable. And things look what we call within normal limits. There's no exceptions to the charting, that needs to be done at that moment. But an hour later, something changes. And now you're going in, you're reassessing that patient, you're going to document those changes.

But you can also look back to see did those symptoms ever occur when another nurse was taking care of that patient and they did their assessment, or is there a physician note that maybe indicates they observed it when they came in. So it's a record and a communication device, and the better your assessment, hopefully, that translates into the better your documentation and your recording of that information, so that we can also track and trend changes, whether they're improvements or declines in the patient's condition, to then be able to react very timely and, and not make assumptions that maybe something is new or something is different, maybe it isn't, it also helps guide us in whether we need to adapt the current interventions. And that's going to take place as a result of what we see over trends in assessment or new changes, relating those to the physician. That's a great example that Jansen gave about a patient having a dark Tory stool and what you're looking at when you call the physician is presenting that picture. But the physician may also decide I'm going to go into the record and actually look at that assessment that that Jansen did, and the one before that, and the one before that, and the one on admission. And they can kind of see where we are already noticing maybe some signs and symptoms that really all add up to perhaps a GI bleed, maybe I need a GI console. I liked the other thing that Jansen shared about that, which was he was asking for specific orders and interventions and physicians are expecting that. So even if they don't agree with you, they want you to use that assessment information to start to put together what might be happening and say to the physician, can we do this or this to maybe figure it out? Or to help the patient in the moment? Is there an immediate intervention that I can ask for an order for and then carry that out?

The chat is really, really exciting. Right now everybody's sharing their stories. I want to point some of them out again. A reader Loff is saying in the Philippines for example, IV insertion, we use penlight to locate the veins, even sometimes just palpitate to locate the veins in the US. There's a vein locator machines or vein cater machines and Malen is saying you should be proud you can do it without the vein finder. And then Zeagler is saying, hey, eras love. We have Agravaine here in the EcoStone, Philippines since 2010. So there's that difference in technology. Roy, what was the hardest thing for you to adjust to when you came to the United States and you started doing these clinical assessments? You're on mute. I'm sorry, my mic is off. I'm coming from Philippines we use paper. Yeah, we use paper in clinical assessment and documentation. So it's really hard to see what page we are going into documenting our assessments. So here in the US, we use the electronic ones. And so it's easier for me to do um, I do my clinical assessment data. So you just need to however for just example in testamentary if is it appropriate for the patient's race? Is it warm? Is it dry, so you just need to click the approach Rate assessment based from your eyes and what is over and covered data that should be included into the clinical assessment field. And I like that I also commend the people behind epic and behind the electronic medical record because they made our life or our life nurses easier and safer. And we can do and provide quality nursing care up. Hi.

I want to talk a little bit more about that clinical assessment. This focus a little bit on the orientation and some advice. I actually found my stethoscope here. How about that? It's like nice, right? Nice necklace that we all match. So talking about equipment, Jansen, what sort of equipment do you need when you're beginning your orientation so that you're prepared to assess the patients? For me, well, in the US here in my specific facility, we already we have all the equipment's that we need in in the patient's room. Every room has its that a scope has its own blood pressure machine, Project monitor that can get the blood pressure and other vital signs. What do I bring inside the room? I guess I have a bath. A penlight. That's it. That's the only thing that I bring inside the room. And, of course, well, other than the equipment before going into a patient's room, I I always make sure that I read short about the patient's background, to know what specific questions that I need to ask the patient or the information that I needed more to be able to help in the treatment plan. You know, and what else? That's it.

Holly, go ahead. Basically, everything is provided there, though. I have my stethoscope. I brought it from the Philippines. It's already we already have one in Spain, reminder home right. available. And even, you know, when you check your blood sugar, everything is provided in the hospital. I have to say about that in terms of what to bring for orientation, while for orientation, even if it also depends on what activities with orientation. So a lot of facilities have I saw a picture there. I'm not sure if it was Jansen, I think it was Jansen were there in a lab with a mannequin. And so many facilities will have you there practicing your skills on a mannequin in a simulation lab or a training lab. So it's cool if you if you do have your stethoscope bring it. If you're just gonna go sit in a classroom, you may not need that. But if there's an opportunity to practice a skill, you want to make sure you have that. And I agree he mentioned like bringing a Pin Light because especially depending on what shift you're on, you may need that even more. And many facilities will encourage you, if they don't have a computer for documentation and looking up information in the room, they may have it on a machine that they want you to bring with you. Not that that is going to perform the assessment of the patient. But again, it may be something that you want to have access to either to look things up right there at the bedside, or to actually document what you're doing and what you're seeing. So some other things might depend on. Like Jansen said he might look up the history to kind of see what's going on.

But if I know that maybe someone has something that needs to be measured, their calf circumference needs to be measured to see if there's increased swelling, I may be bringing in a paper measuring tape with me, um, hospitals usually have disposable one. So I may be bringing something like that. You know it sometimes you just have to have a little bit of background from that handoff report or from looking at the medical record to see what you're up against. And then you can tailor your list of things to bring based on that. And you have people like Holly from Connetics to help guide you through the entire process. Gonna give another shout out if you would like to live and work in the United States apply to Connetics forward slash applied They're on your screen, and we can get you started. And you can start living the life of these wonderful nurses that we're talking about. I want to get to some final advice we are running out of time, Roy, what is a piece of advice that you would give nurses to help them understand and prepare for these differences that we've talked about? One advice is for me, for the nurses in the Philippines or even in the other country is for you to really go on experience go on that side. Because in that way, you will be able to learn a lot of skills, pain Change is inevitable. And we just need to focus on what your goal in life that is to provide quality nursing care, you need to be an advocate, you need to also hone your skills and abilities while you are still in your home country. Because it's really different here in the United States. It's a more when it comes to the technology, it's really up high. So you just need to embrace all of the learnings and be you will be guided also by a lot of good professionals and doctors here in the US. So that's it.

Holly, what are some resources that can help nurses prepare for clinical assessments? And what some advice you can give them? Um, well, Connetics, and some of our partners do offer some pre arrival modules that can help refresh the knowledge part of what assessments look like, what are some of the terminologies that maybe you're not using every day, but you might see them pop up on an electronic medical record here. So I think if those are available to you take a look at those. If you're doing continuing education for and you're allowed to choose your topics, this is a good one to choose. So what I mean is, let's say that you're told you need to do continuing education to renew a Texas license, and you're not here yet. And you're like, Well, what should I do? Well, there are certain states that have specific topics, but then they have general. And in the general that's like pick things that you know are going to be helpful to you if you're going to make that investment to renew your license and keep it active. Look at things that are going to keep that terminology and then information and knowledge fresh. Secondarily, if you don't have a stethoscope, but you can get one, get one and listen to lung sounds and listen to heart sounds and start to get used to that again, practice on family members, hey there, our loved ones. So they know we have this dream. And maybe they'd be willing to be a practice patient for us so that we can get used to that, the less the more awkward you seem, when you're trying to get used to implementing all of these things, the assessment skills themselves, the terminologies, the technologies, you want to feel as confident as you can feel when you get here, because you need to project that to your patients. Now, that doesn't mean you're not going to learn and you're not going to have plenty to learn.

But if you can preemptively start to get familiar with those things through videos and tutorials and hands on practice, and even asking physicians Hey, I know you said this patient has these lung sounds Can I listen? Because normally that's not something I do. But I think it would be interesting. Some of them may be willing to help you learn that way at the bedside where you are. Now. I know it's different for everybody. But those are just some tips that I have based on what some nurses I've worked with over the years have shared with me. Thank you, Holly. Jansen, what's some advice that you can offer nurses who are coming to the United States or they just got here? They're learning about these differences? Let us know what's some advice? Well, honestly, that was one of my concerns. I didn't know what to expect in the US. Well, I got I got the chance to work in the hospital in the Philippines, but I'm sure the setup will be different. So personally, what I did was I talked to my friends who are in the US and ask them what to expect. And also the power of the internet is really helpful. So there are a lot of videos on YouTube where in you will see how to be a nurse in the US so and very important. Do all your modules your transitional modules, which Connetics provided us before going into the US? We had multiple of module was with different topics that were very helpful. And they just prepared us to be successful nurses here. And right now. I'm on my seventh month and I'm really enjoying working here. Thank you very much good ethics.

Thanks Jansen. That's awesome feedback. I appreciate that. Yeah, absolutely. Holly actually heads up the training modules in that those the clinical orientations there. So it's always good to have that feedback. I want to say thank you to all of our guests for joining us today and lending your expertise and your experiences to educate our audience and what it's like to live and work in the United States as a nurse. Of course, if you would like to apply to live your American dream, you go to Connetics,, forward slash apply, and we'll hook you up. Thank you so much, everyone for joining us. Before we go here, let's just go through our future shows that we have coming up next week. equality, diversity and inclusion was that like in the United States, August the fourth career progression, remember, we're here every Friday, same time, same place, August 11, Immigration Q&A, all of your questions about retrogression about green cards about TN Visas, our immigration lawyers will be here live for you to ask your questions in the chat on August the 18th.

It's our Connetics Career Day, we have about five, six client healthcare facilities that are going to be presenting to you, it's gonna be kind of like speed dating for a job, you'll be able to ask them all of your questions yet, it's actually really fun. And then you'll be able to get a better idea of the different facilities that you can apply and work for. On August the 25th. Stateside, we're going to be focusing on the northeast, what it's like to live in the Northeast of the United States, the different opportunities that we have for you there. So it's going to be a really, really great show for you to watch. The love for a talk show. Holly's going to be back on August the eighth working alongside preceptors. So we're going to stay on that clinical topic that everybody is enjoying today as well. Our Connetics college every Monday, we have Connetics College, we're talking about the English exam and the NCLEX exams. Our partners give free live classes to you in order for you to be successful to pass those exams are completely free. They are streamed live here on our channel. Every first Monday have Aspire RN is going to be doing and close classes Swoosh Niner are both do English classes for us top of the top. All of these partners of ours are the best world class as well. I pass we'll also be doing NCLEX classes for us this month and every month. So please come back. Join us again next week. Thank you all again to our guests and to our audience and as we always say, onwards and upwards. Take care everyone