Nursing Scenarios – What Would You Do?

Good morning, good afternoon, good evening, wherever you're watching from and welcome to the Lefora Talk Show season 6 episode 1, I'm your host Danielle Freedman, it's nice to see everybody today. So excited to be back. I've been back from maternity leave, where I took a little bit of break to care for my babies, and now I am so excited to be back with you all. Today we have a special show. We are going to be talking about different nursing scenarios, and we are going to hear from experts what they would suggest. What would they do? Please let us know in the comments where you're watching from. We love to see where our viewers are watching from. And we would also like to give you an opportunity to answer the nursing scenario questions. Let us know what you think. What would you do in these scenarios. Some of them can be quite difficult to navigate. So we're hoping to be here and give you some good advice on how to transition, clinically, culturally, and all of that good stuff when you're coming to the United States. So I see we have somebody who's watching already good morning to Portia. Please, once again, put in the chat, let us know where you're watching from. Bernice is watching from Ghana, good morning to Bernice. And we would love to see where all of our viewers are watching from. We got someone from Nepal. Good morning everybody.  

So, let's bring out our experts so we can get started with our special, special nursing scenario show. Good morning, everybody. Good morning, Holly, good morning Kaye, it's been a while. It's nice to see you good morning Holly and Leo, Hi, happy New Year. Have not seen for New Year, I know. I can't believe it's already 2025. The time flies Congratulations to the baby, Danielle, and I'm pretty sure you, you've very been busy lately and we appreciate you giving us time to help our colleagues coming to the United States. Well, thank you, Kaye. Well, I know you know how it goes, but thank you. I appreciate that, and it's nice to see you again. It's been a little while. And Holly, good morning. Good morning. I don't know if we can get you on camera, but we see you a big, dark screen, so hopefully we'll get you on camera as we get started through the show. But thank you guys, both for coming on. Happy 2025 thank you for giving your time to speak to our nurses. I know we got a fun show ahead of us, so I'm excited to get started.  

So if you want to each take a moment to introduce yourselves, Holly, if you'd like to go first, sure. So my name is Holly Musselwhite. I'm a nurse of 24 years, and I'm the Senior clinical manager at AMN International, and I work with the nurses who are going mostly to direct hire, but also some staffing nurses as well, as well in different parts of the process. And really enjoy helping those who come here to be set up for success. That's the most important thing, because they're making such a big leap. So most of my 24 years, I have been either a preceptor of international nurses or a program educator or building programs or supporting them in some way. So I think at this point I can say it's one of my big passions. 

Well, we are very happy to have you with us here today to hear all about your passions. Leo, we can’t see you now. Alright, Kaye, do you want to go next? So good morning, good afternoon and good evening to everyone watching around the world. My name is Kaye, as you can see, travel nurse, hacker here, travel means travel internationally and locally in the United States, I'm from the Philippines and migrated to United States almost 20 years ago, when I first signed my first contract, and I've been a contract nurse ever since, traveling around the different states in the north east coast as well. I'm mostly in the operating room, but I had experience in pacu, labor delivery and also partly some mentorship, preceptorship, charge nurse roles as well. And happy here to share my experience with you and how to troubleshoot and, you know, sustain this and enjoy this nursing journey. 

Alright, okay, well, we're excited to hear about your wealth of knowledge as we go through our nursing scenarios. Thank you for being on and last, but certainly not least. Let's hear a little introduction from Leo. Hi, good morning. Thank you for having me on the show today. I hope I will be able to share my story and implement and inspire everyone. So I was born in Saudi Arabia and raised in the Philippines, went back to Saudi Arabia, and before getting my citizenship in Ireland, I work in Saudi Arabia as a nurse, and now I have a US green card. Now working with my dream hospital, Mayo Clinic, I've taken my passion for nursing. Being licensed across six countries and five continents. So that's Philippines, Saudi Arabia, Ireland, USA, New Zealand and Australia, making the first Filipino Irish nurse to achieve international licensure worldwide. And also, I have a 15 years of nursing experience from all those countries. I started as a critical care cardiovascular nurse, dialysis, nephrology nurse in the Philippines. Then I transitioned to clinical research and nurse management oncology. I also did some travel nursing job, emergency medical, surgical pediatrics and even community I've probably done it, but I'm also I also have a bachelor's in nursing, Masters in Nursing Administration and Masters in Business Administration from UK, and I've earned post grad certification in Clinical Translational Research in Ireland.  

Yeah, wow. Leo snaps for you that is awesome. Very, very impressive. I am very excited to hear more about your thoughts and your journey. I didn't know all of that background that is very, very interesting. So if you're just joining us now, I'm Danielle Friedman. I am the host of the Lefora Talk Show for today, I'm coming to you from AMN Healthcare International, where we have both direct hire and staffing positions. So if you want to come to the US, like Leo, we would be happy to help you. I'm going to drop our link in the in the chat. It's amnhealthcare.com/International, and we would be happy to help you come to the US and reach your American dream. So before we get started talking about nursing scenarios, let's talk about, real quick, that, that big word with the capital R, retrogression that I think a lot of nurses on here hear. You know, even when I say it's, I get a little bit of it's just one of those words you don't really want to hear, but it's something that we're in. And I would love to hear a little bit more about everybody's experience coming to the US with retrogression. Leo, you came in 2024 so this is something you've seen firsthand and experienced. Can you tell our viewers a little bit about your experience coming to the US with retrogression, and any advice that you have for them? 

Absolutely. Coming to the US as nurse is a dream for so many, especially for Filipinos and Indians. And trust me, I get it. Ever since I graduated, that dream was very crystal clear to me. But let's be real. The biggest struggle isn't just a process. It's the feeling of being stuck, if you think about it, nurses trying to get to the US usually fall into two groups, like first, those still battling the NCLEX, pushing through a review after review, feeling like they're in endless loop. Then there's second group, the one, the ones who passed but got caught in the web of retrogression, waiting in defend, waiting, independent, in depth and indefinitely, independently, unsure if their priority date will move, and that way it can take like forever I've been through. It's the excitement, the frustration, The when is this ever going to happen? Moments. But here's what I've learned, being stuck is just part of the process, not the end of it, because once you get through the roadblock, everything changes. And it's just like stepping into that dream after all that waiting, and it's worth every step. Um, you know, people me when I asked me what kept me going through the long wait and uncertainty of the retrogression, I always go back to the two things, facts and experiences. I've always backed up my nursing journey with research. But more than that, I listened to the experiences of those who came before me, their stories, their struggle, their victories. It me. It also my mindset. 

Thank you for sharing, Leo. What I'm hearing is you thought about the facts of the situation. You thought about others who had done it before you, and you just stayed motivated, and now here you are. You're in the US, living your dream, working at your dream job. So very inspiring story. Kay, let's hear from you next. What advice do you have? I know you've been doing this for a long time. You're a wealth of knowledge. What can you tell our viewers on how to stay motivated during retrogression? So I would always think retrogression in a is a way. It's not really a bad thing. In my opinion. It. Has pros and cons to many things. And one of the main things of red aggression is really, you know, regulating the, of course, the quality. That's why we want to come to America, right? Because there is a standard we it's a better, better, better livelihood for us, better situation. If this is not something that is valuable, I always think my mindset is, then there's no reason to come to America, right? It removes the specialness of it. Some things are worth waiting for. Likely, you have mentioned it's worth the wait.  

There are things we you know, that happens for a reason, and retrogression is not something that that really we can control fully. It happens because, again, for a good reason, that we want to make sure that when you get here you have jobs right. And it's not like it's going to degrade or fully, fully, fully dilute everybody here in the United States, making sure that we get the best quality care. And we're well, we're waiting for that. Like Leo have mentioned that he invested in his experience, and he invested time to listen to other people what they went through. As for me, I'm very lucky back then, because when I finished my nursing program, there was not a lot of need for nurses coming to the United States. It was more of the IT or computer people. So there was not much nurses coming to the United States when I when I finished. But then after that, it was just a retrogression of six years, and my colleagues and my classmates had experienced it. And my best advice would be there is you don't stop your life because of retrogression. I would always recommend people still pursue what you want to do if you want to come here to the United States, still pursue that passion, submit that application. But you don't need to stop and wait for me. I don't wait. I make sure that I make use my of my time while there is a delay. So there are a lot of things that you can do. Invest in your clinical experience. Invest in your professional, professional growth. Invest in your financial literacy. There's so many things you can do while waiting during retrogression, because at the end of the day, it's not the person who came here first, it's the person who did the most when they were given opportunity. 

Excellent advice. Kaye, I could not agree more. I think it really comes down to just doing what you can do, controlling what you can control. Take that NCLEX exam, take that English exam, up your clinical experience, all the things we talk about on these shows. I think that's very good advice. And I love the work smarts and not hard. I think that's a good little motto, maybe to live by during this time. And Holly, we would love to hear from you. You've been working with international nurses for what it's like 15 years, little bit more than that. So you also have a lot of experience. You've seen a lot of things. What advice do you have for our nurses who are struggling with retrogression right now? Yeah, I so I've been working with international nurses for a long time in various roles, like after my first year of experience as a nurse here, I started doing precepting of nurses. So then I moved on in 2007 to actually work with a staffing agency, and I was with them for over eight years, so international staffing of nurses and allied professionals. And what was interesting is, as I joined that year, was when we started to see some real slow downs with a very long retrogression, which Kate mentioned earlier. You know, sometimes it can take a while, comes in cycles, is what I've learned.  

And so it's like, if you're not in it, when you begin the process, it may come along while you're in the process. And so what I've learned is very similar, but obviously in my role, I'm working with nurses over that period of time who get very frustrated. And I even wasn't sure that I would be doing the same thing over the course of my career because of retrogression, what I ended up doing, I think, was learning a lot more about what else is maybe out there that's an atypical pathway, things that I didn't consider, both in terms of my professional career and what I saw nurses and allied professionals consider to be able to still realize their dreams. So some of them went to places that they didn't plan on going. Met new communities because the communities they thought they were going to end up in for their first US job, where they maybe knew a few people is not where they started their life here. So I think it taught me a lot about being open to change and being flexible. It's how I got the opportunity to work with Ally professionals during that time. So that's in addition to what Kay said and Leo about, you know, getting experience. And strengthening yourself in a few different ways. It's also about maybe being a little more open to possibilities that you might not have originally considered. 

I love that Holly being open to possibilities you might not have considered, and being more flexible. I think those are very wise words for our viewers to hear. So thank you for sharing. Um, so before we jump into our nursing scenarios, I see a lot of people joining in the chat. So I just want to give a few shout outs, because I love to see where everybody is watching from. We have Porsche watching from Poland. We have Evans watching from Kenya, Jane from the Philippines, voila. From Jordan, wow. We are just covering the globe, everybody. It's so great to see everybody today. We are so honored and thankful that you're joining us for the LA fora talk show, and we would love to hear your questions in the chat as we go through the show. So please feel free to put them on.  

I see Holly nodding her head, our expert panel is excited to hear from you. So let's get started. Let's talk a little bit about the US labor market before we get into our first scenario. So things look a little bit different than they did. You know, four or five years ago, when we were in the thick of COVID. US vacancy rates seem to have approved a little bit. Retention rates have improved a little bit. But hospitals are still hiring. They're still looking at the future. There's still a lot of projected nurse shortages retirees, and hospitals are still looking to fill those gaps for the future in their future planning. So with that in mind, let's talk about a couple of nursing scenarios and give some advice to some of our nurses who might be watching and can see themselves in these shoes. So our first scenario, we have a nurse with one year of bedside nursing experience in a secondary hospital that is hopeful to coming to the US and living out their American dream. I'm sure a lot of you are watching and can probably relate to this nurse. Let's say that this nurse has passed the NCLEX as well. So Kaye, I'm going to turn to you first. What advice do you have for nurses on how to prepare, given the weight and expectations of hospitals in the current market? 

Yes, thank you. Actually, this is my scenario when, when I came to the United States, I've had one year experience back then I started, I initially really didn't think of going to the United States. But a family member had mentioned, you know, there is an employer that is here in the United States that's our recruiting here. It says to us, my experience to that is, I'll go check, check what's in there, and then make sure that you ask questions that are pertinent to a lot of what you're going to be expecting coming to the United States. For me, I always want to check out first. I It's nice to hear the background of other people, what they say, but it's not it's only a factor. It's a variable. Me going there and actually talking to that recruiter, it's very important, and me doing my homework after that communication is very important as well. While waiting, there are things that you can also prepare for. Is going over other people's journey when they were having one year experience, what did they do? As for me, I'll submit my application once I find the right employer for me, and then look at the expectations.  

You know, what are the things that they want to questions on the tracks as we go submit my application, once I find the right yeah, so I would, I would say, what are the things that I will be handling when I arrive in the United States? What are the cases is that similar to what I'm doing right now, if the answer is, there are differences with the acuity of the patients, the next thing I will do is I'll go to the resources that I have. There's a lot of online resources that I will study before arriving to the United States to make sure that I'm acclimated to what they're doing in the other side of the world, and also I can get in touch with the hospital educator or hospital HR, to give me idea and on, what are the things that I would expect during my orientation. There's so many learning things, and I think one year, two year preparation will be a great amount of time. I love that. Kay, I think that's really great advice for our nurses. So it's preparing clinically. What can you do to get ready for when you're going to be bedside in the US? Ask those questions to HR, ask those questions to those who hired you. Look at what different scenarios might be different between where your home country is. Services and in the United States, practices might be different. How are you going to get prepared? I think those are all really good pieces of advice for our audience. Holly, do you have anything to add to that? 

I completely agree. And I think the other thing that I might add is when it comes to those differences, a lot of times when nurses are preparing to interview, you're often given a chance to ask during an interview if you have questions for the manager who is interviewing you. So have those questions that Kaye mentioned prepared so that you can start to get that information even before you might get an offer, you kind of can start to mentally prepare for what lies ahead and how to look up that information. The other thing I've seen that I like to share with nurses is med surg, which is a very common need, is also one where we're seeing increasing numbers of cardiac monitored patients on med surg units. We're seeing technologies that, in some countries are only used in higher acuity settings. For instance, some folks will tell me they've never seen IV infusion pumps if they work med surg overseas, or they don't see central venous lines, and they don't do certain drips, because those are things for ICU or HDU in their countries or in their hospitals. So knowing that in many med surg settings here, those factors mean you have higher acuity patients med surg and that clinical transition can very be very challenging. And while you will get some training, the expectation is, if you had to know it for like NCLEX, you're probably going to need to be pretty comfortable at the moment you step in the door with the concepts, especially like disease processes and things like that, so that when you learn those newer technologies, you're not also having to figure out common conditions and disease processes that we hopefully would you would be solid on before you get here. 

Alright, okay, well, good advice, also from Holly for a nurse who might be in that situation. So thank you, Holly. I think we're going to turn to our next situation, because we have quite a few to go through, and I know everybody who's watching would love to learn more. So we'll start with you, Leo, when we do our next situation. So I think this is pretty common among nurses that I've witnessed, and I'm sure that you all have seen there are nurses who you know right now are looking for their ideal situation. They're looking for their ideal job. They're interviewing at multiple interviews, and then maybe they get an offer, but they want to wait it out and see if they can get their ideal job, which I can totally understand. If you have an ideal place in mind, you have a family member, you have a cousin, something like that. Maybe you're thinking, I'm hopefully going to wait it out. So that's a common situation I see occurring. So let's take a specific example, if we have you know, let's pretend nurse Danielle. So nurse Danielle is coming to the US with five years of experience from the Philippines at a tertiary hospital. Nurse Danielle has an offer from a hospital in Mississippi, and she has a friend who's going there as well that's also accepted an offer. But she has a cousin in California, and is ideally looking to come to California. So right now, she is going to wait it out and see if she can go to her cousin in California and get a job there. And I know this is kind of a common scenario that you all have witnessed. So Leo, what advice would you have for a nurse who is considering whether to wait or to move forward with something that might not be their ideal situation. 

This is definitely a tough decision. With five years of experience in the Philippines, it's exciting to have the chance to start in the US, but deciding between Mississippi or California can be overwhelming for me. It all comes down to the long term goals, sometimes the first opportunity, like the one in Mississippi can be a stepping stone to bigger things. Personally, I've learned that every experience counts, even if it's not your ideal place to start waiting for that perfect job in California with her or his cousin is really tempting, but the longer you wait, the longer it takes to start your career here, like in the US, I took opportunities I didn't expect to be my dream job, and they ended up shaping my entire career, like I was in Saudi Arabia. And then I was in in Ireland, but my initial goal was to go to the US. It took me almost like 10 years before it finally happened. So I'd ask myself, what can I gain from this opportunity right now, and how does it fit to my bigger plan? Every step in in the journey is part of your story. 

I love that Leo, every step in your journey is a part of your story. Sometimes you end up going places you didn't always expect, but it's part of your journey to get there. And it kind of reminds me of what Holly said about being flexible and taking steps that you may not have initially thought you were going to take. I see Holly nodding your head in agreement. Okay, what advice would you have for nurses who might be in this situation where they have an offer from somewhere that they might know somebody who's going there, but ideally, it's not the exact offer that they were really hoping for. Should they wait? Should they see? What would you advise to nurses in this situation? 

Yes. Thanks. Danielle, it's very interesting because, as everybody knows, and I'm very vocal to it, my first hospital when I arrive in the United States is probably in remembrance of yesterday's event. MLK is called Harlem Hospital in New York City, and everybody knows that MLK was actually, you know, actually had a strategy there, and Harlem hospital operating room staff helped him survive. Um, I did not know what Harlem place was before and I accepted the job. However, there were a lot of people who commented after I took the job, that you should not go there, you know, you came from one of the best university in in the United in the Philippines, you should be deserving better workplace. And I said to them, You know what? Things happen for a reason. My it all will boil it down to what is my priority, right? So my priority is, is not to be close to my family. I mean, I love being with my family, don't get me wrong. But my priority at this time is to really, number one, get to United States. Number two is to be able to gain experience. Okay, so when I landed in that hospital. Everybody knows it's not a top Hospital in New York. It's not a top Hospital in northeast coast or United States. However, what I focus more is, what will I get from here? Okay, so what are the things that I will get? Maybe the benefit of having the brand name or the prestigious name. It's not something for me, because prestigious name also comes with big responsibility and accountability. I question myself, Am I ready for that? The answer is no. I only have, like, one year experience in in a smaller community hospital. I think I'm not ready for it too. I don't want to go to a big place, to my ideal place, and then only to find out that, hey, I'm not a part of their expectation, and I'm going to lose it. I'm going to feel defeated, right?  

So for me, I want to be prepared whenever, when the time comes that I will land that job and there's and I always tell people, there's no perfect job, there's no perfect place, workplace. You have to make it perfect for yourself. You're going to have to find what the goodness of that place is, what are the benefits? Are the people nice around that? Because for me, people don't leave place because of high salary. For me, people stay on those jobs because of good people, good culture. Those are priceless, good management. So if that workplace is a very good vibe. I'll stay, you know, and then later on, I will find a better place. It's sure. It's California. It's a high paying but guess what? I stayed where I am. It was not the highest paying company, my highest paying hospital. I've been, um, however I took I, I took advantage of those benefits that were ahead of me. What are those? They have good educational benefits. So I enrolled myself in a good school for my masters. The hospital paid for it. They have great health benefits. When I delivered my baby, I had no pain. I had not no payment at all, zero. And they had good Retirement and Pension. And on top of it, there was a good family that was built actually, even after being there, like more than you know, that was my first job, almost 19 years ago. They gave me a call yesterday, saying, Hey, how are you doing? They were calling from the front desk, you know, the charge nurses call me with other nurses on the video and that is way more precious than financial so for me, focus on non material things. See, focus on the benefits, focus on the good. You will make the workplace perfect for you. 

That was really, really great advice. Kaye, I know you couldn't see my face on the back end, but I was going like this the whole. Time, yes, yes. And I love that you said that the front desk called you after all of these years and the nurses called you. That's so special. Um, you know, it reminded me of something. If you've been watching these shows for some time, you'll recall that my mom, Tanya Friedman, used to host these shows. If you notice my last name and something she always says, she always says, is, look for the good, which is very much in line with what Kaye said. Nothing is perfect. You gotta look for the good. Look for the good in that job. As Kaye said, she found a job that may not have been the highest paying, but had amazing education benefits, retirement benefits, health benefits and all of those things are, are priceless. Um, so very, very good advice. Kaye, I loved that. That was great to hear. Um, Holly, I know we were talking about the scenario of a nurse who's deciding between taking a job in Mississippi, where they might have a nurse friend who's also accepted or waiting for an ideal job in California, just to remind our viewers, have you seen this happen often? How does this usually kind of pan out? 

I, when I first came on board with AMN International, I wasn't seeing it as much, but now I am starting to see it a little more. Where we have people who are making these types of decisions. And in the past, when retrogression was in full effect, as I mentioned, I experienced earlier. I saw it then a lot, and I worked with a lot of professionals who ended up mostly because of timing and the desire to come to Leo's point, you know, you're not going to be able to come any sooner than, you know, making that decision. So if you if they made the decision, and they came and they sort of took, maybe the unexpected path, but it was part of meeting their personal priorities. In many I would say I have a hard time thinking of areas experience where it didn't turn out well. One, there's all sorts of stories I have that I could share, but we don't have time. I will tell you. One in particular went was went to a very, very cold climate after coming from an almost desert climate, and was just like, totally not the original plan, but it worked for her, for her family, for the family that she expanded as she arrived, and I guess had been here about a year and had another child so similar to Kaye's experience. You know, those are things you're not planning on when you may accept that offer, and yet they come and life happens, and you keep moving forward. So I have seen it work out very well, so long as I think people in are informed and they're prepared and they are aware of as much as possible about what they're going into so that they can adapt and still meet the goals that they have for themselves and their families. 

Amazing. Well, thank you, Holly. Love all the suggestions and additions, and I can see our viewers do too. I see Emily says yes, good advice. Chloe says 100 Christine says true. Macaron says yes. So I'm glad that everybody is taking the advice from our experts, who have really lived through all of this and able to use it and hopefully help yourselves when this when the time comes and it's time to transition and reach your American dream. So thank you all for your comments. We appreciate it. I see also Victoria says hello from an A former OGP nurse in Maine. Hi, Victoria. It's nice to see you. She says I came from a very warm and very cold climate, and everything worked well. So there you go. I'm sure a lot of nurses who are watching that are in the US may have had a similar story. They didn't necessarily think that they would end up where they were, and they did, and it all worked out for the better. So very happy to hear that. Okay, so let's turn to our third nursing scenario. So I think a lot of nurses, when they imagine coming to the US, have a certain vision of how they think their orientation is going to go. So let's start with you Leo. So our scenario is a senior nurse working in Abu Dhabi in the ER started working in her new US job four weeks ago. She had a meeting with the educator and Preceptor, and was told there was concerns because her progress was very slow and she seemed to need a lot of prompting for the basics. They ask her what she needs to be successful, but she doesn't feel prepared to respond because she thought her progress was meeting expectations, and the preceptor was really nice. Leo, if you faced a scenario like this before, how might you respond in this type of scenario? Real. 

This is such a relatable situation. Moving from Abu Dhabi, or like in my case, like Saudi to a new place, like to the US, and transitioning to a new role can be a big adjustment, like wherever or whichever you might feel like you're doing well, but sometimes there are differences expectations, especially when it comes to the US healthcare system. I've been there myself, thinking I was meeting expectations, only to find out there were areas I wasn't fully understanding. So I think the key, the key here is communication. When your educator and Preceptor point out concerns, it's not about failure, it's about getting clarity. So ask for specific feedback on what needs improvement, like specific details, and don't be afraid to ask questions about the expectations you have to meet a certain level or certain point. And remember, every seasoned nurse has faced a learning curve, and it's okay to take extra time to adjust. This is just not this is just another part of your of your journey to grow and succeed. So don't be afraid. And really important is having a clear communication, or just hold on, ask and, you know, reflect on what what's happening. 

That is great advice, Leo, for somebody who's watching and might be feeling a little bit anxious about coming to the US, thinking about that scenario in the future, definitely being reflective, open to the open to the advice. I think those are all key pieces of advice. So Holly, I'm going to turn to you next. Is this common for nurses to experience? Is this something that you see come up a lot? I would say it comes up more than most people might expect. So even those of you who are very senior nurses, when you transition into a new setting, a new area, a new culture, there are going to be so many differences. And sometimes the goal of the team initially is to really help you feel as good as you can about those things, and so they're trying to help you succeed and have a positive outlook. But that doesn't mean that behind the scenes, there may not be some concerns, and to Leah's point, bring those concerns forward by being well informed. Let's say you perform a procedure with your preceptor. Maybe you   go in and you do a head to toe assessment with the preceptor observing you when you exit the room, ask the preceptor how you did and if they say okay or fine, don't stop the conversation there request additional clarity on maybe, what are one or two things that I could do better the next time I do it, or I'm glad you think I did okay, but I felt really slow, and I don't think the patient fully understood some of my instructions.  

Do you have any specific things that you think I should change, and that will get you that specific feedback. So fine is not fine. Okay, is not okay. It's just a little tiny general piece of information. And over the course of time, if you're not getting those nuggets of feedback that are more specific, then when you do have this scenario happen to you, if it happens, you feel completely shocked, and that's not what we want. We want to feel informed, even if it's stuff that we didn't expect. It's better to hear it directly and in the moment than to hear it cumulatively and somewhat late in the process. 

Great, great advice, Holly, so if you were just tuning in, Holly was giving advice for if you are a nurse that is thinking about your orientation and thinking how to make sure you are getting the best prepared, getting feedback on what you're doing and essentially correct me if I'm wrong. Holly, but essentially, the advice was to ask for specific feedback, not just getting general feedback. You know, asking specific questions, asking for specific feedback. And that's how you really progress. That's how you really get better. Absolutely, from day one, that's extremely important for you to do. Alright. Thank you, Holly Kaye, I saw you nodding your head as well, anything you wish to add on this kind of scenario. Yeah. So a person who did orientation every three months, that's me as a traveling nurse. We changed our jobs every three months, technically going through onboarding and orientation you will never. Be at par to anybody, even after your orientation. Imagine, because, imagine this, this person that you've been talking to have been there for five years. There will you will never be the same functioning nurse like that person has been there for five years, and you are only there for two weeks or one month or four weeks, right? So, so number one is, don't be hard on yourself.  

Okay, give yourself, give yourself time to learn. Don't expect that you're going to be the same person like that colleague who's been there for 10 years, 13 years, 15 years, right? Because you're not going to be however, there is only a level of expectation that is, that is necessary for you to perform it's a level of expectation that is acceptable. Okay so the first thing that you will have to know when you when you arrive in that place, is, where is the skills checklist? Okay, I'm going to repeat that skills checklist. It's very important for you to have in your hand at the beginning of your training. And without that, it's like you're navigating your orientation without any map at all. So when you have a skills checklist, you go over that, and it's a big list. For me as an operating room nurse, it's an eight page, okay, eight pages. So it will give me an idea on the things that that is expected of me as a nurse. Number two is, if you have an orientation timeline. If that facility has orientation timeline, try to have it. What is expectation from me in 30 days? What is the expectation for me after 45 days? Okay, so at least your guidance.  

If you feel like you're not being at far after one after one month, start talking with your educator or your resource person, your perspective, say, hey, you know what? It's 30 days already, and this is the skill checklist. I don't I think I'm still missing a lot from here, and I don't think I'm going to be up to the time that I'm readyafter my three months orientation, right? So know the resources that you have to go through what there are a lot of intranet services there, go log in, and you'll be able to get those information and put extra time if you feel like you don't have enough time for orientation, get resources and read it at home. For me, what I do for me to be at par every single contract that I am at, I look at the cases the day before, and I read it before arriving to the workplace, because at the end of the day, I'm the one who's going to benefit from what I'm doing. Right? It's going to make my life easier, so I'm putting extra time for learning, but it will benefit me. 

Great advice. Kaye, so what I'm hearing is seeking out those resources so you know what the expectations are of you, which I think is going to be super helpful, and maybe spending a little bit of time upfront to understand what you're walking into, and that will serve you better in the long run. So great advice from all of our experts on this scenario. So thank you guys for sharing. So let's turn to our next scenario, because I know we're getting close to the hour, and I'm sure these are very helpful, as we can see from the comments, and I want to make sure that we get to go through all of these. So let's turn to our fourth scenario. In week three of his orientation, a nurse's preceptor advises a nurse that a patient complained about his approach. I know this is something that a lot of our nurses probably fear when they think about coming to the US and working with patients who might be of a different diversity, gender background. That's something that can be very anxiety provoking. So this nurse's preceptor advises the nurse that a patient has complained about his approach. The patient said that the nurse didn't talk to him when he came in and just began arranging the bedside table with medication.  

It was also upsetting to the patient when the nurse moved his hand away from the table without any verbal warning. The preceptor recommends that the nurse speak with the patient, but he feels very embarrassed. He feels the patient is rude and unappreciative because the patient told him to leave the room. Leo, what advice would you have on how the nurse should approach the situation with the patient? Yeah, I totally get how the situation could feel embarrassing and frustration and like you're in a week three of your orientation, and suddenly you hear a feedback that doesn't sit well with you. But the reality is, you're in a new place. You're probably adjusting and communicate again. Is such a huge part of patient care, because some patients are all like patients. They don't only they are not only after physical treatment, but they are also there to feel, acknowledge, hurt. And the thing is, the nurse did not ask for, like, a permission. Like the nurse could have, like, asked a permission, or have communicated clearly. It's understandable that the patient's reaction caught you off guard. But the key here is that it's not personal.  

The patient may have felt ignored or uncomfortable when the nurse didn't communicate before moving his hand or setting up the bedside table. It's important take a step back and recognize that this is a learning moment, and feedback, no matter how it feels, is part of growth. So just be open and accept feedback from your preceptor, the advice from your preceptor, to speak with the patient. Might feel uncomfortable, but it's a chance to rebuild rapport. It's a chance to connect again with the patient. Opportunities show the patient that you care, that you care, and their feelings, which ultimately improves the patient's experience. It's not about right or wrong, it's about providing the best care as possible and learning from each encounter and bridge the feedback, this will help you become a stronger and more confident nurse. 

Thank you, Leo. I think that was great advice. I think for any of us in life, getting constructive feedback can sometimes feel a little bit uncomfortable, but as you said, that's how you grow in life, that's how you become better, that's how you learn to manage your patients better, and at the end of the day, that's really your goal as a nurse, to give your patients the best care possible and be the best nurse possible. So thank you, Leo, that was really good advice. Kaye, what advice do you have for nurses on how to manage patients who might not be the most friendly or the most warm towards them? Very difficult. The patients are very are very common, I would say difficult. Colleagues also exist. Danielle, so as I as time goes by, in my journey in travel, nurse, one thing that I really did target is my personal growth. Primarily it is because you will realize later on that there's a lot of things that that you don't know in life here in the United States, when you come here, there's so many, so much diversity, and the only time, the only way that you will learn that the diversity cultural differences, is by exposing yourself to many people as you can.  

How did I handle difficult people? There's so many difficult surgeons in the world. Everybody knows that right being in the or is not an easy, easy job, easy task. First things first that you keep in mind, not all battles are worth the fight, okay? And second thing is, likely you have mentioned that these are your growing opportunities. If someone says so and you're not aware of it. And there's also things that you don't know, and nobody knows, right but, but one thing that you should focus is you know that those things that you don't see to yourself, especially when you are here in the United States, when it's a melting pot, a full of cultural diversity. Example is, I arrive in New York City, or any big metro you're going to land in, there's going to be a lot of cultural diversity, which you will find, one might be rude to them. Two might not be rude for me. So what you want to do, let's explore that. Keep on communicating with these people. Read about it, be open minded. What will matter most here for you to survive difficult scenarios and challenging people is it's not your academic grades, right? Is your learning attitude. If you have a very good learning attitude, doesn't matter if you're an A student or B student, but your learning attitude will determine your success here in the United States. If you have an open mind, you listen to other people, and you take actions to correct those mistakes and get better, then you will be the best in surviving this kind of scenario. 

Thank you. Kaye, I think that's great advice for our nurses who are watching who might be feeling a little bit anxious about coming to America, which is very exciting. But like you said, it's like a boiling pot. There's a lot of diversity. Obviously, it depends where you go in America. Is a big place, but being open, as you said, not every battle is worth fighting and taking feedback and just making yourself better at the end of the day, that's really the goal. So thank you for sharing. So I see we have a few questions in the chat before we get to our next scenario. So let's quickly take some of those questions. And if you have any questions and you're following along, please feel free to put them in the chat. I see one from Kershaw. Kershaw says, will things be different in Trump's administration when it comes to the visa process for nurses? So Kershaw, I see K did a little give me there? If you want to learn more about our thoughts on immigration, you can go ahead and check out the onwards and upward show on the AMN Healthcare International page, we do an immigration Q and A once a month with legal experts, and they give their thoughts. So you can go ahead and watch that show. Go to our page and watch our most recent show. There's some thoughts there for you. Candacy has a question for you Leo, Candacy says, Leo, did you do the NCLEX on your own or through the agency? 

I did my NCLEX on my own. Alright well, there we go, easy enough, Leo. I'm curious, if you wouldn't mind sharing with our viewers how AMN Healthcare International supported you during that journey to the United States. Yes, of course. So my journey has been really up and down. So I was in, I think it was I was in Ireland when I got a job in Florida, and it was not with AMN. So I was really delighted when I got the job there. But then I had to, you know, do brainstorming with my friends and especially my cousin. And then she told me, she gave me an advice that, just wait for the citizenship, so you have a plan B if you don't like the US, so you can go back and work back in Europe. So I waited for like, five to six years, and then on the sixth year, I was really ready. I've I had my traveling, I had my education, so I had my experience, so I was ready. And then one day, I just got this news, we're not going to take you anymore. The employer backed out, and then my world just got, you know, it was a I got a devastating news.  

So I was so sad. And then one day, I was just on my work, I was on my break, and then I receive an email from AMN, and then they said, oh, there's an interview in Minnesota. And I was wondering, there's only one hospital that I know in Minnesota and I and that is Mayo Clinic. So I emailed immediately, and I said, What is the interview? So they said tomorrow, so I didn't have time to prepare for that. So I said, Okay, I'm not going to prepare for this anymore. I just wanted to know their values, their mission and vision, if they resonates with me. So okay, I just reviewed everything there. The next day, I had an interview. I got the job. Amn has really helped me a lot from start to finish. They helped me to recover my application. Because I thought I'm not going to be able to recover that. And imagine, in just six months, I was able to go to the to the US. So because the interview was like June and then, oh, sorry, not six months, but like December, I already know that I'm already leaving.  

And after three months, or four months, I got my visa, and then I booked my flight. And every time it was really smooth, flowing for me. Now, they were helping me since, like when I before, even before coming to the US. They helped me with the processing of my visa, with everything, and with relocating. They're really nice. They always ask me, How am I? And if there's anything that they can do to help me. So I was really, I'm really happy about AMN, I think this is now the largest recruitment company for nurses going to the US. So I'm really thankful. And I think it was really a blessing in disguise to, you know, to have AMN got rejected from my previous job offer. Wow, I didn't know all of that background, Leo, when you shared that your employer pulled your offer. Oh, my heart just sank. And I'm sure a lot of nurses who are watching can kind of relate to that feeling. But like you said, blessing in disguise. Life works in funny ways, and sometimes things happen for a reason, and now here you are thriving in Minnesota and working at your dream job. So I'm so glad that we were able to help you along that journey and bring you to the US to reach your American dream. And thank you for sharing that was very, very inspiring to hear here. Go ahead, Leo, I can see you got something on the tip of your tongue, and would you? Would you ever imagine that in my diary 10 years ago, I've written there, I wanted to work in Minnesota, and also, one door closes, there will be another one that will open. So I think that's, that's the one that thing that happens, 

My goodness, that's crazy. What? Wow. You were foreshadowing where your life was going to take you. That's amazing. So I'm sure when you got that email, you were like, is this where I'm supposed to be? That's amazing. Well, thank you for sharing. Leo. That is quite the story, quite the journey very inspiring for our nurses to hear. So thank you for sharing so I see we are almost at time, so I'm not sure that we're going to get to another scenario. I'd rather take a minute right now to just go around and thank you all for taking your time to share your wise advice with our nurses and give you an opportunity to share any last piece of advice for a nurse who I think Leo kind of classified it pretty well. You have nurses who are either in the bucket of they're considering coming, they haven't taken the NCLEX, they're not even sure where to start. And then you have bucket b of nurses who have taken the NCLEX.  

Maybe they're, you know, thinking about if how they're going to make this happen. They may have a job offer, they may not somewhere where they want or not. Then you also have the nurses who are in process and waiting, which is exciting, and the nurses who are here. So I guess we have four different buckets of nurses who are potentially watching the show. But what advice would you guys have for the nurses who are watching and may be thinking, you know, is this something I could do? Holly, we'll start with you. Yes, it's something you can do. There is a lot of work on your part. It's also important, as Kay mentioned earlier, to do good preparation. Understand as much as you can about each opportunity that comes your way, be sure that the priorities you have are ones that are going to really be the most meaningful. Salary is not always the most important thing. It's about maybe a sense of belonging and being able to be set up for success from the beginning. So there are many opportunities that are out there that you might not have considered or would even label your dream, and yet, if you do, you may find that it's even better than you ever imagined.  

And you're not disappointed. Instead, you're here and you're successful. So be open to those opportunities and educate yourself and prepare yourself. Get strong clinical experience to make sure that that first job as you begin your US career is one where you are set up for success. Work with a good partner and continue to ask questions and use the time wisely while you're waiting to come. Thank you. Holly, great advice for everybody listening. Kaye, let's turn to you. Yeah. So thank you, everyone again for joining us and hope, and hopefully this will give you more information how to survive coming to the United States. It's all worth it. Coming here, okay, this is your dream. Work hard for it. And some people who be like discouraged by retrogression, rethink your dream again. When you're feeling down and depressed or disappointed with what's going on with the world, you feel like you don't want to push, push for your dream. I want you to take a pause, stop and then think why you started again.  

Okay, every time you're ready to give up, always take a stop, take a pause and repeat to yourself, why did I start this process? Why? Why did I want? Why did I want this? And keep on reminding yourself that, because it's easy to give up, especially when there's retrogression or there's discouragement or there's challenges ahead. People have come to me saying, I guess America is not for me, you know, because they you know, the process didn't turn out well, or there were employers who are backing out. Those are normal process. But one person should not stop you from your dream, not an agency or not a not a not a bad person who's challenged, who's giving you challenges, because there's a lot of good people out there, there's a lot of good agencies, there's a lot of good employers out there, and not one should stop your dream just because of a challenge or disappointment. Again, keep on repeating. Why do you want to do this? Why do you want to come here? And if you can write it down so you can see it all the time, read it, put it on your phone, put it in your screenshot, right, and put it on your I mean, your on your phones. What do you call this? One front, front picture, right? So again, it's not easy. If it's easy, then it's not special. If it's easy to get then it's not worth it. Okay, when it's harder, and if this is your dream, you work hard for it, then that's the taste of success when you reach it. Okay, so keep on going. Never give up. Take time to learn of the things that you can do. What? While you're waiting again, there's no wait. There's just opportunity to be better. So when you get here, you can be the best person you can be. 

Thank you. Kaye, very inspiring words. I see some comments thanking you for the inspiring words. You know, I think the biggest takeaway that I have taken from doing these shows and learning from all of you is that everything happens for a reason. Take the stepping stones as they come, and at the end of the day, control what you can control. Do what you can do to get yourself to the US, get filed, get your priority dates, get in line, make sure that you are up in your clinical experience, passing those exams, making sure that you are the best nurse possible. So when you come to the US and you're ready to start that American dream, you're prepared. So thank you guys for that wise, wise advice. I do see a couple of comments I just want to shout out to I see Emily says, I tell all nurses wanting to come to the US. AMN is the best. So thank you, Emily. That makes me so happy to hear I see Marcelo said, manifesting indeed. Marcelo says, same experience with AMN OGP international here. So I'm so glad that you all have had good experiences, and if you want to come to the US with AMN Healthcare International, just like Leo, you can apply on our website. It's amnhealthcare.com/international, and our recruiters would be happy to help you, and honor to help you reach your American dream.  

You know, there's something Kaye said, If it was easy, everyone would do it. And it reminds me of this famous Tom Hanks quote that something along the lines of, if it were easy, then everyone would do it. It's the hard that makes it special. There we go. If it wasn't hard, everyone would do it. It's the hard that makes it great. So I hope that these experts today give you inspiration to not give up on that dream. It is attainable for each and every one of you. You just gotta work hard and make sure you know that you are doing everything you can do to be the best that you can be, and we would be very happy to partner with you and help you reach that dream. So thank you so much to my panel today. It was great talking to you all. Thank you for your inspiring stories and your wise wisdom. I see Holly putting her finger up. What am I forgetting? 

No, you didn't, but I saw an important comment I really want to jump on. Oh, so there was a comment towards the bottom there. Let me see about do you suggest to go back to bedside? So for those of you who have been listening, you've heard us talk about experience and how important it is and to be prepared clinically. Being at the bedside is one of the best things you can do. It also is highly desired by most employers here. So it's very unlikely that you're going to find someone who will give you an offer if you do not have current, relevant bedside experience, even if they have a very robust training program. It's usually built for someone who has good bedside experience. Thank you, Holly, good advice, and thank you for catching that. I also see there was another question about NCLEX, so let's go ahead and take that one as well. Essentially, I just want to make it clear for this person who's asking about NCLEX, get that done. Get it done. Your experience. What did they do? Get it done, and then apply and that. And then we can help you. You know, we often talk about our success, which you can go onto our website and leads you through exactly how to get to the US. But you know, if I had somebody asking me, How am I going to get here? What's the best way to do it? Number one, take the NCLEX. That's your golden ticket. Get it done. Get it past you.  

Number two, apply to work with an agency that you trust, someone that you want to come with, someone that you've heard others have good experiences with, that can help you reach your dream, your goal. I see everybody nodding their heads, and get in line. That means get your priority date. That's when your application is filed. That's your number two step to take. Everything else can kind of work in the background. Once you have that priority date, you can up that bedside experience, which Holly, you know, underscored, is so, so important. So that's kind of, you know, a little bit of a two second what you could do right now we obviously, we have a lot of shows that go into a lot more detail, but that would just be my bit of advice and bit of encouragement if you are looking for tangible things to do. But you can check out our website, you can check out our social media, and we go into a lot of detail. How to Make yourself, you know, the most marketable you can for US employers, what to look for when you are applying, and all of that good stuff. Did anybody have any final comments? Because I saw everybody kind of going like this. Holly, did you have a final piece of advice you wanted to share? I kind of saw you going a little bit like this. 

Nothing to add for this one. I think we have some great past shows that you can take a look at that you mentioned. Please do that where we try to provide you with as much information as possible between our Lefora Talk Show and the onwards and upwards that we do on the AMN side. 

All right. Well, there you have it. Thank you to the panel today. I appreciate all of your time. Thank you for being here and sharing your wise words of advice and inspiring stories. We have our upcoming shows for the next month and rest of this month. So we have from seven to eight Pacific Standard Time, same time as always, onwards and upwards. On January 31 we're going to be talking about kids in the USA. We'll come back on February 11 for another Lefora Talk Show. And also make sure to check out our podcast nursing in America. We have a new RN journey to the USA podcast season, and we want to hear from you. What do you want to see in our upcoming shows? Please put in the comments. We would love to know what's going to be helpful for you. So thank you all for joining us today. We really appreciate it. We appreciate all of the comments, and we look forward to seeing you all again soon, onwards and upwards everybody.