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Transitional Modules for International Nurses in the USA

Hello, everybody. Welcome to the Connetics USA weekly show. Today, we're going to be talking about a really interesting topic. Clinical transitional modules. My name is Holly Musselwhite. I'm the clinical nurse educator for Connetics USA, which is now a part of AMN Health Care. And we're pleased to get you to join us today. So I want to take a moment to let everyone sign on.

So I want to do some quick introductions with you who've been willing to join us and it looks like I've already got one person, John, who is joining us from the Philippines. So welcome. Glad you're on with us today and then wrote us from Riyadh. So you're in Saudi. Hello. Very, very neat place to be. I'm sure it's fascinating to see where everybody's signing in from. So please let us know in the comments. And while you're doing that, we will start talking about who's joining us and then we'll jump right into our topic.

So, Mark, if you don't mind, I'll start with you. Yeah, thanks. And hello, everyone across the world. My name is Mark Jones. I am one of the clinical managers here in the Office and International. I am happy to join everyone today. So one of my roles is to kind of assist in that transition process for our nurses coming abroad to the U.S. in terms of their clinical transitions. So I'm happy to be here today. Thank you for joining us, Mark. And then next, we have Fong. So, Fong, I will let you introduce yourself to our audience today.

Hi. Good morning, everyone. I'm one of those we call that Traveler. I have been walking for about 11 months here. Yeah, so far. I'm so happy. So Fong has had the chance to get to America after a very long process, I'm sure. And so she's now getting to live the dream and she's gone through, I'm sure, a lot of interesting experiences as she moved here and began her work in the U.S. and learned more about our culture and experienced it. And then, AJ, I will have you go next and then we'll have Staal go. Hi, good morning, everyone. I mean, I'm a nurse and I've been a nurse like five years ago and currently, I'm in Florida. I arrived about a month ago and it was a good transition. So till now, I'm still adjusting to everything here. So I'm still looking forward to a lot of things. Very good.

Yeah. So you're going to be starting your new job soon here in the U.S. so you're just kind of adjusting and preparing. So we're really glad to have you on today. And last but certainly not least, Sterling, if you will introduce yourself. Hello, everyone. My name is Sterling Edgar. I work for O'Grady, Peyton International. I am an international and I am our senior education specialist. So I help our nurses get enrolled in their pre-arrival education modules through our online learning system, make sure that they get those completed before they come and then assist with any as-needed remediation items while nurses are on assignment in the US in regards to additional education. Happy to be here. Thanks, Darrell. We're so glad everybody joined us. I will take a peek at the chat and see some of the other interesting locations that our nurses are in today. So let's see. Miguel is in Oman, Francis is in Kenya, and Evangel is in Nigeria. Gabriel is watching us live in Ghana. Carol is in Kenya, all in Thailand. Wow, this is awesome. So we have a lot of countries represented here today. Caesar's in the UAE. And Nita and you know, where are you in Ghana? Another nurse from Ghana, Murtala from Nigeria, and Arlene from beautiful Jamaica. It is a beautiful place. I've been there. It's lovely. Ghana, Kuwait, the UK, Mercedes from the UK. Laura Lane So that's awesome.

Thank you so much to everyone who's joining us today. I will check back in the chat in a little bit and see what other comments and things you want to share with us. And we're also in a little bit going to open it up to questions. But before we do that, we wanted to have some information shared with you from our panel here today about the topic. So we're going to start with some of the basic information about clinical transitional modules, our organization and many others who help nurses transition from where they're working overseas into the United States will encourage you to do some clinical preparation before you get here. There are a lot of things that you're going to be tasked with to adjust to life, to settle in, and then also to start to get familiar and comfortable with in terms of different clinical practices, different policies, and procedures, different, you know, roles that the U.S. nurse may have that may be different overseas. So it's a lot of adjusting to do. And I hear people talk about drinking from a fire hose, and it's a pretty accurate description, but we want to help you prepare for that. So first off, Mark, if you wouldn't mind, tell us for an international nurse why it's important you work with our international nurses from, you know, all different countries. Why is it important that they do some clinical preparation before they even get here?

Think so. I think the key and I'm sure many of you know from studying for your English is there are practice differences when you get here to the U.S.. Yes, you're coming as an experienced nurse. Some of you may have 20-plus years of experience, but that does not mean that you're going to be excluded for some of these practice differences that we see. That's why it's such a key to kind of work on these modules where you are currently working. It may be a certain policy where you are not allowed to do something as a nurse that we do as a nurse routinely here in the US. So for example, I'd be in search of one of those skills that some of our medical surgical nurses, it may be a physician's responsibility in your current setting or urinary catheter insertion, depending on your gender, you may only be allowed to insert for a female patient, or you may only be allowed to insert for a male patient depending on the part of the world you're coming from. So that's kind of why it's one of those key important differences that you need to practice on, along with policies and procedures and things of that nature. Absolutely. And Sterling, would you mind telling us you work with the nurses when it comes to being assigned to some of these topics and think, what's the best time for them to work on this clinical preparation prior to their arrival?

Yeah, I think. Farley, So we find that it's best to work on these modules in advance of coming to the U.S. We assign a lot of our education modules months and months before you come to the U.S. while you're in sort of an immigration holding pattern. It may be when you are interviewing with the facility or maybe after you've already accepted a job. But we want to get you these modules assigned in complete added before you make those really urgent concrete plans to come to the U.S. because we know in the last month, two months before you arrived to the United States, you're going to be so busy tying up work overseas, getting personal things taken care of overseas before you move. It's such a stressful time. So we really want you to get these modules assigned and completed early so that you can retain the information. You don't have to rush through them.

You can really absorb what the material is teaching you as well in the U.S. Some states require you to have CE credit in order to get a license, so we want you to go ahead and get that CE credit. So our licensure team can start working on your license and that it's not a hold-up or delay for you. Thanks. Sterile. That's really good information and I know occasionally we're popping up the link. If you're interested in applying with Connetics nursing recruitment agency, it'll pop up there on the screen and so you're welcome to check out that link maybe we can help you with some of the things that you're going to need to do to fulfill your American dream. The next question is for all of you and the thing that I'm wondering is what kind of topics are probably going to be the most useful. So maybe each of you could give me a couple of topics that you think will be useful or that have been useful in the case of maybe Fong and what she's dealing with.

And actually, I think I'll start with Mark and then the rest of you can kind of chime in after he shares a couple. I think for me, and I see so many topics that are really important for you to know as you come here to use. I think for me, my best piece of advice would be what is something that you study NCLEX that is not part of your daily routine as a nurse. You know your skills better than anyone else. So I can kind of pick different regions of the world where I can say this particular topic is probably a little bit more important than another. And obviously EMR, that will probably be the most important one for everyone. A little bit harder to get that, but know what your current skill set is and know where you're going. And the differences lie between what you started on NCLEX. Absolutely. So, Fang, you've been here now for a while, and so from your perspective, what are, what would you say are a couple of things that should be studied before you come? All right. I think for the knowledge basis, everybody will be well prepared because you need to pass the legs and everything. Well, I have no problem that all our candidates will be, you know, efficient for that knowledge base. But there's one thing I want to emphasize computer skills. You know, nowadays we all use computers. So for my facility currently, we are using the at-peak software.

Yeah, it really gives me a hot time in the beginning. And even now the mature staff I mean the local staff, you know, they still have some difficulty, you know, to find where to sign, where to find things, how to order. Yeah, I think that is the one, not the topic we should include. Mm-hmm. I completely agree. Yeah. Yeah. R is big and also bound. Do you find that it's using the computer, but it's also that you may document things more exhaustively? A lot more information is probably going in there, but a lot more checkboxes and things and prompts that you're being given based on what information is that you're putting into the system. Well, yes, the searching for all those, you know, the place where you need to enter and where you need to find the information is a headache, is a big headache. And it's a necessary one.

So if at least your actual comfort with the computer is there, I think that's important. And some modules will expose you to some concepts of EMR before you get here. And then every system you mentioned Epic, every system's a little different. And also and that's because of where you work and what your policies are. Every system's a little different. So it can be customized, but there are some major players out there. Epic is very well known. Cerner is another system that's probably pretty well known. I think there are a couple of others that come up kind of frequently, but those are two of the most well-known.

So exploring that, I completely and completely agree and it is a little bit of a headache, but you'll get there and I think you're probably feeling a lot more comfortable now, right? Yes, of course. Yeah. So many times are exploring absolute length. Okay. AJ, you're not yet started here yet, but what things have you seen that you feel like they're really good to study before you get here? Oh, you're muted. AJ There you go. So like for me, the most essential thing is the basics, the fundamentals. Can you bring your mike up? AJ So for me, the most important thing is the basics, because it's where we came from that we, we tend to just like overlook about it. So for me, the best thing is to know the basics because the series theory is like the other ways that you can see the patient, the signs and symptoms are quite different compared to yours like when you read a book or when you see it on a video. And so you need to at least learn the basics of your laboratories, for example. So you need to learn from it and just look where you would become comfortable to excel more and move forward to it. So just learn from it, yeah. AJ you mentioned labs specifically, and I think that's really good to touch on because when you get here as a nurse, you're, when you're at the bedside, you're the eyes and ears for that physician.

They're not usually as present here and the nurse is really the driver of the care. So they're picking up on what those abnormal labs are. They're going and assessing the patient and looking at the clinical presentation and seeing what's different. And then they have to follow up with the physician and give a very good, concise description of what they see, what the labs are, what the vitals are, and what they think might be if they give suggestions for order. Hey, doc, can you give me orders for this or that? Because I think it would be helpful. So putting all of that together, when you say basics, it is basic nursing. And so if you're rusty on some of those key things like labs or assessment skills, you've got to get refreshed on that. Sterling, what about you? What do you think is really important to review before they get here? Yep. So certainly those basic clinical practices, skills that we've all touched on, you know, we have some great courses on medications and documentation and like things that, you know, fall risk lab values like you mentioned, Holly. But I really love some of those soft skills as well. For example, in customer service, time management, and communication, even though all of our nurses are English passed and trained, a lot of times communication here in the U.S. is very difficult because Americans speak so fast. The vocabulary can be different as well as accents can be a challenge depending on what region you're working in. So we have a great communication course that we can assign to help with some of those soft skills and customer service.

That's a big difference in the U.S. that patients are treated a bit differently. Their expectations are much higher a lot of times. And then certainly the time management course is so vital for when you first get on the unit, as we mentioned with the computer documentation, sometimes you feel like you're taking so much time on the computer, trying to find something, trying to document something correctly, so that time management course can really help you prioritize your tasks. Thank you so much. Sterling So you guys have given some really great information. I want to move on to talk a little bit about how much time we might need to devote because of course everybody's busy. And so when you're saying, Oh my goodness, I'm supposed to do something else in preparation, I don't just have to get the paperwork together for my immigration or my licensure. This is going to take some time from you too. So, AJ, I wanted to ask you and your experience how much time it took you to complete the things that you were working on for your clinical transition. Well, for my transition would be I made it a point that my minimum time would be like a week, but the maximum time would be two weeks for all the models that I I've been given so that in that way I won't be lazy enough just to think that it would be after a month. So I made it a point because we're all busy and we know how stressful it is when you are tired and you don't have a timetable for all of it. So I made it a point that I'll do the modules in the morning. Then at the meeting at lunchtime, I would have a snack and rest or a quick nap. Then in the afternoon, I would tend to answer the modules for till the evening if I'm still at the point of sanity of doing it. And yeah, I am able to take a rest.

Yeah, that's what I did. Gotcha. So you took the approach that I'm going to really kind of get all of these things done in a tight period of time instead of stretching them out sterile. Mentioned that, we try to assign it where you've got some time ahead of time, a few months. But we know that some people, they're like, this is when I can get to it, so I'm going to get to it Now. It sounds like that's what you did. Fong, Did you do the same thing? Did you try to block it off into a couple of weeks and get them done, or did you stretch them out slightly? Yeah, I think a bit the same. But I will do time. I mean, I will do a plan, you know, I will go in and see which module, you know, will take longer time. So I will use bigger blocks of time to study that. Yeah. You know, I will be more flexible, you know, one day I will do one topic, all know the shot modules I will do, you know, two topic or three topics so I could finish in about. Yeah, one or two weeks. Okay. So you guys had relatively similar approaches. That's good to know. So it may be that the important thing is when you're initially assigned the modules not to feel overwhelmed, they are doable.

So if you look at your list and you go, Oh my goodness, I got all of these things to do, just take a deep breath, it'll be okay. And we have to experience folks who can tell us that. All right, Mark, my next question is for you. Why not? What do hospitals and clinical facilities feel is important for the nurses? Why do they feel it's important to do that clinical preparation before the nurse even gets here? I mean, they haven't even started work with them yet. So why is that important from the hospital's perspective? Sorry. I think one of the biggest keys is when you are coming here to the US and, you know, sometimes you're interviewing with unit leaders, sometimes you're just kind of getting an offer. Oftentimes they expect an experienced nurse to come into their unit and you are an experienced nurse. You know, our models are to bring in experienced nurses. So when you're talking to that manager, they want to see some of those skills come through. Now, we do our best on our side to educate those managers in those facilities that, yes, they are experienced. Still, there are some practice differences you need to be aware of as well that will result in you having a longer orientation than your typical contract nurse coming to a facility in the U.S. But that's why it's so key to prepare and work through those clinical modules pre-arrival.

That way you can get that theoretical knowledge, you can see those videos, and now it's a matter of acting on those theories and those videos that you've seen. So that's probably the biggest key is those, as I said, managers, expecting an experienced nurse with time and within reason of being here. M Yeah, I think that's great insight there. Expectation versus all of the things that you're adapting to, whether it's different equipment, the electronic medical record, or how we package, our care items into, into different arrangements. So there's so much that you'll be learning, but there's still an expectation there that you come with a baseline, I guess, and that you take some of that experience. You know, Yes, a nurse is oftentimes we know oversees a lot of the nurses have seen the same textbooks you and I were taught with. So it's not that the material wasn't covered, but how it plays out in real life. It may be applied very differently here in the nurse role. And so starting to prepare for that, knowing the hospital's expectations is an important factor in whether this is worth me doing or not. The other thing I would add is that you're preceptors that you will work with. They've never worked in a lot of these countries or have any idea what the differences are. So they may assume when you get there and they say to you, Have you done this or have you done that? And you say, yes, but they're like, okay, great. I got an experienced nurse. But as time goes by, they may realize you did do it, but you did it differently. Or maybe the focus on that procedure was a little different or your responsibilities were a little bit different, or how you document is a little bit different.

And so at least if we use this to kind of bring you to a certain baseline, hopefully, that helps you meet some of those expectations a little bit sooner and feel more confident. It's important to feel as confident as you can when starting something new like this. All right. So the other thing we wanted to talk a little bit about is you've done these transition modules and now you're going to arrive here and start your orientation. And I saw a question in the chat, which I actually think is a good one. So Angie says, Are there modules to be completed when you arrive in the U.S. before you start work, or are you taken straight to the floor? So, Mark, I'm actually going to let you answer a little bit of that because it's a great question. Yes, that is a perfect question. So from our perspective, we want you to complete the modules that we assigned to you prior to your arrival in the US. The reason for that is, to give you the knowledge and to give insights into how those particular intervention skills diagnoses may be looked at here in the US. Still, also because when you speak in working here in the U.S., you know, nine times out of ten, the hospital that you are going to be working at is also going to have modules that you need to complete in those first week or two of your orientation period. And we call that general hospital orientation. So there may be some facility-specific guidelines and policies that you need to know and take modules on. Maybe you are going to a unit, for example, that sees a lot of bladder irrigation.

Well, they're probably going to want you to take a module on bladder irrigation as well, whereas that is not necessarily one of the standard bundle modules that we would add in. So that's a great question to give you kind of a better insight into what it would look like once you work through those modules, both pre-arrival and in that first couple of weeks of general hospital orientation. That's typically when you get out to the floor and you start getting that hands-on experience. Yeah. Thank you, Mark. So, Fong, I wanted to ask you, how did the pre-arrival how did the pre-arrival modules impact your orientation experience at the facility where you are? Oh, well, as you go along, the topics you will definitely gain some different and new knowledge. As Mark already mentioned to you, there are definitely some discrepancies between, you know, each country. Yeah. So it will give you the ideas that you know about, to sum up, some of the differences that you might, you know, face down in the day-to-day work. And yeah, I think the I feel that the, you know, the effort, the professional communication is really important. As Gillian mentioned. Yeah, it really helps. And the preceptor, the orientation with the preceptor is also, you know, fault. Yeah. It's very important as well. So make sure you approach your preceptor politely and ask them. You know, the main thing is that as Mark says, that is you, you are confident to know about all of those skills.

But the important is that you let them show you once you don't let them do it first. Yeah. Huh. So that's a common nursing preferred way of learning. See one, do one, teach one. And it's okay to ask, Can I go with you and see you do it first and see if they'll let you learn in that way? Sometimes they're very amenable. Sometimes they're like, Let's do it together. So you can be prepared for that, too. That's right, yeah. Sterling, Is it possible the nurse will see these topics while they're doing pre-arrival and then they might see them again during their orientation? Yeah, absolutely. So we have one course in particular that I've been thinking about, as we've been mentioned in preceptors, called a proactive approach to orientation with the preceptor. So that is really going to set the nurse up for success in communicating with their preceptor, working with them day to day. It gives you some great examples of how to ask your preceptor. At the end of the day, you know, what did I do well today, what can I do better tomorrow? So that course in itself is really going to help you structure and know what to ask for your orientation. But certainly, there are many topics that we give in pre-arrival modules that you'll see. Again, some of the things that I think can be most helpful in those modules that the nurses will see right away is maybe equipment in the modules that they don't have back home.

So then when they get to the floor, they see a certain piece of equipment and they're like, yes, I saw this in one of my modules or even vocabulary differences as it relates to medication. So overseas you may call a drug one thing and here you're in you completely different, but it's the same medication, whether we're using a generic versus a trading name. Then for those really important topics, for example, customer service, we may give you a course on that, but then your facility may give you a course on customer service as well. A lot of hospitals really pay attention to those patient scores and customer service scores. You'll hear a lot of that in orientation. And a lot of hospitals have their own policies and procedures as it relates to certain topics. So they'll certainly want to provide their own education as well. Yeah, for sure. Fong the Sterling mentioned a lot of topics that I know are really good, and I know you covered yours, but is there anything that when you think back, knowing what you know now, you wish maybe you had reviewed or spent a little more time looking at before you came to the U.S.? Well, I think still the coach. Oh, yeah. There's one more. One is, I think, you know, the history and the health care system of all the U.S. in the U.S. is quite important.

You know, when I first get sick, we have the primary care, we have the urgent care and the emergency care, you know, So back in Singapore, you know, it's totally different. You know, So when our you are sick, you can straightaway go to the emergency room. So I make a big mistake in going through that emergency. So, yeah, I think, you know, we should include some of the health care systems in our topic maybe. So it's also a benefit to our candidate too, as well. I completely can understand what you're saying. We have probably all counseled nurses for the first time. They don't feel well here and must access the health care system. It may be very early in their time. Things happen. And so if you're thinking, well, this is what I did at home when I felt sick, it is very different here. There are acuity levels to be used. And also, if you go to the wrong one, it can be more financially burdensome to choose an ER for something that maybe could have been cared for in an urgent care center or could have been even. We have many telehealth options now that are coming online, so you know you may be able to see a doctor online and then send a prescription to your pharmacy and you're like, I didn't even have to go anywhere for this. So there are lots of things. And I think that's a great point. So thank you for sharing that. So Mark, what feedback have we heard from the nurses about the resources for pre-arrival preparation in general? We tend to get pretty good feedback on the resources that we send out. However, we're always looking to improve.

So, you know, if you are going through this process and you've got the modules and you said, man, you know, one of these wasn't very helpful, but there was another one that was incredibly helpful. We want to know that feedback. But in general, you know, we do a good job of evaluating periodically as well, of course, as we think are most important when we base that feedback on what our clients and what our nurse managers relay over to us. Where was our challenge in the orientation period? So we take that information into account. One great example I always like to give, you know, you need far more autonomy as a nurse here in the U.S. You know, you're not going to be as dependent on the physician right there to make decisions in real-time for you. So so, for example, when you call a physician and say, hey, there's been a change in the breathing pattern to have some shortness of breath. Now, that physician is immediately going to ask you, well, what do their lungs sound like? They won't be telling you what their lungs sound like because they're not right there at the bedside ready to assess that patient. So that's where those modules and that feedback is important for us to know which modules we need to choose for you right now. And the one thing that's really important when you see that on the module is to take it and say, I haven't listened to lung sounds since nursing school, and if that's the case, find your family and your friends and your stethoscope and listen to some lung sounds because it's really hard to start from the beginning when you're already here. And like I said earlier, drinking from the firehose. So try to start applying some of that when you can, even while you're overseas.

Don't just watch the module. Try and start saying, let me practice some of these techniques on the people who wouldn't mind being my practice patient or if the hospital gives you that opportunity. I've had people who will say, I talked to the attending physician. They understood that my goal was to go overseas. They knew already that things were going to be different and they taught me some stuff about what they're looking for, what they're listening for, and now I can use that so you can begin applying it even before you get here. AJ This next one's for you. So when you start your orientation, which is coming up soon, what do you, what are you expecting is going to be different based on when you studied the modules, you go, you know what, That's going to be different for me when I go to work. So what are you expecting? Oh, you got to unmute again. AJ There you go. Actually, because I came from the Philippines and we know there are many things and ways that are still used there that were previously used in the past years but are quite different here in the United States. So I think the procedures, the ways and a lot of materials and equipment that are being introduced in here, we know that there are lots of things that are being produced and being used in different countries. So I'm expecting more. I'll be able to learn more and be taught. Yeah. So that's yeah. And you mentioned procedures. You know, Mark, we talk about doing some Foley catheter insertion and the limitations that you may have with what gender you're allowed to start those with.

There's also the fact that in some places the materials that you'll use for the procedure are individually packaged. You'll go into your supply room and you're going to grab each piece of that procedure. In the United States, many of those are packaged pre into one package or the whole thing. So the procedure is assembled for you. And why do we do something like that? Why do we package it and put it all together like that? The one is the time management piece so you don't have to go searching around for each individual. Item two is also the field of sterility that you will use for that particular intervention. So, you know, it sounds a little daunting when you first come up to this package and you open it up and you have three different sterile towels that you're pulling out and you go, Oh my gosh, which do I put where I'm used to? Just set my sheet under my patient, getting my supplies right here. So the main purpose is infection control. If one of those packages is put together the way they are, but also needs time management. So you're not going in hunting pieces, but also going back to that infection control. So you don't forget a piece that you may need because we do have best practices and policies that we have to follow for inserting in a sterile environment. Right. And breaking the sterile field puts the patient at risk for an infection. We would rather grab a new kit if we've broken the sterile seal than put the patient at risk for infection. So very much about preventing any negative outcomes that might happen due to violating that sterile field or perhaps doing the procedure in an order that even puts them at raw risk, depending on what you're doing. All right. So let me just take a look here. I haven't I haven't read from who else is joining us. So I see Diane from Singapore and Ziggo from the Philippines. Godfrey's in Canada, and another nurse from Jamaica.

Monique Hello, Monique Elma from the Philippines. Marcus is on, Pon is in Kuwait, Walter is from Angola and another nurse is from Canada, Millie Joseline is from Brazil and Yousef is from Saudi Arabia in Riyadh. As well. So again, it's so awesome to see people from so many different parts of the world who are joining us. Isaiah from Kuwait and Murtala from Nigeria. Botswana is where Brenda signed on from and then Sheba from the UAE. So great to see you all here with us today. Thank you so much for joining us. There is another question that came up from Nisha. She says, At what point exactly do we actually get the modules to complete? For example, two months before arrival? So we were talking about that a little earlier with Sterling. And I know depending on what organization you're with, they may time it a little differently. So it's not always everybody does the same thing, but still, do you want to talk a little bit about that? Again, just a kind of recap. Yeah, absolutely. So what we mentioned earlier is we want to give these to you several months before you arrive in the U.S. I would say really 6 to 4 months before you arrive in the U.S. is our goal because we don't want you to be rushed right before you come to the United States. We require the courses to be done before you travel to the U.S. and we know those last few months before you pack up your family and move your whole life to the U.S. is very stressful, which is why we'd like to get them done ahead of time, especially. So you retain that information.

You do not have to rush through the courses all at once. And so you get your credit because some states in the U.S. do require you to have CE credit in order to get a license. So we want our licensure team to go ahead and be able to start processing and applying for that license. And so it's important if you if you're getting those a little closer to your arrival time, for whatever reason, don't delay because Esther mentioned the closer you get to your arrival, the busier you are with all those preparations for yourself, your family, your finances, your work. And we know that some people do choose to kind of procrastinate, but it doesn't usually help in the long run. With all the other things you have. You want to get the most out of this that you possibly can. So mark the feedback that we get from the hospitals, what are the most common experience gaps that they perceive when nurses are orienting when they first arrive? I would say in terms of ranking them, our top two are going to be policies, procedures, and EMR and those are usually the kind of big ones. Next up, medication names are a pretty common focus as well. As many of you know that our medication names may be a little bit different here in the U.S., We may have several different pharmaceutical companies that make the same type of medication with a different name for each one of them equipment, you know, I.V. infusion pumps. There are some of those things that maybe if you're in a medical-surgical setting, you probably just have as much exposure to it.

That takes a little bit of time and repetition to get used to those. And then as we kind of mentioned earlier, some of those are what we would consider more basic interventions for nursing interventions such as I.V. insertion, and urinary catheter insertion. So those are kind of the big five that we usually focus on and highlight there. Obviously, there could be some others that come up, as Sterling mentioned, communication, those customer service skills, and those soft skills that we look at as well. And then time management, that's going to be a big one as well. You know, you have been doing things one way now you kind of have to learn how to cluster care and knock out several tasks at one time for your patient. Mm-hmm. Yeah, that's really great feedback. And when you're thinking about preparing, that seems like a very long list of things that you're going to have to navigate through. Everybody's going to have a little bit of a different experience. Maybe they're more comfortable with adapting to how to manage time. Still, it also is when you have that opportunity to observe your preceptor working in that first day or two or three that you're you're in that observation mode, you really want to soak it in and talk about it. So the more knowledge you gain about why they do things, maybe clustering care the way they do, the more you can start to adapt your thought process accordingly.

I see Joy from Kenya joined us Hadiza from Namibia and Agnes from Zimbabwe. And that's from Pakistan. So again, lots more countries are being represented here today, more than I think I've ever seen on the shows I've been on before. So it's kind of cool. So as Thurl, you mentioned something earlier that I didn't really go back to, so I'm going to go back now, which is remedial modules or being assigned modules even once you're working here. So can you tell me the reasons why a nurse might even need to do some modules once they're here on as an individual versus the usual modules that we might give everybody? Yep. Great question, Holly. So often once nurses get to their floor, it might have been a while since they did the modules before they came, or they may just be seeing new diagnoses or equipment that they're not familiar with. And our clinical managers can make the recommendation or the clinical managers at your hospital can always recommend to us that you get some additional education. But those can really run the gamut of anything that you may be experiencing on your unit that you're not totally comfortable with, or you just need some practice. So for example, that could be titrating drips if you are struggling with that and orientation and it's taking you a little bit longer than it should, we can assign some additional education to help you get up to speed with that task. Same for any different equipment. Are online learning platform is a help stream and they have some great courses specific to you know certain pumps or even hospital beds.

Any type of equipment that you may see in the hospital, how to insert a catheter. For example, Mark's mentioned that. But COVID was a great example, too, because, you know, within a period of several weeks, COVID-19 popped up. Our nurses needed information fast. So if our nurses were deployed to a COVID unit or saw COVID patients on their home unit, there was education readily available that we could assign to our nurses to help bring them to speed with what they might experience with the COVID patient. And that was a really great asset for us because that affected it. It affected everyone, all at one time. Yeah, that's a very good example. Thank you, Sterling. Excuse me. So I want to talk a little bit about the technological differences. Mark, what are the biggest differences in training techniques that are used here in the U.S. to help nurses on board? You? Some of the bigger differences are just going to be your exposure to the equipment. You know, even if you've had some experience with different equipment and unless you're coming from a couple of the few hospitals in the Middle East that have very similar US equipment, the technology and equipment are going to be a little bit different. Generally speaking, you should get some skills days and time with it in that general orientation period in those first couple of weeks. But more importantly, it will be on you to self-advocate for yourself as to where you need help with the technology you are facing. You know, different parts of the world may see different things. So for example, our nurses coming from our African countries are going to need a little bit more with that computer time, you know, the EMR orientation, you know, our nurses coming from some of the Caribbean countries may not see as many of that IBM fusion pumps on their medical surgical floor.

So they're going to want some more time with that. For our ICU nurses, perhaps a CRT is not something that they complete in their current environment in ICU, but they're going to have to see that machine pretty frequently here in the US. So those are some of the examples that I see pretty frequently. Now, obviously, certainly not limited to that list of items as well. Absolutely. So, Sterling, when it comes to documentation, what is usually covered in our pre-arrival modules? Yep. So we have one specific course called professional nursing documentation, and that is going to give our nurses a very big large-scale overview of documentation in the U.S. Of course, a lot of our nurses are moving from paper to computer documentation and that is certainly a big transition. So this course is really going to set up the expectations of what our nurses could see in the U.S. Now, think I mentioned earlier that she uses Epic at her hospital. Holly, you mentioned a few others such as Cerner. So one thing that we wish we had access to was visibility into each of those systems. But because those systems are licensed out, we do not get visibility into each EMR system that you may be using at your hospital. So one thing that our nurses can do that is very helpful is if you know what EMR system you will be using here in the U.S., for example, Epic Cerner, you can often go online, whether it's on YouTube or through different articles and at least watch some videos so you can see what the interface of the system looks like. You can see what each tab looks like, you can see what certain care plans look like.

So at least it won't be complete, I would say, foreign to you. That's kind of funny. At least it won't be totally foreign to you when you see it. Your first few days of orientation, you say, Oh, yeah, I remember seeing this when I looked up these programs, but another piece of our pre-arrival modules that I want to touch on is type in practice. This is actually very helpful to our nurses who are currently on paper charting because we expect all of our nurses to submit a typing certificate before they come. This is part of the pre-arrival modules and we do that to ensure that. Your typing speed is up to par because if you are a very slow typer or you're looking down at your keyboard and having to press each letter individually with one finger, it will take you a very, very long time to document. And quite frankly, you don't have time to type that flow. So that's why we encourage all of our nurses to practice their typing speed, make sure you're typing very fast because then you're not looking at the keyboard searching for the letter A to type out your notes. And unfortunately, that really does slow down our nurses. If they haven't practiced that before, they come to the U.S. But certainly, that is one of the biggest and best things you can do is practice your typing and practice your computer navigation skills. All right.

So basically what I wanted to ask AJ kind of a follow-up to that is what device did you use AJ to complete your preparation with your modules? Well, what I did and what I'm comfortable with is using a laptop in comparison to only using my phone as it gives less stress to my eyes. And I'm getting quite comfortable in using it because, in the long run, it will help me during my duty times. And yeah, the laptop is better than a personal computer in my personal opinion or absolutely. Okay, So I appreciate you sharing that perspective. I think that also makes it, of course, applicable to the typing that Sterling mentioned earlier. And if you don't have a computer accessible to you, a laptop, or a personal computer, and you don't have an easy way to get one, you may need to make the effort to borrow from a friend or family member who has one. It is worth the effort to be able to practice these things and become more skilled in using those devices. Think about it this way If you are learning so many new things and having to demonstrate competency and so many new things. You're not comfortable using the mouse or as Sterling said, you're doing what we call I call this hunt and peck where you're hunting for the key and you're pecking with your finger on that individual. It's slowing down. And it's something that can be addressed while you're still here.

So it may seem. Oh, that's silly. Why would I worry about that? But it truly can help you to have those skills already in place and be comfortable when you're learning so many other more, I don't know, maybe higher priority topics and skills. Once you get here. Okay. I just want to mention that connects in the chat. You'll see we've posted about a referral option bonus for you if. You know, nurses who have an A there in clicks those ends are great to refer to Connetics. So the link is listed in the chat and here on the screen for you, if you're one of those nurses or you know someone, we would welcome the opportunity to provide you with a bonus for that referral. So check it out on this link. It'll give you some instructions on how to make that referral and how to be recognized as the referral source, which is really important to make sure that if we actually are able to bring that nurse on board into the U.S., you are recognized as the person who should get that bonus ranking from Nigeria. Thanks for joining us. And Saphira from Saudi, thank you so much to you for being here today. So the last thing is some final advice. And we've got just a couple of minutes left. So from the sort of around the group and I'll start with Fong. What was one piece of advice you'd give to nurses to help them prepare for the difference in their role in the U.S.? Just one. I'm sure you have lots. Yeah. Okay. So just one. Okay. Be at your own pace. So I know this study means that you can always, you know, be slow or, you know, do things you don't really you don't enjoy.

You are enjoying the time as you know, doing your things alone is only what I mean. Is it your plan, your pace? Because that's why I'm saying this is because you are new to a new environment and a planned pace will make you more confident and digest all that you learn. You know, in one day or two they are like, you know, maybe I give an example. You know, for the first week, you can take up to 1 to 2 patients and don't you know Z rates that so you don't you will be stressed if you take more than that no matter what reason? Yes. So that's it time for you to learn and 1 to 2 patients if you are confident with one 1 to 2 patients, then you can go on. If you still cannot tell your preceptor that you are still not comfortable and you need some more time. Yeah, at your own pace. That's great advice. And Sterling, I'm going to have you go next and then A.J, and then we'll have Mark rounded out. Thanks, Holly. So my advice would be to take your pre-arrival courses seriously. I know that sometimes you look at your list and it seems so long. We give you three months to complete those. So if you could prioritize one course every other day or every third day, however, that works out, you're really going to retain that information. You're going to get the courses done gradually. You won't save them until the last week before they're due and you're stressed. And when you think about the time it takes you to complete your courses, now really think about what you'll learn and how much time that will save you once you're in orientation. Because you may learn several things in your courses, that's going to save you a lot of headaches and trouble and orientation because you're already going to have exposure to those topics. Right. All right. AJ, you're up next. What is your piece of advice? So I think I'll just give it that overall.

So just prepare yourself physically, mentally, and emotionally because you'll be introduced to a lot of different people and a lot of different attitudes. So just prepare yourself in all of those aspects. Good point. Yep, There's going to be a lot coming at you, so the more you work to prepare ahead of time, it's kind of like if you are planning to run a marathon and that's kind of what this is. You want to make sure that you do some practice marathons and you want to train for that and not just expect that when you get here, you can run the marathon without having done some work ahead of time. All right, Mark, last but not least, well, I really love all those pieces of advice that everyone's given. So to kind of around it out now, my biggest piece would be to know that you were the go-to person in your previous setting and you're coming here. You're going almost to feel like you're a new nurse at times because there are so many differences that you're learning on the fly. So my main piece of advice with that in mind is to embrace the conversations that you have with your preceptor, your nurse manager, and your educator, where you are identifying areas of improvement. So areas that you need to do better in, can be uncomfortable. It can sometimes be a little bit disheartening sometimes to hear this feedback because as I said, you were that expert previously, but the more you embrace those areas, the better and stronger nurse you are going to be. As you come out of that and you learn from those experiences, I Absolutely, completely agree.

Great advice. So I want to just close out by talking about well, I'm going to answer one question here. So, Cesar, you ask, where can you find the modules? So depending on which organization you work with, whether it's one of us with AMN International, AMN International, or if it's another organization that you're working with, you would have to ask them what is the platform that you're using to do the training and work with the team there to get you assigned. So usually the access is given by the company that's facilitating that for you. However, let's say the company that you're working with doesn't provide that. I still think it's worth you looking at some of the topics that we mentioned and talked about online. There are a lot of companies out there that offer continuing education on a wide variety of topics. So when you do some research online, you'll find free YouTube videos, and you'll find even free continuing education. Sometimes it's not maybe as pretty audiovisual as some of the modules that we might be able to give you access to. But the information is still there. And if you want to invest a little bit financially, some companies offer subscriptions where you could get a year of access to continuing education modules with hundreds of topics. And it might seem like, Oh, should I put my money there? But truthfully, it is an investment in yourself to help you have an easier time transitioning in the future. So that's what I would say about that.

With the Connetics College, we do have some topics that we can excuse that we are covering in the next few weeks. So for those of you who have yet to do your in-class, you may find it very helpful to attend Connetics college and click class with one of our and collect partner instructors from either Aspire or IPASS. So every month we have some guest lecturers come in and join us and share some really relevant topics. There's lots of great content surrounding the upcoming Next generation, and classes start April 1st, as well as some key topics that will be covered by the class that is important for international nurses to understand.

And we also offer English preparation topics with Swoosh and Niner. So you'll see that we have something being covered every Monday for the Connetics College and depending on what milestone you're working on to get yourself here to the U.S., those resources are available open source, just like this particular web show. So we invite you to join us for that. Remember that if you're interested in applying yourself, you can go to our website. Our link will be listed in the chat and right here on the screen for don't forget about those referral bonuses for your are-in friends. Take a look at that link as well Thank you so much to all of you who attended today Please join us for future sessions. We're going to continue to cover clinical transition type of topics and figure out what we can do to continue to help you grow and prepare for your eventual U.S. nursing career. Thank you to our guests to join us today, Fong, AJ Sterling, and Mark Hughes, great to see all of you. Hope maybe we can see you in some future sessions. Thanks again to everybody. Hope to have a good rest of your day or night. Take care.