What are Nurse Preceptors and Their Goals

Hello everyone, my name is Holly Musselwhite and I'd like to welcome you to the lefora talk show season four, episode six. Today we're going to be talking about working alongside preceptors. I think this is going to be a really fun interesting show for all lot of you who are joining us, if you would please comment in the chat where you're viewing from. And I see some already. So joy is from Uganda watching from Uganda. And oh, yes, is from Nigeria. So I guess you go by Jeff. So Hi, Jeff. Welcome. We're glad you're joining us for the talk show. Today. I am a part of the Connetics nursing agency for international nurses, which is a part of AMN and our sister company, O'Grady Peyton we are the AMN international. So we are excited to work with healthcare professionals from all over the world helping them realize their American dream. Hi, Cynthia. Hi, Melanes. And hello, Margaret from Kenya, Cynthia is also from Nigeria. So looks like we've got a couple of nurses coming in from Nigeria today. And maybe a few more by the time we finish up. If you have not applied to Connetics, or if you are interested in applying to Connetics, please go to our website at ConneticsUSA.com/apply. You'll see it there on the tagline. We would love to hear from you. And I'm going to take a look. It looks like Nat from Ghana and ER nurse is also joining us. So welcome, Nat glad you're joining us today. Thanks so much. Okay, so before we get too deep into our topic and introduce our guests for today, that's going to be joining me I'd like to talk a little bit briefly about our success path. So the Connetics AMN success path for our international healthcare professionals, most particularly nurses is to begin with the NCLEX. And I work with our nurses who are in the NCLEX review. And it is a very challenging process, but it is worth it. And it is definitely doable with some great resources. So those of you who are studying for the NCLEX, please keep it up.

Get that milestone finished so that you can work towards finding your sponsor here in the US, we will help you prepare for an interview. And then once you've got a sponsor work through the visa framework with you and the licensing and credentialing process, including your English exam, we do have support available for some awesome English programs, English proficiency study programs. And then we have our get ready game plan where we are helping you prepare and accelerate for that transition here to the US. When you arrive, we partner with the facility and with you to help ensure a smooth transition doesn't mean that it isn't challenging, but our team has great resources available to help you adjust and settle in here in the United States and enjoy and prosper in America. So thank you again for joining us today. I see we have to hear from Pakistan and Helen from Zambia, and Lizelle, the Zelensky from Riyadh. So welcome to all of you. I'd like to go ahead and introduce our guest nurse for today. So we'll bring in Bryan now, Bryan, thanks for joining us today. Hi. Good morning. Bryan, you're still on mute. Oh, there you go. Good morning. Morning. Good. Thanks for joining us today. I'm Bryan, I'd like for you to go ahead and tell our audience. Yeah, my name is Bryan Wonga. I am currently working as a trauma ICU nurse in Central Texas. I arrived in the US just last year in November. He worked in the Middle East for 13 years prior coming here in the USA. And it has bee n an enjoyable stay and work life here in the US so far. Thank you, Bryan. That's awesome. We're so glad that you're able to share your expertise with us today. One thing that I did want to emphasize is you're sort of like having two guests because you not only have immigrated here and worked with an intern with a US preceptor when you started here but also now are a preceptor for nurses. Is that right? Yeah, I started to share what I have learned since I arrived here in the US, as well as what they have experienced in other parts of the world. That's awesome. So we're gonna use both your experience as a new US nurse but not a new nurse completely. And as well as being a preceptor here, I think that you'll have a lot of wisdom to share with us. And so I'm really excited to kind of pick your brain. Before we move along, I will say hello to George watching from Nairobi, Kenya. Thanks for joining us, George and catchy from Nigeria as well. So more, more nurses from Nigeria joining us today. Um, so Bryan, let's talk a little bit about the preceptors role in and what the responsibility of a preceptor is, especially since that's what you're doing at times now. So, in general, what is your responsibility as a preceptor?

As a preceptor, your main goal is to make sure to adapt to the new work environment to adapt with standard policies and procedure of the hospital and of the United States, based on the practice that we have here. So we would provide guidance on how the flow is going in the unit or specific unit that you are in, how to communicate with your peers, with the patients with the doctors and any other members of the health thing. And apart from that, we know that there will be a lot of anxieties, there will be like, some questions in the minds of the new nurses as they just arrived in the US, we also consider the feelings, the emotions of this new nurses, so we have to take care of the Oriente or the new nurses holistically. So that sounds like there's a lot of emotional support, as well as helping them you know, learn new skills or adapt the skills they have, to the way things are done here in the United States for nurses and their role here. So right possibility yes, we have to adjust, we have to adapt with scales that we have from our previous experiences that will may be applicable, some will not be applicable in here. So we just try to know and understand what are the things that we may continue with our practice as a nurse here in the US, and those that are not allowed to do here, and we should avoid it.

And so I've, I've been oriented myself mostly as graduate nurse here in the US. And when I was in Oriente, there were definitely some periods where I wondered if I even the right thing to become a nurse, because it does get very stressful at times when you're trying to adjust and learn your role and deal with all of the different information and responsibilities that are coming at you. So what would you say is the biggest responsibility the Oriente has in the process, the biggest responsibility of the orienting the entire process is to have an open mind. And to be flexible, and to be able to adapt to the current situation. You need to know basically, the standard operating procedures, the policies of the hospital or the institution where you work, because this will give you a backbone on your practice, you will base your practice your skills, based on what they asked us to do, based on the laws of the state based on the policies and procedures of the hospitals. Then it takes courage to be courageous in order to face new challenges, and have a positive mind, have a positive mind to accept, like constructive criticism, have a positive mind and accepting positive or negative comments? So it's just a matter of point of view, just look at always the positive side. Yes, there will be like negative things or negative issues, but we can always learn for those issues and move forward to become a better a successful nurse here in the US. Yes, Bryan, from some of the nurses that I have communicated with after they start working here. It's a big adjustment when they realize how much of an expert they were prior to coming to the US to start working here. And then how many things they sometimes have to learn and adjust to like mentioned earlier, there's things that you may have been allowed to do somewhere that you can't do here.

And there's also things that you know, Oh, you can't? You need to seek out information to make sure that you're practicing the way you're supposed to be within the nursing scope and the state Nurse Practice Act. So did you have moments where you felt like you were just a beginner again? And you know, maybe it was like, did you ever question what did I do? Well, before I come here, in the United States, I already conditioned my mind and myself that this will be like, an entirely new practice. But there will, there were some practices that we had to do my previous experiences that are applicable in here because we base our training and education also in new US textbooks and the previous work that I had, mostly managed by Americans as well. So they're trying to adopt what the American practice is, when it comes especially to safety of patients, and based on the scopes and practice of the nurses. So what is important is that whenever you are in a new work situation, have an open mind and do the effort to learn the new things. And basically, when it comes to skills, skills wouldn't be there, that will be an asset for the experienced nurses. But just know your limits. Because in here, we may not allow to do certain things that we used to do in other places. And there are also things that we are asked to do in here that we were not allowed to do in other places. So communication, open mindedness and adaptability or possibility would be key factors in order to be successful.

So I think that kind of segues nicely into my next question or discussion point, which is the nurses that we work when they arrive here and they start work, they actually have their own license in the state they're going to work in in most cases. So in that situation, is the or sorry, is the preceptor responsible for illegally responsible for the nurse making any mistakes while they're orienting? Yes, both the Orientee and the preceptor got the legal responsibilities, because the first chapter has been given the authority over the Orientee, so as much as possible, the Orientee and the preceptor will work hand in hand, in order to have a safe practice, and in order to be able to adapt to the current situation and to avoid any legal issues. So that's really important that the preceptors bear responsibility in the sense of, you know, guiding the nurse and verifying that they are competent and safe to practice more and more independently, by the time they finish with their orientation. However, because that Oriente has their own license, they are expected to practice as what we call a prudent nurse, under the Nurse Practice Act in that state. So if the nurse if the nurse makes a mistake, that's out that's, you know, an honest mistake, then they would look at what happened, how it happened, what we can do to minimize the risk to the patient. And there's a reporting process and a risk management process. We won't go into that today. But I will say it's important to recognize that while the preceptor has some responsibility, the Oriente is practicing under their own license in this situation. And so it's very important that if they're not certain about something, that they make sure that they verify their own knowledge or skill or ask for help. And that, Bryan, I don't know about you, but I, I am a lifelong learner as a nurse and so there are things that I don't know today and I will go to seek that information out or I'll find out that there's updated practice guidelines for certain things. So are you still learning or do you do now know it all because you become a preceptor?

Well, just like you learning is a continuous process. So every time that there will be something or updates we have to do I improve myself by having look into the new laws, the new updates for our practices. And in fact, in our institution, were given the opportunity to continue our studies, we can take our masters, we can take our higher level of education, we have short courses being offered, or like there will be like, special offers that you choose. So these are being given here in the United States, but it may differ in each state or institution where you're working at. The good thing is that in here, you will learn continuously, because in the entire year, it's not just you're being given the responsibilities to learn during the orientation process, but remember, during the whole year, and it's like a cycle that we need to keep on updating our skills, we need to update the new policies and procedures of the hospitals because they keep on doing research, they keep on doing the updates. So we have competences, these competencies we have during orientation. And even after the orientation, we have yearly evaluation of our skills and competence. Gotcha. So there's continuous learning almost whether you want to or not, but there's a variety of resources. And there's a variety of ways that things could change. It could be a new policy, or practice or a piece of equipment in the hospital that you're going to have to learn about and bring into your daily work life. Or it could be something within the Nurse Practice Act and within your state that changes. So before we move on to our next topic, point, I want to say hello to Sarah Nora from Thailand, Jenny Lee from Bermuda, hi birdie from the Philippines. And Metta not from Kuwait, Lorna is watching from Istanbul, Turkey, and Esther is in the UAE. So we got people from around the world that are joining us and wanting to learn more about working alongside preceptors. Um, so let's talk about the training to become a preceptor here in the US. What kind of training did you have, when you were given that responsibility? Yes, the institution has designed a training module for the preceptors. So each preceptors should undergo a training that would give a uniform guidelines regarding how to deal with the orientation or the IES that we got. So we sit in a class for a day. In fact, I have a schedule for training again for today. So this training will include the upper approach, how to manage the paper works, and how to guide the preceptor or the IES, or the Oriente in the clinical area, how to do the assessments, the evaluations, the how to deal with their attitudes, or behaviors, and as well as what are their own even personal concerns, because this would affect their work? situation.

So it sounds like it's a very comprehensive program at the facility where you're at. And that's great. I know that some of the other facilities that Connetics works with also have a day or so of training in what's expected of the preceptor what the resources are, what are some of the norms and challenges that international nurses face when they're onboarding here, and how to support them through that process. And I think that every nurse is an individual, but we also know that different cultures and healthcare systems have different norms. And so when the nurses get here, they're having to adjust to a lot outside of work. And then when they get to work, they're also still adjusting to what healthcare is like here, what the patient's personal and family culture a B. So I call it drinking from a firehose because there's all kinds of information coming at them and things to adjust to. What did you What did you find helped you the most when you were working with the preceptor that you were assigned to? Oh, the one that helped me a lot when I was new, that just kept my mind open my previous skills, and my other experience and other parts of the world that helped me to adapt well, so it's mostly based on my experience. And what I have seen to my colleague, what we adjusted more was the documentation process. The documentation process that we have, they are so specific. And they are so really specific in doing the assessments and documenting on time. And that is the thing that my preceptor gave me a focus during my orientation time, because we have a different system, or even though that we have the software, in other facilities, but they have different type of documentation, even though that the things that you need to document are the same, but how you will document it that matters most is Bryan. So I think that is a good point, you came from Middle East as your last place of work.

And so you had some exposure to computer documentation. But then you got here and realized you might be putting information into a computer system, but there were still going to be some differences as to what you have to put in and how you have to document it. And I think that's a pain is some people are gonna also transition from paper where they may document certain things into a computer system where there's a lot more checkboxes to do, and a lot more navigation with, maybe with a mouse or a trackpad. So getting used to that, in addition to everything else, becomes sometimes a little frustrating for some of the nurses I've talked to, they get a little tired of trying to figure out sometimes how that computer system works. But what are some of the ways that they can maybe practice and improve their comfort level with the computer systems they're going to work with here in the States? Yeah, and artificially, right, given the time during the orientation the entire week, just to do the computer works. So there will be like simulation programs that you need to do and play around with documentation. So have time to practice that during orientation time. And always ask your preceptor the things that you need to document and how to do it and have a small note, if you can, what are the important things that you need to remember during the documentation, it will take some time to put it in your system.

Like, in the beginning, I was just trying to read it one by one, what are the things written? But now you know, already, when you click a certain thing, it would you know, where the place of that certain thing that you need to document is being placed. So that will adapt to the speed of your workflow. Yeah, so it is a lot of practice. And I like that your facility is able to give you some simulations to practice. Sometimes when it's more scenario based, it's easier to understand why you're doing what you're doing, or the how even so what do you enjoy most about being a preceptor here in the US? Well, I enjoy sharing my experience. And most of all, I enjoy my precept three, or my Oriente learns a lot and be able to adjust and adapt well with the current situation. And based on the evaluation that he or she would have, at the end or in between the entire orientation process. The evaluation shows good, the results good. And we get a good feedback from her or hand that and it shows also and the workflow and how he or she adjust in the work situation, that would be really satisfying. Yeah, I think that's what I enjoy most about training nurses is when they have success when they have those Aha, sometimes it's a small moment, a small success in the overall journey, but it just makes you feel really good when you see that people are learning what you're attempting to share with them and they're very engaged and of course when they're excited about something that's even more fun. We have our lien watching from Jamaica today and joy watching from Kenya as well. So for those of you who have joined us in the chat, you can also put if you have comments about or questions about being a preceptor or working with a preceptor here in the US, and we'll try and get to some of those a little later in the show. So please feel free to put your questions in there. And Bryan, and I will do our best to answer them. Um, so Bryan, some times, we find that the international nurse who's adjusting may find it difficult to know what they don't know. But they usually do understand how they learn best. So how can a nurse communicate to a preceptor what their learning needs are?

Yeah, basically, before the beginning of the orientation process, in our facility, we have the checklist of the strengths and weaknesses of the new nurse, what are the things that they're good at what they think that they think that they need improvement, and sometimes they just say we don't know. But in the entire process, they will be able to assess themselves. So there are also, there's also a checklist of the common or the skills or knowledge that are necessary for a specific unit. So they have to read in it, it's specific skills or knowledge that are needed in order to be successful in the area or the unit. And we look into that, and we work on it. And we check in between like every chef or like every other two weeks, there will be a touch point to evaluate the situation. How is the nurse doing? How is she adjusting how well it's doing in orders to the number of weeks that he or she is having on the unit. So it's daily evaluation, if he or she is at work at the same time, sometimes you will realize only during your, your work, or the orientation. Oh, we didn't used to have this in my previous experience. Oh, it is a common procedure in here, but I never had it before. So we look into that and we give focus on whatever the nurse initially knows the strengths or weaknesses, plus the ones that they discover in between the orientation or within the orientation process. So it sounds like you're used to seeing the nurse have a self assessment. And then as you go along throughout the orientation process you're evaluating to see, are there areas that still need improvements? And are they maybe they thought they knew something. And when it comes time to demonstrate that here, they still need a little bit of work to be able to perform it the way it needs to be done. So there's, there's day to day feedback, and that's really important.

Let's say that a nurse is told after they do a procedure here, maybe for the first time that was okay. What is your interpretation of? Okay. Well, okay, for me means like, Oh, I've done that or, like, there will be some questions that you need to ask to further dig, whether he or she understand it fully. It's not just okay means okay. For me, okay. means we need to be confident. I'm very okay. Let's say very confident. Just being okay. Only it's not enough for me. Must be really confident. Yes. All right. So your understanding and mine are the same then if someone is telling you that you did. Okay. My advice to people? I don't know if you would say the same is why don't you see if you can get a little more specifics. What did I do well, and what could I improve on? And sometimes that's where you're gonna get the feedback that helps you grow from okay to unconfident and I've met, even met the expectation, okay, may not indicate you've met the expectation of the person who's evaluating your performance. So it's really important to get specifics, even if even if they come back and tell you Okay, well, okay for me means you know that you did well, okay. What does well mean? Is it well enough? What are the things that maybe I could still work on and do better and what do the things that I did well enough that I should just keep doing those. So specifics are really important when we're talking about that orientation process of feedback.

So I see Millie is joining us all the way from Canada, Amelie, that means you're a little closer to us than maybe some of our other nurses. But we're glad that you're joining us today and Nat from Ghana is also joining us. So I'm Bryan. Sometimes a preceptor and an Oriente just don't quite match. And what I mean by that is maybe the learning style of the Oriente and the training style of the preceptor aren't really facilitating success for that Oriente. What should I, what should it oriented do? Or some I heard you mentioned, so an internationally educated nurse, what should that nurse do if there's a mismatch between them and their preceptor? Hmm, I wonder if we lost Bryan for a minute. Okay, so we'll try and get Bryan back on. And in the meantime, I will move to look to see if we've got any questions yet. It doesn't look like we do. So be thinking about whether you have any questions about working with preceptors or becoming a preceptor here. I Bryan, welcome now. That's okay. It's okay. We'll keep rolling. Um, no, I actually had a question for you about what happens if a preceptor and an Oriente, it's not a good match between the two, maybe the preceptors training style, and the oriented learning style just aren't matching, maybe it's a personality thing. What could happen or should happen in that situation?

Well, based on our experience, as well as together with my colleagues, there were instances that there's like, not a good match between the precepting the preceptor. But there are procedures that they that we follow. Communication is one of the keys that will help to resolve these kinds of issues. Like what happened was, our precepting is not getting well along with the preceptor. And like, each one of us got its own style. And the style of teaching or the way of reaching something, or doing a procedure may differ from one another. But what is important is that you maintain the standard and you arrive at the same point. But there are some cases that really, the perception of the preceptor differs and the ways and how to get the things done, like for example, in prioritization and how to do see the patients first which medications you need to give first. So they have different styles. So when this kind of things arises, they look into it, you try to communicate first within the preceptor, the need to discuss what's the difference among them, and they could meet halfway, and he they need try to adjust with each other. If they will be able to adjust and work well, then that's good, but it's still it's not working. They tried to communicate involved, like the clinical coaches or nurse educator, they tried to discuss the differences and try to resolve it. But if worse, comes to worse, it's not really working well, they may advise different procedures to try to assess what's wrong with between the poor and the perceptive then they would either they would ship the perceptive to other preceptors to evaluate to have different styles of teachings, or sometimes they may request for switch of preceptor. So, but it undergoes the process, they have the process, they dig into it. And they would look into the trainings that they may do again with preceptors that they may include. Other factors may include like, like the nurse that was new is like, very experienced one and he or she may think that, Oh, I got this experience and I got this practice. Well, sometimes that what I'm saying from the very beginning that we keep our open mind, when we come here in the US that things may be different, that things may go. We finally in our previous practice, so these are the things that we consider.

And it sounds like you've had some exposure to those different issues with mismatches. And I have as well. And that is, pretty much the advice that we give is it's important to communicate, it's also important to advocate for yourself. So if you're struggling with something, but you're not opening up and sharing, you know, this is very difficult for me to learn in this way. Can I try and learn it in a different way? Or do you have a different way of, of, of practicing or teaching this particular skill or, you know, and if you can't quite get there with that preceptor, I heard you mention, you could talk to a clinical coach or an educator, and oftentimes the educators are able to help as well. And they understand that sometimes it's teaching style and learning style mismatch, sometimes it's personalities. And what is important is that you as the Oriente continue to make progress. So if those mismatch issues have become something that is holding your progress back, and you're not speaking up, that can lead to concerns about you know, whether the success that they need you to show in order to finish your orientation is going to happen in a timely manner. So don't wait too long. If you have those concerns. Advocate for yourself, but talk first to the preceptor and share with them a little bit about what your challenges with what's happening, maybe say, Can we take this section a little bit slower, because I'm still working on trying to learn it, they also want to know that you're engaged. So for instance, Bryan, have you ever showed someone something to do, and then told them, You need to review this even more when you get home or when you have your day off, you really need to try and understand this well, before we move on to something else. So it may take some effort on your, on your own time even to really learn that topic. So that when you come back, you're more comfortable with it.

Right? Yeah, actually additional things that fears or support system really matters, because based on what we have in our friends, newcomers or in the US, they just keep it within themselves. They don't share with others, they don't speak with their preceptors they don't speak with the educator, so they are in the middle of the orientation. And still, they have been keeping it for some time. So support system would really help this like if we have peer, so friends that you can verbalize your feelings and share. What are what your feelings, what are your ideas. And it turned out that like, one of our friends opened up before, and it turned out that there are others also that are experiencing the same. So until such time that we have our educator know about it, and the discussed about it, and only the time the steps has been taken. So they have discussed it. And thanks God, they were able to finish their orientation. And now they're a bit comfortable. And they are successful. So the a lot of them already been telling that, oh, I want to quit, I want to transfer. I don't want to do this anymore. So it happens. So just communicate and have a support system and try to do your best to review whatever you have taken in the critical areas or in the trainings or seminars have a time to reflect on it at home, and our time to reflect on both the downside and the upside for the data, take something in order to improve it and to keep the good ones up. And that's it.

No, I think that having that peer support system is part of your survival mechanism when you're going through the adjustment to the US. So if you isolate yourself, if you don't, you know, have people around you that you're reaching out to end it doesn't mean that they're going to be your best friend or that you know, you've just have an instant trust bond with them. But that dialogue instead of bottling everything up is what can allow you and the team that's trying to help you move past that and sometimes that means a change in your preceptor. But again, if that's going to be the piece that holds you back, then we don't want to go week after week after week with you know, limited to no progress because this is the real challenge that you've got that you're facing. So I completely agree opening up to your peers, and, and trying to figure out a way forward is going to be advocating for yourself and your own progress. Um, we do have a question from Millie, she says, How long is the orientation? So I'm gonna let you answer your experience. And then I'll share a little bit of mine as far as a lot of the facilities that we work with. Yeah, the orientation process or the design of this facility, the first each other, and the first also on the type of a new nurse, like for the i ns. In our facility, we have the program, eight to 10 weeks. And it could be longer if you need to extend your orientation if you if you and your preceptor deemed to need to have some more time in order to adjust and adapt with the current work situation. And some, in some other instances, we are not handling yet the local graduates, the US graduates, we have different type of orientation scheduled June. But for IEs in our facilities, we have eight to 10 weeks. So every two weeks, there will be like touch point, they will check the progress, how well is the nurse adjusting or adapting with a work situation.

So that's similar to some of the other feedback that I get from our nurses across the United States. That, you know, they may be looking at eight to 10 weeks for some high acuity areas, they may be looking at a little longer. The other thing that I've seen is some facilities prefer to almost individualize it. So a nurse that is seems to be adapting really quickly and adjusting well and maybe had some familiarity with similar health care system or like you, you know, coming from the Middle East, sometimes there's connections there with more American practices. And so in that case, they may see that transition go a little more quickly, but others may struggle. And so in that point, they want to try and figure out what are those struggles? How can we help the nurse overcome those, but it may take a little more time. The Nat says is preceptorship, the same as mentorship. So for me, that being a preceptor, typically, they have different or potentially different names for the role. So you may see some preceptors at a hospital, their role is a preceptor, but they're not actually called that they may be called something else. However, mentors are usually not as day to day hands on with the patient. So most people in a mentor role are going to be there to sort of coach you at a less frequent pace. So that the preceptor is one who's going to be with you at the bedside or in hands on practice. And your mentor may be somebody who is sort of a communication point for you. And they help you with more than just your clinical challenges, but maybe something in the community that's confounding you, and they can be there to support you through that. So that's my experience. But Bryan, do you have mentors at the hospital? And are they different from the preceptor role? Or is it synonymous? Oh, for us, they specifically we have preceptors we have clinical coaches, nurse educators don't have this, like mentors will be like clinical nurse educators that have like, touch points only.

Yeah. And I've seen some hospitals also will have what they call an ambassador program. And if that's the case, those nurses and or sometimes they're not nurses, there are other members of the facility team who wants to help international nurses

to assimilate and understand and conquer that adjustment process. So again, hospitals may call it something different, but usually mentor the idea of a mentor is a little bit different from that clinical preceptor role. Um, so Marlene says in preceptorship, apart from the evaluation of the Oriente at the end of the orientation for progress of training, the preceptor should be evaluated by the Oriente as well. for effectiveness of teaching, so there will be room for improvement for both. And, Bryan, I think you were saying that earlier that the nurses can give the preceptors feedback formally. So what does that look like? Where you are? Yes, it's the same. The end, or even in between, we have the evaluation. We evaluate the orientation, the orientation also as well give us the evaluation. And both we look into it, we see what are the things that we need to improve? And what are the things that we give focus on? So it's both ways, right? Yes, so and I've seen some organizations as well, where it's not just at the end of the process that the preceptor gets feedback, it's actually at regular intervals. So you mentioned touch points. And I know some facilities use a touch point almost on a weekly basis to come together with the preceptor the Oriente, sometimes the educator, sometimes the department manager, and they talk about how things are going. And when they ask you, how are you doing?

Again, fine, is often not really fine. In our world, we want to hear more than that. So you can brag about your progress a little bit, you can say, Well, this week, I'm really excited because I started my first IV since I arrived, and I got it on the first stick. I'm kind of struggling with these IV pumps, they're a little hard to figure out how to program so I'd love it if I could get some extra time to practice that during the week. But that shows that you're engaged, you recognize your own successes, and you also are aware of where you can improve. And it takes courage you mentioned Bryan earlier, be courageous and be positive. And here the the goal is to be always progressing. So if you seem aware of what those areas of opportunity are in your own performance, and you're able to vocalize those great, and then your preceptors can back you up on those things. They can also suggest other things you can do. But that's also your time to say, you know, my preceptor and I, we get along really well. But I see that, you know, sometimes when I'm with the alternate preceptor, they do things differently. What should I do? Which one should I follow? That question comes up a lot, too. And if you need to give feedback in private about something that's going on with the preceptor, that's typically where you can speak with a unit educator or I guess, Bryan, maybe the clinical coach at the facilities where you work.

Bryan might be frozen. Okay, I'm sure we'll get him back in just a minute. All right. So Marlene, I like that you mentioned that we have the opportunity to give feedback about the preceptor and the performance. And yes, there is. There is a understanding that not every preceptor and Oriente will be the perfect match. And there are some preceptors, who absolutely love being preceptors. And there are others who are like, it's a little tough for me to be a preceptor because I have to juggle what work I have to do. And I have to help this person, orient and become comfortable themselves. So I think the more they enjoy what they do, the easier it is for someone to feel like they really are being shepherded through the process in an effective way. So I'm Bryan, I'm, we talked a little bit about being engaged in the process. What when you're orienting a nurse, what tells you that that nurse is really engaged in their learning process? What are the signs of that? Based on what we have is that the nurse itself keeps on updating the preceptor and we have open communication and he or she is comfortable sharing his ideas, his or her difficulties during the entire process. And they keep on asking questions without hesitations, whether it's with a procedure, whether it's with the policies and procedures. So being open, being open when it comes to the professional side and workplace and be able to practice these Nabal to improve her practice and adjustment in the area that she was the, the, the nurse is really eager to learn and really into the practice or into the, into the new work situation? Yeah, that's very, that's a very good summary. And I agree with all of that, I think that it takes a it's okay to be in learning mode again when you get here and the more we as preceptors see that you are, you know, trying to soak it all in and learn it and retain it and start to use it in other skills. So for instance, if you are, you know, performing a sterile procedure, like a dressing change, and then, you know, you go to do a sterile urinary catheter insertion, practicing good sterility is a sign that you're respecting patients need for safety. Bryan, I heard you mentioned safety a lot. But when you're in your preceptor role, what is your biggest fear?

Well, my biggest fear is the my preceptor or Oriente would not be able to adjust well, and will not be able to practice the right thing when he or she is about to end the orientation process. Because for me, it may lead her to any legal issues or any safety issues, he or she is not able to adapt the current working situation. Yeah, and I think that's what I've heard from some of the other nurses that I speak with is when they're told that something is not safe, or they haven't practiced a safe technique, or maybe observed a part of the procedure that's considered making it more safe. That is what leads to concern about whether that nurse will be able to be independent. What are some of the things that you find maybe are the hardest challenges to adapt to when it comes to safe practice here in the US? The most difficult thing, or the hardest part is that if you keep your old practice that are not in line with scope of practice, or policies and procedures of the hospitals, so when you come here in the United States, try to learn what, what are the legalities? Or what are the safe practices and procedures, know the policies of the hospital and know the state laws and the scope of practice of nursing and whatever state you are working in? Because that will help you guide on safe practice? Yeah, that's really good advice to understand what the legal aspects are what's expected of you. And then I think, we haven't talked a whole lot about it. But a lot of times Preceptors are a resource that a nurse knows they can go to, but the preceptor is only going to know and remember so much. So what other resources should the nurse be regularly accessing during their orientation? To help them verify that their understanding is correct? Or how to do something or what's expected of them?

Yep. In our facility, we have an online system for the policies and procedures, whatever questions that you have, you can always open the folder. Like in our institution, where we put the policies and procedures is any specific concerns that you have, like whether it's a nursing procedure, whether our procedure of doing something or a procedure and discharging patients and procedure, procedure and referrals, or whatever it is, it's in the computer, we have the files, you are given the access, and you can ask your preceptor if you don't know how to open it or how to access it. There is a charge nurse that you can you can always access well, to give you guidance, when it comes to how things are being done. What are the policies and procedures or how to access the policies and procedures in your unit. And in the unit we have also hard copies, some of the hard copies of the necessary or common procedures or things that we do that in order to guide us in our daily practice and most has vittles and facilities have those online resources. They have ways you can look up medications, if you're not familiar with them, you can use the computer system to do that to look up policies and procedures. You know, a lot of times if there's something updated, the policy is updated, and there's usually like an email message in the internal email system to alert you that a change is being made. There's a lot of places and, and resources, I guess. So the preceptor is one of many in most organizations, and it's important that you're that you're using all of those resources. And not a prudent nurse is not going to do something to a patient and put them at risk if they're not sure. So when we talk about practicing safely, if you're not sure, then make sure you use those resources to become sure whether that's reading up on the procedure, and then going and saying to your preceptor, okay, I read up on this, and this is what I think I have to do. And this is I might need your help to remind me or, you know, whatever, but have that dialogue, if you need to make sure that you're not forgetting those resources, once they're given to you during your orientation, that they're still there that they're great for you to access because their standard, they're not going to change from day to day, they are consistent.

So Peter is asking, how long will it take for new orient new Lee newly nurses to finish orientation process. So new graduate nurses in the US undergo a different orientation because they're new graduates, new international nurses and many organizations have several weeks that they may be given initially. And then if need be based on the individual or the specialty and the amount of information that needs to be learned and absorbed, that orientation may be more than that may be extended. But the goal is for you to demonstrate safe, competent care, and be eager to learn and okay with learning, it's okay to learn it's okay to ask questions. Because it's all in the name of being safe, safe practice is the key. Locke says I live in a country where nurses perform some major procedures due to a shortage of physicians acute shortage of physicians. While I have worked in the ER, I perform procedures like drainage, minor tendon repairs, artery puncture, wow, you've done a lot. So you know, patient safety is compromised and you want to learn all the needs to be addressed. So locks will go back to what Bryan and I were just talking about, which is you will have resources both for your state Nurse Practice Act, and then your policy and procedure manual at your facility that will outline what you are allowed to do both in the state and in the facility itself. Keep in mind that every state is different. And some states that may be more rural may have broader things that they allow RNs to do. Some may be allowed to do that to do more invasive things, if they have certain types of training that are considered acceptable at the Nurse Practice Act level, and within the facility. So it's important to really, you know, don't assume, and they'll go, I did that at home. And so I can probably do it here. Make sure that you go to those resources. Really before you get here I would say study up on your Nurse Practice Act for the state you're going to come and work in. And that kind of leads we're really close.

We got like one minute left. So what advice Bryan would you give the audience that is watching today and thinking about coming and working here in the US and working alongside preceptors. So I may say that they need to be courageous, and whatever challenges that they may face. Second, communicate, communicate. Communication is a key in order to be successful. Communicate your strengths, communicate your weaknesses, especially in your practice in your workplace. This will resolve things. This will make things easy, and it may help to clarify things as well. Third, be flexible, be flexible, because everything is different. So we need to adapt to the current situation. Weather just today is different. Tomorrow will be a different story as well. So that's it, have an open mind. Have an open mind to learn new things and continue learning. Learning is a continuous process. And you'll be successful, especially here in the US. Yeah, even once you finish orientation, you're still gonna learn, you're still gonna have questions. Your leaders are still learning, they still have questions. So we are as nurses, continual learners, and that's part of the great thing about being a nurse. Um, and I do want to talk a little bit about some of our upcoming shows before we sign off.

So we have a Connetics career day coming on the 18th. And we have a show on August 25, about stateside working in the Northeast. And I'm excited for what's coming on that both of those shows, I think it'd be awesome. In September, we're going to do CGFNS English exams discussion one year after the CGFNS organization approved additional English exams for the visa screen process, we're going to talk to guests experts in that show. Understanding your job offer is September 8, please sign on and join us for that one as well. Because when you get an offer, sometimes the excitement is at fever pitch, you're thinking about the future and the dream. But it's important to understand what you've been offered and how that's going to affect that process and that dream. So we will help you analyze your offers. And that show, September 15 immigration Q&A will give you an update on what's up with immigration and retrogression. And then we have another state shot stateside show coming up towards the end of September. Our next love for a talk show is September 12. And it's on overcoming challenges and I'm sure that we'll have a lot of great advice for you. Our Connetics College also has shows every Monday at 6am Pacific Standard Time. And so those are both NCLEX topics for those of you preparing for your NCLEX test and then English. So swoosh and Niners both partner with Connetics for great resources for preparing for your English proficiency exams. And we hope you'll join us on those Mondays for those free courses to help you prepare for your journey to the US. Thank you so much, Bryan, for your time and for sharing your expertise and experience with us today. Really appreciate it and look forward to maybe doing some future shows with you back as a guest. Hope you have a great rest of your day and good luck with your preceptor class. Yeah, thank you so much also for that opportunity and time. My pleasure. Thanks, everyone.