Working with Different Patient Care Roles

Hello everyone, welcome to the Lefora Talk Show  season four episode seven our expert edition, I am pleased to be here with some great guests today. And my name is Holly Musselwhite, I'm the Clinical Nurse Educator for Connetics USA with am in healthcare. And today we're going to be talking about working with different patient care roles. So it's a very broad topic. But we've got a lot of great practical advice to share with you. And we're also looking to get your questions or comments. So in the comment section, please type in where you're signing in from where you're watching from. And if you have a question or a thought that you'd like to share, just put that in the comments. And we will randomly be stopping to take a look at those and see if we can't share some additional thoughts in relation to your questions. 

So there's Cecilia and Mhadz. Good morning, since you're on the East Coast and central part of the US to you both Good morning. How are you? 

My name is Cecilia Houston. I am also an international nurse born in Panama, Central America. And then I have been living in the States for 25 years. I have been a nurse since 2007. And I have work in different fields and the healthcare system. I started my nursing career as a tech and then currently you know, I am working for OGP International and in the management side, so I have a various experience background in critical care, observation, care management, home Hill. And then also in the other side of my life, you know, I will also go Aspiro, the US Army Reserves as an officer for 13 years. So I relate to your stories and experiences and your journey and the US a through a lot of perseverance, adaptation and resiliency.

My name is Mhadz. I am originally from the Philippines. So I've been a nurse for quite a long time now. I used to be a clinical educator when it was still in the Philippines and then moving to the United Kingdom to work there as part of the critical care team. Well, I would say the transition primarily from being a clinical educator like theories, you're dealing with books you're dealing with, in a modules to the actual patient care at the bedside. So I think that it's one of my 360 degree turntable. But now I am well I've been a hit to work and live in England for roughly four years. Before coming here. I was able to go home to the Philippines just to you know, recalibrate and then after a month, I started my career here as one of them registered nurses, particularly one of the IES we call it here in America. That is that stands for Internationally Educated says well, hard, big Connetics. I am currently employed in one of the biggest hospitals here in Texas, USA, Baylor Scott and White. I am specifically assigned and working in our medical intensive care unit in the organization. So yeah, welcome everyone. And I hope I will be able to give a please, you know, share some, you know, experiences and you know, to everyone. So yeah. 

If you're interested in applying to Connetics, you can go to Conneticsusa.com/Apply , it's there on the bottom of the screen, and submit an application to us and we'd be happy to take a look and see, maybe we can find a match for you.

I want to just briefly show our success path. So the Connetics Success Path, since we've got a few people who are saying they're interested, or they have family who are interested, this is the Connetics, USA nurses recruitment agency success path for nurses. And so it's comprised of seven steps. And below each of those is sort of a little bit more detail. So the first thing you're going to have to do is get your NCLEX done. So if you haven't already done that, that is kind of the most important piece to the process in terms of being qualified to then be interviewed by various clients and, and find a sponsor for your visa. So having that in NCLEX is like a critical piece. It sounds really scary. But I can tell you that since April, we've had the next gen and NCLEX in place. And we're seeing some good results with those nurses who are completing a very structured program. So if you're also like, Well, how do I study, you need to find something that's going to cause you to have some accountability to, to have someone who's kind of nudging you along and keeping you on track, because that process should really only take about three to six months on average for you to study, take your exam and pass, then you're going to prepare for a job interview.  

Once you have that sponsor, we're going to work with you on your visa framework, gathering all the documents you need, we will assist you if you're going through the Connetics success path with your licensing and credentialing as well. And then we have our get ready gameplan. So as you get closer and closer to arrival, we have to start to talk about the particulars of that. When you arrive there support through concierge services, picking you up at the airport, getting you settled in your community, finding that grocery store that has the foods you like, and enjoy and prosper. All of that process is really hard work. But it is it is a very rewarding process as Mhadz and Cecilia can both tell you. So they have had to go through those hurdles. And they understand that that reward is definitely the result of a lot of hard work and effort. And then, let's see, I think we I'm gonna go back to the comments in a couple minutes. But for now, I kind of want to get started with some of the content of the show for today. So the first thing is let's talk about who or what roles make up the healthcare team besides the nurse. So who are we talking about? So Cecilia, in your mind, who do you think of when you think of the healthcare team outside of just the nurse role? Oh, the SS is everybody who is in the unit. You know, we do have several team members including the nurses, our other co workers are also nurses, the techs, nurse assistants, sometimes called that way. lab technicians, radiologists, therapists, especially the housekeeping, the dietitians, the pharmacy, everybody works together as a team in the unit. So they also consider power or the healthcare team. So that's pretty much what you will see and of course, the doctors, the physicians, any type of specialty, cardiologists pulmonologists respiratory therapists.  

So Mhadz, is there anybody else that that Cecilia didn't mention? That's a role that you may have in your setting. She mentioned a lot. So he, I think I would totally agree to what they eat too much. So primarily everyone in the healthcare setting, from the attending consultant down to the well, I wouldn't say down, but to include our utility are transformed. So everyone is just contribute to patient care to delivering patient care. So I would say everyone is a huge part of, you know, patient experience as a whole. So yeah. Oh, and you mentioned a term that some people may not immediately latch on to. So I want to stop for just a second, the patient experience. And that's something that's a big focus here in the United States healthcare system. So obviously, that's subjective. That's what the patient feels about their time when they're in the hospital, whether it's the ER, the ICU, etc. And we actually pay a lot of attention to that patient's experience. So having all of those people that although those roles be considered part of the healthcare team, means more eyes and ears and more influence on having a positive patient experience when they're in the clinical setting. And we see that in the physician's offices and the hospitals in the rehab facility. So it's very pervasive within the US healthcare system to be considering that patient experience. Thank you for bringing that up. I'm so mad this question is one that I you may be able to compare and contrast a little bit as well. But is there a hierarchy within the healthcare team itself, where you are now and then contrast that to where you were previously? Maybe in the Philippines? 

Well, I will be very straightforward regarding that. Before coming here to America, I have the privilege to work like what I've said in United Kingdom, and I would say, UK, and you'd as has have pretty much similar in terms of how you deal with or interact with and work with the entire members of the healthcare team, I would say, hierarchy is not existing, because, well, based on my experience, each and every one in the team has their own distinct function. Like there is no such thing as Oh, you're a nurse, oh, you're a doctor, or you're just only this or you're just only that? No. So everyone is actually there is no sense of entitlement, I would say, Well, I'm very fortunate enough to be able to experience that before coming here in America, because like what I've said, I've got the, I've got to experience it firsthand when I was sitting UK, and then coming here. So it was actually just a continuing experience for me to which is very good Twitch, as I am, I can compare it from a previous shop. I would Well unfortunately, there had been a hierarchy. Well, in my own personal opinion, I can say that, you know, I had well, I have been able to experience like, Oh, you're a nurse. And if you're trying to like be assertive and speak up, you will be like, regarded Oh, someone that who tend to know everything, you're just a nurse or you're just this and that. So I have been able to experience that before. And it's not a good thing. It's not a good thing. When I've been able to work here, both in the UK and America, my morale just get boosted in such a way that there is no hierarchy.  

There's no hierarchy, there's no sense of entitlement, like but it's it can't be one that's just been very effective. And just trying to focus on how to deliver their function and roles and responsibilities towards again, the at the end of the day, when you come to think of it, it's the quality patient care that we are actually that is our goal, isn't it? It's not about us. It's not about what who you are, it's not about what you are, but it's about all about our patient. So yeah. Thank you. So that's a great comparison. And we're gonna delve into why that is so important here that you kind of peel, peel the hierarchy structure away if you're going to be a nurse here in the States, but it's also sometimes a big surprise if you haven't been in that before because it shifts your responsibility to the nurse a lot more you have to speak up in those settings and It also, I think it I like to make sure that our nurses understand that it's not so much a critique of where you are now. So if there's something different if the norm is different, then okay. But be aware that when you get here and you're going through your clinical transition, there's going to be significant differences and impacts, which is the whole reason we're doing this show, because of how nurses, and those other roles are going to interact. So this is somewhat a little bit of a survival skills for that part of your role. So Cecilia, let's talk a little bit about the US healthcare system and the role of the nurse in relation to other members of the team. How does and more specifically in the hospital? How does that nurse function in relation to all of the other roles that are around? 

Yes, things. One of the roles that the nurses have in the US is advocator, we are the gatekeepers, you know, we advocate for our patients care, we make sure that, you know, in the end, all team members work together for the same common goal. And then especially when it comes to patient care, we always make sure I'm gonna use that terminology as like, We are the gatekeeper, we save God or patients, making sure that they are always received the best care possible, then we collaborate with team members to make sure that the patient received the care. And one of the things that definitely takes into perspective, if that communication was had to take place with other team members to ensure that the patient received the best experience the best care possible. Yeah. So it really is about the nurse kind of being aware of everything that's going on around that patient, you're doing a lot of coordination, you're making sure that before that, you know, let's talk about, you used a transporter as part of the team earlier mad. So if the transporter shows up and says, I'm here to pick up Mrs. Jones, and you're like, what for? I'm the gatekeeper, what are you here for, I don't know, I don't have an order for her to go anywhere, there needs to be some community, you're like, stop, because I have to think you're out as the gatekeeper where she's going whether you even have the right Mrs. Jones, and you are kind of that where the buck stops to put it in American terms, I guess.  

So it's a lot of responsibility. And it means you have to be very aware of what's going on around you and what may be coming for the patient. So sometimes that may be speaking with a physician, you know, and there's another physician who's just come in and rounded. And now that next physician is here, and you're the one who heard the first conversation and you're going to hear the next one, and you're trying to keep it all together on behalf of that patient. So the advocate role is also a very good way of describing how important it is to be the nurse for that patient. To see Cecilia, I know you mentioned earlier, you've done a lot of roles and one of them is as sort of a Nurse Aide nurse tech, and a lot of our nurses in the roles that they have overseas may work with someone who has that title or a similar idea. But I want to ask you what was your experience in working in that role here in the US? Okay, so one of the spirits that I can talk is and then that's that includes sometimes we have to have that emotional intelligence and how to how you perceive other people and how they feel you don't know that experience until you work on their own shoes. You know, understanding other people feelings, thoughts, and see the world from other people perspective is important. When I was a tech you know, I have a good and challenging experience. I work with nurses and I can put two different scenarios and nurse one and I'm gonna label as nurse one is a nurse that I was with call me, included me and the patient care. So an example of that was for example, this nurse will call me to help and assist them to turning and reposition my patient and, and during that time, the nurse took the opportunity to do the skin assessment.  

So the nurse I was with there to help me but then I have a sample nurse two that will always ask me for help. And as soon as I got in the patient's room, the nurse will walk out the room and left me alone. So once I was a tech I was I also was a nursing student, I started, like I mentioned before, in a nursing home when I wasn't going to nursing school, but then later on, you know, I was doing part time, my nursing school going during the day work nights. And then, you know, I was able to see some of the difference between what is my scope of practice, as a nurse tech, even if I was going to nursing school, I still had to do my duties as a nurse tech. Okay, so that nurse that walk away and left me alone, when I became a nurse, I was talking about that situation, I say, I will never be the nurse. So you know, so I understood when I became a nurse, what nurses do, and what techs do. And in the end, one thing that I learned that the most important thing is to be able to work as a team and collaborate to accomplish the same goal. In like I mentioned before, it's selling care to your patients is our priority. You know, game gave me I mean sight, when our when my texts and say, well, let's get together at the beginning of the shift. Let's, what can you do today? How can you help me that communication has to take place, and then I was remember, you don't never want to be the nurse, to the walk away? When you ask for help? Yeah, 

I love the first example you have to because it shows that you know, many hands make light work. So that process of turning and repositioning the patient that goes faster for the text, so they can go keep doing other activities like that. But also, you as the nurse, have the visualization of the patient's skin. So you can do that skin assessment, make sure there's nothing that you need to be addressing, and then be able to document that. So it's sort of like a bonus activity. But because you're collaborating, now you're building rapport with that person, and you both have a contribution to make to that patient. So I love that example. I did that a lot. And I don't know about you, but I used to tell my text to that I worked with, you know, Jane, I just gave Mrs. Smith some pain medicine, she's probably going to be a little sleepy or so if you have something you need to do go do it now before the pain medicine kicks in, or, you know, just because they're going to be sometimes doing some very hands on activities, I want them to be safe with the patient. I want the patient to have an awareness as well that we as the team communicate, like if you've ever gone into the patient's room, and they assume that you all are hive mind, right? Like everybody knows on the team, what is going on. And it's like that looks really good if you can make that happen. But it comes down to really good communication with you and the rest of the team. So Mhadz, how do you partner with other members of the team to make sure that you're providing great patient care? 

Oh, well, as part of well, you know, that teamwork is an integral part or should be an integral part of you know, patient care, we normally well, I need to be very specific, you know, well, working with other members of the healthcare team, for example, Nurse Sooners, we normally, we normally have what we call body system. So a senior nurse is being paired, for example, to a lesser experience or a dwelling less experienced nurse. So primarily because they will like tag along and then they will learn from each other basically, in rendering patient direct patient care, so that less experienced nurse could have learned so much from the more experienced nurse. And in the same way that more experiences can also learn from a lesser or less experienced nurse. Primarily, they are benefiting. It's a symbiotic relationship basically. So for example, in my case, I have been a nurse for quite a long time, but obviously, technically when I came here, I'm a neophyte, because I know the basics of nursing care. I know the standard of nursing care, but the thing is the protocol, you have a different set of guidelines here that you need to familiarize yourself with. So I have been assigned to a mentor or a preceptor here, and I've been guided as soon as I've been off from my orientation. I've been guided by more senior nurses in the clinical area. Talking about policies, how do they how do they do certain things is specific to their practice or is specific to their protocol, the protocol of the organization. It's very important, it's very important. And I could also say that working here, in partnership or alongside or along with the other members of the healthcare team, I would vehemently agree to what we said effective communication, I think that is the price.  

That is the most essential part of working in any organization, not only in healthcare, in the healthcare setting, but in totality, when you work, you need to speak up when you work, you need to bear in mind, especially when you're in the healthcare setting, you're not just only dealing with buildings are not just only like, like selling products, but you're actually handing a knife of an actual person. So you need to be more precise, be more attentive and be more how they say Be more careful, especially when you relay information. You may like, like, like for me, like English is not my first language welcoming here, or when I first worked in United Kingdom to teach English, you need to speak English and you need to convey yourself. Well, in English, I know that being a nurse is not just about being able to specific actor speak a specific language. But then you need to bear in mind that having a great communication skill will greatly contribute to the, you know, for the positive patient experience, because obviously, you're going to be talking with doctors, you're going to be talking with your techs, you're going to be talking with your corners, and you're going to be talking to your patients. So like for example, when you do assessment, well, you need to be very precise, or of course, you need to be accurate. So, having that effective communication is a must. So talking again, with how we work usually I can say we have body system. Well, even though we are not like assigning to a particular body. In the unit, we are for example I use Well, I am working on a night shift. So for example, all the nights that like or, for example, the night team would have like help each other, for example, you get to get your admission. So you all of the nurses, well, this is basing from my own experience, actually, just last night, before I came home from work. So they when they saw by patient was coming like from outside hospitals or admitted a patient, they normally they go to you and you know what? Meds just going through documentation, we're gonna do all the bits and you know. So yeah, that's how we do our team work there. So basically, there is no, I will say you will, like get assigned to do this and do that. So that everything would be like just running very seamlessly. So yeah. 

So it sounds like you work with a team that's very cohesive. And that shares the challenging workload and everything. But I also heard, going back to communication, this is what we want you to do, this is what we're going to do. So everybody knows there's no assumptions, who's doing what? And then I'm going to assume that if you have that kind of team, not only do they offer to help you, but you must be reciprocating, because that is what keeps the team cohesive is a little bit of give and take from everybody to make sure that everything's taken care of, and then you have a better shift, even when it's chaos, you have a better shift, because people are cohesive. Yeah, may I just make mention about like, a great example would be, for example, you have a code? Well, you need to like delineate each of everyone's responsibility, oh, you're going to be transcribing you're going to be giving the medication, you're going to be the one to do the compression. One should be the leader to do the code. So not everyone should assume a you know, a particular function because that will actually ruin the systematic approach. You know what I mean? So there should be really a, a, well, a delegation of tasks. Yeah, so that's a perfect example like doing codes where everyone was the cohesive like what you said, I really love that we're cohesive and yeah, collaboratively, performing all the tasks towards you know, patient care and safety. 

And that is a difference when I speak with nurse is from overseas. And we and we go through what codes may look like where they're currently working. It's a little bit less defined. So those roles may kind of just be occurring. But here that's a standard that we should be calling out who's going to transcribe who's going to do the chest compressions? Who's going to be leading the code? Who, if you're not in certain settings, you may have to call a rapid response. So who's going to do that, but everybody who getting the code card, I'm like, thinking of all these things, I'm picturing this scenario. So there's, it comes back down to making sure that people know what's happening. And that's only going to be through good communication. All right. So there's some consideration that should be given, obviously, when we're deciding what we need to delegate to whom. So Cecilia, if you're delegating to certain roles, what are some of the main considerations that you need to have as the nurse when you decide what to give? To whom? Yes, definitely, one of the things that I mentioned early on is to know the scope of practice. As you might know, for example, you delegate a task to a tech, you need to know what the techs are allowed to do in the facility. One example that I can say about that, in some facility techs are able to do blood glucose checks, they are trying to do that. However, in other healthcare facility, techs are not able to do that. So, so getting familiar with what they do, what they are responsible for, and you know, asking questions about the scope of practice that you are not familiar with is important. Follow the chars nurse asking the nurse supervisor, and the end user to understand as a nurse, it is important to also know that is the tech is responsible, or is trained to do blood glucose, in the end is you are going to administer the patient have ordered insulin to be given.  

And for some reason that Tech has not been able to get to that patient, one of the things that I recommend, don't go find the tech to get that glucose is you're gonna go give your insulin, you know, it's your responsibility to make sure that that blue blood glucose is another level where you will administer safely, insulin. So taking about consideration in the communication when you after you take in reports, you know, check with a text to see what is that throughout the day that you will be able to assist me with and what can I help you with? You know, is this a team member collaboration, and not only one member responsibility is how can we get there to make the oldest test to complete all the steps. The other piece that also I will take in consideration based on my experience is if a unit had only one take and the unit back capacity is 25. But think about that one take we had to do all the vital signs change best for those patients. And that's huge that is humanly impossible to do that. So keep those things in consideration. Like I say, you know, put yourself in other people's shoes to understand what they're going through. Is that possible? They're gonna do those steps? And then how can we help you and how can you help me throughout the day? Yeah, those are really great points to Cecelia Thank you. I'm, I especially like your example about if you can't find the tech or they, you know, they haven't gotten the blood glucose reading yet. Just go get it, because you're gonna have to give that insulin and it has to be on time. And so, you know, I think in a lot of facilities that we partner with, I find that that role is there, but it may have evolved over time, so they do have a lot more rooms assigned to them.  

And that means that if you're not collaboratively speaking with them about what you can take care of what they can take care of what you may need to partner on and do together because you need two people anyway, it can go a lot rougher during the day if you're just kind of hunting for them. And I liked what you said earlier about try to meet at the beginning of the shift and make a little bit of a plan as to kind of what that's probably going to look like so they have an expectation. I did many a bed bath and assisted people to get showers and various things as a nurse. Why? Because sometimes nothing makes a patient feel better than being clean. So you can have a lot of other interventions in your pocket. But those things that may be basic needs when you help Fill those, sometimes you really make a huge impact to that patient experience. Spending 15 minutes trying to hunt down a nurse aide who has a lot of patients themselves to do that may not always make sense. So it may be that when you go in to do your, your last assessment, you may think, Well, I don't think the nurse Tech has gotten here yet. Let me take some linens, and maybe I can change the bed and help this patient get up to the chair and, you know, at least take care of this one, and then go start the next piece of my day. So getting your mind wrapped around what they can do. There's an overlap and scope, right mods. So there's some things a nurse can do, that a tech can also do. And it doesn't mean that those things can only now be done by a tech just because you have them on the team, you still have to do as Cecilia said, I think it doesn't make sense for me to go find the tech if I need to get this done. So what are some things Mhadz that nurses can do to build solid working relationships with other members of the healthcare team? 

Whoa, well effective. I would say like, same building, like getting to know well, just the basics, for example, you get to like mingle or talk to like other members of the team, like for example, your colleagues. And just for a very concrete example that I just had last night, actually, we had a potluck together with my biggest one of our doctors, I know that I have been able to observe this here in America is very popular, you know, potluck when someone is leaving. So just as nine, I've been able to, like, bingo with them, and just talk to them, you know, out of work, or you know, stops that are not related to work, you get to know them, like just behind the scrubs are more than just behind this Proverbs, or a uniform, so you get to know them more about me as a person as a whole. So I think that being able to like having like a casual conversation with them, you know, try to know them more deeper, more than just a cold lead, but more of like a more of a, you know, a vulnerable person, or a human being, it's just like, you're even able to, like know how they are coming from, because it's just really superficial for us to like, just to see them like to work, you know, sometimes when things are not going that good, you tend to have like some sort of like, bad fights or something like not so good experience. And then you tend to like John stem, but sometimes if you really know that person, the you will understand him or her. So I would say like, just merely having potlucks like that will give you a great avenue for you to know your colleagues better. And then know like, you talk you can talk to staff like what I've said like, it's not, it may not be necessarily of work related.  

It could be like, Oh, you talk food Cook or the culture of food, or you'll be it's just so amazing that you'll be able to like talk about conversations about sounds like in relation to like food, and you get to know the culture because of the food and entirety you're actually getting to know that person even better. Like what except for a year. And I think under this only one way for us to function more effectively as a team, not just a because at the end of the day, no, no man is an island, especially in the healthcare. We're in the healthcare world. So, yeah, so just typical conversation, like just even which is a very simple phrase by asking them hi, how are you feeling? Are you okay? Today, it will make a person's the day you know what it means, especially when you're having a rough time. Because when you can think of it well let's face it through if we are actually working in a very stressful working environment, so having each other's backs is actually very helpful and we know that you don't only have like a doctor or colleague nurse just beside you here the friend we had someone there a very, uh, helping him ready to like, get ready to like help you. So I think By doing that, you actually break the glass, like it breaks the barrier can function more effectively as the home health care professional as a whole? So yeah, so Mhadz, I'm gonna steal that. No, the person behind the scrubs I like that a lot. And that is, you know, the at the end of the day, we want to feel like somebody cares about us as a person when we're at work that actually goes a long way towards us wanting to go to work every day is knowing that at least one or two people if not a whole team cares about each other.  

And yeah, nurses we seem to like to share about ourselves around the dinner tables or a break room sharing a good meal. Sharing new foods, things we haven't tried before, is always interesting and fun. So yeah, knowing people for who they are outside of work makes work more fun. All right, so I'm gonna skip back to the comments for a minute. We have Ghafar from Kuwait asking about timeframe, how long will it take to get jobs sponsorship or visa for USA Ghafar As a medical lab technologist. So we do have openings for medical lab techs and some of our partner locations. And for that, I've seen nurses come on those types of visas for medical lab technologist within just a few months. So it can be a very fast process sometimes a little faster than you think. It can also take a little more time. So it may depend on how quickly you're able to get your documents together, what time of year you're being filed. What type of visa filing you have or the sponsor is offering. But I would say that sometimes within a year, it's pretty. Or I would say very possible that you could be here that quickly. Are our green card sponsorships which are typically what Connetics and AMN does for international nurses. Those take longer. So Mhadz How long did it take for you from the time you were got a job offer until you got here to the US. 

Actually, surprisingly, I was expecting it to be very that long, like I was expecting the worst like yours, or you get about two years. But you know what, surprisingly, I am proud to say that I've been able to, like finish everything and you know, touch down America after eight months in total. And then I'm just so proud to share that I even didn't have any data processing or how do you call it a document processing agent or? I was so hands on by doing that. So why was I call myself team DIY me. So I did everything like from the job offer. And then from the I-145. And, of course, with assistance with a great assistance from fanatics, so just want to get this opportunity to really give a great shout out to Connetics for helping me seamlessly with the process. So yeah, it really just took me eight months. I actually have my timeframe, the timeline here. And yeah, as I was looking back with all the processes, yeah, just, I was just so happy. And I was just so amazed that yeah, it is possible. So for all of you guys out there, who is you know, they're out there application know that? You can do it. Yeah, that's great. And I think right now, we may have some nurses watching who are aware that the visas are retrogress. So that is unfortunately slowing some things down. And we are hoping to have an update soon on retrogression. So stay tuned for an announcement on an upcoming web show for that once we get our most recent visa bulletin issued. However, the goal right now for our organizations is to continue to file visas to continue to partner with our hospital organizations to get jobs in placements and get nurses visas filed so that when those priority dates do come current, then that process is in high gear. And people move really quickly through the remainder of the process which we can get you all the way to the point that all you're missing is getting your consulate interview scheduled.  

So that means your visa can get filed. You can get your visa screen you can you know go through all of those steps while you're waiting for retrogression to lift. And once it does once a priority date becomes current. Then we push really hard to get you your consulate interview and get you here within a short period of time and get you started working hospitals are eagerly looking for nurses to come in and get started and so they are still very much engaged in the process of looking for qualified international nurses to bring onto their team and get through the process as far as they can until retrogression starts to move again. So keep looking for updates on on retrogression, throughout the coming week or so. And hopefully, we'll have some announcements that are good news. In the near future. Fingers crossed. Um, Cynthia, I think we kind of answered your question. As far as what Mhadz shared his is the ideal time, and he was not affected by retrogression. So thank goodness for that nods. But for those of you who are like, What am I supposed to do, the time that it will take is now dependent on what's happening with retrogression. But as far as we have nurses who if they interview and they get a job offer within a few days, within days, two weeks after that could be having their visa filed and moving through that process. So it's really exciting to see that there's still some things that can be done while we're waiting for those priority days to come current again, Tom is watching from the Philippines, it looks like third with a friend that we're on live today. And then. Let's see. Philly Sanchez says Do you have a branch in Missouri independence. So I do know that we have some clients in Missouri, I'm not exactly sure where independence is my apologies. But we do have hospitals that we partner with in Missouri. So if you're interested, you can go to ConneticsUSA.com/apply. And we can see if we can maybe get you connected with one of our clients in that area. Francis says hello following from Kenya any news on the October visa bulletin. So stay tuned, Francis, because we're looking out for it just like you are. And as soon as it gets released, we will be planning to do a show and go live with everyone and kind of share with our legal expert team that we have on occasionally on our shows what's going on and what to look for next, as this October visa bulletin is released. All right, and then Rica is watching from Boho Philippines. That's a new location for me. I hadn't heard there was a boho Philippines. But that's cool. So thanks, Rika, for joining us today. Um, so Cecilia, since you've had several roles, what advice would you give to a nurse who is struggling to have a good working relationship with a nurse tech? Yes, definitely. 

Once again, I'm gonna mention collaboration, communication, ensure that everybody is aware of what is going on throughout the day, get together, whether texts, you know, the beginning or the chef, or were any other team members, you know, to coordinate what is happening to your patients. Another team that I also recommend is about also giving feedback. If you are delegating a task, there's a follow through, make sure that you check on the tag and make sure that you know, was this done damage, you didn't get it down, then I can jump in, to help you out. Having that communication, you know, is the key to collaboration. Also, you know that during the Horos I think pretty much every unit does thing Horos and sometimes they may include that text and esteem Horos make sure you communicate things going on. Especially when your patients you have confused patients, we know that those are challenging and it's important that that patient's safety is part not just only the nurse but everybody can contribute to keep an eye on that patient at the beginning from the beginning to the end of the shift. So comment using the C's we say like a communication collaboration and definitely trust and team members. Make sure you are flexible and look at you know that patient care is a rewarding experience for all of us and then look at each team member positively you know when one thing member have this negative outlook where everybody you know, that is very contagious among team members. Try to look at giving care to a patient as a positive experience and you know, try to keep positive communication between each other. 

Yeah, that's great advice. Cecilia, thank you. Um, I know, Ahmad, that there may there may be some roles that we talked about earlier that you work with, I want to maybe look at a different role like, do you have respiratory therapists who work on your unit? What do you mean? RT? Yeah, currently? Yes, that's actually one of the measures, while significant difference, because when I was working in the United Kingdom in critical care, we didn't have any respiratory therapists. So we have one is the one. But we all do all the tests. We don't have like an authority who is responsible solely for the medical mechanical ventilator. But coming here, we have an RT, so I was like, trying to, like, punch my own hands by touching the ventilator because I'm not, I am not, I am now not allowed to, like, touch the, you know, because we I am very well versed. Fortunately, with the use of ventilator because I used to work in United Kingdom, why when I've been aware, we are allowed to, like adjust the settings that are make the ventilatory support, like the PIP the P support, the tidal volumes, you know, and those other technical sauce. But moving here in America, specifically in critical care, we do have a respiratory therapist who is responsible, again, for the mechanical ventilator if the patient is intubated. And then as an example to Little did I know, at first, of course, when I was still on orientation, that I am not to give the nebulizer or any sort of like respiratory medications, it is a Respiratory Therapy switch, again, when I was still in United Kingdom be I mean, I used to give all the power of nebulizers I mean, I'm very much well first up that universalize kind of thing, and then a you know, just in the eye using the evaluator to which now I need to like Bear in mind that, Oh, you are not allowed to do that. It's something beyond your responsibility. And then you have, you know, the RT is part of your healthcare team. And then one major thing as well apart from respiratory team is the presence of pharmacies.  

Well, we have pharmacies there in the United Kingdom, but it is more they are more functioning as you know, to top up or to lease or to do some inventories of the medication. But again, when I started working here, you know, when I just got to realize I'm just so fortunate to realize you know, when in the NCLEX in the actual NCLEX exam, because you know, these examiner's are really fun of like asking the rules and responsibilities of each of the healthcare professional, I get to realize that, you know, the mere function of a pharmacist, for example, is to dispense medication. And part of the major role of the nurse is to administer the medication. So it's not just about topping up all the you know, locking medications in the cabinet, but it's more of like, you know, preparing the band's of giving it to them registered nurse and the registered nurse with the registered nurse, I mean, what actually will actually administer it to the actual patient. So you see, there is the basics of nurse. That's why I'm saying a while ago, the basics of nursing is just being inherited from one place to another, but it varies with you know, the kind of work set up the presence of this healthcare each of the healthcare team, and as a newbie, and as a new joiner to that organization, it is for you to understand these rules. So yeah, these are one of my you know, transitions and one of my one of the things actually that I need to bear in mind because I am now actually working in you know, new environment and then the organization with a new policies and protocols. So yeah, 

yeah, really good points there too. I think that understanding where what roles exist and Cecelia said this earlier, knowing the person or knowing the role, the scope and everything, sometimes the Nurse Practice Act will not prohibit you from touching a ventilator. However, within that hospital, they have decided that the respiratory therapist will be doing X role and responsibilities that changes sometimes where your focus becomes, you know, managing to patients and the nursing activities around two patients versus one like you had before when you were doing everything. So as soon as you start to get a sense of which roles there are in the hospital, where you're working, you want to understand the nuance around what's expected of them, what they're what they're supposed to be doing, and how you as the nurse need to interact with that role as well. Cecilia, I have one more question. And then we'll go to like sort of our last points for this show. So let's say you have a situation where a housekeeper comes to you and says, I just cleaned Mrs. Jones's room. And Mrs. Jones, she looks really pale. She doesn't look like she did yesterday, when I clean her room, she doesn't look good. What would you do with that information? Because we said earlier, the people working on the unit are part of the healthcare team. So would you go, that's a housekeeper, what does she know? Or would you need to take a different approach? 

Definitely, I think I wouldn't listen right away to that concern, because, you know, they are also part of the team. Some of the housekeepers, they may have some BLS training. So they're able to identify some of these conditions and things go in because they don't have a license. You know, that doesn't mean that they cannot report patient conditions. So definitely take that in consideration, jumpin go assess your patient, and does a good credit to that house, you know, for keeper for, you know, connect, and you know, recognize that that was a team collaboration, and let us their supervisor know that their housekeeper, you know, helped to save the patient's life. So including, including, it's important to do that. Yep. So recognizing that they may see something that you didn't pick up on, they may know, maybe it's your first day back, you had a nice vacation, they know the patient better than you do. So they were talking to them about different things while they were in the room. And now they bring this information. So we do consider that, you know, the more eyes and ears we have, and the more we give value to their ability to bring things that will benefit the patient, the better our team is, and the better the care and the experience of the patient. So am I sorry, mods in then? final advice? What would you tell a nurse or a healthcare professional who's getting ready to come and work in the US healthcare system? Like, what's the best thing that they can do to be ready for the changes that they're going to face? 

I would say, Oh, don't worry. I mean, it would be easier said than done. But don't worry, because I know that coming from their shoes before I arrived here, he had so many doubts, he had so many questions. So, so many uncertainties, but I would say that the reassurance of don't worry, because when you come here, you will have a very great amount of support. They are very supportive. They are very, they're very open. They are very, how do you call this welcoming? So yeah, so obviously don't worry, I know that sometimes that things would not go on to what we want it to be. But know that at the end of every storm, there's a rainbow in may sound to be a cliche, but in every Saunders I mean, there should be a better bass coming here. And I know that with the issue of like retrogression like the this and that like the you know, you wait for your visa for so long. But at the end of the day, this shall pass and you get to realize that when you come here you will get to realize like what I've said that it is all worth it. So I would say just keep going on just keep the faith just try to cling on to the dream to cling on to the goal and hit that mark in flying colors. So yeah, just be steadfast I know sometimes that you can feel that, oh, this is hopeless. Oh, this is not doing any sense anymore. Or, and like for my case, I was like, oh, did I do the correct thing did i to the correct decision of like moving from, you know, from my previous workplace and to come here, you know, back to scratch. You know, try to learn all the users you will try to question yourself, try to question your decision.  

But you know what? I would Yeah, I would always go back One pipe said like, yeah, have faith and be positive, be optimistic and know that, for example, there are helping hands that is ready to help you. Like, for example, I've always been so grateful with the Connetics, they helped me a lot. Like what I said, I've been so hands on, in terms of my actual application here, I was just doing on my own on my own pacing, and they have been there to guide me. And then and I am here now I am here now. So it is not impossible for you to have the same, the same experience. So like what I had, it might be slightly different. But you know, you're gonna reach to your destination, you know. So yeah. I think that's a perfect note to finish this show on. So Cecilia, thank you so much for being on with us today. I hope you'll join us for future shows and Mhadz as well. But we've really, I think, had a really good conversation. I hope that the nurses who've attended today have had some good takeaways that they can think about and used to prepare. I want to post really quickly up on the screen, the Connetics College, and then our upcoming shows. So we'll pull those up for you and let you take a look at those. So the Connetics sorry, the onwards and upwards shows, those are our Connetics shows. They are coming up September 15. Is immigration Q&A. I wonder what we're going to be discussing then. So hope you'll join us for that September 22.  

We're talking about life in the Great Lakes. So those states that are up a little to the north and near the Great Lakes regions in the United States on September 22. On October 6, we're going to talk about taxes in the US and then on the 13th we're going to have another healthcare facility showcase with our north side. With North Side a client facility that we work with in the state of Georgia, they are awesome, and I hope you guys will join us so you can get to know Northside and maybe that will be a place you'll be interested in going. And then our Lefora talk show we should have one coming up again in October. We have on Mondays every Monday we have a free Connetics College course for you. So on the first and third Mondays, we are joined by our Connetics and NCLEX partners Aspire RN and Ipass. And they will provide great content for those of you preparing for the NCLEX. And then on the second and fourth Mondays of the month. We have classes from Swoosh on PTE and Niners on IELTS. So we very much appreciate our partners, taking the time to provide nurses throughout the world with great information on how to prepare for those really important examinations. At this time, I'm going to finish up our love for a talk show. Thank you so much for attending and onwards and upwards.