Understanding US Nursing Job Market

Transcript

Hey, everybody. It's Earl Dalton. I am the chief clinical officer and vice president of clinical

services here at Health Carousel, and welcome to our discussion today on, nursing in the USA.

We've given a lot of thought to this, to this particular presentation. I certainly do hope, that you get a lot out of it. So welcome to nurses around the world. I'm so glad that you got a chance to join us today.

Let's talk for just a second about what we'll cover in in today's session. So, I thought it would be helpful for you all if I went over the US job market, the trends that we're seeing across, across the United States, as nurses seek jobs here in America. I think we should go over how placement works within our hospitals, and then let's understand changes that happen in placement. Right? This happens to nurses every now and again.

It can be frustrating, I think, if you don't understand what's happening there. So I'm hoping to shed a little light on that. Hopefully, that you find that interesting, and that it helps out. And then, of course, along the way, if you have any questions anywhere during this discussion, I sure would love to capture them.

Know that we have a team here at Health Car Sol that is monitoring the chat with an e, and so I will either directly answer a question, if you have one. If not, certainly, our team will get back to you with your specific set of, of questions. So, please do use that, q and a chat frequently. That's always helpful to get the most accurate information that we have out to you.

So moving forward, let's, let's spend a minute, sort of talking about, the state of nursing in the United States, what's happening inside of our job job market, what are the trends there.

This should give you some context at sort of the macro level inside of the United States, and the US job market for nursing. So I hope you find this interesting.

But let's start with why hospitals, hiring is more complex today. Alright. Great. And so, you know, nurses in the United States, nurses all over the world, this is true all over the world, right, are just expected to do more today, than they ever have.

Right? The the patients are aging. They are more complex than they've ever been. Right, rarely anymore do we see a patient with a singular diagnosis.

Right? Generally, it's comorbid, rate multiple diagnosis patients, polypharmacy, that sort of thing. Right? And so, we certainly are seeing an increase, in the complexity of the patients in which we are serving.

Right? This comes at a time really around the world, but certainly I'll focus this part of the conversation into America.

Right, along with increased acuity with our patients, more than ever, we're seeing experienced nursing retiring and and, and exiting out of nursing. So this is leaving a younger, less tenured nursing group caring for the most complex patients that we have seen in history, here in the United States. And so that certainly has created a, a very unique dynamic for us, here in the United States.

This graph, while seemingly, a little busy, and certainly I understand that it's a little small, possibly for the device that you might be looking on here. But the graph is representative of the number of years. This is sort of graphically state the the sort of loss of experienced experienced nurses inside the United States. You know, we are seeing on average about ten thousand patients hitting sixty five or above per day inside the United States.

Right. So, the number of nurse number of patients who are going on Medicare, Medicaid programs, which is, right, the government assisted, health care, insurance carrier in the United States. We're seeing just a tremendous amount of people per day, heading into those programs, and thus seeking more care. But the graph the graph is representative of, the lost years, in nursing workforce.

So if I had forty years of nurse experience and you had forty years of nurse experience and we both left nursing, we would lose eighty years of experience out of nursing. Right? Because you left and I left and we had forty years each. So it's been estimated by two thousand and thirty, we'll be losing over two million years of nursing experience out of nursing.

Right? So that's a very staggering number.

And the positive in all of that for for nurses around the world that seek, employment in the United States, this means that we have an incredible gap. Right, the amount of nurses, that the United States needs moving forward. This is actually true around the world. Right?

The amount of nurses that are needed around the world, is, is a staggering number, right, between now and really twenty thirty five, despite the fact that this graph goes up to about twenty to thirty. Right, but on measure, right, we have just just in droves, numbers of nurses who are exiting the workforce due to the math of their age. Alright. And so, so that creates a very unique dynamic about the need for nurses, in the United States as we move forward.

Right? It's a very positive work environment.

And so, I like this graph a lot because I think it really does sort of summarize what I've been talking about up to this point. Right, and that is if you sort of follow along on the graph here with me. Right? If we look at the gray line, or at least gray on my computer, right, the lighter line, right, we have increasing complexity with our patients. Right? Patients, again, are, multiple diagnosis at the same time. They are they're on polypharmacy.

Right? Just tons of, drugs and meds trying to keep themselves going. And so this creates a very complex patient that is making their way into the hospital settings in the United States. At the same time, if you look at the red line, the nursing, workforce is getting younger.

Right. All of that tenure, all of that experienced nurses, they are exiting, right, due to the math of their age, and that and they're, leaving our profession. Right? So we have a declining experienced workforce and a increasing, complexity of peer model inside of the hospitals.

Right? And so make no mistake, ladies and gentlemen, what we are solving for here is the gap between the complexity of care and the experienced workforce. So hospitals are keenly interested in getting more nurses, and certainly nurses that have experience at bed side. These are things that are highly coveted by, by the CNOs in the United States, right, the the leaders of hospitals in the inside of the United States.

They are constantly trying to close the experience complexity gap, that they have between, between the care they have to provide, and the nursing workforce that they have in place.

So let's just talk about how a hospital placement system works in the United States. Right. And and I've been all over the world. Right?

I've I've traveled to several countries, and, and this is the process in the United States. It is not the process, that is used around the world. So you may this this likely will be different, in some ways, than from what you might be used to in your home country. But it's worth reviewing here, I do believe

So in the modern recruitment process inside of the United States, there are several pieces to getting hired inside of a job. And this is true whether you're working with a company like Health Carousel, or if you're actually working directly with a hospital. Right? So, part one, step one.

Right? I'll take the time to go through these because I think they're important, is that recruiters post the jobs. Right? So whether it's a hospital recruiter, directly for a job or it's a recruiter out of a staffing firm, such as Health Carousel, right, doing that work.

Right, the job one is is that the hospital identifies the need for a job. From there, applicants submit their online resume.

And I wanna pause there and just really make sure, this would be a repeating theme for me. I'm gonna overstate this during our talk today. But, but that that resume is the next step in that process. So after the hospital identifies that it needs help and it needs to hire another nurse, which, you know, tons of hospitals are hiring. Right?

The next step is the key point of review, in your skill set as you present it to a hospital is the resume. So, so we're gonna go through this and talk about this a fair amount, but making sure that you have an accurate, up to date resume that reflects all of the skills and abilities that you have, all of the jobs, all of the education.

And certainly here at Health Carousel, we help you with that. We understand that those can be hard things that pull together, but it is a key piece in the hiring process within the United States. It is the first thing that happens. Right?

A hospital will look at, your skills and ability, as written as part of your resume, in an online, situation, right, in an online tracking, moment. Right? So, you would submit an application or will submit it on your behalf, right, that includes your resume in an applicant tracking system. Right, every hospital has that.

Right? Health carousel has that. Alright. It's a pretty common practice here in United States. From there, hiring managers scan and select the resumes that they want.

So without you in the room, without talking to you, they are going to read that piece of paper that is your resume, and that decides who they wanna take a step further with and have interviews, and who, doesn't meet the the criteria that they have, for their job, and they deselect those people by simply passing over the resume, right, and not choosing that person. Right? From there, there's a hiring board typically. Right?

Hiring is rarely done in a hospital by one person. Right. The interviews are done through team efforts. So people who are stakeholders, people who are, maybe gonna be pairs of yours on the units that you might be working in, become part of the interview process, in the United States.

So that's pretty typical. And, again, I just wanna really make sure that I'm highlighting the importance of your resume, as a communication tool that is first looked at by the hospitals, to review your skills and your competencies and the experience that you bring to the table.

So from there in the nurse job application process, right, you're gonna submit a resume. Right, then you're gonna go, undergo reviews and interviews with that hospital, and you're gonna complete a skills checklist, right, of the, of the things you have to do. So what the hospital is getting at is, you know, I've got a I've got a a nursing, unit, nursing ward, that needs these competencies and this set of skills. I need an applicant who matches as closely to those competencies and skills as I possibly can.

So if you're applying for an ICU job or you're applying for a, med surg job, right, which are, common jobs, in inside of the United States, right, it's important for you to think about what skills, what competencies, what experience do I wanna highlight in my resume that will get the attention of this hiring manager. Alright. That's an incredibly important piece, so that you are selected for interview. Alright.

From there, the hospital understands and you should understand what you have transmitted at that point in time is self reported information. Right? The things that you say you can do, the competencies and education that you have. Right?

At that point, it's all just things that you said you can do that haven't been validated. So those things are validated through, the steps number two and number three that are in the slide that you're looking at. Right? And a team of people will actually get on a call with you who understand this work, and they're gonna ask you direct questions around the clinical abilities that you've described, right, your ability to manage and have the competencies, right, the knowledge base, right, to do the work that you're doing.

Right? So whether it's the OR, the ICU, the med surg unit, right, mother baby areas. Right? Can you do the things that you've outlined and talked about in your resume?

Right? There'll be a real review of that in the, interview process. Right? And then as part of that also, right, hospitals are gonna want you to complete a skills assessment where separate from the knowledge that's in your head, what skills have you actually done to work with, with the patients?

Right? And so all those things are put under major review in the hiring process so that, so that nurse leaders can be sure that they're getting somebody who can actually do the work, that their resume defines that they can do. Right? It's an incredibly important piece of the process.

So, you know, I would certainly challenge you, if you haven't dusted off the old resume, for some time, right, it is important to take that document out, right, to run it through, AI models, run it through, right, Google searches, that sort of thing. Right? What are the important, pieces of you, that you wanna sort of put up front in the window? Right?

And make sure that as someone picks up your piece of paper, right, your resume, that they're saying the very best that you have to offer them for your nursing skill set. Right, that's an incredibly important piece of the process.

From there, right, broadly, right, in your resume, I would have nurses, think about their skill sets and the things that they're putting forward into four pieces. Right, these are the things that hospitals look for, certainly in the resume and then secondarily, probably more importantly, in the interview process. Right? And so these things would be the pure clinical skills that you have, right, that your ability to to problem solve, right, your ability to communicate, and your alignment with their organizational values.

Right? These are all things, that that you can speak about and, can demonstrate, not only in your resume, but certainly be prepared to talk about those things, in an interview process. Right? And I always tell nurses to think about themselves really in two dimensions.

Right, one is right, I'm totally making up a scenario here, but if you're an emergency room nurse, right, do you have the competencies and skills to perform emergency room nursing to a high level? Right, that's what, that's what's gonna win you that job over someone else. But the second dimension of being an employee, at at organizations at the sky size and scope that we're talking about here, they also had to have great employee skills for the organization.

So are you a good team player?

Are you are are you someone that can go and make sure that you're helping out others when your work, is lesser? Are you someone who's always in conflict with someone? You always manage to be fighting with someone and have a, you know, that sort of thing. Right? No nobody wants those things inside of a unit. Right? So, while it's incredibly important to be technically competent at your job if you want, you know, in this case, the emergency room job, right, it is just as important to an organization that you're gonna be a good member of the team.

And those are employee behaviors that people will be testing for or looking for. Right? Are you a team player? Will you help out in a pinch?

Right. Are you a positive person, or do you come to work as a negative, person all the time? Right. Are you constantly in fighting with the peer groups, or can you get along with others, right, and are generally, you know, an amenable person?

Right? These are all things, that people take very seriously, when they're thinking about jobs, in the US health care system. Right? So, so please do take those things into account as you're building your resume, and as you prep for, for interviews.

Right? And, again, I wanna overstate that health carousel, for this group. Certainly, we help you with both sides. Right?

We have a team, of very experienced nurses here at Health Carousel that will partner with you to make sure that your resume, absolutely states the very best things that it can for you. And then we also have a interview prep module that you can avail on where we will sit down and help role model and interview, with you, where, where we can go back and forth as if it was a live interview, and you can get your words right. You can make sure you're capturing the right things for an organization.

And, and those things all are, the prep pieces that we find that help make nurses incredibly successful, as they look forward to getting their job in the United States. So, so just know those things exist, and, and we would love to talk to you about that as if those are things that you have, more interest in, as you get closer in your journey to come into the to the United States.

So let's talk about the journey, right, and, and put it in sort of a model where everybody can see all of the pieces.

We're specifically focused on, on resume, job interview, job preferences portion of the discussion.

But, but these are all the steps that you would have taken, right, to finally get the up to the arrival stage here in the United States. Right? So you have to pass NCLEX and file a visa. Alright. These are all things that are very common to you and, and then you would understand these are all the steps in the process to get to United States. But when you get to that assignment, a selection piece, right, again, your resume is the very first thing that we're gonna share with the hospital. So, if on your preference list, you've identified, I'm totally making this up right, that you wanna work in the middle of the country in a warm weather state, then we're gonna we're gonna parade your resume around all of the facilities that fit within the selection criteria, that that you've given us.

From there, we will take the resume that we've agreed on together. Right? And, again, this is your document that outlines your skill sets. Right? We, we don't make any of that up on your behalf. We want it to be as accurate and as real and as authentic to the actual work, experience and educational experience that you have. And so we will then transmit with your permission, your resumes out into, into the places where you've told us you have, preferences.

Right? The the one sort of footnote I have on preferences is that the more preferential you are, the more conditions you have in the places that you'll work, which is totally up to you. Right? You can limit or expand this, as much as you want.

But the more preference features you have inside of your preference list, the more you limit the amount of hospitals that are not inside of your preference list. Right? So, to create a a totally fictitious example there, if you said to me, Earl, I only wanna work in a very warm weather state that has a beach, right then, there's probably, that comes to mind, a great five or six hospitals across all the United States that fit those criteria. Right?

Warm weather state on a beach. Right there are a very limited number of those. So that would exclude literally thousands of hospitals that have great jobs that you could consider, but, but your preference list has filtered those out because those aren't things that you're interested in. And if that's your case, right, that is certainly your preference.

But I always do like to point out to people, the more conditions of preference that you put in play, the more you are limiting the number of hospital choices, that may exist for you on the other end, which, which then, of course, we're happy to, to promote your resume, and, and, into those hospitals.

But, you know, it does come with that you're competing for a job amongst other nurses in a very limited number of hospitals. Right? So, so please note that, right, and, and make your selections as you see fit. That is certainly your preference, and prerogative as a professional nurse, coming to America.

So with all of that said, right, what what happens in the United States every single day is that there are nurses that are gainfully employed who lose their jobs. Some of them resign, some of them retire, some of them won the lottery and wanna move on. Some of them are terminated, right, for for poor for poor for performance. Right?

And so those things just happen, in the job market. So what that means is that the job market, and this is true in your home countries as well, right, that the job market is very dynamic. Right? And, and so what I tell nurses all the time is we can look on the job board today, right against your preferences and maybe see twenty hospitals, right, that have jobs that fit the criteria that you're looking for.

Right? It's a mid surge job at a certain region. Right? All of those things. We could look tomorrow.

There there could be none of those jobs. Right? Hospitals are charged with getting their jobs filled as fast as possible in whatever means necessary. So when they have an opening, they certainly do lean into a partner organization like ours.

They help fill those jobs. But they're also looking for people who came in off the street. They're looking for people who are working in other parts of the hospital that might wanna transfer into that area. Right?

If, OB nursing, mother baby nursing has been your goal and a job opens up, maybe you transfer out of a different area, the hospital into that area. Right. So there's lots of different ways, that people connect into jobs. But make no mistake, it is the hospital's mission, to have zero opens.

Right? They want all of the positions that they have to be filled, and that's their goal every single day. Right? And so, we are partnered with just a tremendous amount of organizations, and they all have openings.

And so we are certainly working with those organizations to help them build their positions. But make no mistake, those organizations are trying to fill their own positions every single day, either through a mechanism like ours, right, or just organically, through people that just show up and, and wanna go to work at that particular, organization.

So, one of the things that we see is that placements can change.

Right? So you may walk to an organization, right there. I'm gonna choose one here in Cincinnati, Ohio just so we can play out, play out the, the, example here. But, let's say you accept the job here in Cincinnati, Ohio as a med surg nurse, and that is gonna be your place of employment.

And then all of a sudden you hear that things may have changed, right, and, and that that placement lock, has got has is no longer in place and the organization says, hey. You know, I don't, I don't think we're gonna be able to use you in that position anymore. Like, what are the reasons why that might happen that you might have to consider a change in placement? So you thought you were going to go to this particular organization, and now you're gonna have to reinterview and go to, get interviewed at other places.

What are some reasons why that might happen? Alright. Right. And so here's there there's a there's a lot of reasons why these things can happen, but here are some of the reasons, that we see that are incredibly common, in this world.

Right? So, the hospital can have a change in workload.

Alright. Right? So hospitals with the best of intentions build out, oh, I'm definitely gonna need a nurse for that discharge unit, right, or an admission unit, within a hospital. And, and as time rolls on, that unit just didn't serve the purpose that the hospital thought it would. Just, right, having a discharge unit, seemed like a great idea, but it just never did flourish the way they thought it would. And so then all of the positions on that unit get canceled.

Some people are already there. They're working in that job, and they have to either get reassigned within the hospital or they have to go find work elsewhere. But their hospital does not workload changes. Right? Just it just might decide to change. Right?

Another way we see that play out are that doctors retire. So if you're a heavily surgical hospital, and a third of your doctors, because they're aging in the same way that nurses are aging, decide to leave, right, then you've got a third less surgeries you have to worry about. So all of the discharge units, that are accompanied to a surgical suite, right, in the post op areas and then out in the recovery areas on the floors, right, that workload may change. Alright. Right. And so that is certainly one thing that we see a lot.

Another thing that might change is the, governmental immigration, laws. Right? The, the exit rules for the country you live in sometimes can change, and the entry rules into United States. Right?

If, if you've been doing your immigration journey, right, you know that that can be, at times challenging, and it can create changes. Right. So, again, you may have locked to a hospital, and the hospital thinks you're coming to help them fill a job in making up a date here, guys, October one. Right, and then the government changes the immigration rules, and now you're not coming on October one.

The hospital needs that job filled. It's a key position for them, and so they go accept a different candidate even though they had accepted you. Right? They'll they'll say, hey.

Listen. We've gotta we've gotta decline this nurse and we because we need someone to fill that job now, and we're gonna go with someone else. Right? Hospitals can can suffer financial changes that they didn't see coming.

So the hospital had planned on filling a bunch of FTEs into into right into positions within a hospital, and, you know, through all sorts of calamities that people just like you might have a calamity in your personal life, like your car breaks down or something happens to your house and it's unforeseen, unplanned budgetary moment where you have to go pay for something that you didn't see coming. So those things can happen to hospitals, where with the best of intentions, they had money set aside for this position to operate in this way. I locked you to it, and then they actually ringed on that, because their hospital finance changed.

And so we see this in a way that, like, equipment broke down that they didn't see coming. Right? MRI machines can fail, usually expensive items. Right, pieces of the building can break, and leak and those sorts of things, and can be hugely costly.

And the hospital didn't see it coming, but it forces a change in their finances and they can no longer afford the position. Those things certainly do happen. Right? And then finally, we do see this, right, where hospitals are, are locked to a nurse, but the nurse changes their mind, sometimes.

And they go, hey. Listen. I know I accepted a job to go to this place, but, but, my conditions have changed, and I no longer wanna do that. And so another reason for placement change can be that the candidate, even though locked to an organization, has changed their mind and decided to go, do something else.

Right. And so, those are are the big ones that I see from my desk, as we lock nurses into, into these positions.

So what happens if if your selection changes? Right? So if, if you wanna make a change or if, if for all of the reasons, that, that the hospital has made a change, right, for all of the reasons that we've talked about, What do you do if that moment changes for you? Well, with us, not to worry.

Right? We have tons of hospital partners, and so while we would have to certainly give you the news, right, that your selection has been canceled, and you're no longer going to that facility. What we will then open up for you is all the other facilities in which we are partnered with, right, which which is nothing to the hundreds of hospitals. Right?

And that's literally thousands of jobs, right, around the country. Right? We'll help you make another choice at a different facility. Okay.

Right? So it's like, fine. Okay. I'm I'm not going to that facility anymore. Let's get the right job for me out of a selection of other facilities.

Right? We certainly do see that a lot.

As we think about that from a specialty perspective, so what I'm talking about here specifically, is, the number of jobs from a macro perspective around the country. So the most jobs that we have in health care, Sal, and this would be true within a hospital, and it is likely true in the country that you're living in. The med surge jobs reign supreme. Right?

There are more med surge jobs. We place more med surge jobs than anyone else, and that should make sense. Right? The med surg units, right, the medical surgical areas, right, are the bulk of any hospital.

So you would expect that to be then where that that's where the bulk of nursing is, employed. Right? And, and that is certainly true in what we see. Right?

Next to that would be your tele and ICU areas. Right, as you all know, heart is a big, you know, it's a big factor around the world. Right? It's number one killer of people around the world.

Right. So we certainly do see a ton of nurses getting placed into the tele and ICU areas. Right. And then you can certainly track it.

It goes on down from there. Right? Emergency room, OR, right on all the way down to, to, recovery rooms. Right?

The post anesthesia recovery unit, right, is only two percent of the placements we make. Right there, PICUs, right, pediatric ICUs, that sort of thing. Right? Very, very low, number of, of placements there.

And that should make sense because they're they're much smaller parts of the hospital.

Right, not not there aren't that many beds in the post op recovery areas, for example. Right? Most places run, rate fifteen to twenty stretchers that they'll recover people on postoperatively.

And so the workforce just isn't as big in those parts of the hospital. Right, and then we have a long tail at the end. Right? I won't go through all of those, but we have, right, a bunch that are in the other category, and it's, it's niche jobs.

They're very small. There are very limited number of them. It would be things like case management, right, where we help, patients, connect to the resources in the community, things of that nature right there. They're just they're one off jobs.

There are very few of them. But, but this is the bulk of it. Right? So, I go back to preferences when I talk about this slide and your preferences in particular.

So if you're a, let's just pick one of the smaller ones here. Right? If you're a pediatric ICU nurse who has very limited, has the maximum amount of sort of preferences that you want like, I I can will only go here in these sort of settings and these places where you've imposed a lot of, preferences within your preference list, right, then you've already limited the number of hospitals that we'll look at on your behalf because that's where you pointed us. And then secondarily, right, you're looking at hospitals then that have very limited number of positions anyway, related to those jobs.

Right. So the amount of time it's probably going to take you to get a job, to get to United States will be protracted. Right? It it'll lengthen because there's just not that many jobs to start, and then you constrain a fair amount of, preferences on top of that.

Right? Conditions about where you'll go to work, which again, I just I I wanna overly state that is totally within your preference. Right? Within our program, you certainly do get the right to do that.

But I do think sort of looking at this from a macro perspective, becomes important. Right? So, so please take that under advisement as as you sort of think about all of that, and getting your placement right. Right.

So faster placement comes with more flexibility. Right? And it does so if your goal is time based and, hey. Listen.

I wanna get to the ice to the United States and get working, right, then, not the less limits you can place on, your, placement, preferences, right, will serve you well. Alright. And, again, if you're already in a limited specialty area, right, where there's just not that many jobs to start if we were looking at the whole country. Right, and then you combine that with I only want jobs that are in a very limited number of states, right, then, then you're limiting yourself.

And it's gonna take longer. It's harder for you to get placed, which can you know, eventually, that will work out, but that can protract your time. Right? It can take a long time, to get that done.

Right? And so just to make that, ultimately clear on this particular sheet, right, if I go back one slide here for a moment, if you are my PICU nurse, right, the, the pediatric ICU nurse that already has a very limited number of jobs available in the country, and then let's just say you only wanted to work in Florida. Alright. Right.

Just look at the amount of the country you've sort of chopped off out of your list where, there could be great pediatric ICU jobs, that are around the country. There just might not be that many in Florida on a dynamic job board. Right. Again, hospitals are always trying to fill their positions.

And so in Florida, it just might be for the next year or so, there are no pediatric ICU jobs, right. Just on the nature of people are holding on to their job or haven't retired or resigned, in some kind of way, and there could be a very limited number of jobs. And literally a state right next door could have ten jobs, but we're not showing those to you, because that wasn't inside of your preference choices.

Right? So, again, the more you narrow your preference choices, the more you're cutting out all the other opportunities that may, sit in front of you. Right? And, again, that is not to sway someone away from where they wanna go and do what they wanna do. That is certainly your right, and we are fully supportive of that. But I do think it's good to know, where how that sort of affects the job market and maybe your timing as you think about getting to the, to the United States.

So from there, what a healthy, job market means to you. Right? So for us, this is, right, these are all the great reasons why you should wanna do nursing inside of the United States. Right there are just, in the United States, it is, you know, I think a beacon from around the world on how to do nursing.

Right in many ways, nursing has evolved in the United States, to be, really equivalent in many ways, on the care team, as important as any other member of the care team. Right? So whether it's the physician, right, the pharmacist, any of the therapy people, right, that have a big factor in care, Nursing really does guide the care, for individuals in the United States, and we are looked upon as the leaders of care, inside the United States. So, within, within the United States, right, we have shared governance models in the hospitals.

What does that mean? That means the nurses are given a say in how the hospital works, how it's not just leaders pointing at nurses telling us what to do.

We we have leaders that bring issues into rooms where nurses sit and they go, hey. Listen. This is a problem. How do we solve it?

And, and all of the people on that committee around the table will get a say in what the correct solution is, and, ultimately, that it that becomes what, what the leaders implement. Right, that is the essence of what a magnet organization is. Right? A magnet organization defined, is that that organization believes that nursing has the most say over patient care and therefore should guide most of the leadership decisions and that the front lines of nursing should be involved in the decisions that are made because we are the ones that are taking care of those patients.

And so, so those are very commonplace in the United States. It is a very, shared model where, where together, the nurses make, great decisions on behalf of the patients, and, and it's wonderful.

And so, you know, beyond that, if you're into research and those sorts of things, right, there is a heavy research component to the hospitals around the United States. There are certainly continuing education, pieces right in nursing. You're almost pushed into, where you don't set to find ways to turn it down, honestly, right, to advance your education. Right?

Nursing is big on its credentials, and, and we do that because in the United States, nursing is looked upon as a science. And like all things that are science connected, we want people to get more, more acumen behind their name. Right? More, credentials, more formal education, more informal education.

So there are certainly loads of ways to do that.

And then in terms of job opportunities and promotions and that sort of thing, right there, nursing is sort of this, escalator that's constantly moving. Right? So there are constantly more tenured, more senior nurses who are moving out, due to the math of their age right in the United States right now where I showed this on earlier slides. Right?

The retirement rate, nurses getting out of the profession is just it's profound. It's going to be profound for the next ten years. So we have all of this sort of escalator, groups of nurses. They were moving off the escalator.

Right? They're getting out of nursing, right, due to the retirement phenomenon. That opens up jobs for preceptors, charge nurses, right, out and out nurse leadership roles, nurse education. So, you're almost pulled into this vacuum in the United States where with time and tenure and good work, you'll be promoted, right along the way.

Alright. We see we see this very commonly. Right? That's just a natural progression, in the United States.

Right? The the younger ones, in tenure, certainly do take over, right, the, the reins from the, older, more tenured nurses who might be moving out of the organization, for for a variety of reasons. Right? So we certainly do see that.

So, you know, I think, and I can say this having visited lots of hospitals all over the world. Right, I think it is certainly, a pinnacle, model, right, for how nursing, can and should work probably all over the world. So it's an exciting time, really, if you think about nursing, generally across the United States.

So folks, that certainly brings us up towards the end of our time today. As I as I opened with, right, I'll sort of end, Right, I would love to see your questions. Right. We've got a team here that will not only look to right.

Certainly, I'll look at your questions. Right. If there's anything I can answer in there, certainly happy to do it right on a clinical basis. If you have specific questions around your journey, that are specific to you, please do state them in the chat, and, you know, and we'll be sure to to get that in front of the the, team here who's helping people get to United States, right, or processing teams, right, and get your specific questions answered.

Right? I I hope you consider this to be in a very exciting time in your life. Right, I'm always impressed by explorers of the world, those who sort of, you know, were getting outside their own nest to explore and see what the world has to offer.

I'm I'm always, incredibly proud of those people and, just it's always a pleasure, when I get a chance to to meet, people who who move beyond their own borders. So that I think all of that is fantastic. So, I'll leave you with the QA slide, and, you know, again, if you have any questions, we sure would love to have them, because we wanna make sure that you are getting, everything that you need from a knowledge perspective out of, out of this discussion. So with that, take care, be well, treat each other kindly, and we sort of look forward to seeing you when you, when you arrive to the United States. Thanks.