How to Prepare for Your First Day as a U.S. Nurse: Expert Tips from an International Nurse

Summary:

What does it really take to succeed on your first day as a nurse in the United States? In this interview, Health Carousel International nurse Jai shares her experience transitioning to a U.S. hospital, including the importance of bedside experience, critical thinking, English communication, and adapting to a collaborative healthcare environment. Discover practical tips to help you prepare with confidence for your U.S. nursing career.

Transcription:

Jai, we're so glad to have you here with us today. For our audience, this conversation is really about preparation or in other words, getting an idea of what US hospitals expect from nurses on day one.

And why staying active at the bedside and maintaining strong English communication skills are so important while you wait for your US opportunity.

Jai will be sharing real examples from her own experience and our hopes are that this conversation gives you a clearer picture of what readiness looks like in the real US hospital setting.

So with that being said, let's jump in.

And so Oh, sorry.

Jai, just wanna, start. Yeah. If you don't mind giving a little bit of an introduction of yourself.

Okay. Hi, guys. My name is Jai. I have been under Health Carousel for almost three years now. I came in here, in the year twenty twenty three, and I'm currently working in the cardiac intensive care unit.

Awesome. Awesome. And if you wouldn't mind, could you share maybe a little bit about your current role as a CCU nurse? You know, what were your first few weeks working in a US hospital like?

Yes. So, actually, I moved to the cardiac intensive care unit a year ago. I am initially in the, intermediate care or a step down unit. It is sort of like the intermediate care is more of, like, the patients are not sick enough to be in the ICU, but, also not well enough to be in the floor.

So we're in kind of in the middle. So with that background, I was very, it made me easily blend with a cardiac intensive care unit, but it's a very specialized unit where most of the patients that we have have heart problems that just generally everything, like it's just generally the heart. They have issues with the, with the STEMIs, heart attacks, any electrical any electrical, issues. And, also, in the facility that I work is we take post op open heart surgery patients.

Very cool. And so, you know, with your transition to the US hospital, I'm sure there were some things that, you know, took some getting used to. But when they, I guess, say hospitals here in the US expect nurses to be ready on day one, you know, having some experience to lean on, What does that mean to you based on your own experience? What were, I guess, your experiences like facing the expectations of of your hospital?

So when I first arrived, like, in the first few weeks, we have the general orientation, whichever probably other hospitals have. And in the facility that I work with, they have their own program that basically, what they called an international transition. So that's a full four weeks, course where we are basically introduced to what the US health care system is. I have been introduced to the Cerner, which is the one, the charting system that we used in the facility.

And I know that there are different types, but that's the one that we use. And that is the most I probably should say the most difficult for me because my experience with the charting is basically probably ninety percent paper charting. So there that's the that's one of the things that I was, like, focusing on more during that four four week period before I went to the floor. And on top of that, I have also been, let's just say, reviewed or refreshed with the assessments.

The nurses here are the doctors actually here are lean on to the nurses when it comes to assessment. They do their own, but because the nurses are there at the bedside from, hour zero up until the twelve hour, the patients, the nurses are the first ones to actually see if the patient got worse.

Even with the very tiniest change, we can actually escalate that more. So during that time, we are trained to be more vigilant about those changes, like, have a really good baseline assessments. And, also, we were given, like, an education as well with just the important, systems of the body, like brain, heart, and the, what was it that one? Your brain, heart, and the kidneys, I think, and then multi organs. And the other times when we are not at work, I just personally study.

It's just my preference so that I would be more ready when I go to the floor. And then there's gonna be a different orientation after that education, that four day four weeks education month.

No. That's that's awesome that your facility has that sort of dedicated orientation format for international nurses. I think that's, you know, I just wanna emphasize that, you know, that's great for you. Not every facility has the foresight, you know, of having something like that available, which I think, you know, being that you're in critical care makes the the knowledge and things that you brought to the sort of to the table ahead of time that much more helpful for you to succeed in that high acuity environment. Do you know, when you look back, are there any skills that you brought with you on your journey that you're happy that you obtained prior to coming to the US through your your previous nursing experience?

Yes. So, I have probably a total now of nine years experience, and then I have more or less seven years experience before coming up here in the US. So I would say that I really have a good foundation when it comes to, you know, just the basics of nursing.

When I was in the Philippines, it's very different. The the approach of care is very different from how they are here. Like, we, in the Philippines, it's more of a team functioning and more of the the doctors leading the plan of care, and the nurses basically just do what they wanted. But here in the US, it's actually very different. It's very collaborative. It's not just the doctors. Nurses are also, included in what we call multidisciplinary meetings or roundings.

The nurses' input about the patient, even, you know, going home, discharged, do they need socials, do they need, help when they get home, is actually also included. And the doctors here also listen to the nurses, which is a very culture culture shock for me, back in the Philippines. Not so much, but here, they actually value your opinion. And, if the doctor knows you I have noticed in the facility that I work with that if the provider knows you and, you ask for something, they actually would would give it to you, like, just like labs or anything. Like, this is just for an example that one of my patients, they were diaries. They've been given a lot of diuretics. Their potassium levels and their magnesium levels during the day lab work was low, and it wasn't replaced.

And I just asked the doctor if, you know, it I'm a night shift nurse, and it's been, like, twelve hours or so that it hasn't been checked, and the patient was peeing a lot.

So I asked if they would wanna check it because, you know, if low levels of potassium or magnesium can cause some cardiac arrhythmias. So the doctor said, yeah. That's a good idea. And so we did. And, actually, all of the levels were very low. So if that wasn't, if that wasn't checked, then the patient could probably go into a very dangerous, heart rhythm. So those little things actually actually are very critical here in the US.

So I think it's back then, I didn't realize how important being in the bedside you know, continual continuing the bedside experience even if it's different from the US and from the Philippines or from wherever you are from. Because even basic stuff stuff like checking blood pressure before giving, blood pressure meds, checking blood sugar before giving insulin, it's the same as here. And your critical thinking as well is gonna be help your skills in putting IVs, checking blood pressure, putting NG tubes. Those are very essential up here. So when you have that experience already in the Philippines, when you come and transition here in the US, there's I would say the bur some of the burden is gonna be offloaded. Because apart from actually, getting transitioned in the US health care system, you're also transitioning to the life here in the US. And I think that can also be a very, overwhelming for new nurses, those who haven't had any, experience abroad.

Right. It's almost like you're going through two orientations at one time.

Yeah. Yeah. Work and then outside of work as well. And so, you know, if you can offload some of the the worker stress ahead of time, Certainly, think from where it kinda sounds like what you're saying, being prepared ahead of time with some of the skills and the maybe even just the critical thinking aspect that's so important.

Yes. Yes. I agree.

I think one of the things too that I should include is practicing I know I this is just, like, based on my experience. I have always think about before, like, why do I have to learn English? English is universal.

But, it is also very crucial up here to actually, be able to convey or, like, to pass on what you're trying to say because that is the communication here is, very important. Sometimes miscommunications can also, you know, can also cause a very detrimental effect on the patient and on the care of the patient at all. So even just, like, talking if I knew this before, I probably would have done this a lot more. Like, even just talking to yourself in the mirror or, like, just recording yourself, it doesn't need to be, like, your accent to be perfect, your grammar to be perfect, but at least it has to be, like even just simple things, simple simple words that that would make you feel more confident when you talk to the patient, I think, is also very important. Because they would know. They would know if you're nervous. They would actually ask more questions if they think that you don't know what you're doing.

Right. Definitely definitely a heavy emphasis on the communication, needs both for you and your team members. You you you spoke to it earlier with the intercollaboration communication, Talking to physicians, talking to your peers, but then also the patients, right? That's a huge part of the nursing care, right? And giving them the confidence in you with the care you're providing.

So would you say that it's safe to say that you're you're glad that you stayed active at the bedside prior to to coming to the United States?

Yes. I probably would have I probably would have left and go home if I if I didn't do it. It's very it's very overwhelming. I know that social media, you know, they they always show what's positive, but it also takes a lot of work for you, for for the people that hasn't been here.

It's not just it's tedious. It it is very tedious coming up here. So, I would probably, yes, stay bedside while waiting for your, priority dates. Just focus on getting your skills honed, your critical thinking skills, everything. Maybe study a little bit more. Maybe think of, like, study for youth for for for you to for it to be easier for you to care for your patients rather than just studying for the sake of studying. I think that's the best way I could put it.

Absolutely. No. I I couldn't agree more.

And to kind of like maybe shift the focus towards some of your experiences that you've had. Were there any expectations in the US setting, that surprised you?

Things that maybe they looked for you to to be able to do that, you were kind of surprised to be be you know, maybe be asked to do those things?

I think in my facility, I don't think I have been asked to do something that I was, like, surprised of because I know probably because I already know firsthand that sometimes we could get floated because those are the things that some of the the other, nurses here that I've worked with that were surprised that they were floated to other units. But I kind of have that thought already in the back of my mind that sometimes with Acuity, you can get floated to other units, but you can always, say no if you're uncomfortable and if you're not sure of.

But with it is also very important to know what your scopes are.

Because I sometimes, doctors would ask you to do something. Like, for example, in the critical care unit with a patient with a swan, they'll ask us to, check wedge pressure, for example. We can't. Nurses can't check wedge pressure. It's not part of our scope, but they do ask nurses that. So if one if one if you are not sure, it's always best to ask your charge nurse or someone more senior than you. They wouldn't they wouldn't think that you are you know, you don't know anything.

It's most it's always important to ask rather than do something and then have a very bad effect for the patient.

Absolutely. I think the the floating aspect of health care in the US, right, that can can be very, you know, shocking and, you know, kind of unsettling at first as long you know, I think you you you hit the nail right on the head. Right? Being comfortable with it and and ensuring that it is within your scope of practice.

Speaking up, you know, asking questions or or advocating for yourself in the moment. And then letting you know, I think that's one of the things that I'm most proud of that Health Carousel offers is our clinical support team, who are paired up with your supervisor to ensure we're supporting your concerns and the things you experience on your assignment so that we can be an added voice, an added coach or advocate for you.

Because certainly there will be things that you encounter that maybe there was not really a way of preparing for, right? But I think, know, overall the theme of the conversation here today is to, you know, give that advice to your peers who want to go on the same journey that you've been on.

You know, kind of a rule book to follow to say write some instructions on, you know, how to succeed. Right? And I think the arching theme is, you know, the bedside experience, the clinical experience you can obtain prior to coming to the US will not only pay dividends for your patients and the care that they receive, but your overall success as a nurse, it is there's so much to get used to.

So if you were to give, I guess, one piece of advice to other international nurses to feel more confident and ready aside from, you know, getting the bedside experience and and and make maintaining your skills? What would maybe be one piece of advice you have?

I probably would say to keep an open mind to not think I know that when you're waiting, it's always the waiting that is a difficult part. And if your if a health carousel would ask you to do something, like, for example, you know, do IELTS, stay at bedside, get your license. It's not because they want it's not because it's not a it's not it's necessary for you to do it. They're not just letting you do it because they want you know, because it's just fun for you to do it. It's actually very beneficial for you.

Just, also, like, maybe other than prepare yourself, also, spend time with your family.

Don't stress too much about, you know, the priority date not being current, and it's still at the same date. Spend time with your family because that is something that I wasn't able to do. I was so stressed out with the priority date. I was so stressed out about I just wanna go here in the US that I actually forgot about the family that I have in the Philippines. So spend time with them, pray, you know, hone your skills, study, and also search about probably a little thing about how the charting looks like. So it just looks like for just for exposure so that you're not, like, too overwhelmed when you get here.

I think that would be Absolutely.

Absolutely. No. That that definitely, is a lot of valuable advice that I think, all of our nurses can certainly certainly use with their with their own personal journey. So, I do appreciate you taking the time to connect with me today. I love being able to converse and and sort of discuss each nurse's, experience and how their, own sort of situation can help to, support and, you know, really just push their peers towards success. So thank you very much for that.