To read the first part in this article series, please click here
The important things to bridge the differences in the professional nursing practice in the United States are:
1. Develop critical thinking skills. Always ask how, what, when, where, who, and what-if questions. Seek to understand the need for what is not understood. It creates deeper and more meaningful learning when we ask questions and search for answers. It also expands knowledge and leads to future change with less frustration.
- Identify the difference, seek to understand and to assess the situation or question at hand.
- Observe the evidence of practice.
- Develop a self-improvement list for ourselves.
- Analyze content, including the policies and procedures of our facilities.
- Interpret, verify and explain findings to our way of understanding.
- Evaluate for relevant criteria to make a good judgment.
- Apply new ways of thinking and immerse into the new knowledge as our own, using it in new clinical settings.
- Create an action plan. Make a strong personal commitment to act differently in the nursing practice. Commit to doing things in new ways and not slide back into the old way of doing things. Adjust our behaviors again as needed. Apply new action plans to adopt better nursing practices for ourselves.
2. Be true to ourselves. Stay strong, positive, and use positive energy everyday. Do not fall into the trap of negativity. Keep eyes open, mind clear, and refuse to go into a negative pit. There is no room for negativity.
- Build our brand. One simple example to think about branding is to look at a change shift. When a nurse comes in tardy; we hear some people say, “She is never late; she is always on time. Hope she is okay.” But we also frequently hear others say “She is always late. We don’t have to wait for her, let’s get started.” Ask yourself: Who do we want to be? It takes a plan and determination to come to work on time on a consistent basis. Our brand is built by what we do day in and day out. We want to make a conscious decision to align ourselves with true greatness.
- Practice positive self-talk to make self-affirmation a daily habit. Think about how many people are able to excel in another land. We use a different language all day at work, and we work in a people profession – around people, and taking care of people. We are a different breed. We are doing great!
- Excel in our strengths. When we posses excellent skills, use them. Peripheral IV (PIV) insertion it is a great time-saving skill. Help out where you are most skilled. Hold onto what is good, but assess if there’s a new, better way. Let’s raise the bar for ourselves.
3. Limit negativity.
- Take pride in our bilingual skills. Being bilingual is a gift. It is not a negative attribute. Speaking bilingual gives us the opportunity to explore understanding of words or phrases that are foreign to us. Volunteer to be an interpreter for patients who speak our native language whenever you can. Never use our cultural background as an excuse for not being an effective communicator. We need to continue to improve speaking English. We can learn to communicate more effectively every day. We can write down our successful sentences and deposit them in a basket. Pick them up to read them again once a while.
- Create ways to help deal with negative people around us. When we distance ourselves from the negativity or person, people may misinterpret our behavior into a negative behavior. Our actions may be interpreted as anti-social. Mingle, but avoid joining in negative talk. It unrealistic for us to expect to never encounter rejection or discrimination in the workplace. That is purely naïve. Rejections and discriminations are likely to happen to us. They happen for many reasons beside cultural differences. We do not appreciate experiencing rejection and discriminations at work. How one deals with the experience is a big lesson to learn. Let’s ask ourselves: What are we going to do if we encounter these things? What can we learn from this encounter? Do we want to tolerate it? How much can we tolerate it? What is our personal limitation? What can we do to change? How much time do we want to spend on unhappy events? Is this experience going to affect us one year from now? Five years from now? Ten years from now? At different times, we do different things. Therefore, a flexible plan will be very helpful. It is easier to deal with situations if we already have a thoughtful plan. At the very least, we have a lawful process to resolve discrimination. Always seek to understand. Explore how things can be improved.
- We also need to find our own ways to deal with whatever we encounter. I will share my own terrible experience. The incident happened just before I was going to a beautiful wedding. I was determined not let the terrible experience ruin a good time at the wedding so I compartmentalized my horrible experience. I went to my secret “P” pocket (I have many words which start with “P” in my mind that I can use to boost my positive energy when I needed). I pulled two “P” (Personally and Permanent) words out. I kept telling myself over and over “Don’t take it personally.” “The problem is hers.” “I did what I need to do for my job.” I also told myself again and again that “Nothing is permanent. This shall pass.” I repeated these sentences to myself until I was at peace. That night, I was able to enjoy the wedding. I could think about how to deal with my bad experience after the wedding.
4. Plan to bridge the differences in our nursing practices in many steps.
- Initial self-assessment and learning to fill the missing pieces of the puzzle for ourselves.
- Find a group to study, to socialize, to make friends, and to learn from each other and the cultures of each one involved.
- Search for a few career mentors for guidance. It will save us a lot of time while we are lost in a maze of professional nursing. In the United States, nursing opportunities are endless; we have a great many options for our advancement. It is not like when we thought nursing jobs were limited to a hospital or clinic.
- Ask for help. Ask for input to clarify any confusion. We want to do it right the first time and we want to do the right thing. We have to triple-check all we do, because patient outcomes are in our hands.
- Past personal beliefs like “Be quiet” and “Silence is a golden” – these don’t have much validity or value here. Not speaking up and not asking questions – these are not appropriate in this country. Do raise questions as appropriate.
Attachment I: Examples of possible solutions and preparation to bridge the differences in changing and adapting our professional nursing practice in the United States.
Our Possible Solutions
Assess and re-assess our patients
- Review and review, and review again physical assessment books. Memorize them as much as possible and as needed.
- Bring a handbook that we like such as “SkillMasters 3-Minute Assessment by Spring House 2006” to work for references.
- Bring bilingual dictionary to work for references.
- Practice American way as soon as we learn. Use it frequently.
Report abnormal finding
- Use SBAR for all verbal and written communications. Write down talking points for our verbal communication also.
- Use read-back method for all verbal orders.
- Ask the caller to spell it out or slow it down as needed.
- It is perfectly fine to state the obvious; let the speaker know that English is our second language.
- Ask speaker to listen to us attentively. It takes time to get use to our accent. Remember, listening skills are very important in any conversation.
Learn emergency responses – RRT, Code Blue with education in ACLS and PALS
- Be aware and tell our nurse managers that we did not have experience in these areas.
- Take initiative to attend emergency-related classes in our hospitals as soon as we can and take as many classes as needed.
- Increase our comfort level through self-study, group discussions and simulation labs. Find a preceptor or mentor to practice with us.
Giving P.O. medications and medication reconciliation
- Take time to observe patients taking their medications every time before we move on to the next task.
- Don’t put meds on the bedside table or on an over-bed table.
- Learn to perform medication reconciliation as needed.
Protect patients’ privacy and protect colleagues’ privacies
- Remember patient information is the patient’s private property. We need written permission from the patient, law and regulations, such as our facilities’ policies before we can share it.
- Plan ahead and create a simple sentence such as “I am sorry that I do not have a permission to give that information.”
Attachment II - SBAR
The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.
Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.
This tool has two documents:
- SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
- SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient
Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.
By SBAR Technique for Communication: A Situational Briefing Model
Kaiser Permanente of Colorado
Evergreen, Colorado, USA
Attachment III – Read-Back
Read-back is a way to verify of the complete order by the person who receiving the verbal order. The receiving person will repeat the verbal order back to the ordering clinician, who will verbally confirm that the repeated order is correct. The purpose of “Read-back” is to ensure patient safety.
Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN