International Nursing with Dr. Jose Arnold Tariga

As healthcare organizations across the U.S. continue to navigate workforce challenges, internationally educated nurses are playing an increasingly vital role. But recruitment is only the beginning—true success lies in how we support these nurses as they transition, integrate, and thrive.

In this episode of the Beyond Nurse Residency Podcast, host Dr. Nicole Weathers sits down with Dr. Jose Arnold Tariga, an internationally educated nurse, clinical educator, and founder of Bridge & Beyond Advisory. Drawing on his own journey from the Philippines to the Middle East and ultimately to the United States, Dr. Tariga shares powerful insights into the realities of global nursing mobility and what it truly takes to build a supportive, sustainable workforce.

Together, they explore:

• The global and U.S. nursing workforce landscape—and why international recruitment is not a quick fix
• Common misconceptions about internationally educated nurses and their competencies
• What international nurses need most in their first 90 days, including psychological safety, structured support, and meaningful context
• Practical strategies to strengthen transition-to-practice programs and support long-term retention
• The importance of shifting from a recruitment mindset to one focused on integration and belonging

This conversation is a must-listen for nurse leaders, educators, and organizations looking to do more than fill vacancies—to build inclusive environments where all nurses can grow and succeed.

GUEST: Jose Arnold Tariga PhD, MSN, RN, NPD-BC, NE-BC, CPHQ, FNYAM, FFNMRCSI

Dr. Jose Arnold Tariga (Dr. A) is an internationally educated nurse, nursing professional development leader, and author with over 17 years of experience across clinical and academic settings in the Philippines, the United Arab Emirates, and the United States.

He earned a post-doctoral certificate in Medical Teaching from Harvard Medical School, where his capstone project on transition-to-practice won first place for its innovative approach. He holds multiple professional certifications, including Nurse Educator, Nursing Professional Development Specialist, Nurse Executive, and Healthcare Quality Specialist.

Dr. Tariga has presented at major national and international forums, including the Association for Nursing Professional Development, Sigma Theta Tau International, and the International Council of Nurses, and has contributed to peer-reviewed publications.

His honors include Healthcare Professional of the Year (Filipino Times Awards UAE, 2019), Asia’s Distinguished Nurse Educator (Asia’s Pinnacle Awards, 2023), and the ANPD Partner for Practice Transitions Award (2025). He is a Fellow of the Faculty of Nursing at the Royal College of Surgeons in Ireland and a Fellow of the New York Academy of Medicine.

In 2025, he was named a Top 10 Finalist for the Aster Guardians Global Nursing Award among 100,000 applicants worldwide.

Dr. Tariga is the author of Building the BRIDGE, a personal and practical guide to navigating professional transitions in nursing.

He serves on the Executive Board of the National Consortium of Academic Nurse Educators and the Philippine Nurses Association of America–New England and engages a global audience of 40,000+ followers on LinkedIn.

Career Journeys: Preparing the Future Nursing Workforce

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp  to explore our resources for new graduate nurses and beyond. 

Transcript

Why International Nurses Matter

Host Nicole Weathers 0:01

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. So over the last several years across the U.S., we've been feeling the impact of this, and I'm gonna say so-called nursing shortage, because I know we do have a lot of nurses here in the U.S., but we still continue to feel like we need more. So organizations everywhere are searching for solutions. And for many, internationally educated nurses have become a vital part of stabilizing their staffing and strengthening their teams. But the truth is that bringing nurses to the US is only the beginning. The real work and the meaningful work is really in creating an environment where they can grow, they can feel that sense of belonging, and they can build a long-term professional home. So today we're diving into how we can support international nurses as they transition into the US. We'll explore the current landscape, we'll talk about what internationally educated nurses tell us they need the most, strategies for building effective support and structures along with transition to practice programs and where this space is headed into the future. And today I'm very thrilled to have with me here today a very special guest, Dr. Jose Arnold Tariga. Welcome, Arnold, and thank you so much for being here with us today.

Speaker 1 1:35

Thank you so much, Nicole, for having me. I'm so excited to be talking about our topic for today because this is very close to my heart. So thank you for having me.

Host Nicole Weathers 1:44

Excellent. Well, why don't we start off by having you tell our listeners just a little bit more about yourself and your background?

Speaker 1 1:50

So I am an internationally educated nurse and have been a nurse for the last 17 years. I started as a critical care nurse back home in the Philippines. And after a few years, I decided to explore opportunities abroad. So in 2013, I decided to move to the United Arab Emirates, started as a bedside nurse, and then eventually moved into different pathways. So I started as a nurse leader and then it didn't work out well for me, which in a way actually turned out well because it redirected me to the pathway of clinical education. I think in almost 10 years of living in the Middle East, I've really blossomed as an educator, both clinically and in academia as well. And then while there, I still wanted to grow more and explore more other opportunities and have heard from friends who were based in the US that there are a lot of sub-specializations in the United States. And so I decided and tried my luck to take the NCLEX, past the NCLEX, and then in 2022, um eventually moved here in the United States. So I'm currently based in Boston and Massachusetts. I currently work as a clinical hospital educator in one of the healthcare facilities here at the same time. I recently just started my own coaching and consulting firm, Bridge and Beyond Advisory, which aims to help nurses and healthcare organizations to facilitate their transition into transformation.

Host Nicole Weathers 3:12

Excellent. Well, you it sounds like you are the best person I could have picked to come talk about this because not only are you very knowledgeable in this area, but you have firsthand experience of what it's like to go through this very unique transition. So I'm really excited to dive into the topics that we have planned for today.

The Global Workforce Reality Check

Host Nicole Weathers 3:33

So I think maybe before we get too far into the discussion, I would love to kind of just hear a little bit more about what's happening right now in the global nursing workforce that we should really understand. So are there things that we need to be thinking about as nurse leaders and nurse educators in the US and things that we should be considering as we maybe explore bringing internationally educated nurses into our organizations?

Speaker 1 4:02

Of course. And I think like it's a very important question, Nicole, because um you must have heard that, you know, we have a lot of international nurses coming in into the country. One of the most important things for US leaders to understand is that the nursing workforce challenge is both global and local at the same time. You know, coming from the Philippines, we we have a lot of nursing graduates, and many of them decide to migrate to other countries for better opportunities. Globally, the nursing workforce grew from 27.9 million in 2018 to 29.8 million in 2023. This was reported by the World Health Organization. On that report, they also said that the world was still facing an estimated 5.8 million nurse shortage. And this still, again, was in 2023. And there is a projection that by 2030, there will still be a shortage of 4.1 million nurses. So as much as it sounds like you know the workforce is growing, there is still a gap. And what also stands out is the is the inequity, because about 78% of the world's nurses are concentrated in countries that represent only 49% of the world's population. And you know, maybe later, you know, I can share the reasoning behind why this is happening. And for me, my personal experience is that in my home country, there are there are not a lot of opportunities. And many of us would want to grow more personally, professionally, and maybe even financially too. Um, when we talk about the US side, um, the pressure is also very clear. Um, we've we've seen reports from the Bureau of Labor Statistics that projects about 189,000 or more nursing openings per year on average over 2024 to 2034. And while HRSA projects a national shortage of about 108 plus plus full-time equivalent RNs by 2038, there's really a lot of recruitment going on internationally. And, you know, if if you come to think about it, I would say like US is one of the good countries in terms of responding to real workforce need, but there also needs to be an understanding that there's a lot of dynamics that goes behind the recruitment. Um, it's not really just recruiting international nurses and bringing them into the US. It's more on what do we do while we are recruiting and before they even arrive here, once they arrive here, and after they arrived and settled here in the country.

Host Nicole Weathers 6:33

I know because I I it there's just, as you said, there's just so much more to it than just getting getting bodies to come here and work for us, right? There's, you know, preparing for it. You can probably talk on a lot about kind of that experience uh from the individual standpoint of all the, I'm sure there's a lot of hoops you kind of jump through to make that happen. And then once they get here, we want to make sure they're successful after they put in all of that work to sit for the NCLEX, to probably do all the things that you have to do to come into the country to work. Um, and then to get them here and not have a good experience would just be heartbreaking, I think. And I love how you gave us sort of a background here on the volume of nurses we have, not just here in the US, but globally, and that it is growing. But even as we continue to grow, we still have projected shortages.

Misconceptions And The “Quick Fix” Myth

Host Nicole Weathers 7:23

So, what do you think is maybe one of the biggest misconceptions about international nurses or international recruitment?

Speaker 1 7:30

I would say I've seen this because um, prior to where I'm affiliated now, I worked in the staffing industry. And so I've seen, I've I've spoken with a lot of different healthcare organizations who were hiring international nurses. And um I think like the biggest misconception is that our international nurses are clinically weak from a standpoint that they were not trained in the United States. Because they will always say that, you know, like, ah, they're not Western trained or they are not US trained, and therefore they would need all these trainings when they arrive here. Um and there's truth to that in terms of the need for training. But in terms of clinical competency, um, you know, I was I was thinking about it, like, if you really, if you use Banner's novice expert model, most of these nurses who are coming in here bring with them years of experience. That's like it because it's also a requirement of the country, actually. Like um, when I was hired to come to the US, there was a requirement from the healthcare organization that I was applying to that I had to have a minimum of two years experience. And the visa processing took around three years. So I technically have waited for like many years before even coming in here. So I brought with me like lots of years of experience. So um going back to the Novista expert model, like many of these nurses would have been competent, advanced beginner, or even an expert in their role in their home country or from the country where they resided prior to coming in here. But then when they are being transplanted here and when they move here, it's a totally different environment. It could be a medical surgical unit, but they're not used to working in that medical surgical unit because it's a different setting in the Middle East or in the Philippines. So that is where sometimes when nurses come here, we think that, oh, this nurse is not clinically strong. But the fact of the matter is they might not just be familiar with how you do your things or your routines in your clinical setting. They might not just be familiar in terms of the processes or your policies and procedures in terms of how can they escalate things? How, who do they call when they need something, if the patient has this, or like how do they work with a multidisciplinary team, which is one of the struggles that I had too when I transitioned first, because of the cultural nuances in terms of how do I work with a doctor? Can I speak up? Because there is retaliation when I speak up back home. When in fact, here in the United States, we are strongly encouraged to speak up for our safety as uh, you know, as licensed professionals and for the safety of our patients. So I think this is a long-winded answer to your question, but bottom line, it's that misconception that they are not clinically strong.

Host Nicole Weathers 9:59

Well, and I think we face this, you know, even in the US. Like anytime, let's say you have a nurse who's worked in med surge for, you know, three years and they are, you know, promoted into leadership. And it's like they're you're really starting over on Benner's novice to expert anytime you change roles or change specialties or try something new. And so I don't think it's any different to expect that that would happen when we're bringing internationally educated nurses in because the setting and the role and the specialty are all gonna probably be different than where they started or what they had prior.

Speaker 1 10:35

Right. Um, and Nicole, I also would like to add one point of misconception in relation to bringing in nurses. Um, I think what I've seen in the industry um is that international recruitment is a quick fix to our shortage here. Uh, you mentioned it earlier that, you know, there's this sticky topic of like, do we really have nursing shortage here in the United States? Um sometimes I see these conversations in LinkedIn, for example. And to me personally, I think like if we look at the statistics, there are a lot of registered nurses. But the concept of shortage is really on do we have these nurses in the areas that they are needed? Like, no one wants to work at the bedside anymore because of the stress, the burnout, and stuff like that. But yes, we have a lot of registered nurses in each of the board of nursings in each of the states. So yeah, like recruitment is not a quick fix. It's really looking into yes, you recruited your nurses, but then you make sure that they also stay within the profession. We don't burn them out to the point that they don't want to become nurses anymore.

Host Nicole Weathers 11:35

Well, and that's why I mean I kind of like hate to go against the green and say, I don't really believe that we have a huge nursing shortage because we have more registered nurses than ever before. But I think where the shortage is, is we don't have registered nurses who are willing to work in some of the areas where we need them to work. And that might be because of the work environment or because of a lot, you know, the burnout and all the different factors that sort of factor in. Um, and so that is that is kind of why I used that kind of loosely, this nursing shortage. And for all of the reasons that you you kind of said there. Um, and as far as it being a quick fix, I mean, pretty clearly it's not a quick fix when you said um, because I wrote down it took you three years for your visa to be processed so that you couldn't even come here to begin with. So you pass the NCLEX, and then three years later, which comes first, the visa or the N CLEX?

NCLEX Credentials And Visa Timelines

Speaker 1 12:28

Um, the NCLEX comes first, but there's even more to that. So, like before you can take the NCLEX, we have to have our credentials verified that our nursing degree is equivalent to the US nursing curriculum. And aside from that, because we are non-native English speakers, we have to take an English exam, English proficiency exam with a specific band score requirement. Of course, like, you know, typical police reports, uh, criminal reports and stuff like that. So all those things have to be completed before we can apply to sit for the NCLEX. And then once the NCLEX is done, you then go through to the immigration process. At least my experience, anyway, is like so, because there are different pathways for international nurses to come to the US. Um, we have the H1B pathway, which is more on the working visa type, and then we have the um green card pathway, the EB3 visa pathway, which gives you like 10 years as a permanent resident here in the US versus the three years um being given when you receive the EB3 or the working visa. Um, so with my process, because I received the green card or the EB3 pathway, it was longer. Uh it took around almost three years versus the H1B, um, which usually takes roughly around six to eight to twelve months.

Host Nicole Weathers 13:46

Okay. But either way, not a quick fix.

Speaker 1 13:48

Not a quick fix, definitely.

Host Nicole Weathers 13:49

Not like, oh, we need somebody. They're gonna be here a month from now and we're gonna get them started.

Speaker 1 13:54

Yeah, for sure.

Host Nicole Weathers 13:55

Excellent. Well, thanks for sharing that. That is, I have no knowledge in this area. So that is very interesting to hear and learn all about that. Now let's

The First 90 Days That Matter

Host Nicole Weathers 14:04

talk about the transition to practice experience. So when we're talking from an organizational standpoint about bringing international nurses, internationally educated nurses, um, into our organization, what do you think they need most in those first 90 days? Like what should we be doing to prepare for that initial 90-day period?

Speaker 1 14:27

Based on my experience as a nurse who has gone through the transition process and now as a nurse who has who's helped international nurses transition as well, um, I would say that for the first 90 days, international nurses need three things the most. One is psychological safety, two is structured support, and the third would be context on why they are doing things. When we talk about psychological safety, um, this is really very important, you know, because many are navigating an entirely new practice culture while they trying to prove themselves that, you know, that they are competent. As I as I said, like it's not just the the people here in the US who are who might be perceiving them as less clinically competent. These nurses were also started questioning themselves because when they're exposed to an area that they do not know what to do or that they're not familiar with, that definitely scares them. I was scared when I first touched an electronic medical recording system because I'm scared that I might be deleting information that is important and you know, like that that might put me in trouble legally. So there, these are one of the things that we have to make sure that when we bring in international nurses, we assure them that you are safe here. There are people that you can ask questions and it's okay to ask questions, and that there's no stupid question, that you will not be judged when you ask questions and when you want to clarify things. We have resources that you can go to. You have we have resources that you can check if you're not familiar with, you know, put your medication, because maybe the brand names that you are using back home is different than the brand names that we have here in the States. Um, and again, you know, like we also need in terms of psychological safety, there's that aspect of making sure that we provide them with a structured support, like consistent perceptors, for example, so that they don't get confused in terms of like, oh, this perceptor tells me one thing and the different perceptor tells me another thing. Because I will not feel safe as a nurse being told two to three different things of doing things. Of course, making sure in psychological safety, making sure that they feel welcomed, um, you know, that they are not being laughed at because they have an accent or like because they just they look different or something like that. When we talk about structured support as well, like I would say that it's also making sure that, yes, you have perceptors, but these perceptors are also prepared to handle international nurses. My experience of transition was that many, if not all, healthcare organizations, um, they have structured residency and fellowship programs. That's one thing for sure. But most of these residency and fellowship programs are actually really geared for nurses who graduated from nursing school here in the US. And therefore, these nurses have been exposed already to you know our healthcare setup here. Well, in fact, like if you bring in international nurses, again, there this are there are those small nuances, like for example, the communication side of things. Like in my home country, I could not speak up when I need something from a doctor because, or if if I catch something, because maybe the doctor will um, you know, will retaliate. But here, there's no such thing as that, or maybe there is, but you know, like at least what I've been told and what my experience is that if I want to bring up something, I can bring it up, of course, professionally. I'll not be shouting with people, but like, you know, because we are colleagues and like we work as a team to, you know, deliver safe care. And in terms of context, like, yeah, we need to make sure as well that we need to always remind them, especially in the initial stage, why we are doing things. Like it's not just for the sake of checking that uh you've gone through this orientation, but you are doing this for the safety. Like, I think like I'm always going back to like speaking up because this is always one of the things that I've seen most international nurses struggle, um, especially nurses from the Philippines. If if you do not speak up, uh, I mean, like the reason why we're speaking up in terms of context is like you have to make sure that you bring up things that you feel are unsafe for the patient. Because at the end of the day, like what we really want as healthcare professionals and as a member of the healthcare team is to make sure that we provide safe care and that also for taxes as you know, as licensed professionals.

Host Nicole Weathers 18:34

Those

Tweaking Residency For Cultural Nuance

Host Nicole Weathers 18:35

are three really, I think, concrete places where organizations can kind of begin to think about. Um, and all of these things, actually, as you're talking about it, I'm like, all of these things are also important for new graduate nurses that aren't internationally educated. So one of the questions that we get sometimes, um, and one of the questions that sort of is rolling through my mind as you're talking about kind of these three main concepts that we really need to focus on is do you feel like if I'm an organization that has a new graduate residency program in my organization, and that's sort of the structured support that we provide, do you think I need an entirely different uh program for internationally educated nurses? Or do you think that some of what we do for new graduate nurses could fill some of these needs?

Speaker 1 19:31

I think that the some of or even most of what you're doing already in the residency programs and fellowship programs that we have here in the states can be given, can be delivered to the international nurses. But like there just needs to be an add-on or an extra, especially when it goes to communication, giving feedback, because I think here um in the states, like we need to understand that sometimes those cultural nuances can be barriers in terms of facilitating that integration. So, like, for example, giving feedback. Many of the nurses, Nicole, I'm gonna always go back to you know being a Filipino nurse and stuff like that, because this is my experience. I couldn't speak for other um international nurses because they might have a different culture. But um, for example, back home, um, when we are be being given feedback, sometimes I will feel very bad about myself. Um, but like here, we are encouraged to seek feedback so that we know how we can improve. And so chances are if you have this international nurse who is really new to being an international nurse, because like for me, I've moved to the Middle East before coming to the States. So I've I've had an idea already as to how to work with an international team. These nurses coming directly from their home countries might not seek feedback or might get offended and might feel bad when they are being given an even an objective or you know, a constructive feedback because they think that, oh, I'm performing very bad at work or something like that. And then that can impact their sense of psychologically, of psychological safety. Like they will think that, oh my God, maybe I will lose my child and stuff like that. And then they cannot perform. So like it has this domino effect of creating this unnecessary stressors for for these nurses. So like if we know that, oh, this is an international nurse, I might need to have a specific feedback model or feedback framework so that I can help them process the feedback in a way that they will think, oh, okay, this is an area that I need to improve on and not feel negatively when being given that constructive feedback. So those small things, um, which can be very different, because like here in the States, we're so used to just being direct. That's already a thing here. And that's that's definitely one of the things that I actually like here. Because at least, you know, I know where I stand with people. Um, I prefer that rather than like going to different ways on how to deliver a feedback because it becomes confusing. But yeah, if if we understand that, then we can train our perceptors that okay, I know that you're used to giving this type of feedback or this process of giving feedback to a US trained nurse, but maybe we'll tweak it a bit in terms of how we give or deliver the feedback from. International nurse. Some of the communication, even like the local language, too. Like I remember before when I was a new nurse here in um Boston, they have different terms that they use that I was not familiar with. One one day, this patient asked me to bring a Johnny. I didn't know what a Johnny was. So this patient said, like, oh, Arnold, can you bring me a Johnny? And I thought that the patient was looking for my colleague John. Because it it also happened that I had a colleague John. So I brought John with me in the room. And then the patient said, No, I need a Johnny. I said, like, John is here. And then they looked at each other and they started laughing. So only then that day I realized that a Johnny in hospitals here in New England is a patient's gown. So I was like, yeah. So I was like, is that a Boston thing? They said, like, like for like, you know, like the older generation, they call that um a patient's uh yeah, they call a patient's gown a Johnny.

Host Nicole Weathers 22:55

I had a lot of things going through my head, and a patient gown was not where I thought this was going.

Speaker 1 23:01

I know. So so these are some of the things that like, so you know, when I started working in my previous job, um helping international nurses transition to different healthcare systems here in the States, one of the main things that I did was I started reaching out to Filipinos, Filipino nurses in those hospitals and asked them to list down all the terms that were confusing to them when they were new, so that I can share this ahead of time. Um, so that these nurses, when we when we do simulations or when we do, you know, conversation, when we had conversations back home before they even fly here, they started hearing these words and they already know, ah, okay, this is what it means in Boston, or this is what it means in Texas or in Washington State. You know, like different types of stuff. It might seem small, but it actually impacts their practice and it also helped them become more confident that they're gonna do they're gonna be doing okay because they understand what this person needs.

Host Nicole Weathers 23:51

Absolutely. No, I love that example. And I think, you know, that's something and and just like with new nurses, like sometimes we're so focused on like the clinical aspects and are they clinically competent and do they have the clinical skills that they need? And we totally lose sight of all these other things, all these other competencies and skills that sort of surround the clinical skills that are so important, if not more important. Um, so kind of having that context, having that understanding of some, even probably what's what they thought was very basic language, right? Um, and it and and being able to, you know, interact and engage with people um in the different areas of the country. In Iowa, we do not call a patient gown uh a job. So that's not happening here, to my knowledge anyway, maybe. But okay. All right. So when you think, okay, so we you don't necessarily think maybe there has to be a separate program, but maybe we augment our existing program for those internationally educated nurses specifically. So, what have you seen work really well? What are some key strategies that you think really help um to kind of maybe augment our existing programs or really uh, you know, provide that structure and context that these international nurses need?

Speaker 1 25:14

Sure. Um, so I think, and you mentioned something actually before answering this question, you mentioned something earlier. You know, sometimes we really focus more on like how these nurses were performed clinically or how can they integrate better in the clinical area. Um, and and that's really true. That's what I've seen too. And that's the reason why it's really important to have some other things or to to look into some other things, not just the clinical transition of these nurses, because if we come to think about it, the the transition for international nurses is really moving and you know, uprooting their lives from their home country to here. So it's not just about making sure that this nurse will survive their clinical roles here in the US, but really also survive the community that they're gonna be moving into, you know, and and and as educators or or as healthcare organizations, we need to make sure that we facilitate that.

Pre-Arrival Prep And Better Onboarding

Speaker 1 26:00

So um I would say that, you know, to what I've seen in terms of like what really helped out um with the transitioning of nurses is making sure that they have the you know pre-arrival preparation, if possible. So I know that, and this is what I know, having worked in the staffing industry, is that in the US, it's mostly that healthcare organizations will partner with a staffing agency or like a recruitment company to bring that international nurses here. So, if possible, that needs to be a talking point between that healthcare organization and the staffing company who's bringing those international nurses here, that if they can, there needs to be those prior preparation, even just the basic information as to what to expect personally and professionally when they come to the US, um, giving them an idea and hopefully an opportunity to practice those types of clinical skills, for example. So, like, and and the good thing about that is like we have technology now. This is the thing. Like you can have virtual sims and stuff like that. So if you can help facilitate virtual simulations on how to use your electronic medical recording system or other critical skills, for example, in your hospital or in the unit that these nurses will be moved into even before they come here, that will definitely facilitate not just psychological safety, but you know, the sense of confidence and competence that, oh, okay, this is when I come to the US, that will not be the first time that I will see these things because I've seen that, at least in theory or you know, virtually before coming in there. Of course, there's a different feel too when you practice those stuff. So again, if if their partners have the ability to do that prior to bringing the nurse here in the US, that's definitely one thing that will work. There needs to be structured clinical and cultural onboarding, which is already, as you mentioned earlier, that we have a lot of established, we have established our residency and fellowship programs here. So that's not a problem. And maybe there's just need to be that small tweak from a cultural perspective, not just for the nurses, but for the perceptors, for the educators, even for the unit managers, um, so that we make sure that these nurses know how to speak up, the hostels can um accept or receive um constructive criticisms or feedback in a healthy way. Um, so those type of stuff. Um and yeah, that's where trained perceptors also is very important. And by trained perceptors, again, you know, I always go back to those cultural type training. Establishing peer support has also helped based on what I've seen. Um, for example, you know, here in the United States, there is a lot of um Filipino nursing communities, and that's one of the things that I've been doing too before. I make sure that if I know that these nurses are going to a specific state, and because I've I've been connected with the Philippine Nursing Organization of America, I usually reach out to their officers if, you know, like you can do a meet and greet and stuff like that, or if there are local communities that they can connect with so that they feel welcome and that they know that they have some people or some organizations that they can go to.

Host Nicole Weathers 29:01

So I'm just not to interrupt you, but curious, when you're talking about peer support, are you talking about peer support like within the organization? Or are you talking about peer support within the community, the com the larger community that they're going to be living in?

Speaker 1 29:15

Um, I would say both. So, because most of the time, like the peer support within organization, I can say sometimes it's easier to find because you, you know, like the leaders in the organization will already know, oh, I have a good percentage of international nurses that these nurses can go to. And I know that a lot, if not all of the hospitals here have that, you know, um, mentorslash body systems where they pair international nurses with other international nurses, not necessarily the same nationality or the same home country, but you know, international nurses have gone through the experience of transitioning themselves. So yeah, it it needs to be both. And then regular check-ins is very important too. Sometimes, you know, it can be a bit, I know that like our structure here is can be very, very challenging. And like leaders are so having been in a leadership position, I can see how things can just pull you out into different directions. But we have to make sure that we make time for, especially for our international nurses. And if if you can't as a leader, you have to make sure that at least your preceptors are, you know, doing regular check check-ins on them. And I would also say that ongoing competency development, as again, like it's not that they're not competent, but they might need to be exposed on how we do things here. Because it could be a different equipment, you know, the same process, but different equipment, or maybe even a different policy and procedure on how we do things.

Host Nicole Weathers 30:40

You know, as you're talking about this, what's going through my head is again, like these are all really great things to do for any nurse coming into the organization. But I can see where some of this discussion around kind of the peer support and the buddy, you know, system. And obviously when you're doing these check-ins and you're you have that ongoing, you know, competency development, it is going to look different and it's obviously applied in a little bit different um situation. So no, I'm I'm writing down number one, anticipatory guidance on what it's going to be like when you get here. Then, you know, training our existing staff so they're prepared to support the internationally educated nurse. And then as you talked about psychological safety, structured support, context when you're training them, um, and then the peer support and regular check-ins and ongoing competency development. I've got a whole list of things that I'm like, this is this is what we need to be doing.

Speaker 1 31:40

Just to add one point, because like there was one um healthcare system that really did an extra mile in, you know, in helping prepare. Like what they did was like they even uh went to a point of like adding some menus that might be like, you know, in their cafeteria so that these international nurses will have some food that they will be familiar with, you know. So like this, it it's it might it might seem small, but like this means a lot to international nurses, missing home, you know. So like this type of stuff.

Host Nicole Weathers 32:07

Yeah, no, I love that idea. And you know, I I imagine, I mean, you're traveling a long ways away from home. And even though there's a lot of positive things to, you know, going down this path and and coming to the US and you know, working here, you still probably miss home. And so any sort of sense of comfort that an organization can offer, and like you said, that's just a a kind of a really small thing that they can do that probably makes a really big difference.

Speaker 1 32:35

Definitely.

The Life Stress Leaders Miss

Host Nicole Weathers 32:38

What do you think leaders or even preceptors underestimate about that transition experience?

Speaker 1 32:44

I think in terms of underestimation, um, I think, yeah, many people would think that it is an easy transition, right? In fact, it's not. Um, as I mentioned earlier, like it's it's really moving everything, moving your life into a different environment, both like personally and professionally. And that can be daunting. That can be so tough. Many of the nurses that I've I've worked with have family members or like are married, have kids. And sometimes they could not travel together when migrating because of either visa conditions or just the financial side of things. Like when I moved to the States, um, I never knew. I was never informed that if I start looking, because I had like one month free accommodation before I have to sort my things out. I didn't knew that I had to pay one up for like one month rent, last month rent, and then like deposit, security deposit or something. And I was just lucky that I have some savings from the Middle East. Because if I have not, like I would I would be so worried. I was like, and it's not cheap here in Boston, which I believe is in many of the states. So you know, like it's it might seem easy, it might seem fun. Um, because like, oh, you know, I'm gonna be experiencing different culture, different weathers. And from the Philippines, like we always see nice things about how nice it is to be abroad, you know, like it's like a Hallmark movie type stuff. But it's very different when you come here. I mean, like it's it's still nice, but you know, once you face the reality, like it's not really easy here. Like you have to work hard for money, you have to, it's a different level. I think like it's a different level. So I think those are the things that sometimes we underestimate. And sometimes um, what I've seen is like we've we failed to check in with some of our international nurses. How are they doing? You know, like that's always one of the things that I mentioned to our healthcare system partners before that when you ask them how are they doing, don't just ask how are they doing in the clinical area, how are they doing in their lives? What I've seen is that many of these nurses sometimes might perform poorly in this in their initial days, not because of clinical incompetence, but actually because they were not psychologically or emotionally okay. Especially if they were married, they have kids, I have to leave my five-month-old back home because when I come here, I don't have somebody to take care of the kid when I work. And I have to work, you know, like this type of stuff. And and I've seen it. I've seen it a lot of times. And, you know, when we start talking to them and some organizations would actually go to the extent of like, oh, if your husband is this, like that, maybe we can find, we can help him find employment or something so that they can come here, you know, and then maybe they can do work um part-time and stuff like that. And and that's a good thing here too, in the US, because there are those a lot of like job opportunities. And nowadays you can work from home. So childcare, um, as much as it's still an issue for many international families, um, at least there's some sort of like, you know, solution to it. So yeah, again, this is a long-wide answer to your question, but yeah, that the transition is really tough. It's it's different when you've lived it yourself. Yeah.

Host Nicole Weathers 35:48

Well, and I can imagine, like, uh, you know, I think that's probably uh a bigger difference with internationally educated nurses and what we see a lot of times in residency with new grads is I mean, it's still a transition either way, but when you are literally like moving halfway across the globe, you're uprooting your entire life, as you said, leaving family members behind. There's a whole nother like emotional level to that. I just imagine it is very, very difficult. And it's not like you can just get in the car and drive and see them either, right? Um, there's that greater sort of distance in between. I appreciate you sharing that perspective. Because again, I don't think that's anything I would have ever maybe thought about when thinking about how do we best support internationally educated nurses.

Building Long-Term Integration And Retention

Host Nicole Weathers 36:34

So let's talk now about leaders and if leaders really want to do this well, what are they doing?

Speaker 1 36:41

Okay, so I know that I mentioned a few um pointers already in our previous um conversation, but um I would say that the top three strategies that I would strongly recommend, and this is based on what I have seen, is that um first we have to build a structured transition model. And again, it can be the, you know, what the organization currently has in terms of like residency, fellowship, your perceptorship program, but just integrating those small aspects to make sure that, you know, the international nurse would have ad hoc support, um, they will have standardized mentorship, they will have regular check-ins, they will have continuous competency development as they transition, that would definitely help a lot. And then um, secondly, making sure that we prepare both sides of the bridge. Again, it's not just focusing on like, oh, this is an international nurse, bring to the states. I'm just gonna focus on training my international nurse. It's also making sure that on the other side of the bridge, those teams, whether it's a preceptor, the educator, the team that's gonna be working with this um international nurse, are also aware that there is an international nurse who might have a different train. And I'm not saying that we have to change our system for the international nurse. It's just really understanding those, again, small nuances of like, okay, this nurse might not speak up. So I will change how I phrase questions. So, for example, I'm not gonna ask yes or no questions because chances are this nurse might just say yes all the time because they want to make sure that they, you know, maintain that harmonious relationship with colleagues. Um, I would be doing that if I was actually, you know, coming directly from the Philippines to here. But like I already know how to work in a different dynamic. So I now can speak up on something like that. So that's definitely very important. And of course, making sure that we also look at measuring the success beyond recruitment. Again, we do not just bring in nurses to fill a number or, you know, like a role. It's really making sure that we continuously engage with them. It's not just bringing them here, you're all set. It's not. Um, make sure that you engage with them, you you provide them opportunities to grow too. Because once, and this is the good thing. My experience was like when I came to the US, I saw how vast the opportunities can be as a nurse, basically because you can sub-specialize. So making sure that if you bring a nurse initially for a bedside role, don't limit their capability or their opportunities to actually move into specialties. Like if they want to be an NPD, if they want to be in research or other, you know, um specialties in nursing, provide that opportunity for them, you know, create the pathway for them because that will help make sure that they feel that they belong and that that will help with your attention too.

Host Nicole Weathers 39:19

Excellent. Um, so as we think about the future, so five years from now, 10 years from now, I mean, we're already very mobile as a society, right? People are moving around within the US, we're we're moving between countries. What do you think organizations will need to do differently to, you know, successfully sort of navigate this mobile um society and internet, you know, international nurses from all over the globe? Um, what are we gonna have to do differently in the next five to 10 years to really manage that?

Speaker 1 39:57

I think that I think we need to change our mindset of like a reactive staffing mindset. Because if you come to think about it, the really, the, the real reason why we we really bring in international nurses is because of the staffing, right? We don't have staff or like we just want to feel staffing and stuff like that. So we need to make sure that you know, organizations will need to shift from that reactive staffing mindset to a to more of a long-term workforce integration strategy. So when when you know, when we think about that, like we have to make sure that yes, I bring this nurse here, but I also make sure that this nurse will grow and integrate into the system, add value and at the same time flourish and you know, hopefully pave that road to other nurses, not just from internal, not just internationally, but even support our local nurses here too, you know, become their mentors as they transition. Because I think you mentioned it earlier, the transition really is not just for international nurses, if you come to think about it. It's also for our new graduate nurses or even nurses transitioning from one role to another. So even at I as an international nurse, I have also, you know, shared my experience and my expertise to US trained nurses, US-based nurses who wanted to sub-specialize in the specialty that I am in right now. So, yeah, making sure that we don't have to just look at that ed. Hopefully, you know, like when we recruit in the future, we have to make sure that there are better transition to practice models. We should not just be said like this is my organization's transition to practice, you have to follow this, like this is set in stone. It shouldn't be that mentality. And yeah, I mean, I'm glad yet I think we both belong to, you know, A and P D. And like there's really massive work in looking at what is what does the evidence say in terms of best practices for transitioning, not just you know, local nurses here, but also international nurses. So we have to keep ourselves updated on that so and and need uh and make the necessary changes, you know, if if if we want to be successful. Stronger retention strategies, again, it's not just like you know, fixing this staffing problem right now because my numbers don't match up. It needs to be a future-oriented workforce integration. Better perceptor development. We've I've seen this over and over again, even if they say that, oh, we have trained perceptors who have gone through perceptorship workshop. Still, there's always still that problem when it comes to you know percepting and mentoring international nurses. Ethical global partnerships, very important. I think there has been a lot of discussions, and sometimes even the mentality that we're bringing international nurses because they're cheap. Actually, we're not. What I've learned is that we are paid based on what is the pre what is the prevailing wage of the county of where you're gonna be working. So it I'm basically paid based on experience. Again, the prevailing wage, you know, it's it's a set standard in each of the counties. So yeah, technically we're not cheap. We're almost like we're the same based on again our experience. Yeah, I think like generally, we just have to, we just need to have like this smarter workforce forecasting. I'm I'm not an expert in workforce forecasting. I know like people sometimes again are very short-sighted. They just want to look into solving the problem now instead of like looking at it from a five to 10 year perspective. So I hope that we look into that. And maybe also consider really stop looking from abroad too. To your point, like there's a lot of registered nurses here. So like looking into the problem that's that's causing our nurses or local nurses here to leave the profession. What can we do about that? There's, I'm sure, and you know this, like there's no, you know, there's no one fix for all these problems that we have. But like maybe we can really try delving into them and seeing how we can help out.

Host Nicole Weathers 43:39

Right. And you know, I I sometimes have very mixed feelings about recruiting internationally, because there's a little bit of like, are we just taking nurses from countries that need these nurses? Now, granted, yes, I understand people are looking to you know better their you know situation. Maybe they're looking for wanting to make this change. But I from like an ethical standpoint, it's like, well, we need nurses everywhere, just not the US. Like we shouldn't be selfish and trying to take all the people to get them here, you know? Um, and so, you know, sometimes I go back and forth on, you know, whether it's it's I don't want to say it's right or wrong, it's not, you know, black or white um decision, but you know, again, I think this as more of a long-term strategy. I think this as a way to, you know, divide, diversify our nursing workforce in the US so that we're we are providing patients with a diverse nursing workforce, um, which I think is an important piece of it. Um, so I think there's definitely value, but I I like the point that you made about it's it's really, I wrote down the word, it's not like a band-aid solution. It's not a quick fix. It's not something that we're just gonna do to solve this issue at this point in time, but like let's zoom out a little bit and look at the the broader impact that this is having on an international level. All right. So we have talked about so much today. We've talked, you've you've given us some really great background around um international nursing and kind of what's happening in our nursing workforce at the global level. We've talked about that immediate transition within that first 90 days or so, um, what people get wrong or you know, maybe underestimate about international nursing. And we've talked about some really great strategies leaders can leverage to do this really well. So before we go, I have one more question. And this is a question I ask of pretty much everybody who comes on the podcast. So if you could change one thing about how the US approaches international nursing support, what would it be?

Speaker 1 45:52

If I could change one thing, I would shift the conversation from recruitment to integration. Because um, when we just talk about recruitment, it's really just bringing the nurse here. But when we focus more on the integration side of things, it's really determining whether the nurse succeeds um during their stay here and that if they feel valued, right? Because we already know that the workforce pressure is real. Like NCSBN um in their report found that there's more than 138,000 nurses who have left the workforce since 2022. And there's still like reports of them leaving. So if you just bring those nurses in here, international nurses, but they're gonna face the same problems that our local nurses are experience, chances are they're not gonna stay. So make sure that they integrate well, that they feel that they're okay. They're I'm like they're you know, they're adding value and that at the same time they feel value by the organizations. And I hope that we also do that for our local nurses again, so that we won't have that issue of like just cycling people into bringing them in here, but then forcing them out because we're not good at taking care of them. That goes both international and local nurses.

Host Nicole Weathers 47:03

That is so true. And so much I think we can learn from those words. So shifting from recruitment to integration, and I think that's a great place to end this episode of the podcast. So thank you, Arnold, so much for coming and sharing all your expertise. I know you said I'm not an expert, but I really think you are. You you definitely have a lot more knowledge in this area than uh a lot of people that I talk to, and I I just greatly appreciate you um sharing it all with us.

Speaker 1 47:31

Thank you so much, Nicole. Thank you for having me.

Host Nicole Weathers 47:37

Wait,

Programs And Resources To Use

Host Nicole Weathers 47:38

before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all, the online nurse residency program. This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.