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CE Home Study Course 20 N O V E M B E R 2 0 0 5 C A L I F O R N I A N U R S E be influenced by employer expectations and willingness to provide support. Because all individuals are unique, the employer must be aware of the needs of individual inter- national nurses. An assessment followed by an individualized orientation program is preferred. Current nursing practice, if similar to an individual nurse's home country or other country, will give the individual an advan- tage in the assimilation/transition process, whereas a nurse who has not practiced in some time may need additional compe- tencies in order to assimilate or transition successfully. Methods That Facilitate Assimilation and Transition The Subcommittee determined that there are methods to assist with the assimila- tion and transition of international nurs- es. As noted above, the Subcommittee observed many similarities with the three other transition groups. The methods are: Language Classes. Communication barriers lead to frustration for interna- tional nurses, other staff members and patients. Communication skills include medical terminology, abbreviations (in- cluding JCAHO abbreviations), colloqui- al terms, medication names, etc. Lack of communication skills hinder interna- tional nurses from assuming a nurse's role and responsibilities. Preceptors/Mentors. These programs provide support for international nurses. Employees volunteering to be mentors may initially contact international nurs- es while they are still in their home coun- try, similar to pen pals, to answer any questions the international nurses may have. Upon arrival in the United States, mentors can provide assistance with ad- justing to a new culture by assisting with life activities and introducing interna- tional nurses to others from their home- land. Mentors need to be trained and, when possible, be from the same coun- try as the new international nurse. Of course, the program can only be suc- cessful if the new nurse is willing to par- ticipate. Mentoring is a continuous cycle of support created by individuals who recognize the difficulties of transitioning into a new venue. Support Groups. Upon arriving in the United States, international nurses enter into a different culture and envi- ronment. Support groups provide sup- port and camaraderie for international nurses and allow opportunities to dis- cuss common problems, concerns, and to share information. Orientation Program. Employers of in- ternational nurses should provide an in- dividualized orientation program. The components should include: ■ Skills Assessment ■ Pharmacology ■ Technology ■ Orientation to the U.S. healthcare system, e.g., types of healthcare workers, delegation, etc. ■ Regulatory information, e.g., Nursing Practice Act, discipline process, etc. ■ Helpful hints, e.g., using eye contact, understanding that some words used have several meanings, etc. ■ Cultural Training for both interna- tional nurses and employees—Differing cultural norms are expressed through be- haviors and attitudes which in turn influ- ence communications and affect staff interactions and performance. Both in- ternational nurses and employers must be aware that each culture has a unique set of beliefs that must be understood if com- munication is to be effective. Areas such as handling conflict, decision making, and role expectations must be explored in cul- tural training sessions. ■ Assistance with life activities such as getting a driver's license, finding living quarters—International nurses enter an entirely new system of living. They may be unfamiliar with activities of daily living in the U.S. culture. Support with these ac- tivities can assist the international nurse as they adjust to the new culture. Public Protection Issues The International Nurse Issues Subcom- mittee identified the following as major public protection issues: Assessment of Competencies. Health problems vary from country to country. International nurses may be trained in dealing with acute care illness, public en- vironment, and/or environmental con- cerns but may not be familiar with the chronic health problems they will en- counter in the United States. Technology also varies from country to country. The international nurse may be familiar with the technology in their country but not technology found in the United States. These different sets of competencies and skills may affect public safety. Language Barriers. A challenge for in- ternational nurses is to develop effective communication skills. This is difficult be- cause medical terminology is different. Technology and medications have differ- ent names. Problems may occur with ab- breviations and words that sound similar, such as atrial and arterial. The inability to communicate a change in a patient's con- dition as well as the inability to commu- nicate that change via writing could compromise patient safety. Lack of Familiarity with the U.S. Health- care System. The home country of the international nurse may not have a sim- ilar healthcare system to the United States. They may not be familiar with the many types of healthcare workers present in the United States or the process of delegation. They may not have knowledge of a nurse practice act or board of nursing. When the interna- tional nurse practices in the United States, she/he must know what they can and can't do. It is important for the in- ternational nurse to be aware of the boundaries of their practice and their re- sponsibilities to their patients. Cultural differences. Each culture main- tains different expectations. The differ- ence in expectations can result in misunderstanding and misconceptions on both the part of the international nurse and other staff. For instance, internation- al nurses from some cultures may be re- luctant to ask questions, fearing that they would be perceived as rude or become em- barrassed to let someone know she/he does not understand. This may compro- mise patient safety. As a response to these concerns, the California Nurses Association and the Na- tional Nurses Organizing Committee de- veloped a Code of Practice for the International Recruitment of Nurses, which was adopted in September 2005 by CNA's House of Delegates. The following information was considered by the House in adopting the resolution. Introduction Many countries worldwide, including the U.S., are experiencing shortages of regis- tered nurses. These shortages, which tend to be more severe in developing countries and rural areas, reduce the capacity of na- tion-states to provide good quality health services to their populations. Some countries are responding to the problem of shortages by systematically recruiting nurses from other countries, in particular from developing countries.