Immigrant nurse in the US

It wasn’t very long ago when I arrived in the US with the aspirations of practicing nursing in this great land of opportunity.  Having worked as a nurse in India and later in the middle eastern state of Kuwait, I was bringing along a diverse experience of two decades of multi-cultural nursing practice.  Having worked with people of diverse backgrounds and perspectives; apart from the everyday awareness that I was different, I found that no matter what the problem or issue, the outcome achieved was grander in scope and reception with the greatest team diversity.  Frankly, I was determined to make it work; I knew I could make it work here; after all, nursing is what I have been doing all my life.  How could it be so different here. 

With this conviction in mind; I arrived in the beautiful country in the year 2017; after a tedious wait of 12 years to get my visa approved.  I arrived at a time; when I was at a peak of my career; when I did not have to apply to be promoted anymore; when I was being easily hand-picked for any of the better roles as soon as they became available.

I arrived knowing; I had to start over again; as a newbie!  And I was more than prepared.

However, did I feel welcome?

Once the initial euphoria characterized by feelings of excitement, a sense of exhilaration and discovery, and a roller-coaster of emotions of a new country began to subside, I knew the honeymoon phase in this new country was over.  The reality had yet to begin.

The first reality I had to accept was that if I expected my co-workers, patients and families to accept me; without having to go through some unpleasant moments,  I had  to articulate in the same way as a native speaker and if the expectations were not met, perhaps my adaptation would never really be complete. Not to say, my color tone was a mis-match as well.  It was both funny and weird when a client actually in the middle of a conversation had the audacity to ask, “God made white people and he made black people.  Where the hell have you come from?”

Since then, I have learnt to read and take note of the cues of the environment, of the people around me; to get a clue on how serious my hospital is about diversity, and how my accent or color tone affected my clients.   Luckily for me, we are definitely a culturally diverse community here.  The workforce, the clients we cater for, the organization itself; screams of diversity.

However, among the diverse groups, there are still sub-groups; the major groups and the minor groups; and I often look for the minor cues that a social identity plays a significant role in organizing an event. They speak loudly even though they are not verbally expressed.

Being an outsider at work

Those were the initial days.  I knew neither the place nor any person who lived there.  Everything was new.  Feelings of being an outsider began creeping in the workplace.  At the time it meant not being accepted and recognized by peers as a valuable and contributing team member; however, now I realize, my peers were equally unaware of how to help me feel welcome.  I never spoke of my fears or uncertainty.  Encounters with perceived social exclusion from the dominant group and perceived pressure to conform to their social norms kept me stressed.

As time passed, I feared stagnation in the same role.  Having a fast turnover rate meant new openings kept coming up.  I began to see hope; only to be disappointed as I kept failing one interview over the other.  For a while I questioned my capabilities.  It felt as though my accent were hindering access to work promotion thus limiting my professional advancement making me feel even more of an outsider.

Loneliness and discrimination

Besides feeling lonely in the country with little or no friends or relatives, there was this untold feeling of loneliness in the workplace because of unfamiliar and uninteresting topics of conversation and being unable to participate in any mutual social activities.

Bullying in the workplace, contemporary forms of racism, whether subtle or unintentional mixed with micro aggression often hindered my progress towards my goals of adaptation.

Communication barriers

It’s not exactly the proficiency, but the different communication style (I still use the words and the spell them the way the British do) that hindered my initial formation of interpersonal relationships and adjusting to new environments.   Challenges in communication can make one feel devalued while totally destroying one’s personal and professional confidence.  Although, I managed to overcome most of the communication challenges at workplace; I continue being nervous and self-aware of my accent in un familiar crowds. Teamwork is of the utmost importance for preventing patient safety risks and effectively contributing in treatment plan meetings; and thankfully; by now I have managed to develop a shared vocabulary to facilitate adequate communication with the team

Work‐related stress

Some of the “shocking workplace realities” that I first experienced at the workplace where the electronic health records and the medication administration methods which were novel to me and contributed to my stress levels at work.  When I came into the country, I brought with me a multitude of complex skillsets such as de-escalation and crisis management, effective therapeutic communication and collaboration, managing multiple tasks simultaneous, and monitoring and evaluating complex situations.  Having worked in mental health all along, these skills came naturally to me.  In addition, my past experiences had given me enough exposure in strategy management and leadership, conflict resolution and performance evaluations, time management and so on.

 Over time, I realized that conformity is desired, rewarded and preserved with tenacity. Authenticity and zeal is viewed as a threat and attacked with a vengeance.   Stressors also came from some peers who perceived my adaptation struggles as incompetence rather than inexperience with a new system.

 Having said that; the expanded nursing roles and responsibilities, the different styles of documentation and the various work expectations came as a pleasant surprise though. . Nursing performance and skills are not universal, but linked to differences in culture and social norms.  

Adaptation Process begins:

“If you always put limits on everything you do, physical or anything else, it will spread into your work, and into your life. There are no limits. There are only plateaus, and you must go beyond them.” – Bruce Lee

I soon realized that blaming my host country or its culture on my survival or lack of it was not the answer.  The answer lied somewhere deep within me.  I had to make it happen.   I had to navigate through these differences in order to successfully function in the workplace and mainstream society. I decided to step up and learn the behaviors, attitudes, and skills of this country.   Emotional and psychological support from my church in the local community was the first step towards our cultural infiltration.

Furthering my Education:

To move forward from my fear of stagnation, I decided on pursuing further education.  I enrolled for my master’s in nursing leadership and administration and completed it in no time.    That helped get me a sense of fulfillment.  A further certification in mental health nursing seemed to seal the deal.  Furthering my education not just boosted my confidence, but also gave me a sense of purpose.

There was no looking back then on!

Finding Voluntary Opportunities:

I found myself a voluntary opportunity to teach catechism to fourth graders.  That was the best thing that has ever happened to me.  I loved every moment being with these kids.  Moreover, it brought me closer to their families and their culture.  I began feeling like one among them.  The ‘outsider’ feeling was slowly diminishing.   This also seemed to boost my morale at my workplace.  I was no longer self-conscious of my accent nor afraid to speak on the telephone.

Reaching Out:

I began the reaching out process.   I made it clear, I was willing to learn.  I spoke about my country and all the places that I had practiced in and about the differences in practice that I had noticed.  I spoke about my culture and was pleasantly surprised when people actually listened with interest. 

Opportunities explored in this land of opportunity!

The United States of America is indeed a land of opportunity!  But opportunity doesn’t just come to you.  You need to go out and explore; and work towards it!  Thus began my quest to turn challenges into opportunities, to explore new ways that gave immense job satisfaction in spite of adversity, to develop an insatiable desire for learning and execution of strategic plans for performance and career enhancement while applying proactive measures to adapt to workplace demands. 

I no longer looked for promotional opportunities.  Rather, I began working on bettering myself and my skills.   I identified problems in my workplace and tried applying strategical solutions to solve them.  I grabbed any and every learning opportunities that came my way.

No longer an outsider!

My perseverance and patience began paying off.  I am today no longer an outsider, but a contributing member of my team.  My team accepts me and respects and values my opinions and I respect and value theirs.   This year, I was nominated by my peers as “The nurse of the Year” on my unit.  I couldn’t be happier.

A Word for the Nurse Administrators:

Make a deliberate attempt to promote realistic images of nurses and increasing diversity in the workplace. Simple acts make a difference, such as sharing information with potential recruits about the successes of nurses to help those interested achieve confidence.

To enable your immigrant nurses develop effective communication skills, try implementing a carefully-designed communication course as an integral part of orientation.   This course should be designed not necessarily to learn Basic English; for they already have a working knowledge of English; rather to introduce them to the common idiomatic expressions, colloquial terms, jargon, and accents of native speakers. To decrease feelings of insecurity and to develop familiarity with the accents of native speakers, encourage these nurses to watch television shows, and listen to radio programs to gain familiarity with the words and pronunciations used.

Many of your foreign educated nurses may express difficulty in learning the pace, organizing their work, and trying to finish on time. They often are uncomfortable “handing over” unfinished nursing tasks to incoming shifts, get confused with unfamiliar medical terminologies, and become scared and overwhelmed by complicated medical equipment, use of technology, and amount of paperwork and documentation.  Assign them to culturally affluent mentors and modify their orientation to meet their individual needs.

Scope for further policy, practice and/or research

Increased stress and anxiety for immigrant nurses is dynamic, multidimensional and highly influenced by culture.

Better infiltration policies and standards need to be implemented to help nurses migrating from minority areas to ease their adaptation process. 

 Perceived resentment may be directed at the immigrant nurses from other nurses which may result in a range of bullying behavior’s which could be either intentional or un-intentional

 Interpersonal relationships among co-ethnic workers have benefits and drawbacks that may affect the work environment and colleagues.