MY RN ORIENTATION AND US RN CHALLENGE STORY

All too soon, I was set to take up the US RN challenge, and RN orientation. I was excited, but, again, somewhat apprehensive.

I arrived in Oakland, CA, on January 8, 2007 and met other international registered nurses recruited by the same agency. We were 8 in the group; and made up of Indian RNs, UK RNs and Filipino RNs. I was the only African RN.

The next morning, we were set to begin a 12hr assignment for the day. We started off from our hotel to the Realtor’s office, where we picked up keys to our apartments. And quickly, we all signed up for the utility services over the phone.

We moved down town to follow up on our social security numbers and also did the drug screen tests. We then returned to the meet-and-greet’s office where we did a bunch of paper work. We ended the day with some shopping.

The following day was for BLS training and certification, and we ended the week with a luncheon with the nursing executives of the assigned hospital on Friday.

The weekend was for a relaxation trip to beautiful sites in San Francisco. We visited the golden bridge, sea lions etc. A welcoming start for US life, and I loved it!

As a novice in the group in terms of travels and cultural exposure, I felt terribly out of place, I could hardly make any meaningful contributions as the group chatted away. I could barely understand anything as the chunk of the conversation was in slangs.

After the weekend's relaxation, we began the general new hire and RN orientation on Monday. And as the orientation gradually traveled towards nursing skills lab, the number of orientees started dwindling to RNs only.

I started realizing my deficiencies in Western nursing as the sessions of the skills lab rolled by. A lot was different and new to me. Even some of the IV restarting kits and tubing came in brands that I could not just pick one and work my way through without assistance.

I started to feel the heat of my US RN challenge; and as we moved toward the group’s discussions and assignments, my anxiety started building up. The RN orientation/Registered nursing skills lab lasted for two days.

Apparently, I could vividly recall when most of those skills were taught and read back in college. Of course, all the books for my registered nursing program and even some of the instructors were from the West. That was more than 6years ago.

However, coming from a developing country like mine, only few of those skills were practiced. The rest had certainly atrophied. I was no better than a US RN who had stopped practicing for 5years. Then it came to my turn to demonstrate how to operate the feeding and pca pumps.You could definitely guess my performance. Embarrassment and failure began to eat me up.

The following week was the beginning of my scheduled 4weeks orientation in an acute medical surgical unit. After that I was supposed to take care of 5 patients as a Californian RN.

I arrived early on the day of my clinical med/surg. RN orientation and reported at the manager’s office. She took me round the floor and introduced my preceptor to me.

By the end of week one of my orientation, I thought I was doing ok at least on familiarization and adaptation to the setting and equipment.

Contrary to my own expectations as coming on well with the orientation, my manager summoned me and my preceptor to her office at the start of week 2 and to my dismay, her appraisal indicated that I was performing far below average. I felt completely deflated.

Of course, all that this hospital wanted was a great output in return for the hard cash they were paying to my agency, and nothing less. My background as RN from a developing country was no excuse. The manager then went ahead and spelled out the consequences for my present abysmal performance.

I became confused, shattered and disappointed. I thought four weeks was certainly not enough for an RN of my background to overcome this technological shock.

Back in my home country I have never touched or used feeding pump, pca pump, pyxis or omnicel. The entire system and even the organizational structure were completely strange and new to me.

The following week, information about the appraisal meeting was all over the department. I became the object of scorn and mockery. It was an awful experience and I felt abused.

I reported this insecurity and the non-confidentiality to my employers. My manager denied spreading details of our meeting to other workers. I told my clinical assignment manager about the embarrassment and requested a change of unit. But this was not granted.

Then other problems followed, including questioning the authenticity of my educational background.

My preceptor restrained me from passing medications due to an alleged medication error on a medication a preceptor witnessed its removal from the pyxis.

I became despondent and felt as if warm oil had replaced the blood in my veins. I went to work each morning dreading the next humiliation, I felt hot and burning sensation inside me. I was always nervous as I had no idea of what the next embarrassment would be. I had no appetite any more. My only food was candy. I spoke in a shaky voice, and was fast loosing focus.

“Cheer up Cyril; where is your enthusiasm?” My charge-nurse asked.

My mind became crowded with deep and distant thoughts, and made me hit my car against a concrete garage pole. I had to park this car and use bus to work. It was not safe for me to drive anymore.

My agency continued to remain in touch and supportive via the clinical assignment manager. I continued to suffer these insults for weeks until one morning when the good news came that my assignment with this hospital had been terminated.

I was however suppose to continue going to work until the end of that month by which time a new hospital would have been arranged for me. However, this new arrangement of me working until the end of the month was short-lived because the maltreatment never ceased.

Then I became unemployed for two weeks. I quickly used that period to get ACLS certified. I later passed a placement interview, and had a new RN job offer.

Then it was time for me to embark on my first 266 miles journey by road to my new hospital assignment. I quickly bought a Garmin GPS to help my bearing.

I reported at this new facility on a Monday morning to start my med/surg. RN orientation. And the reception here was great. Fellow workers were friendly and cared about one another.

Incidentally, the hospital was a teaching hospital with lots of learners with different cultural backgrounds and interesting accents.

There were many international RNs, Medical students, nursing students, residents and paramedic students everywhere. The hospital was literally a classroom and a good starter for foreign educated nurses with no western experience.

Normal RN orientation period for foreign educated RNs and new grads was 12 weeks. I quickly reassessed myself and identified those weaknesses I needed to work extra hard on. I quickly mastered the operation of the various pumps and other equipment.

I also worked on my communication, accent and documentation. Before end of week 8 of my med/surg. RN orientation, I was OKed to be on my own.

I still thought I had to do more. There were many advance nursing procedures I never had the chance to practice or observed during the RN orientation!

Thus, I needed to invest in self development. I purchased a couple of skills lab videos and reviewed advance and unfamiliar nursing skills. I also needed a good grasp for the American pharmacology. I purchased a PDA and got it loaded with software on pharmacology and nursing handbooks.

Within 6 months I was OKed to float to DOU (direct observation unit), an ICU step down. Then floating to other units became a routine. I still learn and always try to stand the test of the US RN challenge.

That was how I survived my US RN orientation from a third world medical/surgical RN to a US RN.

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