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US RN ADAPTATION BY INTERNATIONAL RNUS RN adaptation for foreign trained RN demands much effort and hard work. As an international RN you learn to become an experienced US RN through nurse orientation and nursing skills lab. In addition, you will need committed personal self-development efforts to enable you adapt to your new nursing world. But some international RNs may need more than just CEs and the general clinical orientation for newly hired RNs. Some will even need extensive US RN adaptation programs to live up to the standard. This US RN adaptation training programs may be in the form of online education to help you learn and adjust to skills like lungs auscultation and other assessments, etc. Your unit may also require more adaptation and certification courses. Say, an ICU RN will need ACLS training and telemetry certification. Most units also arrange regular updates and in-service trainings on equipment and special procedures for their staff. Adaptation to US RN program is part of some RN agency's transitional and adjustment program for their employees. As you learn and practice to adapt to the US system, you will need handy reference materials like RN drug guide and pocket RN reference for quick consultations. Are there still some procedures that seem new and strange to you? Great and practical real nursing skills videos have helped lots of foreign RNs in the area of US RN adaptation and nursing skills. You can even get slightly used copies of these videos on the market. And if you are the smart and fancy RN, there are great software products for your PDA too. This soft ware comes in the form of RN drug reference, procedures manuals, nursing skills etc. It may take months to years for some international RNs to completely adjust and adapt to the US nursing program. This learning and familiarization period even continues after your clinical rotation. Practice-based US RN adaptation or clinical orientation is next. The number one and most priceless resources here are your co-workers;some colleague RNs are very supportive and understanding, especially those with whom you share similar RN training background or agency. Another method for RN adaptation training is giving yourself much more exposure as far as the US RN practice is concerned. You can achieve this in the form of using some of your off days for RN per diem, part time/adaptation jobs. There are lots of adaptation and nursing opportunities either within the same hospital or in another hospital. The unit or hospital policies and protocols are always different. Even the flow sheets and computer programs for charting are different. You still receive some orientation in whichever unit or hospital you do this adaptation program. That way, you learn and adapt to different and interesting policies. In some units for instance, no one pages the doctor except the charge nurse. You will also learn that in some hospitals you don’t need MD’s order to place an order for lab tests you deemed necessary. And there is this one too: using tubings that you don’t need a filter before giving TPN! Then the 'shocker': one of my RN friend's adjustments in a new hospital was to learn how to prepare TPN. The RNs received ingredients from pharmacy and prepared TPN in the medication room. Very intriguing huh! You will have to learn and adapt to all those nursing skills. A school of thought however recommends that whilst doing this part time and adaptation (even for your full time job), you get a personal liability insurance. Your employer may offer you RN liability insurance but that may not cover everything after all. And, remember to always adhere to your facility’s protocols and policies in your day-to-day RN practice and adaptation programs. Almost every legal case against an RN is treated in reference to your hospital’s policies & protocols. Another good and very supportive environment for adapting to US RN practice is the teaching hospitals. A lot of learning and self-development trainings programs are organized for both RNs and student nurses. But you got to be cautious here. In a typical American teaching hospital, you have so many residents (of all levels) coming from different parts of the world. They trained under different environments and so have varieties in their individual experiences. Some of them are also in their transitional training period. On few occasions, the residents do have mistakes in their orders. As a licensed RN, you must always ensure that you are receiving and implementing the appropriate order. You must assertively question any inappropriate order. And if possible go along the medical or nursing hierarchy to get a wrong order corrected. RN advocating for their patient is one important skill you will soon acquire during your adaptation. However, in the process of protecting your patients this way, please be conscious of the thin line between assertiveness and anger. US RN ADAPTATION AND FLOATING FOR THE FIRST TIME. The Registered nursing profession is one of the most stressful jobs. Even the fact that you don’t know the sort of patients you will be assigned any time you report for work is a big stress. The worse of it is floating. Floating is a common US RN practice in most American hospitals. You may therefore do adaptation in other units than your floor. As a licensed registered nurse, (no matter your specialization) you can be floated to almost every unit. Most hospitals start floating newly hired RNs six months after their orientation. And floating to unfamiliar units can be more stressful. How do you handle a situation like floating to unfamiliar units? First ask for orientation or adaptation, usually a day. But if you are still not comfortable, request for an additional orientation. And if your facility refuses this request, demand to complete a skills checklist for that unit. Having stated your weaknesses and what you can do confidently, go ahead and take your assignment if the charge nurse and supervisor still insist. This way, you are protecting yourself and your RN license. US RN ADAPTATION WITH LPN/LVN & CNA IN TEAM NURSING As part of your adaptation, you will need to prepare a mental checklist about your team members. Few of the CNAs can be very helpful and will contribute greatly to your assessments, and even be able to identify potentially dangerous situations. They will even teach you so much during your adaptation and orientation. You learn basic skills like how to operate the dinamap, do bed weighing etc from them. Others cannot even make out abnormalities in the vital signs, or even if they do, they just don’t care and will not alert you. Please know who you are working with and make room to regularly check on him/her. You are responsible and answerable to every aspect of your patient’s care. In fact, there have been incidences like confused patients walking out of the facility or jumping out of the window whilst a CNA was sitting the patient. US RN adaptation also demand learning and mastering the practice of RN/LPN team nursing. You work with the LPNs (LPN/LVN are known as enrolled nurses in other countries), and you are the team leader. The beginning of this adaptation is usually stressful but with time, you get used to it. Some times student nurses are part of your team. Different hospitals practice different type of team nursing. In some hospitals, you and the LPN have all your patients together as one assignment, and you do assessments, develop plan of care and do charting. You will also pass all IV medications. Other facilities share the LPN’s patients among the RNs. Thus, each RN does the assessment and IV medication etc for at least one of the LPN’s patients. And the LPN also does the oral medications of one patient for each of those RNs. Part of your RN job description is team leading. And so you got to learn, adjust and master this skill. Another hospital will prefer to let the LPN and charge nurse form the relief team. They do all the accu-checks and blood draws etc, and also relief RNs for lunch break. Each hospital has its own style and trend as per the nursing policies and protocols. And thus, US RN adaptation for international RNs or nurse orientation varies from facility to facility.
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