Starting your nursing career in America sounds promising, with its competitive salaries and opportunities for growth. But for many global nurses, adjusting to the American healthcare system means facing social isolation, language barriers, and cultural confusion. 

Whether you’re a new nurse in a US facility or preparing for the transition, we’ve got you covered. We’ll explore culture shock, what to expect in a US healthcare setting, and practical tips for moving to a new country. 

Understanding Global Nurses’ Migration

Many nurses worldwide are drawn to opportunities in America’s healthcare system despite the challenges they may face. The nursing profession is currently grappling with a crisis marked by stress, burnout, and a significant shortage of registered nurses. In fact, the National Council of State Boards of Nursing anticipates 610,388 nurses intending to leave by 2027.1 

Given the ongoing challenges in the nursing profession, combined with the historically prevalent practice of the USA outsourcing its nurses, the current situation presents an attractive opportunity for nurses worldwide seeking new career paths. However, nurses tend to forget a crucial factor: culture shock. 

Culture shock refers to people’s uneasy, perplexed, and disoriented sensations when placed in a foreign and unfamiliar cultural setting. People often experience this phenomenon when they encounter social behaviors, norms, beliefs, and practices that are very different from their culture. 

When entering a new healthcare environment, it’s common to experience symptoms of culture shock, including: 

  • Feelings of homesickness and loneliness 
  • Challenges navigating language barriers, which may cause you to feel inadequate 
  • Discomfort adjusting to less formal patient interactions 
  • Confusion stemming from differences in healthcare hierarchies 
  • Physical exhaustion resulting from the stress of adaptation 

These could manifest in several ways: 

Hierarchical vs Collaborative Leadership 

In many countries, healthcare systems operate under hierarchical leadership structures, where directives are strictly followed without question. However, American hospitals prioritize collaborative leadership, encouraging input from all team members regardless of rank. This shift can lead to confusion and discomfort for nurses accustomed to more rigid hierarchies. 

Communication Styles 

Variations in communication styles can also contribute to culture clash. For example, in some cultures, indirect communication is preferred, while Americans tend to value direct and assertive communication. This disparity can result in misunderstandings and frustration among healthcare teams. 

Read More: 6 Top Challenges Faced by Global Nurses Moving to the US And How to Address Them 

8 Strategies to Avoid Culture Shock

Moving away is never easy. Here are several tips on what you could expect and how to adjust to your new life. 

1. Expect Diversity 

The patient population served by US healthcare facilities is diverse, encompassing a range of ethnicities, cultures, languages, and socioeconomic origins. Global nurses should be ready to communicate effectively with patients from a variety of backgrounds and to respect individual preferences and cultural variations. 

On top of this, international nurses will also encounter various racial backgrounds among their colleagues. According to the American Association of Colleges of Nursing, the diverse representation in nursing are as follows:2 

  • 80.6% White/Caucasian 
  • 6.7% African American 
  • 7.2% Asian 
  • 5.6% Hispanic 
  • 0.5% American Indian/Alaskan Native 
  • 0.4 Native Hawaiian/Pacific Islander 
  • 2.1% two or more races 
  • 2.5% other nurses 

Thus, understanding and embracing the diversity of patients and colleagues is essential to provide culturally competent care and foster inclusive healthcare environments. 

Related Article: United in Healthcare: Why Diversity is a Key Component of Compassionate Care 

2. Adapt to Patient-Centered Care 

Patient-centered care, which considers the holistic needs of patients alongside their medical requirements, is highly valued in US healthcare. Global nurses are encouraged to engage actively in patient education. So, involve patients in decision-making processes and prioritize their comfort and well-being. 

For instance, a patient expresses uncertainty about their treatment plan. As a global nurse, take the time to listen to their concerns, explain the plan in clear terms, and involve them in decision-making. 

You could say: “Mrs. Garcia, I understand you may feel unsure about your treatment. Let’s discuss it together, and I’ll explain everything step by step. Your input is valuable, and we’ll make decisions together that best meet your needs and preferences.” 

3. Stay Updated on Best Practices 

Staying updated on best practices is crucial for global nurses to maintain high standards of care delivery. By continuously seeking new knowledge and incorporating advancements in healthcare and research into their clinical practice, nurses can ensure they provide the most effective and advanced care possible.  

This commitment to ongoing learning not only enhances patient outcomes but also fosters professional growth and ensures nurses remain well-equipped to address the evolving healthcare needs of their patients and communities 

4. Collaborate Cross-Functionally

In the US healthcare system, teamwork with doctors, nurses, therapists, and others is crucial. For international nurses, working closely with these professionals not only ensures good patient care but also helps them adjust to American ways. By collaborating and communicating well, nurses can learn from their colleagues and feel more at home in their new workplace. 

For example, you may coordinate care for a patient who requires input from doctors, nurses, and therapists. Working closely with your colleagues and actively participating in discussions allows you to contribute to creating a care plan tailored to meet the patient’s needs.  

Through this collaborative process, you’ll provide better care and learn from your colleagues and adapt to the healthcare system more smoothly. 

5. Learn Systems 

Keeping accurate patient records and tracking treatment plans is crucial. Global nurses must be comfortable using electronic health record (EHR) systems and following documentation rules. This helps protect patient privacy and makes sure care is consistent. You can cope with culture shock related to documentation and technology by taking the following steps: 

  • Training and Education: Seek training sessions or courses on electronic health record (EHR) systems and documentation protocols. Many healthcare facilities offer orientation programs for new nurses, including those from diverse backgrounds. 
  • Shadowing and Mentorship: Request opportunities to shadow experienced nurses or mentors who are proficient in using EHR systems. Observing their workflow and asking questions can help you familiarize yourself with the technology and documentation practices. 
  • Self-Study and Practice: Dedicate time outside of work to familiarize yourself with EHR systems and documentation procedures. Practice entering mock patient data or documenting hypothetical scenarios to build confidence and proficiency. 
  • Ask for Support: Don’t hesitate to reach out to colleagues or supervisors for assistance or clarification when navigating EHR systems or documentation requirements. Most healthcare teams are supportive and understanding of the challenges faced by new nurses, especially those adjusting to a new cultural and professional environment. 
  • Stay Positive and Patient: Recognize that adapting to new technology and documentation practices takes time. Be patient with yourself and celebrate small victories along the way. Remember that every challenge you overcome is an opportunity for growth and learning. 

6. Connect and Immerse 

Building a support network is vital for foreign-born nurses facing culture shock. Nurses can find comfort, guidance, and a sense of belonging by forging relationships with coworkers, fellow immigrants, and local organizations.  

Joining professional societies and attending networking events provides opportunities for professional growth and cultural integration, helping to alleviate feelings of isolation and disorientation associated with culture shock. 

Additionally, immersing yourself in the new community and culture is essential for developing cultural competency and understanding. Engaging in cross-cultural exchanges, attending cultural events, and participating in community activities can broaden perspectives and expose nurses to new ways of thinking and living.  

This fosters a deeper appreciation and acceptance of cultural differences, reducing feelings of loneliness and alienation often experienced during periods of cultural adjustment. Welcoming new experiences with curiosity and an open mind facilitates cultural adaptation and enhances the sense of belonging, ultimately easing the adjustment stage into a new cultural environment. 

7. Enhance Communication Skills 

Communication skills are vital for effective integration into any new environment, including the healthcare setting. This applies to all nurses, regardless of their background.  

For those who might be operating in a language different from their native tongue, ongoing language development can be particularly beneficial. Engaging in formal education, language exchange programs, or immersion experiences are valuable opportunities to improve fluency and cultural understanding. 

8. Practice Self-Care 

Prioritizing self-care is crucial for immigrant nurses navigating culture shock to maintain their physical, emotional, and mental health. Additionally, engaging in stress-relieving activities such as hobbies, exercise, and meditation can help alleviate burnout and anxiety.  

Setting reasonable expectations, defining boundaries, and seeking professional support when needed are essential components of self-care for immigrant nurses adjusting to cultural shifts. 

Read More: World Mental Health Day 2023: 7 Coping Strategies for the Nurse Burnout Syndrome 


Worried about culture shock? PRS Global provides comprehensive support to help you overcome the challenges of adapting to a new culture. From cultural orientation programs to ongoing assistance, we’ll be with you every step of the way until you feel prepared. Contact us today to learn more about how we can help you. 


1 Martin, Brendan, et al. “Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses.” Journal of Nursing Regulation, vol. 14, no. 1, 2023, pp. 4-12. PubMed, doi:10.1016/S2155-8256(23)00063-7. Accessed 5 Apr. 2023. 

2 “Fact Sheet: Enhancing Diversity in the Nursing Workforce.” American Association of Colleges of Nursing, Accessed 26 Jan. 2024.