Healthcare workforce conversations are refocusing beyond staffing levels to experience design.
As retirements accelerate, new graduate hiring remains strong, and preceptor capacity tightens, the question is no longer how many nurses—but how teams are built.
In this upcoming PRS Global webinar, we'll hear from three voices at the heart of this work:
• Kara Murphy, President, PRS Global (Moderator)
• Amanda S. , Chief Nursing Officer, LifeBridge Health Sinai Hospital and Grace Medical Center — System Design
• Megan Schwartz, Nurse Manager, Sinai Hospital Medical Center — Unit Execution
• Grace Valle, Registered Nurse, Sinai Hospital Medical Center — Nurse Integration
This conversation is structured through three critical lenses:
• System Design — How workforce strategy is built for long-term clinical stability
• Unit Execution — How skill mix and team cohesion are operationalized on the floor
• Nurse Integration — How experienced internationally educated nurses (IENs) transition, lead, and shape team culture
We’ll explore what happens when international hiring becomes part of a broader team strategy and how successful integration can drive stability, retention, and preceptor capacity.
We’ll cover:
• How experience mix is reshaping workforce strategy in 2026
• How to rethink orientation for IENs by bridging experience with new systems and equipment.
• How to translate hospital strategy into daily practice on the unit
• How integration and growth opportunities drive long-term retention
• For healthcare leaders, this is a critical shift from filling roles to building resilient nursing teams.
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Kara Murphy: Well, hello
everyone, and thank you for
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joining. I am super excited
about this webinar. We have
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three different perspectives,
and I'll share with you a little
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background. So in January, I had
the honor to join our team at
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the airport to welcome three of
Sinai, Sinai's nurses, and I
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have to say, there's something
really special about watching
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nurses and their families arrive
for the first time. And if
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you've been to Baltimore in
January, it's even more exciting
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to take them outside and see the
snow and the cold and all of
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that. But then I was also with
them for their first day, first
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time they went to Sinai
Hospital. And the welcome there
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was pretty spectacular. So Sinai
has their different leaders and
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managers. Welcome these nurses
with a sign. But I just loved
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the time that they took to say
hello. How was the journey you
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are welcome here. And so Amanda
and I talked and gosh, to be
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able to capture what integration
looks like for international
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nurses and why that is so
important is exactly why we're
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here today to talk through how
are thoughtful leaders looking
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at international integration
into their teams. And so I'm
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going to have them introduce
themselves. I have Amanda here,
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and I'll have you start. And if
she looks super familiar, it
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it's because she's on the Becker
CNOs to know for 2025 so super
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excited to have you here,
Amanda. Go ahead and introduce
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Amanda Shrout: Yeah, thanks,
Cara. I really appreciate you
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welcoming me and my team today.
We're very happy to be here and
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talk all things In ternational.
Nurses. I'm Amanda shroud. I am
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the chief nursing officer at
Sinai Hospital and Grace Medical
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Center in Baltimore, Maryland.
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Kara Murphy: Thank you, Amanda
and Megan. I you know, to to
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have a manager here to say,
okay, that's what it looks like.
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Big picture, but here's what it
looks like on my unit. Is really
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important. So go ahead and
introduce yourself.
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Megan Schwartz: Yeah, great. So
my name is Megan Schwartz. I've
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been with Sinai Hospital for the
last 15 years. For the last six
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years, I've been the nurse
manager of b6 which is a Medical
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Surgical Unit here at Sinai, we
specialize in oncology and also
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gynoc surgical cases.
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Kara Murphy: Great. Thank you.
Megan and grace is a nurse who
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arrived almost three years ago.
And Grace, I'm so thrilled to
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have you here to share your
perspective and your experience.
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Go ahead and introduce yourself.
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Grace: Yeah, sure. Thank you
Miss Cara for having me here.
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It's my pleasure. It's my and my
honor. So my name is Grace
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Valley. I'm one of the
International nurses from PRs
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global, of course, and I
practicing here in Sinai
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Hospital of Baltimore for almost
three years this coming August.
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Yeah, that's great. Well,
welcome all of you. So, Amanda,
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maybe we can just start big
picture. And I'd love to hear
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from you on how does Sinai, how
does life bridge, look at
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international from a big
picture? Yeah, so let's start
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there.
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Amanda Shrout: Yeah. So
international nurse recruitment
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is part of our strategy. We have
a long history of recruiting
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international nurses to be part
of our organization, and really
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it's embedded in our fabric of
being a place where we value
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diversity. And over the last
three years, we have partnered
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and really brought in many
nurses from lots of different
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countries, maybe a little bit
longer than three years this
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most recent stint. But, you
know, I've been in this role for
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about a year and a half now, and
we continue to project out how
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many international nurses we're
going to bring in the coming
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years. So we have a very robust
recruitment strategy. Obviously,
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retention comes along with that,
and we have lots of focus on
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retaining our team members as
well, but understanding really
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the, you know, that cycle of
hiring and you know, nurses, we
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recognize that recruiting
internationally is a is a big
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component for us. So we project
really how many nurses we like
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to bring each fiscal year, and
then we engage in interviews
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with the PRS team to ensure that
those nurses are the right
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nurses for our culture and our
units that need them. And then
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we partner that with a large
domestic, you know, recruitment,
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lots of internet or lots of
domestic recruitment activities.
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I'm not going to get the words
out, so we just had an internal
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recruitment fair yesterday where
we had over 70 clinicians come
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and join us. And so we're still,
you know, we're partnering the
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domestic recruitment with
international recruitment. And
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really, we know they're not
coming for a period of time. So
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international nurse recruiting
is not a short term strategy. It
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is a play for long term
stability, and that's really how
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we use it.
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Kara Murphy: Yeah, that's great.
And I love that you share. There
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are so many things you are all
doing. I mean, we could have
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several different episodes of
this for all of that
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international is just one piece
of the stability and Amanda. One
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thing I get asked all the time
from organizations who are just
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starting is like, how do you
communicate this at the
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different levels, to your board,
to other leaders, to the units?
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How does that
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Amanda Shrout: Yeah, so we had a
board meeting recently, and we
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talk about recruitment and
retention at every board
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meeting. I mean, everybody's
hospital board is invested in a
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stabilized workforce. And you
know, lots of questions from our
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board about is this still, you
know, the right strategy coming
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out of covid? We've seen a lot
of stabilization of the
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workforce, which we're all happy
about, right? Like we all want
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to have more consistent nurses
in our organization. So that's
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really positive, but really, you
know, with a lot of challenges
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with immigration, you know, our
board asks good questions, and
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we really talk to them about the
partnership with PRs, about, you
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know, really the long term play
here, it is not a short stable,
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you know, a stabilizing measure.
If you need short stabilizing
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measures, you've got to do
something else. You can onboard
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some experienced nurses, if you
can find them. But that's not,
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you know, that's not really the
answer. And so we talk openly
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about the strategy with our
board, both the international
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strategy and the domestic
strategy, and then, really with
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our nursing staff, we focus on
the importance of bringing
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experience to the bedside. One
of the things that we really see
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with international nurses is
that not only are they bringing
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years of service and years of
experience in nursing, they're
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also bringing a lot of different
perspectives from many other
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countries around the world, and
really bring that both to our
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patient population, but to each
other. And they're amazing
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teammates. I mean, I we watch
nurses who have been in, you
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know, 10 different countries or
different units around the
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world, and they know how to be
great teammates, and so that's
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something that is really
impactful. And I think that
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brings a role model experience
to our team, especially our new
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grads, who really need that.
They need that opportunity to
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see what it means to be a good
teammate and how to do that. And
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I think that's part of what our
international nurses bring, they
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also bring a lot of experience.
So they've had leadership
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positions before. They've run
charge in large units. They are
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preceptors and mentors, and that
that experience is part of also
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what we talk about, really
capitalizing on all of the
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things they bring, not just the
clinical components.
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Kara Murphy: Yeah, I love that.
And it sounds like you're very
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strategic with sharing, with the
board and different levels on on
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the strategy and how this plays
a part. And it is definitely not
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the short term, but it is a way
to bring stability long term. So
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Megan, you know, you see this on
the unit every day, and I'm sure
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you know what the strategy is
and the different parts. So how
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does that look on the units? And
how do you look at staffing,
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maybe differently with that
strategy? Yeah, that's
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Megan Schwartz: a great
question. So regardless if it's
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international nurses or if it's
our domestic nurses, that's
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something as a unit leader, you
take that the staff retention
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and the support on the unit when
it comes to making staffing
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decisions or making unit
assignments, that's very
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important. So with doing so, we
want to ensure that we're very
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intentional when it comes to
staffing. Do we have enough
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skill mix? Do we have enough
experienced nurses, with our
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novice nurses, are there enough
nurses that have a particular
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skill set to ensure that we have
enough staff to provide care to
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all types of patients? So that's
very intentional, not only from
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a safe skill level, but also
from a supportive level. We want
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to ensure that if you're a new
nurse on the unit, regardless if
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you have you know, years of
experience or just new
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experience, or just new
experience. We want to ensure
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that you have team members that
you can reach out to. So that's
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one piece of it. The other piece
is when we're making
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assignments, it's not just based
on geographical like locations,
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like are all the rooms grouped
together on the units, but we're
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looking at the acuity of it to
ensure that these that the nurse
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has the skill set to care for
those patients acuity, and also
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just to spread out the acuity as
well. And then another piece is
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to ensure that we have support
on the unit, whether it charge
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nurse who has who doesn't have
an assignment or or who has a
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lesser assignment. We want to
show that they're available,
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that they're visible, and
they're proactively rounding
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with the staff, regardless if
it's an international.
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International nurse or a
domestic nurse, and then, in
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addition to that, leadership, so
leadership here at Sinai,
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especially, one of my main skill
sets is that I'm very hands on,
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very visible, along with many
other leaders here at Sinai, we
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are on the floor constantly.
We're running on the staff,
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especially our new staff, who
you know a lot of times are in
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international nurses, and
providing that real time
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coaching as well. And then we've
also have a buddy system here
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too, which we found to be very
successful, to ensure that all
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of our nurses are able to get
consistent breaks so they'll
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able to coordinate break times
with their buddy. And then also,
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if a staff or a patient has a
request, but the primary nurse
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is tied up, they can always then
reach out to the buddy or the
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charge nurse to help with that
patient needs. So these are all
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just just examples of common
tactics that we do, not only on
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with our international nurses,
but with all nurses here at
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Sinai.
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Kara Murphy: Yep, that's great.
So you really take the
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organization strategy and take
it to the unit level. And thanks
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for giving us some examples on
how that works. So Grace. I
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would love to bring you in at
this at this time for healthcare
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leaders who are listening, you
know What? What? What did you
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bring? What did international
nurses bring with their
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experience that you want to
share and you want leaders to
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know? Oh, based
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Grace: on my experience, I've
been nursing for about total of
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19 years now. So prior coming
here United States, I have my 17
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years of my experience in Middle
East. So it's so different, very
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far different from here to
there. So as an international
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nurses, I could say that we have
a earn experience from our
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previous organizations, and then
we have shaped our high equity
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of care. And most mostly is we
are very committed. Not only
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committed, we have a long term
commission commitment to our
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organization, and that's our
international nurses.
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Kara Murphy: Is, yeah, that's
great. Thank you for sharing,
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kind of from your perspective,
what what that looks like. And
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you know, with international
recruitment is just the very
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beginning, and the real success
comes from the integration, and
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that starts at the beginning. So
I'd love to dive into kind of
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what is that? What does that
look like at the beginning?
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Grace, let's start with you. I
can imagine coming to the United
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States the first time, starting
at a new organization. There's a
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lot going on. Maybe, maybe take
us back to what is it like when
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you first arrive to Baltimore,
almost three years ago?
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Grace: Oh, they will have a
troll back now. So the first
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part, first part, of course, I
gave me I'm not for my in my
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side, I came not on the Middle
East. So I travel a long
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journey. I takes me at 24 hours
in air to and to landed here. I
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think we landed in Washington,
and then so when I landed, we
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are three, three PRs babies that
to come here and say, with
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Sinai, of course, same hospital,
and we are from different
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countries. I came from Middle
East, the other one from the
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Philippines, the other one is, I
think, in United Kingdom, so and
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we have to meet each other. But
prior for that, I'm very
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thankful that we have a Facebook
group that we talk and we learn
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each other and so, oh, you're
when is your when is your
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flight? So all we have the same
flight. So we we talk to each
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other. And then finally, we have
a plan prior coming here and
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then, but if that's so, we have
still, I'm so anxious that time
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because, okay, I'm landed to a
different country and how I'm
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supposed to do and so when I see
the the banner, oh, it's a big
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relief. And oh, my god, thanks.
God, I see my name on that
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banner, Grace, welcome. Grace,
value and PRs global. So is this
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a big relief for me? Okay? And
then we landed, we meet each
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other. And then after that, one
of the PRS team assigned to us
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pick up in the airport, directed
our four star, very comfortable
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hotel. I think there's already
11pm in the night, so we're very
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exhausted. And then she said
that, oh, the following day, you
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have, we have to wake up early,
but in your side, you came very
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late, so I'll just take that at
11pm that's our call for going
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to the target to make sure
everything is, you know, packed
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up, and everything we need is we
make sure that we have it
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around, okay, and then when we
go back to target, the. Then we
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have plenty of time to pick up
what we need, of course, and
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then they gave us a very
exciting and until now, I have
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it the the rice cooker that feed
from here, because we're
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Filipino, we love Rice right?
All of us have a rice cooker.
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And then from then on, the next
day, we still came back to our
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hotel, and the following day we
make sure, and they make sure
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that we are endorsed properly to
our place to live in. That is a
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very, very special and we feel,
felt that we're safe. Oh, this
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is your place. This is your
apartment. And they didn't left
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us behind that you just throw
back, no, we make sure that even
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step inside to our doorstep, the
PRS staff is still there with
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us. So yeah, and here we are
again. Oh, there's a long story,
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more and more story, but I think
the most precious one, and they,
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I feel with it, even the they
will talk about the school of
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our kids, yeah, the nearest
groceries in town. So every
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everything is just okay, you're
good. So everything is we feel
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home in this 48 hours, or hours
staying and with the with the
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hell the stuff of the PRS, yeah,
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Kara Murphy: well grace, thank
you for that. I'm going to go
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back and share with the team too
about why that matters. But for
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our team, being there and
supporting you is like our
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favorite thing that we do, and
we think it's really important
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to make sure that you and
families get settled in. So it's
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something that we won't change.
And I would share just for
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organizations. If you don't have
that service level, someone
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needs to do it, because how
important was that for you grace
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to have that support at the
beginning? Yeah. Well, thank you
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for sharing that. And Megan, you
know I loved how you were there
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for the welcome the last time I
was there. But I can imagine,
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even at the unit level. What
does that look like when you
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have an international nurse just
starting? And how do you look at
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the welcome and making sure that
they feel like they're part of
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the team, since this is direct
hire and and they're joining
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your team?
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Megan Schwartz: Yeah, we
recognize that that's that's
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critical. We want to ensure that
our international nurses, in
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addition to other nurses as
well, feel welcome to the units.
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We recognize that it's very
scary for international nurses.
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I mean, they don't know anyone
here. They left their friends
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and family back home, and many
come alone without family, so we
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want to ensure that they feel
right away, that they feel
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welcome to on the unit. So even
before, you know, even before
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they actually come to Sinai. We
have their email address. We
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connect with them. Just say, you
know, welcome them to the unit,
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introduce them to leadership.
And then upon hire, when they're
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here for their onboarding
apartment, with our appointment
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with HR and OC health, the
leaders will actually go down
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and meet the international
nurses, and we'll take a picture
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together, and we'll hold up a
sign that says, Welcome to
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Sinai. You know, we love our
international nurses. And then
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we take them, we bring them to
the unit and give them a tour of
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the unit, in addition to
introducing them with all staff.
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And then moving forward, we'll
introduce them for the first
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week or so, we'll introduce them
during shift huddles, so that
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way you know both shifts can see
and enter and meet the new
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employee. And then we also
introduce them in staff meetings
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as well.
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Kara Murphy: So you make sure
they know everyone, and they
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feel like they are absolutely
yeah, we
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Megan Schwartz: want them to be
able to feel like they can go to
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anyone to ask questions or for
help, not just their precept or
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other leaders, but any of their
peers on the unit.
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Kara Murphy: I love that and
grace, you know, I know it's
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been almost three years, but
going back to that moment when
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you first came on and you
started the orientation and the
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welcome, you know, was there any
small things or big things, or
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what? What made you feel a sense
of belonging and that you were
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part of that.
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Grace: Team leaders are very
visible, yeah, and they're very
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hands on. So when we have, when
my first day here in Sinai, we
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have an orientation leave off,
and we met from the president of
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the Sinai to the lower, I could
not say lower part of the family
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of Sinai introduced themselves
for us, and that's a big impact
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to us, because, oh, wow, the
president of Sinai is just here
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for us to introduce themselves,
and we're just and just to let
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them to know that. And and even
Miss Amy is a president. She is
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so feasible and very welcome.
Even she's having a caring card
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every weekend with us. I love
her, yeah, we all love her. We
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do Yeah, we love her. And so we
have this Sinai also, one on one
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specific. For international
nurses, and it's very helpful
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for us for this one, because in
this, in regards with the
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equipments, we have a different
kind of equipments in
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Philippines and Middle East. But
specifically here in Sinai, we
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have some equipments, or some
kind of procedures or protocols
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that talks about in the Sinai
101, specifically to to the
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international nurses, you will
never left behind here, because
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everything they touch and
whatever you need is in there,
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is almost there.
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Kara Murphy: Yeah, yeah, that.
That's great. So you felt a
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sense of belonging and a
welcome, just with all the
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different love, like everybody
being available, that's great.
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And Amanda, you know, I'll say
one thing that I always notice
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at hospitals, right, is the
leadership. It when you can have
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the same type of caring heart
leadership at every level.
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That's when you really make a
difference, and you and you and
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Amy are a fantastic team.
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Amanda Shrout: We joke that we
share a brain sometimes because
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the same thing, but I think, you
know, we both are deeply
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committed to stabilizing our
workforce and really being able
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to build a strong workforce, and
we've done a lot of
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stabilization over the last two
years. A lot of that is credit
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to international nurses we've
brought into key areas, and the
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strategy around that, we've
bolstered our emergency
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department, our neuroscience
unit, and we're continuing to
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recruit and I think that's very
impactful. I think the other
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piece that you know can't go
unsaid is how important
341
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listening sessions are with team
members, both domestic and
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international. But one of the
pieces that we really heard
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early on from many of our
international nurses were just
344
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about, you know, that FaceTime
and being able to ask questions,
345
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and not always questions about
work, but questions about the
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schools or transportation
options, or, you know, being
347
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flexible with their schedules,
because all of those things
348
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impact all of our lives. Like I
have a six year old, his
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kindergarten schedule impacts my
ability of being at work on, you
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know, at certain times. And
that's true for every nurse.
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Like we all have different
things in our lives, and so it
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became really important to us
that we open more listening
353
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sessions. And so we are now
doing listening sessions at 90
354
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days of employment. So we're
meeting all of our international
355
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and domestic hires across the
organization, not just nursing,
356
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within the first 90 days, we're
connecting back to them, as
357
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Grace said, they meet us at new
employee orientation. We
358
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introduce ourselves, we let them
know that we host listening
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sessions, and then, you know, we
follow up over and over again.
360
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So you see us rounding on units.
You see us bringing the caring
361
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cart. They also see us doing
patient rounding and validating
362
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that our patients are receiving
the highest level of care. And
363
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so I think it's that visibility
that creates the connection, and
364
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that connection is what, you
know, builds that trust and that
365
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teamwork, and also, you know,
the loyalty. And I think that's
366
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something that we've seen over
time.
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Kara Murphy: Yeah, share with
us. You know your your
368
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connection and all that you're
doing there. I do want to know
369
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that you actually start this
communication prior to them even
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arriving. And over the last
about 18 months to two years,
371
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we've seen more organizations
doing a monthly town hall to be
372
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able to connect with the nurses,
maybe go over some of the
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equipment, but it's a way to
create a sense of belonging
374
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prior to them even arriving. So
Amanda, maybe you can share a
375
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little bit about the town hall
that you guys are doing.
376
00:23:53,380 --> 00:23:56,740
Amanda Shrout: Yeah, we noticed
there was an option to really
377
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start introducing our
organization to our
378
00:23:58,780 --> 00:24:01,740
international nurses while
they're waiting to come. So that
379
00:24:01,740 --> 00:24:05,400
time period between, we've
interviewed, you've accepted our
380
00:24:05,400 --> 00:24:09,180
offer, and now we're waiting for
your priority date, or we're
381
00:24:09,180 --> 00:24:12,180
waiting for your paperwork, or
we're waiting for something in
382
00:24:12,180 --> 00:24:15,240
the middle of that, like,
amazing email that we get as
383
00:24:15,240 --> 00:24:18,120
leaders that say there's a
flight booked, like, that's our
384
00:24:18,120 --> 00:24:23,120
favorite email, yeah. So that
time frame between like those
385
00:24:23,120 --> 00:24:27,800
pieces, we have set up town
halls with prs. We do it in
386
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collaboration, where we
introduce the organization. We
387
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are introducing the leaders, so
the nursing directors, myself
388
00:24:36,740 --> 00:24:40,100
some of the support services
that we offer with our clinical
389
00:24:40,100 --> 00:24:45,040
coaches and our educators, we're
introducing, you know, what it
390
00:24:45,040 --> 00:24:49,420
will feel like on orientation,
so what that orientation process
391
00:24:49,420 --> 00:24:52,840
looks like, what resources they
will have, and then we're
392
00:24:52,840 --> 00:24:55,840
introducing the opportunities
that we want them to get
393
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involved in really early on, we
have a robust professional
394
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governance. And structure at
Sinai grace is an amazing part
395
00:25:03,720 --> 00:25:06,840
of that, and many of our
international nurses are because
396
00:25:06,840 --> 00:25:10,320
they bring the depth and the
experience and the bedside
397
00:25:10,320 --> 00:25:14,340
leadership to really help us
guide practice decisions and
398
00:25:14,340 --> 00:25:18,720
really empower their teammates
to participate in that as well.
399
00:25:18,720 --> 00:25:21,920
And so we introduce those
options really early, we also
400
00:25:21,920 --> 00:25:25,160
introduce our clinical ladder
program, which our international
401
00:25:25,160 --> 00:25:28,820
nurses are immediately able to
start being a part of. I think
402
00:25:29,060 --> 00:25:32,480
that is unique. I don't think a
lot of organizations immediately
403
00:25:32,480 --> 00:25:36,020
offer that, but we consider our
international nurses our direct
404
00:25:36,020 --> 00:25:39,200
hire. They are our direct hire,
but we consider them part of our
405
00:25:39,200 --> 00:25:43,900
family from the first day they
start here, and so they get all
406
00:25:43,900 --> 00:25:47,200
of the opportunities that we
afford to any of our
407
00:25:47,200 --> 00:25:50,140
domestically hired team members.
That includes nursing
408
00:25:50,140 --> 00:25:54,460
certification, as I mentioned,
clinical ladder. We also have
409
00:25:54,640 --> 00:25:57,880
clinical advancement funds that
are available for them to
410
00:25:57,880 --> 00:26:01,680
utilize to get specialized
training, or, you know, a
411
00:26:01,680 --> 00:26:05,580
specialized certification. And
so we really, we introduce all
412
00:26:05,580 --> 00:26:08,400
of those things early, so that
they understand that they're not
413
00:26:08,400 --> 00:26:11,760
just coming here to work a shift
at the bedside, that they are
414
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truly part of our team, and that
we value them, and we want them
415
00:26:14,760 --> 00:26:18,780
to continue growing with us. And
so it's been really impactful.
416
00:26:18,780 --> 00:26:24,020
We've had great experiences. I
actually had a nurse on the last
417
00:26:24,020 --> 00:26:28,400
call that we did. She's in the
UK. Her question was, Is it okay
418
00:26:28,400 --> 00:26:31,820
if I take a leadership role
before I come to Sinai? I know
419
00:26:31,820 --> 00:26:34,220
I'm supposed to stay at the
bedside, but I'm being offered
420
00:26:34,220 --> 00:26:36,800
this promotion. And, like,
Should I do it? And I was like,
421
00:26:36,980 --> 00:26:39,860
Yeah, you should definitely.
Like, if that's what you want to
422
00:26:39,860 --> 00:26:43,780
do, we are here to support that
like, I have no qualms about you
423
00:26:43,780 --> 00:26:46,960
going into a leadership role,
and you know you're going to
424
00:26:46,960 --> 00:26:49,600
have, you're going to be at the
bedside for us, but we always
425
00:26:49,600 --> 00:26:52,300
need leaders, and we want you to
grow as much as possible, and
426
00:26:52,300 --> 00:26:55,600
we're committed to that. And so,
you know, it takes a long time
427
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for nurses to get to us. We know
that's part of the process. We
428
00:26:58,780 --> 00:27:02,940
want nurses to feel like they
are empowered to do whatever it
429
00:27:02,940 --> 00:27:06,300
is that they want to do before
that, and then, you know, come
430
00:27:06,300 --> 00:27:10,140
and join our team and bring that
breadth of experience to their
431
00:27:10,140 --> 00:27:11,100
new role here.
432
00:27:11,940 --> 00:27:15,840
Kara Murphy: Yeah, I love that
you actually impacted a nurse
433
00:27:15,840 --> 00:27:19,800
and were a mentor to somebody
who hasn't even started yet and
434
00:27:19,800 --> 00:27:22,580
in the process, but they're part
of your team already. Yeah, and
435
00:27:22,700 --> 00:27:27,200
yeah, to be able to, and I'll
say just on, on the nurses side,
436
00:27:27,200 --> 00:27:32,360
Grace, you can jump in on this
too, but to be able to feel that
437
00:27:32,420 --> 00:27:35,480
while you're waiting, because
there are nurses, but their
438
00:27:35,480 --> 00:27:39,380
biggest concern is, are they
going to drop us? Are they, you
439
00:27:39,380 --> 00:27:42,880
know, do, will I still have a
place. So to be able to connect,
440
00:27:42,880 --> 00:27:46,780
be able to answer questions and
share, is just really powerful.
441
00:27:46,780 --> 00:27:49,900
I love that you all are doing
that, and for any leader
442
00:27:49,900 --> 00:27:55,780
listening, I think that's like a
must do, and it absolutely we've
443
00:27:55,780 --> 00:27:59,800
seen that it's been directly
impacting retention as well. So
444
00:27:59,800 --> 00:28:04,860
that's fantastic. Alright, so,
Megan, you know, the other
445
00:28:04,860 --> 00:28:07,980
question I always get asked is,
How do you do the orientation?
446
00:28:07,980 --> 00:28:10,740
Do you treat them like new
grads? Do you just put them in
447
00:28:10,740 --> 00:28:16,740
regular orientation? I would
love for you to how does the
448
00:28:16,740 --> 00:28:20,100
orientation for international go
on the unit?
449
00:28:20,339 --> 00:28:24,199
Megan Schwartz: Yeah, no, that's
a great question. So orientation
450
00:28:24,199 --> 00:28:28,579
for our international nurses, it
actually aligns with orientation
451
00:28:28,579 --> 00:28:34,099
with with domestic nurses. So we
have recently transitioned to a
452
00:28:34,099 --> 00:28:37,399
new type of orientation, and
Amanda can probably highlight
453
00:28:37,399 --> 00:28:40,659
that a little bit more in depth,
it's called T Sam. Is called
454
00:28:40,659 --> 00:28:46,359
talent acquisition. Talents
acquisitions, sorry, talent
455
00:28:46,359 --> 00:28:51,639
skills acquisition model. So
it's a tiered competency model.
456
00:28:51,759 --> 00:28:55,959
So instead of traditional
orientation, where it's more,
457
00:28:56,019 --> 00:28:59,439
you know, it's based on, like a
timeframe. You start with one
458
00:28:59,439 --> 00:29:03,059
patient grass, move up to two
patients with T Sam, you
459
00:29:03,059 --> 00:29:06,119
actually start out with five
patients, and then it's based on
460
00:29:06,119 --> 00:29:09,479
competencies you'll do. You'll
start out with basic stuff, such
461
00:29:09,479 --> 00:29:14,219
as assessments, and then as you
meet those competencies, then
462
00:29:14,219 --> 00:29:16,619
you'll progress through that
tier, and you'll do a little bit
463
00:29:16,619 --> 00:29:19,679
more with your patients, until
you meet the fourth tier, which
464
00:29:19,679 --> 00:29:22,099
is the highest tier, where
you're doing everything and
465
00:29:22,099 --> 00:29:26,419
you're really utilizing that
critical thinking skills. So we
466
00:29:26,479 --> 00:29:29,779
thought that that's been very,
very successful. It's not tied
467
00:29:29,779 --> 00:29:34,879
to an actual timeframe. So
again, it depends on how fast
468
00:29:34,879 --> 00:29:38,119
those nurses are progressing,
meeting those tiers and
469
00:29:38,119 --> 00:29:42,999
progressing through the tier to
TCM model. In addition to that,
470
00:29:43,059 --> 00:29:48,039
we ensure that, you know, not,
their orientation is is very
471
00:29:48,579 --> 00:29:52,479
thorough. It's very supportive.
We have our nurses. Obviously,
472
00:29:52,479 --> 00:29:55,659
you're assigned, you know, with
a primary and alternate
473
00:29:55,659 --> 00:29:58,779
preceptor for continuity and
consistency. But in addition to
474
00:29:58,779 --> 00:30:01,919
that, you're also be. And
closely followed by unit
475
00:30:01,919 --> 00:30:04,919
leadership, in addition to a
clinical coach. And we'll check
476
00:30:04,919 --> 00:30:08,399
in with these, you know, with
it, with the orientee and the
477
00:30:08,399 --> 00:30:12,599
preceptor regularly, pretty much
on a weekly basis, in addition
478
00:30:12,599 --> 00:30:15,359
to having formal meetings the
beginning, middle and the end of
479
00:30:15,359 --> 00:30:18,599
their orientation. And then, as
what Grace had said, we also
480
00:30:18,599 --> 00:30:22,339
have a Sinai one on one for our
international nurses. This is
481
00:30:22,339 --> 00:30:25,039
specific to our international
nurses. And they'll have that
482
00:30:25,039 --> 00:30:28,759
weekly where they'll spend, it's
four hours every Monday, and
483
00:30:28,759 --> 00:30:31,999
they'll spend time with the
educators here at Sinai. And
484
00:30:31,999 --> 00:30:34,759
again, they'll go over different
equipment, different policies
485
00:30:34,759 --> 00:30:37,939
and procedures here, and even go
over different like medical
486
00:30:37,939 --> 00:30:41,079
terminologies. That's more
specific for the the US,
487
00:30:41,079 --> 00:30:45,159
comparative out outside of the
US. So we all in all it's been,
488
00:30:45,159 --> 00:30:48,279
yeah, we find it very successful
and very, very supportive.
489
00:30:48,880 --> 00:30:50,980
Kara Murphy: Yeah, I really
appreciate you sharing just the
490
00:30:50,980 --> 00:30:54,820
approach and Amanda. It sounds
like your unit managers have it.
491
00:30:54,820 --> 00:30:56,980
They they are figured
492
00:30:56,980 --> 00:31:01,860
Amanda Shrout: it out. You
transition to T Sam when we
493
00:31:02,040 --> 00:31:05,340
onboarded 50 international
nurses in the ED and we wanted
494
00:31:05,340 --> 00:31:08,280
to capitalize on the evidence
that really showed that
495
00:31:08,580 --> 00:31:12,660
experienced nurses need
different orientation, and we
496
00:31:12,720 --> 00:31:15,600
need to be able to build their
orientation around their
497
00:31:15,600 --> 00:31:18,960
competencies as Grace shared,
she's a nurse of 19 years she
498
00:31:18,960 --> 00:31:23,480
had 16 years of experience when
she got to us. And so Grace
499
00:31:23,480 --> 00:31:26,300
definitely knows how to do a
patient assessment. She knows
500
00:31:26,300 --> 00:31:31,340
how to give med she she knows
how to run a plan of care for a
501
00:31:31,340 --> 00:31:36,200
patient. What she doesn't know
is our version of Cerner, our IV
502
00:31:36,260 --> 00:31:40,720
pump. She doesn't know how
rounds happen on our units. And
503
00:31:40,720 --> 00:31:46,120
so we we modified that
orientation based on a lot of
504
00:31:46,120 --> 00:31:49,840
the feedback that, you know, we
could do a better job. So we
505
00:31:49,840 --> 00:31:52,600
went out to the literature, we
learned that other organizations
506
00:31:52,600 --> 00:31:56,500
were using T Sam to orient new
grads and experienced nurses,
507
00:31:56,560 --> 00:32:00,660
and, you know, we implemented
that in our emergency department
508
00:32:00,720 --> 00:32:05,280
about a year and a half ago, and
we onboarded 50 nurses very
509
00:32:05,280 --> 00:32:09,960
quickly. And what we really saw
is that they were the ramp up to
510
00:32:09,960 --> 00:32:13,860
them being, you know, in fully
productive, independent roles
511
00:32:14,040 --> 00:32:18,660
was much quicker, and also they
felt much more competent and
512
00:32:18,660 --> 00:32:22,100
confident in their skills
because they were taking full
513
00:32:22,100 --> 00:32:24,920
loads from the beginning.
Because a lot of times, like,
514
00:32:24,920 --> 00:32:27,560
nurses will tell us, and new
grads will tell me too, like I
515
00:32:27,560 --> 00:32:31,340
was so intimidated to move from
one nurse or one patient to
516
00:32:31,340 --> 00:32:36,020
three patients, or, you know,
one patient to a four patient
517
00:32:36,020 --> 00:32:38,240
assignment, and how am I going
to do all these things? Well
518
00:32:38,240 --> 00:32:42,220
with your T Sam, it's so gradual
that you're able to, like,
519
00:32:42,220 --> 00:32:46,180
really get that feel. And I
think, you know, we've gotten so
520
00:32:46,180 --> 00:32:49,420
much of that feedback directly
from nurses like Grace, where we
521
00:32:49,420 --> 00:32:53,080
were able to really take a look
at our orientation models and
522
00:32:53,080 --> 00:32:56,860
move to something that worked
better for everybody, better for
523
00:32:56,860 --> 00:33:00,700
us as leaders, with maybe some
less time on orientation.
524
00:33:00,700 --> 00:33:04,140
Because CNOs think about that a
lot. And then, you know, also,
525
00:33:04,260 --> 00:33:07,680
for nurses to feel more
confident in, you know, being
526
00:33:07,680 --> 00:33:11,400
able to take those patients. And
certainly, I know Grace had a,
527
00:33:11,640 --> 00:33:15,480
you know, different experience
with orientation. We weren't
528
00:33:15,480 --> 00:33:18,600
doing T Sam back then. So I'd
love to hear grace your
529
00:33:18,600 --> 00:33:21,620
perspective on, like, what you
see as a difference, you know
530
00:33:21,680 --> 00:33:24,740
before, and then what you see as
a preceptor now,
531
00:33:26,059 --> 00:33:31,159
Grace: oh, way back on my time.
We are just using our file book.
532
00:33:31,159 --> 00:33:34,219
We have this book, and we make
sure that we have to check on
533
00:33:34,219 --> 00:33:38,359
that it's, it's very organic
thing as well, before we have
534
00:33:38,359 --> 00:33:43,479
the assessment IV insertion and
all those stuffs. And then we
535
00:33:43,479 --> 00:33:47,379
just really back to, you know,
basic to compare with the the
536
00:33:47,439 --> 00:33:52,479
and I see that those who are
those are new oriented. They're
537
00:33:52,479 --> 00:33:57,339
just moved so fast, yeah,
because I can do that. I already
538
00:33:57,339 --> 00:34:00,639
did that, and they have the more
confidence for themselves, to,
539
00:34:00,639 --> 00:34:03,419
you know, to enjoy their work,
because you've already done that
540
00:34:03,419 --> 00:34:05,999
before. You just have some a
little bit Polish on these
541
00:34:05,999 --> 00:34:10,079
things. But they doing great
things, and they doing a great
542
00:34:10,079 --> 00:34:14,459
job to this orientation. And I
myself during that time, my time
543
00:34:14,459 --> 00:34:18,959
is going to share for you a
little bit moment that my
544
00:34:18,959 --> 00:34:25,055
preceptor make sure that our
clinical educators fit in our in
545
00:34:25,055 --> 00:34:29,075
our personality, so we can be
Jive together, and we have a
546
00:34:29,315 --> 00:34:33,875
rapport together. And at the
end, we make friends for our
547
00:34:33,875 --> 00:34:36,635
preceptor and as at our
orientee, we'll make some you
548
00:34:36,635 --> 00:34:41,379
know, we're very much not only
be confident, but you know, one
549
00:34:41,379 --> 00:34:46,239
day, the time that they will be
go by ourselves, we are make
550
00:34:46,239 --> 00:34:49,839
sure that, oh, I can do that,
because our preceptors always be
551
00:34:49,899 --> 00:34:53,679
there to us and help us and
guide us, always, even though,
552
00:34:53,739 --> 00:34:56,619
even though, in the last two
weeks that we have to go on with
553
00:34:56,619 --> 00:34:59,319
ourselves, still, our preceptor
is still there, and not only the
554
00:34:59,319 --> 00:35:01,799
preceptor are. Around the
community, around the
555
00:35:01,799 --> 00:35:04,679
organization, you can ask them
any questions,
556
00:35:05,040 --> 00:35:09,420
Kara Murphy: yeah, yeah, which
has to be amazing that you feel
557
00:35:09,420 --> 00:35:14,400
confident and comfortable asking
anybody a question, even if
558
00:35:14,400 --> 00:35:16,620
Amanda is walking by. Always,
559
00:35:20,179 --> 00:35:25,579
Amanda Shrout: always basics
Megan. And I joke about it all
560
00:35:25,579 --> 00:35:28,819
the time that I'm like, I do
think people know it's my
561
00:35:28,819 --> 00:35:31,819
favorite unit. And Megan's like,
yes, everybody knows. Just put
562
00:35:31,879 --> 00:35:37,759
it out there too. I know it's,
you know, the nurses on basics
563
00:35:37,759 --> 00:35:41,679
are amazing. I get to do patient
rounds a couple of times a week,
564
00:35:41,679 --> 00:35:45,759
and I think it is my most fun
thing that I get to do. But I
565
00:35:45,759 --> 00:35:49,359
get to hear about the amazing
nurses this morning. I heard
566
00:35:49,359 --> 00:35:52,779
about Jill, who is one of our
international nurses. I rounded
567
00:35:52,779 --> 00:35:56,739
on one of her patients last
night, and or Jill was her nurse
568
00:35:56,739 --> 00:36:01,739
last night, and she was like,
she was so kind, and she, you
569
00:36:01,739 --> 00:36:05,159
know, elevated my concern about
my pain, and she really took
570
00:36:05,159 --> 00:36:08,099
great care of me. And, you know,
those are the things that I
571
00:36:08,099 --> 00:36:12,119
love. So being able to round on
patients is so great, and we
572
00:36:12,119 --> 00:36:15,119
frequently hear that feedback,
both about our domestic nurses
573
00:36:15,119 --> 00:36:18,119
and our international nurses,
but I think it's just, you know,
574
00:36:19,199 --> 00:36:21,919
the the one thing that I want
for other nurse leaders is to
575
00:36:21,919 --> 00:36:25,999
really engage at the bedside and
understand the impact that all
576
00:36:25,999 --> 00:36:29,779
nurses are having on the
clinical care. But I think there
577
00:36:29,779 --> 00:36:32,959
is a special impact that our
international nurses bring, and
578
00:36:33,019 --> 00:36:36,259
it really is based on their
experience. And, you know, the
579
00:36:36,259 --> 00:36:40,479
compassion and empathy that they
bring to being, you know, from
580
00:36:40,479 --> 00:36:43,239
being in so many different
situations and taking care of
581
00:36:43,239 --> 00:36:46,959
different types of patient
populations, and I just, I think
582
00:36:46,959 --> 00:36:49,479
it's really special, and it's
something that we really value
583
00:36:49,479 --> 00:36:50,499
here at Sinai.
584
00:36:51,219 --> 00:36:53,559
Kara Murphy: Yeah, I love that,
and I appreciate you sharing
585
00:36:53,559 --> 00:36:56,799
about the onboarding, because
that is, you know, probably my
586
00:36:56,799 --> 00:37:00,039
number one question that I get
asked. And I think, you know,
587
00:37:00,039 --> 00:37:03,959
many organizations started where
just put them in, new grads, and
588
00:37:03,959 --> 00:37:07,739
you're right, experienced nurses
are different, and there's a few
589
00:37:07,799 --> 00:37:12,779
areas like the EMR and
understanding that and learning
590
00:37:12,779 --> 00:37:15,899
that, and then the equipment. So
you guys have kind of carved out
591
00:37:15,899 --> 00:37:19,499
additional training on that, but
kept moving along with the
592
00:37:19,559 --> 00:37:23,419
onboarding and training as an
experienced nurse. So thank you
593
00:37:23,419 --> 00:37:27,979
for for sharing that. So you
know, one of the things that I
594
00:37:27,979 --> 00:37:31,939
think is probably the most
rewarding for me is to hear
595
00:37:31,939 --> 00:37:35,539
stories of nurses after three
years that are staying there
596
00:37:35,539 --> 00:37:40,599
because it's such a good fit and
because of the focus that an
597
00:37:40,599 --> 00:37:44,799
organization gives on
integration. I can't stress that
598
00:37:44,799 --> 00:37:49,119
enough. And retention is so
important, not only for
599
00:37:49,119 --> 00:37:53,979
international but for any nurse
that we have. I mean, that's a
600
00:37:53,979 --> 00:37:57,579
lot of your stability. I'm sure
that is happening right now. And
601
00:37:57,579 --> 00:38:03,059
so Megan, you know, once a nurse
comes to the unit and gets
602
00:38:03,059 --> 00:38:08,219
settled in, and what have you
seen for retention and
603
00:38:08,219 --> 00:38:09,599
engagement over time?
604
00:38:09,840 --> 00:38:11,400
Megan Schwartz: Yeah,
definitely, that's a really good
605
00:38:11,400 --> 00:38:14,280
question. Well, obviously, from
the beginning, you want to
606
00:38:14,280 --> 00:38:16,800
ensure that they feel welcome
within the unit, so that they
607
00:38:16,800 --> 00:38:20,660
feel supported. But in addition
to that, you want to ensure that
608
00:38:20,660 --> 00:38:23,360
they're engaged. You want them
to be they want to we want to
609
00:38:23,360 --> 00:38:27,560
ensure that they feel valued and
that they're a part of decision
610
00:38:27,560 --> 00:38:31,220
making on the unit, and part of
that is to get them involved in
611
00:38:31,220 --> 00:38:34,580
perhaps different committees or
different unit activities, and
612
00:38:34,760 --> 00:38:37,280
just to kind of leverage
whatever background that they
613
00:38:37,280 --> 00:38:40,660
have as well. Many of our
international nurses, we find
614
00:38:40,660 --> 00:38:43,420
they have copious years of
experience, many of which were
615
00:38:43,420 --> 00:38:46,600
running charge or were on
different committees where we're
616
00:38:46,600 --> 00:38:50,020
a part of different types of
projects within their previous
617
00:38:50,200 --> 00:38:53,980
work experience and finding out
what, what is their niche, what
618
00:38:53,980 --> 00:38:56,440
is what is that that they like?
What is it that they've done
619
00:38:56,440 --> 00:39:01,620
before? And we can leverage that
and perhaps have them maybe be a
620
00:39:01,620 --> 00:39:04,380
part of a project on the unit,
or maybe start off with doing
621
00:39:04,380 --> 00:39:08,580
audits on the unit, just to get
them more familiar in terms of
622
00:39:08,940 --> 00:39:11,220
looking at whatever best
practices there are, and
623
00:39:11,220 --> 00:39:14,340
providing coaching their to
their peers, and slowly, just
624
00:39:14,340 --> 00:39:16,920
getting them involved and
ensuring that, you know,
625
00:39:17,340 --> 00:39:19,740
encourage them to be a part of
the clinical ladder. That's a
626
00:39:19,740 --> 00:39:23,960
huge hit. You know finding how
easy it is. You know that it's
627
00:39:23,960 --> 00:39:27,260
obtainable to get your not
saying it's easy. You have to
628
00:39:27,260 --> 00:39:31,460
put some work into it, but it is
obtainable to to to advance in a
629
00:39:31,460 --> 00:39:34,100
clinical ladder. And once you
actually sit down and explain,
630
00:39:34,100 --> 00:39:37,700
look at all these ways. It's not
just based on your clinical
631
00:39:37,700 --> 00:39:41,920
experience, but it's also based
on how engaged you are within
632
00:39:41,920 --> 00:39:45,340
the organization and also within
the community as well, many of
633
00:39:45,340 --> 00:39:48,100
our international nurses and
also other nurses as well, or
634
00:39:48,460 --> 00:39:52,840
are involved with some clinic
community activities. You know
635
00:39:52,840 --> 00:39:56,500
that Sinai is also involved with
such as the Baltimore Hunger
636
00:39:56,500 --> 00:39:59,200
Project and other community
events like building
637
00:39:59,200 --> 00:40:03,120
playgrounds. And you'll be
surprised at how many nurses and
638
00:40:03,120 --> 00:40:06,120
her, and especially from our
international nurses, attend
639
00:40:06,120 --> 00:40:10,860
those those events. So biggest
piece, yeah, is, is engagement,
640
00:40:10,860 --> 00:40:13,860
getting them involved with the
unit, with the hospital. And
641
00:40:13,860 --> 00:40:17,400
Grace is a big example of that
as well. She's advanced in a
642
00:40:17,400 --> 00:40:20,780
clinical ladder. She's a, you
know, she's one of our strongest
643
00:40:20,780 --> 00:40:25,220
charge nurses on the unit. She's
a preceptor, she's in she's the
644
00:40:25,340 --> 00:40:28,700
representative, one of the reps
for the Sinai nursing Congress.
645
00:40:28,700 --> 00:40:32,960
She's a member of the b6
professional shared governance
646
00:40:32,960 --> 00:40:36,020
committee. So that's just an
example of one employee, but
647
00:40:36,020 --> 00:40:39,620
there's many other you know, of
our international nurses that
648
00:40:39,620 --> 00:40:43,060
are also as invested as Grace
is, yeah,
649
00:40:43,060 --> 00:40:46,480
Kara Murphy: I love that grace.
What has he stayed at? Sinai,
650
00:40:46,600 --> 00:40:46,960
oh,
651
00:40:47,560 --> 00:40:49,420
Amanda Shrout: grace is never
allowed to leave.
652
00:40:50,560 --> 00:40:52,780
Kara Murphy: Well, that's,
that's one answer. Amanda,
653
00:40:55,960 --> 00:40:57,340
moving on to the next question.
654
00:40:59,199 --> 00:41:06,899
Amanda Shrout: But also, like,
would be, you know, can't even
655
00:41:06,899 --> 00:41:07,859
think about it.
656
00:41:08,699 --> 00:41:12,659
Grace: Thank you so much. I
appreciate that. Yeah, it's a
657
00:41:12,659 --> 00:41:15,599
big heart. We're friends
everywhere. She's following me
658
00:41:15,599 --> 00:41:17,879
in Facebook and same likewise.
659
00:41:18,300 --> 00:41:22,160
Amanda Shrout: Yes, I watch
Chris' daughter. She's amazing.
660
00:41:22,520 --> 00:41:25,880
They look so much alike as well,
but like Grace's daughter is
661
00:41:25,880 --> 00:41:30,020
just like the most beautiful. So
I'm very grateful to have grace
662
00:41:30,020 --> 00:41:30,560
here.
663
00:41:31,280 --> 00:41:35,240
Kara Murphy: That's awesome. But
and grace you, I mean, clearly
664
00:41:35,300 --> 00:41:38,540
you are loved, and that's
probably a big reason. Is there
665
00:41:38,540 --> 00:41:41,680
anything else that you're like?
This is why I'm staying here,
666
00:41:41,680 --> 00:41:43,840
and this is why it was such a
good match.
667
00:41:45,040 --> 00:41:49,180
Grace: I'm just just working
here in Sinai, but I'm growing
668
00:41:49,180 --> 00:41:57,100
here professionally. Yes, I am
on I had my clinical ladder. I'm
669
00:41:57,100 --> 00:42:01,800
so engaged, I don't know this is
my passion as is as a nurse,
670
00:42:01,800 --> 00:42:06,840
it's my passion and engagement
to all the leadership. I include
671
00:42:06,840 --> 00:42:11,940
myself. I make make sure that
some actively working on those
672
00:42:11,940 --> 00:42:15,660
things with the help of my
leadership. Of course, always
673
00:42:15,660 --> 00:42:20,300
Megan is there, and always I'm
asking questions and, you know,
674
00:42:20,300 --> 00:42:27,020
advice, and she's always with
me. And what can do this? Okay,
675
00:42:27,020 --> 00:42:31,640
maybe you can have this one. And
she is always open to that. And
676
00:42:31,640 --> 00:42:36,200
not only me, to everybody, to
everybody. And then Sinai is
677
00:42:36,200 --> 00:42:41,080
investing to us, not only
international, especially all
678
00:42:41,080 --> 00:42:47,500
those domestics for our clinical
ladders, professional growth as
679
00:42:47,500 --> 00:42:51,460
like as both my leaders saying
that I'm already have my, I
680
00:42:51,460 --> 00:42:55,780
think, 12 courses, a charged
nurses, I pass all those that's
681
00:42:55,780 --> 00:43:02,220
clinical clinical ladders, and I
have a big opportunity that as
682
00:43:02,220 --> 00:43:07,560
an SNC acute representative,
that I attended the A N O L, the
683
00:43:07,560 --> 00:43:11,160
American organization of
learning leaders in San Antonio,
684
00:43:11,160 --> 00:43:17,640
Texas. Yeah. So I'm very happy,
and I have been privileged when
685
00:43:17,640 --> 00:43:21,560
they I receive an email, oh, my
God. I'm just two years here in
686
00:43:21,560 --> 00:43:25,580
Sinai, and I'm participating
this big organization in United
687
00:43:25,580 --> 00:43:31,040
States, and I'm happy to share
what I've learned to the all
688
00:43:31,040 --> 00:43:36,500
leaders of the Sinai community,
and a good feedback about what
689
00:43:36,500 --> 00:43:40,540
I've said to them. And so I'm so
blessed, and I think I cried
690
00:43:40,540 --> 00:43:45,280
that time? Yeah, I cried that
time. Yes, really I am. And then
691
00:43:45,880 --> 00:43:49,720
this is the place to grow and
contribute, and I feel like
692
00:43:49,720 --> 00:43:50,800
home, that's it.
693
00:43:52,000 --> 00:43:55,000
Kara Murphy: I can definitely
tell that grace. And I love
694
00:43:55,000 --> 00:43:59,800
that. And what I love the most
is you came on a contract,
695
00:43:59,800 --> 00:44:02,700
right? But you're not staying
because of the contract. You're
696
00:44:02,700 --> 00:44:05,640
staying because of all these
other things. And I hear a lot
697
00:44:05,640 --> 00:44:09,720
about growth and Amanda, I heard
you earlier talking about that.
698
00:44:09,720 --> 00:44:14,820
That's a significant part of
your retention plan for all
699
00:44:14,820 --> 00:44:20,340
nurses, all team members. And I
know you recently had a reunion
700
00:44:20,340 --> 00:44:24,320
for your international nurses,
and some of them over 20 years,
701
00:44:24,980 --> 00:44:29,540
is that growth part? Is that a
big part of why most of them are
702
00:44:29,540 --> 00:44:30,200
saying?
703
00:44:30,800 --> 00:44:32,780
Amanda Shrout: I think so. I
mean, I think there's lots of
704
00:44:32,840 --> 00:44:36,500
reasons that people say. I think
we have a great community of
705
00:44:36,500 --> 00:44:39,860
international nurses here where,
you know, outside of work, they
706
00:44:39,860 --> 00:44:43,000
are each other's family, and
they're our family. I mean, I
707
00:44:43,000 --> 00:44:46,780
think you grace and I follow
each other on social media, and
708
00:44:46,780 --> 00:44:50,680
I I feel like I am seeing her
daughter grow up, and, you know,
709
00:44:50,680 --> 00:44:55,300
I'm sharing my family. And that
is, I think that's not unique to
710
00:44:55,300 --> 00:44:58,120
the International Strategy at
Sinai. I think that is unique to
711
00:44:58,120 --> 00:45:02,040
who we are as an organization. I
came here over 10 years ago
712
00:45:02,040 --> 00:45:05,460
looking for a professional home,
looking for a place to grow, and
713
00:45:05,700 --> 00:45:09,360
I've been given a lot of
opportunity here to do that. And
714
00:45:09,360 --> 00:45:14,700
I think that I feel like this is
my home, and I want every nurse
715
00:45:14,700 --> 00:45:17,820
to feel like this is also their
home, and their home is my home
716
00:45:17,820 --> 00:45:21,320
and and I think that is part of
our culture. I think that's who
717
00:45:21,320 --> 00:45:24,380
we are. A Sinai. We have a lot
of people who've been here for a
718
00:45:24,380 --> 00:45:28,040
long time, like Megan and many
of our other leaders, but we
719
00:45:28,040 --> 00:45:32,600
have some original, we call them
OG international nurses who came
720
00:45:32,600 --> 00:45:39,140
in the early 2000s 2002 to 2009
and we still have about 100
721
00:45:39,740 --> 00:45:44,620
maybe 110 of those nurses who
work in our organization, they,
722
00:45:45,220 --> 00:45:47,860
you know, contribute in a lot of
different ways. They may still
723
00:45:47,860 --> 00:45:50,860
be at the front line, which is
amazing. And you know, really
724
00:45:50,860 --> 00:45:55,240
working at the bedside as
mentors and as preceptors and as
725
00:45:55,240 --> 00:45:59,860
charge nurses. And I, you know,
when I think about the number of
726
00:45:59,860 --> 00:46:03,060
nurses that they have raised
over the 20 years in our
727
00:46:03,060 --> 00:46:07,740
organization. I am in awe of
that and and really I think that
728
00:46:07,740 --> 00:46:11,280
excellence is, you know, built
there, built in that tenure, and
729
00:46:11,280 --> 00:46:14,700
I think that's part of our
culture here. But we also have
730
00:46:14,700 --> 00:46:18,480
nurses who have progressed in
leadership roles. Ronald de
731
00:46:18,480 --> 00:46:22,040
tohonis is an international
nurse from one of our first
732
00:46:22,040 --> 00:46:26,600
groups, who is our executive
director of procedural and
733
00:46:26,600 --> 00:46:30,740
perioperative services. And you
know, renalda exudes
734
00:46:30,740 --> 00:46:35,720
professionalism, and I think,
you know, she brings a wealth of
735
00:46:35,720 --> 00:46:38,360
experience from the Philippines.
When she first got here, she was
736
00:46:38,360 --> 00:46:41,560
a clinical instructor in the
Philippines. She was an or
737
00:46:41,560 --> 00:46:44,800
nurse. She came here and has
done progressive leadership
738
00:46:44,800 --> 00:46:49,120
roles. She was a team lead, an
assistant manager, she was a
739
00:46:49,540 --> 00:46:53,800
charge nurse in the or and
interim manager, and then an
740
00:46:53,800 --> 00:46:58,000
educator, and she is now the
director. And I think that
741
00:46:58,000 --> 00:47:02,580
experience is also something
that you know is is not unique
742
00:47:02,580 --> 00:47:05,700
to Sinai. I know that other
organizations promote from
743
00:47:05,700 --> 00:47:10,200
within. I think it is part of
our culture to really always
744
00:47:10,200 --> 00:47:12,900
give the first look to our
nurses who are contributing so
745
00:47:12,900 --> 00:47:18,120
much. And I think that is unique
to what happens here, and the
746
00:47:18,120 --> 00:47:22,220
opportunity to grow in those
roles and really understand
747
00:47:22,220 --> 00:47:26,540
that, that that exists for
everyone. And as Grace said, you
748
00:47:26,540 --> 00:47:29,180
know, we give lots of
opportunities. We launched a
749
00:47:29,180 --> 00:47:31,760
charge nurse professional
development pathway in the last
750
00:47:31,760 --> 00:47:34,820
year and a half. That's been
really important. We've always
751
00:47:34,820 --> 00:47:38,360
done a charge nurse workshop.
But how do you build really good
752
00:47:38,360 --> 00:47:40,840
charge nurses, and how do you
sustain them, and how do you
753
00:47:40,840 --> 00:47:44,200
keep them engaged in growing as
a charge nurse? That was really
754
00:47:44,200 --> 00:47:48,880
our charge and so we built out a
12 class curriculum that they go
755
00:47:48,880 --> 00:47:52,780
through over 18 months. And it's
really like a learn at your own
756
00:47:52,780 --> 00:47:56,860
pace opportunity, and that has
been wildly successful. We've
757
00:47:56,860 --> 00:47:59,920
had many international nurses
and domestic nurses go through
758
00:47:59,920 --> 00:48:03,000
it, but I think it's this
opportunity to understand what's
759
00:48:03,000 --> 00:48:06,480
at that next level, beyond
charge nurse, where, you know,
760
00:48:06,480 --> 00:48:10,260
what is that opportunity for
leadership? How can I lead at
761
00:48:10,260 --> 00:48:13,260
the Chargers level? And then
also, if I'm looking at that
762
00:48:13,260 --> 00:48:17,580
next level, what opportunities
exist for me to understand, you
763
00:48:17,580 --> 00:48:21,920
know, skills or tools and
resources that I need to be able
764
00:48:21,920 --> 00:48:25,280
to go into an assistant nurse
manager role. And, you know, I
765
00:48:25,280 --> 00:48:28,160
think that's what we want to
build. We want to build the
766
00:48:28,220 --> 00:48:32,420
opportunity to do whatever it is
you want to do next, but do it
767
00:48:32,420 --> 00:48:33,140
with us.
768
00:48:33,500 --> 00:48:37,760
Kara Murphy: Yeah, I love that.
Well, this conversation has been
769
00:48:37,760 --> 00:48:43,060
amazing. I would love for you to
before we end, for each of you
770
00:48:43,060 --> 00:48:48,280
to share. If you had one piece
of advice for a leader who is
771
00:48:48,280 --> 00:48:52,000
just starting this program at
their organization, what would
772
00:48:52,000 --> 00:48:56,320
it be and grace? I would love
for you to start. What would you
773
00:48:56,320 --> 00:49:00,340
say to a leader who's just
starting this program as advice?
774
00:49:01,300 --> 00:49:05,160
Grace: Well, as an international
nurses, don't hesitate to hire
775
00:49:05,220 --> 00:49:09,900
an international nurses, which
was very well experienced, and
776
00:49:09,900 --> 00:49:14,520
they can bring you the best of
their most to your
777
00:49:14,520 --> 00:49:19,740
organizations, and we're here to
help you and to build an a
778
00:49:19,740 --> 00:49:23,660
community so that we have a one
a common goal.
779
00:49:24,980 --> 00:49:27,560
Kara Murphy: Yeah, that's great.
Thank you grace. How about you?
780
00:49:27,560 --> 00:49:28,820
Megan, yeah,
781
00:49:29,300 --> 00:49:32,480
Megan Schwartz: again, I would,
you know, strongly focus on
782
00:49:32,480 --> 00:49:38,000
welcoming these international
nurses to your unit. Be mindful
783
00:49:38,000 --> 00:49:41,200
that this is very scary for
them, so to ensure that they
784
00:49:41,200 --> 00:49:44,080
have the support, not only from
you, but from their peers, is
785
00:49:44,080 --> 00:49:48,100
critical checking in on them
routinely, even after
786
00:49:48,100 --> 00:49:50,980
orientation, you still want to
check in on them, not only to
787
00:49:50,980 --> 00:49:54,400
ensure that everything is going
well here, but also to check in
788
00:49:54,400 --> 00:49:57,280
about home life as well, and to
see if there's anything that you
789
00:49:57,280 --> 00:50:01,440
could do on on our end to help
facilitate. That we also have a
790
00:50:01,440 --> 00:50:06,660
program here as well, where in
where nurse international nurses
791
00:50:06,660 --> 00:50:13,020
can sign up. And the goal is to
find a mentor for them from a
792
00:50:13,140 --> 00:50:17,100
area, like from a similar
cultural background that perhaps
793
00:50:17,100 --> 00:50:20,360
can be a mentor with them, that
can help them kind of move
794
00:50:20,360 --> 00:50:24,440
through this transition as well.
So yeah, that's what I would
795
00:50:24,440 --> 00:50:25,040
recommend.
796
00:50:25,520 --> 00:50:28,760
Kara Murphy: I love that, and I
love that you added in also ask
797
00:50:28,760 --> 00:50:31,520
them about things outside of
work, on how they're
798
00:50:31,520 --> 00:50:34,160
transitioning, because at the
end of the day, we want them all
799
00:50:34,160 --> 00:50:37,280
thriving within their
communities outside of work as
800
00:50:37,280 --> 00:50:39,680
well. Megan, what advice would
you give?
801
00:50:40,219 --> 00:50:43,359
Amanda Shrout: Oh, I think you
met me, but that's okay. Amanda,
802
00:50:47,439 --> 00:50:50,739
I would say, you know, from a C
suite perspective, I would say
803
00:50:50,739 --> 00:50:55,119
that, you know, I hear other
nurse leaders saying it takes so
804
00:50:55,119 --> 00:50:59,379
long to get an international
nurse, and I think that is one
805
00:50:59,439 --> 00:51:02,639
of the hesitations around,
really, you know, building an
806
00:51:02,639 --> 00:51:07,199
international nurse program. And
I think that I would say, start
807
00:51:07,199 --> 00:51:10,259
now. You know, the other best
time to start was, like two
808
00:51:10,259 --> 00:51:13,799
years ago. But, you know, now is
a great time. So I would
809
00:51:13,799 --> 00:51:18,359
definitely say that. And then I
would also really just focus on,
810
00:51:19,079 --> 00:51:22,639
on, you know, leveraging those
listening sessions and being
811
00:51:22,639 --> 00:51:26,299
available to understand what
tools and resources both the
812
00:51:26,779 --> 00:51:30,439
frontline international nurses
need and our leaders like we've
813
00:51:30,439 --> 00:51:34,279
pivoted along the way. This is,
you know, not a destination.
814
00:51:34,279 --> 00:51:38,659
It's a journey, and so being
able to pivot and make changes
815
00:51:38,659 --> 00:51:42,039
and give tools and resources
that both our leaders and our
816
00:51:42,039 --> 00:51:46,359
international nurses need that
happens when we're listening and
817
00:51:46,359 --> 00:51:50,739
when we're actively engaged in
seeking that feedback. And I
818
00:51:50,739 --> 00:51:54,159
think that is really important
in building out an international
819
00:51:54,159 --> 00:51:57,039
program. It's really
understanding that it's not
820
00:51:57,039 --> 00:51:59,679
going to be cookie cutter, that
different nurses are going to
821
00:51:59,679 --> 00:52:03,299
need different things, and that
we've got to build in the
822
00:52:03,299 --> 00:52:06,599
ability to be flexible and
adaptable to meet those needs,
823
00:52:06,599 --> 00:52:10,499
so that we can retain those team
members. Like, you know, every
824
00:52:10,499 --> 00:52:13,079
nurse wants to stay in a place
where they feel like they are
825
00:52:13,079 --> 00:52:16,499
treated as an individual and
they are cared for, and that
826
00:52:16,499 --> 00:52:19,919
they are recognized for their
meaningful work. And in order to
827
00:52:19,919 --> 00:52:23,119
do that, it's got to be more
individualized. So really
828
00:52:23,359 --> 00:52:26,899
ensuring that you've built out
structures in your organization
829
00:52:26,899 --> 00:52:31,519
that you can leverage to get the
tools to the people who need
830
00:52:31,519 --> 00:52:32,059
them.
831
00:52:32,659 --> 00:52:35,719
Kara Murphy: Yeah, well, thank
you for that. And you know, I
832
00:52:35,719 --> 00:52:39,199
think if everybody who's
listening, if you take away one
833
00:52:39,199 --> 00:52:43,959
thing, it's really how important
the integration piece is, and
834
00:52:43,959 --> 00:52:49,239
looking at your current programs
around retention and onboarding
835
00:52:49,239 --> 00:52:52,239
and all of that, and how does
that fit in with experienced
836
00:52:52,239 --> 00:52:55,599
nurses that just happen to come
from another country? Because at
837
00:52:55,599 --> 00:52:57,579
the end of the day, and I heard
this a lot today, you're
838
00:52:57,579 --> 00:53:00,899
building teams, and you're
preparing for the future to make
839
00:53:00,899 --> 00:53:05,759
sure that your your teams, are
taken care of. And the other
840
00:53:05,759 --> 00:53:08,999
thing that I would add is
there's so many organizations
841
00:53:09,059 --> 00:53:14,279
like Sinai who have learned with
doing international and have
842
00:53:14,279 --> 00:53:19,019
best practices, and so that's
one thing that we love to share,
843
00:53:19,019 --> 00:53:22,279
is what others are doing. And we
often connect people with
844
00:53:22,279 --> 00:53:25,039
different organizations based on
what they're looking for with
845
00:53:25,039 --> 00:53:30,199
the best practice. You know, I
can't thank our clients enough,
846
00:53:30,499 --> 00:53:34,579
and certainly, LifeBridge
healthcare has been a just a
847
00:53:34,579 --> 00:53:39,019
fantastic partner to work with
when you have two organizations
848
00:53:39,019 --> 00:53:42,939
who see things very similarly
and have the same goal that
849
00:53:42,939 --> 00:53:47,979
individuals thrive once they get
here. It's It's really amazing.
850
00:53:47,979 --> 00:53:52,239
So on behalf of PRs, thank you
all for for everything that you
851
00:53:52,239 --> 00:53:56,259
do every day and grace. I
thought it was so neat to have
852
00:53:56,259 --> 00:53:59,799
your perspective here to share.
So I appreciate you taking the
853
00:53:59,799 --> 00:54:04,499
time today as well. So with
that, thank you, everybody for
854
00:54:04,559 --> 00:54:09,119
joining today. And if you're not
already following Amanda on
855
00:54:09,359 --> 00:54:12,539
LinkedIn, I would do that. She
has all kinds of cool things
856
00:54:12,539 --> 00:54:15,839
that she shares. So thanks
again, everybody for joining.
857
00:54:15,959 --> 00:54:17,339
Thank you. Bye.
