Latest / Becker’s Healthcare Podcast / Caring Without Borders: How International Nurses Are Shaping U.S. Healthcare

Transcript

Caring Without Borders: How International Nurses Are Shaping U.S. Healthcare · Becker’s Healthcare Podcast

0:00
Hello, everyone. This is Erica Spicer Mason with
0:02
Becker's Healthcare. Thank you so much for tuning
0:04
in to the Becker's Healthcare podcast series.
0:07
Today, we're going to talk about caring without
0:10
borders and how international nurses are shaping US
0:13
health care.
0:14
Joining me for this conversation, we have with
0:17
us two leaders from Insight Global Health.
0:19
We have Brenna Hamsh, the director of global
0:22
delivery,
0:23
and doctor Jamie Brennan, chief nursing officer.
0:27
Brenna, doctor Brennan, thank you so much for
0:29
being here today. Welcome to the podcast.
0:31
Thank you so much.
0:33
Great to have you both on the line.
0:34
And before we get into the heart of
0:37
our conversation, I wanted to learn just a
0:38
little bit more about your roles at Insight
0:41
Global and what drew you to this work
0:43
around international health care talent.
0:46
Awesome.
0:47
I can go first. My name is Brenna
0:48
Hamshie. I'm the director of global delivery, like
0:50
Erica mentioned, here at Insight Global Health over
0:53
our international nursing program.
0:55
I've been with Insight Global for close to
0:57
ten years now,
0:58
and this is definitely a role I didn't
1:00
know that I would be getting into eventually,
1:03
but,
1:04
got the call shortly after they opened the
1:05
division post COVID or as a response to
1:08
COVID as I suppose.
1:10
I got the call from my now leader
1:11
asking if I would, you know, help them
1:13
get this stood up and work on kind
1:15
of the delivery piece, making sure that the
1:17
clients were getting the service we were promising
1:19
to them.
1:20
And, really, as someone who's been with the
1:22
company for so long, I really appreciate how
1:24
Insight Global is really proactive, and we pivot,
1:27
and we've always been great business partners to
1:29
our clients.
1:30
But what drew me to this opportunity specifically
1:33
was just how different it was
1:35
and how new and exciting it it seemed,
1:38
kind of like a breath of fresh air
1:39
with a long term solution to our customers
1:42
that wasn't just a traveler that was gonna
1:44
be on-site for twelve weeks, but truly creating
1:46
a long term solution for our customers and
1:48
also making sure that we're taking really great
1:50
care of the nurses and kinda creating a
1:52
sense of generational change,
1:54
for families across the world. It just seemed
1:55
like something really interesting and new, and I
1:57
was excited to be a part of it.
1:59
Yeah. Well, I can hear the excitement in
2:01
your voice, Brenna, about the work that you
2:02
do. So thank you so much for sharing.
2:04
And, doctor Brennan, how about you? Tell us
2:06
about yourself.
2:07
Yeah. Absolutely. So I've been a nurse now
2:10
for the last twenty years,
2:11
which seems crazy to say out loud. But
2:14
for the first fifteen, I was actually in
2:16
the hospital and health care setting. And so
2:19
I got to experience some of these staffing
2:21
shortages and challenges firsthand,
2:24
especially during COVID when Brenna actually helped stand
2:27
up this program, which is kind of ironic.
2:29
But I got to see also
2:31
some of the other organizations
2:34
that actually placed international
2:36
nurses.
2:37
And, unfortunately, I got to see firsthand how
2:39
it can be done really poorly.
2:41
And so when this opportunity came at Insight
2:44
Global for me to be the chief nursing
2:46
officer and actually help these nurses transition in
2:49
a way to set them up for success,
2:52
help them through that entire journey, I really
2:55
jumped at it. You know? And then, of
2:56
course, meeting the Insight Global Health team just
2:59
really sealed the deal for me. And part
3:02
of my role, probably my favorite part of
3:04
my role,
3:05
is that I really get to see nurses
3:07
through their entire journey.
3:09
So once Brenna's team hires them and they
3:11
onboard,
3:12
they go through our academy
3:14
in Manila, Philippines.
3:16
And they go through a one week intense
3:18
program really focused on those things that are
3:21
different from Philippines practice to The United States.
3:25
And then once they're deployed here in The
3:27
United States, I still get to follow-up with
3:29
them
3:30
on any performance concerns, any educational needs, any
3:33
questions they have, and that part is really
3:36
fun to me.
3:37
Doctor Brennan, I was just going to say
3:39
being with them throughout that continuum must be
3:42
pretty rewarding. So,
3:44
yeah, appreciate you sharing more about your work
3:46
as well.
3:47
Yeah. Absolutely.
3:49
And I think this topic today,
3:51
international talent, is so important because we know
3:54
that this is a primary lever for many
3:56
hospitals and health systems and health care organizations
3:59
more broadly as they're looking to address
4:02
pervasive workforce shortages right now. So I'd love
4:05
to know from you both, what do you
4:06
think is often misunderstood
4:08
about what it takes to to integrate international
4:10
nurses successfully,
4:12
and where does the industry still struggle with
4:13
this?
4:15
Yeah. Absolutely. I can jump in here. So
4:17
I think the main thing that's misunderstood
4:20
is primarily in The Philippines. You know, they
4:23
go through nursing school, and they use The
4:25
United States curriculum.
4:27
And I think oftentimes,
4:29
our US based clinicians think that they must
4:32
also practice the same. And so there's a
4:35
lot of differences between the practice. The knowledge
4:37
is the same, but we wanna make sure
4:40
that we are having all of our nurses
4:42
go through this one week training prior to
4:44
deployment
4:45
to address those things that they just don't
4:48
practice regularly.
4:49
You know, for for instance, one of the
4:51
things is narcotic diversion here in The United
4:54
States.
4:55
Huge deal. There's heavy scrutiny.
4:57
There's a lot of effort that goes into
5:00
ensuring narcotics aren't diverted, and that's just not
5:03
the same in The Philippines.
5:04
And so teaching them the importance of why
5:07
we count narcotics here, why it's so important,
5:10
and why it's so scrutinized
5:12
is really important and really helps them be
5:15
successful
5:16
once they're deployed.
5:17
The other piece is really
5:19
the simulation lab piece. In The Philippines, a
5:22
lot of times, their first, you know, kind
5:25
of go to is to call a physician
5:27
and say, you know, hey. We have this
5:29
patient and their their status has changed. In
5:31
The United States, we have a lot more
5:33
kind of autonomy.
5:35
We have different order sets. We have different
5:37
policies and protocols that we can follow before
5:39
we get to the point where we have
5:41
to call a physician.
5:42
And so we like to give them sufficient
5:44
time to practice those steps that they learned
5:47
in nursing school to close that gap and
5:49
bridge that gap before they get deployed.
5:52
Yeah. And I'll just add,
5:54
I think my favorite part about this program
5:56
and this offering
5:57
is that it's not a hard thing to
5:59
bring into your system or your hospital.
6:02
It really is just an intent intentional approach
6:05
that it requires. And that's something that our
6:07
team takes really seriously as how can we
6:09
be as thoughtful as we can and as
6:11
intentional as we can. Each hospital is different.
6:14
Each city is different. Every nurse is different.
6:16
And so we really work hard to not
6:18
just, you know, provide an experience that we
6:21
think is gonna work for everybody, but something
6:22
that works for each individual and each leader.
6:26
And, again, it's not something that's really challenging
6:27
or hard. It's more so just let's take
6:29
an intentional approach. So our team does a
6:31
really great job of, you know, consulting and
6:33
educating where we can different hospital leaders to
6:36
make sure they understand what challenges they may
6:38
face and be more proactive in that approach.
6:41
I think probably every
6:43
nurse or every hospital has interact with a
6:46
Filipino nurse before. They're really hardworking.
6:49
They're great to have on your staff, and
6:51
they also are educated in English,
6:53
primarily in The Philippines too, which makes that
6:55
transition pretty easy as well.
6:57
And that paired with, you know, Jamie's education
6:59
that she's built out at the GRID Academy,
7:02
really, we prepare them as as best as
7:03
we can, and then we partner with the
7:05
leaders,
7:06
the preceptors to make sure they understand, like,
7:08
hey. You might face a challenge with their
7:09
communication at this point or, you know, we
7:11
would we would expect that you give feedback
7:13
in this way so that the nurse can
7:15
receive it or whatever the case is. But
7:16
being really consultative in that approach to make
7:18
sure that everyone is on the same page
7:20
and has the same goals in mind.
7:23
Brenna, appreciate those add ons And appreciate the
7:26
clarification too that it's not necessarily difficult to
7:29
bring in or to integrate international nurses, but
7:32
it does require some of the intentional,
7:34
pieces that you just touched on. And so
7:37
I'd like to talk a little bit about
7:39
retention
7:40
as well.
7:41
Recruitment gets a lot of attention in the
7:43
health care workforce space,
7:45
but retention,
7:46
you know, we've heard from leaders is oftentimes
7:48
even harder to
7:51
successfully do. So
7:52
once an internationally educated nurse is on the
7:55
ground, what does meaningful support really look like
7:58
for that nurse, and what should hospital systems
8:00
be doing differently in how they partner with
8:02
IEN programs?
8:04
Yeah. That's a great question. Erica, thank you
8:07
so much. So meaningful support is actually one
8:09
of the reasons I came to Insight Global
8:11
Health. I was extremely impressed
8:14
with how many people are here to support
8:17
these IEN nurses and also our clients.
8:20
Not only is it Brenna and myself, but
8:22
we also have an experienced lead, we have
8:25
an engaged lead that are in constant communication
8:28
with these nurses. And a lot of the
8:30
things that we found
8:32
that would, you know, kind of prevent them
8:35
from being retained
8:37
were things like, they have family in Chicago,
8:40
but they're placed in California.
8:42
They, you know, practiced in The Philippines in
8:44
the ICU, and we placed them on med
8:47
surg.
8:48
These are things that our experienced team and
8:50
engaged team has really leaned into to identify
8:53
early on
8:55
to ensure that these nurses are placed in
8:57
the right
8:58
facility, in the right area, you know, in
9:00
the right state to make sure we're decreasing
9:03
the risk of turnover
9:05
from the get go. Because we understand how
9:07
expensive turnover is and how hard it can
9:10
sometimes be to retain nurses.
9:12
The other thing that I found really helpful
9:16
is
9:17
identifying those practice gaps that I talked about
9:20
previously.
9:21
And some hospital systems might not realize what
9:24
it means for a nurse to work in,
9:26
for instance, a province in The Philippines.
9:29
Sometimes working in a province means that they
9:31
saw two patients a day,
9:33
or they were in more of a clinic
9:35
setting, or they were more of a urgent
9:37
care center setting. And so the transition for
9:40
them might take a little bit longer.
9:42
And so where we may have, you know,
9:45
a structured orientation
9:46
or a residency program or something like that,
9:50
it's really important to impact that retention
9:53
by kind of remaining flexible and saying, you
9:55
know, I know our residency program is twelve
9:57
weeks, but this nurse needs thirteen weeks because
10:00
of the the situation that they were in
10:02
in The Philippines. And to me, that's really
10:05
impacted their retention.
10:07
Yeah. I love what you said, Jamie, about,
10:09
like, it really does start with the recruiting.
10:11
So my team has to be so intentional
10:13
about the conversations that they're having from the
10:15
time that we are first interacting with that
10:17
nurse. But then our engaged team who's working
10:19
with these nurses, you know, day in and
10:21
day out while they wait out their timelines
10:23
for retrogression to come to The States,
10:25
that we understand exactly, you know, what unit
10:27
they're still in. Are they still working in
10:29
med surg, or have they transitioned to a
10:30
different unit? That's gonna depend on, you know,
10:32
who we send them to. Do they wanna
10:34
live in a big city? Are they scared
10:36
of being somewhere where it snows? I'm from
10:37
Florida, so I personally would be.
10:40
So really just staying in touch with these
10:41
nurses while they're waiting out their time to
10:43
make sure that not only are they staying
10:44
active in their bedside roles, but we have
10:46
a really good understanding of what is their
10:48
number one priority when they're coming to The
10:50
US
10:50
and placing them somewhere that makes the most
10:52
sense for them.
10:53
And then the other thing I'll touch on
10:55
is the touch
10:57
based, conversations that we have with the leaders
11:00
at the hospitals from a clinical performance perspective,
11:03
and that's where Jamie and her team get
11:04
really involved to make sure that they're performing
11:06
really well. But, also, the personal piece is
11:09
so important. I think we all know and
11:11
appreciate that if you're not doing, you know,
11:14
well at home or something's going on with
11:16
your kids or your mom or you're struggling
11:18
to pay your bills, whatever the case is,
11:20
it's really hard to bring your best self
11:23
to work. And so it's really important that
11:25
our engagement team drives really strong relationships with
11:28
those people and our consultants so that they
11:30
can ensure that these people have everything they
11:32
need at home and from a personal perspective
11:35
so that they can show up and be
11:36
a really strong nurse to our clients.
11:39
Yeah. I mean, personalized,
11:41
hands on, those are two terms that come
11:43
to mind when I think of what you
11:44
both just described. You know, you're talking about
11:47
considerations here
11:48
in regards to geography, location,
11:51
practice gaps,
11:53
consistent communication, and really just understanding
11:56
what's going on with these individuals behind the
11:58
scenes, you know, outside of work. It sounds
12:01
imperative. And,
12:03
supporting somebody who's relocated
12:05
internationally is, of course, different from supporting a
12:08
domestic employee. So I wanna just get a
12:11
little more granular here. I know you've both
12:13
already shared some fantastic examples of how you're
12:16
approaching the support for IEN nurses.
12:19
How does Insight Global think about well-being across
12:22
the cultural, personal, and professional areas, and what
12:26
does it really mean to be a destination
12:28
employer for this population?
12:30
Yeah. That's a great question. I think,
12:33
you know, Jamie and I are here today,
12:34
but there's a huge portion of our team
12:36
that's dedicated to nurse experience and engagement.
12:38
It's probably the largest portion of our team,
12:40
honestly.
12:41
And those
12:42
people are all about making sure the nurse
12:45
has a great experience, again, from that very
12:46
first contact call
12:48
to their last day on contract with us.
12:50
And that could be over the course of
12:51
six to seven years depending on, you know,
12:54
immigration timelines and, you know, retrogression and everything.
12:57
So it's really important, I think, number one,
12:59
that we have a strong relationship with each
13:01
nurse. I touched on this earlier, but in
13:02
order for them to show up and be
13:04
a good, consultant for us and a strong
13:06
nurse and, you know, patient safety at the
13:08
end of the day is what everyone's worried
13:09
about is to make sure that they're taken
13:11
care of as a person. That also means
13:13
they're family.
13:14
And so really understanding what's important to them,
13:18
and supporting them through that. What I will
13:20
say it's been really cool to see over
13:21
the last couple years is we've had nurses
13:23
on-site, and we have these engagement teams driving
13:25
relationships
13:26
with the nurses as we've had people invited
13:28
to weddings.
13:30
We are part of the initial group of,
13:31
you know, announcements. When nurses get pregnant, they're
13:34
excited to tell our team, which just kinda
13:36
shows you the level of relationship and investment
13:38
our, you know, nurses have with our teams.
13:41
I think the the important piece here is
13:43
is the cultural piece too. Jamie touched on
13:45
this, but at GRID Academy, we spend a
13:47
lot of time talking about just, like, what
13:48
is it like to live in America, what
13:50
is it like to work in America, and
13:52
how is that different
13:53
from how, you know, life in The Philippines
13:55
may work. But there's a piece of it
13:57
that's also, like, how do we make this
13:59
new city, whether it's, you know, a really
14:01
rural location in America
14:03
or it's, you know, New York City? How
14:05
do we make that feel like their second
14:08
home?
14:08
And so we do a great job of
14:10
getting other, like, cultural groups involved. So there's
14:13
a really large population of Philippine
14:16
Nursing Association of America with chapters all over
14:18
the country. We usually tap on them,
14:21
you know, to get involved and partner with
14:23
us. We really try to create a second
14:25
home for these people, and that may look
14:27
like cultural events or, you know, on-site, you
14:30
know, meetings and lunches, town halls that we
14:32
host. I know Jamie's traveling next week to
14:34
do a a town hall with a CNO
14:36
at one of our locations
14:38
to talk through just employee experience and how
14:40
we can continue to drive that and make
14:42
it better, make sure that they feel heard,
14:44
is really, really important. So not only are
14:46
we focused on cultural adaptation, but also how
14:49
can we make them feel at home, what's
14:51
their personal life and professional life look like,
14:52
and, ultimately, how can we drive them to
14:54
feel like they belong here? And once those
14:57
nurses get to that point of belonging,
14:59
we feel pretty confident that that's gonna really
15:01
protect attrition as well because if they can
15:04
create a community where they live and the
15:06
people that they work with, they're less likely
15:08
to leave. And so we really partner with
15:10
our hospital system clients on making sure,
15:13
that we understand what what's going on in
15:15
that city, you know, where are the best
15:17
school zones. Let's let's make sure our nurses
15:19
live in the best area so their kids
15:20
go to the best schools
15:22
And doing all of this on the front
15:23
end so that by time they arrive, they
15:24
just have to focus on work. All the
15:26
other roadblocks
15:28
are cleared for them, and they can just
15:29
really focus on being the best employee to
15:31
the health system that they're working for.
15:33
Yeah. That's perfect, Brenna. And just to add,
15:35
you know, from a clinical lens, all of
15:37
those things that Brenna said are so important.
15:40
And when we're at GRID Academy in The
15:42
Philippines and we're taking these nurses through this
15:45
educational program, as Brenna said, we do focus
15:48
a lot on the cultural differences, like how
15:50
Americans talk at you versus to you and
15:53
how, you know, in The Philippines being silent
15:56
is very respectful. And in the, you know,
15:58
in The US, it could mean something very
16:00
different. And so we focus on those things,
16:02
but also all the work that Brenna's team
16:05
does and all the work that our engage
16:07
and our experience team does at Insight Global
16:09
Health
16:10
really builds trust,
16:12
and trust is what is actually
16:15
going to make them
16:18
successful. They trust that we are going
16:19
to do all of the things, like find
16:21
them the best neighborhood and find the best
16:23
school for their kids. And in those instances
16:26
where they do run into challenges or there
16:29
is an issue with cross cultural, you know,
16:31
personal or professional issues, they actually reach out
16:34
to us and they say, hey. I have
16:36
this problem and I trust you, so I
16:38
want you to help me solve it. And
16:40
from a clinical lens, that is so, so
16:42
important because they're taking care of patients.
16:45
And if they made a mistake or they
16:47
feel like they're being treated unfairly or they
16:50
feel, you know, that they need additional help
16:53
in some type of education,
16:55
that trust becomes so important.
16:58
Absolutely. I appreciate hearing both the clinical lens
17:01
and,
17:02
you know, more of the on the ground,
17:04
what's behind the nurse lens in terms of,
17:07
human and cultural elements. You both shed so
17:10
much light on all of the very important
17:12
areas that organizations need to be considering.
17:16
To close us out here, you know, workforce
17:18
pressures in health care, they're certainly not going
17:20
anywhere, and they will continue to change. So
17:23
I'd love to know where Insight Global is
17:25
focusing its energy right now.
17:27
And what's one thing you wish every CNO
17:30
or chief human resources officer really understood about
17:34
internationally educated nurses that maybe they don't understand
17:37
right now?
17:38
Yeah.
17:39
I can jump in first on this one.
17:41
I think
17:42
for my team and and really the larger
17:44
part of of our group right now, we're
17:46
focused on how can we continue to deliver
17:48
for our customers at a large scale. And
17:50
what we're seeing is we're hiring the nurses,
17:52
and the client need is continuing to increase.
17:55
So we're focused on continuously
17:57
hiring really strong nurses at a high volume,
18:00
and getting their visas filed quickly so that
18:03
they can come to America as soon as
18:04
possible.
18:05
I think if there was, you know, something
18:07
I would really want a a c level
18:09
executive from a a hospital or health system
18:11
to understand is that this truly is a
18:13
long term solution.
18:15
We we built this program
18:17
to get away from the traveler issue that
18:19
was happening during COVID and and how can
18:21
we create something meaningful and impactful.
18:24
And, you know, it it seems like it
18:25
can be a heavy lift, but as I
18:27
mentioned earlier, it's really not.
18:29
We are really take a taking a consultative
18:32
approach to our customers to make sure, you
18:34
know, every step of the way we're providing
18:35
support.
18:36
We kinda take all the work off their
18:38
plate
18:39
and create a solution that's long term. You
18:41
know, these nurses are staying on-site long longer
18:44
than the three year contract even, and we've
18:47
so far seen a sub 1% attrition.
18:49
So we're really excited about that and continuing
18:51
to see these people grow and buy homes
18:53
and have babies and really plant roots in
18:55
these communities.
18:56
We'll support a customer who needs three to
18:58
five nurses. We'll support a customer who needs
19:00
500 nurses. Really, the the size doesn't matter.
19:03
All specialties,
19:04
if you're facing a problem right now, which
19:06
a lot of hospitals have mentioned to us
19:08
is, you know, we've hired a lot of
19:09
novice nurses. We need some more experienced nurses.
19:12
A lot of our nurses have ten to
19:13
fifteen years of experience in The Philippines or
19:15
maybe even working in Saudi or, you know,
19:17
somewhere in The Middle East where they've really
19:19
refined their
19:20
skills. And so that's something we can also
19:22
help with. And I think my favorite compliment
19:24
we've ever gotten about the program in general
19:26
is just that these nurses have such strong
19:29
patient care. You know, they're DAISY award nominees
19:31
and winners, but also they're changing the culture
19:35
of the units that they're working on in
19:36
such a positive way. And it just makes
19:38
me so proud of the work that we're
19:39
doing and continuing to do. Not only are
19:42
we taking care of American patients and they're
19:43
providing great patient safety, but, like, people on
19:46
the unit, other nurses, other leaders are feeling
19:48
the impact of our nurses in a cultural
19:50
way, and they're being positively affected by these
19:52
people every day. So that would be my
19:54
note to the executives who are thinking about
19:56
IENs.
19:57
We'd love to talk to you and and,
19:59
you know, educate you more on what that
20:01
could look like for your
20:02
system. Yeah. Absolutely. And for me, you know,
20:04
from the clinical side,
20:06
it's really understanding that staffing challenges here in
20:09
The US don't really seem to be shifting
20:11
in our favor, unfortunately.
20:13
You know, I like I said earlier,
20:16
I've been a nurse for twenty years, and
20:18
fifteen of those I was in the hospital.
20:20
And I was the proponent, you know, director
20:23
of nursing that said, no. We do it
20:25
this way. You know, this is how we've
20:26
done it. And so, unfortunately, we're kind of
20:29
at an impasse
20:30
where how we've always done things isn't really
20:33
working for us. You know, we don't have
20:35
as many nurses graduating from nursing school. There's
20:38
so many ways that nurses can work outside
20:41
of the hospital. Whereas when I graduated nursing
20:43
school, you worked at a hospital. You know,
20:45
if you got lucky, you worked in a
20:46
doctor's office.
20:48
And so it's kind of challenging CNOs and
20:51
CHROs to think outside the box.
20:54
And if that's not staffing inpatient with IENs,
20:58
do you have a virtual care center that
21:00
you're setting up that we could utilize our
21:02
IENs
21:04
for work remotely in The Philippines? Is this
21:07
something that we could help you with that
21:09
may not mean deploying nurses into your facility,
21:12
but they could help assist and support your
21:14
nurses from abroad?
21:16
Those are things that I really, really enjoy
21:18
about Insight Global Health is, you know, like
21:21
Brenna said, we're always constantly evolving and changing
21:24
and, you know, trying to tackle new issues
21:26
in the hospital setting and health care in
21:28
general. And so these are things that I
21:31
would love to to help any CNO, CHRO,
21:34
health care executive think through.
21:36
Well, Brenna doctor Brennan, I know that our
21:39
audience
21:40
has a lot to take away from this
21:41
episode, a lot to consider about IENs. And
21:43
I wanna thank you both for shedding light
21:45
on such an important area of the health
21:46
care workforce today, and thank you so much
21:48
for your time.
21:50
Thank you. Thank you, Erica. We enjoyed it.
21:53
And we'd also like to thank our podcast
21:55
sponsor for today, Insight Global Health.
21:57
Listeners, be sure to tune in to more
21:59
podcasts from Becker's by visiting our podcast page
22:02
at beckershospitalreview.com.