Letters

Positively changing staffing As a young nurse having recently taken on a charge nurse role, I greatly appreciated Maureen Kroning's thoughts on staffing in her article “The Domino Effect: Staffing for ‘What Is’ Versus ‘What If’” in the February issue. Kroning makes several great points in her article; she really hits the nail on the head when she states that staffing for “what is” the hospital's current census creates a number of issues, many of which can have detrimental effects on both patient and nurse satisfaction and, more important, patient safety. My hospital has drastically changed the way each unit is staffed based largely on productivity alone. The hospital's new staffing guidelines don't take into account patient acuity, patient outcome, or nurse satisfaction, much less patient safety; to be quite frank, if patient outcomes are suffering, then perhaps our hard work is simply in vain. As a charge nurse, I deal directly with staffing and understand the frustration that staffing for current patient census places on caregivers and patients alike. My unit has struggled to find a staffing solution that works well; in fact, staffing is a constant source of debate on my unit. I'm eager to share Kroning's excellent article with my unit's management in the hopes of encouraging a positive change in staffing for both employee and patient satisfaction! Thank you for publishing an article that addresses current issues faced by nursing leadership. Internationally educated nurses and American nursing programs I found the June issue's “How to Positively Integrate Internationally Educated Nurses” by Claudia DiSabatino Smith, PhD, RN, NE-BC, and Judy Ong Ho, MSN, RN, ACNS-BC, CPHQ, to be a very interesting article. I was one of a group of nurses who arrived during a nursing shortage in the late 1980s to fill open positions at a national Level 1 trauma center. The facility had an excellent program to help integrate a mix of nurses arriving from the United Kingdom, Canada, Australia, India, and the Philippines. One aspect that wasn't addressed in this particular article is the challenge faced by nurses who remain in the United States and attempt to continue their education. I had gained experience in America as a unit manager, case manager, nurse clinician assigned to a surgical service, and senior clinical nurse in both inpatient and outpatient areas. In addition, I arrived in the United States with my RN training from a London teaching hospital, two U.K. postgraduate certificates in neuroscience and intensive care nursing (6-month full-time courses), and a year of postgraduate clinical nurse experience also obtained in major London hospitals. Upon arrival to the United States, I passed the only stipulation to practice, which was the NCLEX. However, when I attempted to apply to American RN-to-BSN/MSN programs, I found that I couldn't obtain educational credit awarded toward the BSN programs because there were no comparably equivalent educational courses in the United States to measure my U.K. education against. I was advised that I could apply for a BSN but would only be considered a candidate if I started in the program at the initial undergraduate level. During my employment at my original recruiting hospital, while competing with U.S.-trained applicants, I was promoted in seniority on four occasions based on reviews of my experience and performance. The administrators valued the contributions of the international nurses and were very supportive and encouraging. However, upon seeking employment at other facilities in several different areas of the United States, I found the experience very disappointing and discouraging. My lack of U.S. training and an American degree was a definite barrier and I was told that, without a BSN, I was unqualified or not eligible for consideration for positions that I had held previously and performed competently for over 10 years. I would be interested in the area of integrating internationally educated nurses into U.S. nursing programs also being investigated. I believe this would be of benefit for retention and advancement of internationally educated nurses after arriving to the United States. Natalie Helms, RN S.D. Pracyk

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