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Latino RNs Back At The Bedside

Maryland county's initiative helps foreign-trained nurses return to practice

Monday July 28, 2008
Yelitze Medina, RN, took part in the Latino Health Initiative at Washington Adventist Hospital in Takoma Park, Md. Photo courtesy Washington Adventist Hospital
Yelitze Medina, RN, took part in the Latino Health Initiative at Washington Adventist Hospital in Takoma Park, Md. Photo courtesy Washington Adventist Hospital
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Aiming to address the need for more nurses, especially bilingual, bicultural professionals, a multi-institutional collaboration spearheaded by the Montgomery County (Md.) Latino Health Initiative (LHI) has successfully shepherded 10 RNs educated in Central and South American countries through the licensure process, providing them the opportunity to again practice at the bedside.

"I love my job," says Ana Ramirez, RN, BSN, a graduate of the program who now works as a critical-care nurse in the neuro-surgical ICU at Holy Cross Hospital in Silver Spring, Md., one of the program's partners. "It's as if I was a nurse before I was even born."

Since moving to the U.S. from Colombia in 2002, Ramirez volunteered in a community clinic but otherwise did not practice. Ramirez says she could not afford to take English as a Second Language (ESL) courses on her own. With the LHI program's moral and financial support, she has her career back.

"Without this program, I couldn't have made it," adds Ionara Dos Santos, RN, MSN, nursing education coordinator at Holy Cross, another participant. Dos Santos married an American and moved from Brazil three years ago. Although she was a nursing instructor in her native land, Dos Santos initially did not pass the National Council Licensure Examination (NCLEX) and stayed unemployed and professionally unfulfilled. Now she helps fellow foreign-trained nurses working at Holy Cross.

The LHI of the Montgomery County Department of Health and Human Services began the Pilot Program for Licensure of Foreign-Trained Nursing Professionals two years ago. It grew out of an effort to improve health outcomes for the county's Latinos.

"We documented a tremendous need for a workforce that mirrored the population in Montgomery County," says Sonia Mora, manager of the LHI. The team knew healthcare professionals living in the community were driving taxis, watching children, or cleaning homes instead of working in health care."

"When they left their country, they never dreamed they would be anything but nurses," says Wendy Friar, RN, MS, director of community health for Holy Cross, which has hired 11 participants. Seven passed the NCLEX within 10 months and now work as RNs. The nurses commit to work at the facility for two years.

Mora talked with the underemployed nurses to learn about the barriers and evaluated programs in other parts of the country before developing the pilot.

"This is such a valuable program for the county, our hospital, and for the nurses," says Debbie Berry, RN, MSN, CPHQ, interim chief nursing officer and associate vice president of nursing practice at Washington Adventist Hospital in Takoma Park, Md., another partner.

How the program works
The pilot provides financial assistance, case management through the county's one-stop workforce center, an ESL course for healthcare professionals and nursing refresher courses at Montgomery College, and practical exposure to the U.S. healthcare system through full-time employment at Holy Cross and Washington Adventist hospitals.

Of the 25 participating nurses, nine now work as RNs, with the balance still progressing at their own pace through the credentialing process, obtaining records from their colleges, and mastering English. When ready, the nurses obtain certified nursing assistant credentials and begin working as "nurses in training" at one of the participating hospitals.

"They give us hands-on experience," says Yelitze Medina, a nurse in training at Washington Adventist. "They allow us to observe RNs and everything about the healthcare system."

Nurses in training shadow an RN, perform duties within their CNA scope of practice, and attend inservices and other educational programs open to RNs at the facilities. Both hospitals customize support and learning opportunities. Friar says staff RNs enjoy working with the nurses.

At Holy Cross, nurses in training work in critical-care units, where the needs are greatest, and at Washington Adventist, they rotate to different units. Many of the obstetrical patients at the latter hospital speak Spanish.

"I felt great because I was able to help them through the process of labor and delivery," Medina says.

On another unit, Medina identified a Spanish-speaking patient with suicide plans and intervened, reporting it to the nurse preceptor and sitting with and listening to the patient. Berry says patients often will open up to a nurse who speaks their language.

Medina trained in Venezuela and served in her country's air force before immigrating to the U.S. four years ago. She volunteered but was afraid to work in health care, not understanding the American system.

Outcomes
"We have a large Spanish-speaking community, and these nurses help us communicate better and make patients feel safer," Berry says.

Average wages earned by those who have completed the program have increased 150% since they enrolled. "It's diversifying the workforce, enhancing the economics of these families, and improving health outcomes with a bilingual and bicultural workforce," Mora says.

Mora plans to continue the program with another group of applicants. The LHI seeks funding to expand the program to other ethnic groups and health professions. Angela Pickwick, instructional dean for health sciences at Montgomery College, says nursing homes also have expressed interest in participating. Pickwick is working on a grant to establish a similar program in another county.

"I thank God for this opportunity," Medina says.

Debra Anscombe Wood, RN, is a freelance writer.

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