In this episode of Elevate Care, Kerry dives into the critical role of international nursing in shaping integrated solutions and workforce strategies for the future. Joined by industry experts Beckie Daniel and Sinead Carbery, the discussion unpacks the challenges and opportunities in international nursing, from the pandemic’s impact on staffing needs to navigating visa retrogression. The conversation highlights the ROI of international nursing, the importance of partnerships, and how domestic and international staffing can work hand-in-hand. Becky and Sinead also share insights on what makes a successful international nurse and how healthcare systems can better integrate and support these professionals. Whether you’re a healthcare leader or simply curious about the future of nursing, this episode is packed with actionable insights and inspiration.
In this episode of Elevate Care, Kerry dives into the critical role of international nursing in shaping integrated solutions and workforce strategies for the future. Joined by industry experts Beckie Daniel and Sinead Carbery, the discussion unpacks the challenges and opportunities in international nursing, from the pandemic’s impact on staffing needs to navigating visa retrogression.
The conversation highlights the ROI of international nursing, the importance of partnerships, and how domestic and international staffing can work hand-in-hand. Becky and Sinead also share insights on what makes a successful international nurse and how healthcare systems can better integrate and support these professionals. Whether you’re a healthcare leader or simply curious about the future of nursing, this episode is packed with actionable insights and inspiration.
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Episode Resources:
Speaker 1 (00:00.182)
Welcome to Elevate Care. I'm your host, Kerry Perez, and today we're talking about how international nursing is an important part of a workforce strategy. So I'm really excited to have our guests here today. We've got Beckie Daniel, who is the VP of Workforce Solutions at Tenant Health Care, and Sinead Carberry, who is our President of International Staffing Solutions at AMN. Welcome to the show. Great. Beckie, let me pass it over to you first to give an introduction and Sinead will come to you.
Great to be here.
Thank you.
Speaker 2 (00:26.712)
Sure, great. So I have been with Tenant for, I don't know, almost five years now, I guess. My title is Vice President of Workforce Solutions. So any external labor that is contingent, so anything that's not a Tenant employee when we go outside of the Tenant employees for whatever that staff you need might be runs through my program. So both internal resource pools and then everything external.
Thank you, Beckie.
today.
Carrie, good to be with you. I'm Sinead Carberry. I'm responsible for the International Division for AMN Healthcare. I started my journey as an international nurse and actually came to the United States over 30 years ago as an O'Grady Payton International nurse and really had the experience firsthand. So I think that that's really what's developed our relationship, very strong relationship with Tennant over the years is just having the experience myself and then Beckie really understanding what it takes to
be successful in an international program. we're excited to talk about that today.
Speaker 1 (01:31.438)
should be a good conversation. let's jump right in. Talk to me a little bit, Beckie, about why you started looking at international nursing as a solution. What were some of your goals and maybe why did you partner with AMN?
So, you know...
I think when you look at staffing, especially when we were in, I kind of separate the way I look at contingent workforces, pre-pandemic, pandemic and post-pandemic, right? But when you're looking at how do you fill these needs, and of course our needs greatly increased during the pandemic like everyone else's, and there's no one solution to all of it. And international nursing is, in my opinion, a very critical piece to your long-term strategy.
So during the pandemic, everyone's knee-jarking, right? And how do we fill our needs now? And this is crisis. And then it not that we weren't partnering with our Greedy Patent, we were.
But how do we now normalize and get back to looking at what is our long-term goals, what is our long-term strategy, and where does the international piece fit? And a little tidbit is I've known Sinead for quite some time. I did oversee the international program with my prior job, my prior company, and got to know Sinead then, and really was able to collaborate on that strategy and move it forward. And so really feel like
Speaker 2 (02:58.902)
we are positioned well for the future and the normalization after the pandemic.
should need anything you want to add.
I think for Beckie and I, it's really about the relationship. It's understanding what Beckie's needs are and then Beckie understanding what the needs of the clinicians are. International nursing can be a challenge to stand up a program and Beckie's being just tremendous as an advocate for the leaders at her individual facilities for them to understand that look, it's an initial lift for them, but the investment in the clinicians at the beginning.
really pays off in terms of getting the continuity of care. And then ultimately the retention, which is tenants' goal, is to bring in international clinicians and keep them for a long period of time after assignment.
Yes.
Speaker 1 (03:46.572)
Great. All right, so there's no truer word spoken than the sort of pre, during, and post pandemic. And you were mentioning sort of long-term strategy. We know with international nursing, there's sometimes some cyclicality as it relates to visa retrogression. First for our listeners who don't know what visa retrogression is, if you wouldn't mind giving a little bit of a definition of that. And then after, why have you continued to invest in international nursing during visa retrogression?
So I would defer to Sinead on.
describing virtual aggression. What I will say from a facility standpoint, it's difficult to understand. And so that is one of the big perks of my partnership with Sinead is when I get stuck in where are we in the process, I can turn to Sinead and she can make sure that I understand all of the details that are going on and any barriers we have to getting the stuff in. But I'm going to punt to you,
Perfect. So I will I will try and make it as simple as possible. We primarily talk about nurses and then occasionally med techs in the allied space, because those are the clinicians that qualify for visas. There is a limit on the number of visas that are available every year. And when there are more clinicians waiting to come than there are visas available, it creates a backlog. And that's what we refer to as visa retrogression. The reason you have to have a very experienced international partner
is you have to understand that backlog and the queue so that you can try and assist your healthcare partners in estimating when clinicians might be ready to start, which is really what the healthcare systems need is I need a clinician and I need to know when they potentially could start. International has some challenges just because of that limitation of visas, but as I think Beckie has experienced with Tennant, it's
Speaker 3 (05:42.838)
ensuring that you continue to recruit international clinicians and that it's not just reactionary to COVID would be an example. just, don't start international recruitment just to circumvent some of the issues we had during COVID. It's really where is international in your workforce strategy and you integrate it into your strategy for the longterm, two to five years ahead, thinking about retirements and bringing in experienced clinicians.
to offset some of your retirements that will happen in the future.
And so why is it so important to kind of keep that pipeline going even when it might be a little bit more of a trickle at some point?
Because it's all about when you get in the queue. And if you stop and start your international program, you're creating breaks in that queue. So in order to have a consistent supply, you want to continue to recruit.
Okay, so maybe moving more into talking about the clinicians themselves, talk to me a little bit about how international RNs are fitting into your broader workforce strategy.
Speaker 2 (06:45.342)
So we've been fortunate in a few areas that we have leaders in some of our facilities that came over as international nurses, very similar to Sinead's background. We also have been a partner with their Grady Paton for so long that we have nurses that have converted into our system that may not be in a leadership role, but that are still working in the facility. So.
When you think about the international nurses coming over, you really want a positive experience for them, right? So we've leaned on our leaders, our leaders in those roles, our international nurses that are now staff, and then really looking at who in our facilities, you know, like I'm going to give an example. Let's say I have four nurses coming over from the Philippines and I have a real strong finance team that has some Filipino
folks that work in it and how can we partner and pair those folks together? So really thinking of how can we make the transition comfortable for them?
That makes a lot of sense. You know, it's important that these are individuals picking up and moving their lives, not just numbers to fill a gap and how important it is to make them feel comfortable. know, Sinead, maybe even from your perspective, what does that feel like as an international nurse when you feel welcomed?
So my experience was a little bit different when I first arrived. I learned later that
Speaker 3 (08:16.716)
The hospital was thinking about changing their minds last minute. So that wasn't a great experience. So I would say knowing that you're coming somewhere where you're wanted and needed and knowing that the health system that's receiving you understands that you're not a new graduate. You may look like a new graduate on the first day that you show up to work because you're in an element of culture and clinical shock. But once you find your feet, then all of the years of experience that you have starts to come to the
front. And it takes a little bit of time, I would say three months for an international clinician to feel confident again. But just remember that they're not new grads. There are things that, yes, we need to learn that are different to their home countries. But the years of experience starts to come through once they're through that transition period. But for me, what I took away from my personal experience was to ensure that we are giving our health care systems
the tools that they need to set up a successful program themselves so that they ultimately have their attention at the end of the day. That clinicians first feeling really determines whether they stay in the long term.
So if I may pull on that thread, what are some of those tools that we help set our clients up with?
Yeah, so we have a clinical team that I would say educates our healthcare leaders about what tools they want to think about implementing before the clinicians arrive. We do quite a lot of pre-arrival education that assists the clinicians to be ready for the transition. And then the other piece that many don't think about is the social support. The clinicians are coming often with their spouses and their children.
Speaker 3 (10:03.955)
and they need resources to be able to integrate into the community. So I think that's the other benefit of our program. Beckie is just the clinical.
I just chime in there. You know, I've worked.
with various other international programs throughout my career, won't say how long, from direct placement to working with vendors for long-term contracts. And you have to really be careful about the vendor that you work with because there is a lot that goes on behind the scenes that my team's not prepared to deal with. We don't have the knowledge, quite honestly don't have the time, right? So having a partner that you have assurances that they're doing all
all of this nurturing and caring feeding before that person ever steps foot into your facility is really key to success. And it's not something that was done 30 years ago, 20 years ago. you know, having that assurance that that will be done and taken care of for all the clinicians coming into our facilities. Another thing I wanted to add is that more recently, I'd say within the last year, is in markets where we really feel like
We want to look a little deeper into international nurses as our long-term solution, our bigger piece of that long-term solution. Sinead has come into the market and met with our leaders with me and we've sat down and really made sure that
Speaker 2 (11:37.802)
our group level understands where we're going, what we're doing, and is supportive, and will drive it through to the leaders that are actually on the floors with them.
Great addition and you know, it does seem like such a strategic part of the workforce solutions and I imagine as you are promoting it and talking with the leadership, you have to reference maybe ROI. Yeah, what's some of the ROI that you've experienced with international as part of your workforce solution?
So I would, well, there's a few. First is that we've converted, right? It's that conversion play to say this is a long-term strategy. We know we're gonna wait for the labor to get here. The labor is gonna be with us for a long period of time. And then we want that individual clinician to become part of the tenant team. We want you, we want you to be successful and we would like for you to be here for a while. So that's number one, it's filling that core staffing need. Number two is that
Although, I mean, when you think about signing a long-term contract, it's like, gosh, you know, that is a long time. But you're locking in at a rate that you're not gonna have that seasonal fluctuation that you would see, let's say, in a pandemic or in seasonal staffing needs or whatever crisis may happen, natural disaster, right? So you have some assurances there and it stabilizes.
that labor that you know is going to be there and you can count on for long term. Am I forgetting anything?
Speaker 3 (13:07.062)
Maybe some of the intangible, Beckie, or not so visible from a financial standpoint would be the years of experience that
the international nurses add to your facility. And when you've got turnover and your most immediate supply is new graduate, I think the years of experience, because what you don't want to lose from your healthcare system is the years of experience you needed in order to grow your new graduates. So I think that that's another pretty significant benefit. International nurses come to the US with about seven years of post-grad experience.
many with many more years of experience. And I think the other benefit would be the cross-cultural benefit. International nurses have journeys to the United States and because the visa timeline is long, they often leave their home countries and go to another country first. And they're bringing those experience, cross-cultural experiences to the United States, which I think greatly benefits their patients. They come with a level of understanding, I think, and empathy.
for the patients and their family members. And I think we hear that and see that in the recognition they get maybe through Daisy Awards or during COVID we had a nurse in one market who got nurse of the year for that hospital. So just those things are maybe the not financial outcomes of international.
Absolutely.
Speaker 2 (14:24.27)
Thank you.
Speaker 2 (14:32.108)
Yeah, and so to piggyback on that, you know, what I have been encountering more so I would say in the last six months or so is and everyone in health care is now playing the new grad game, right? I mean, we're having to, you know, our our workforce is moving on to other things or aging out or for whatever reason, we're having to have the new grad play and recruitment. And so how do we get that novice nurse, that new nurse to
that experience seasoned nurse. We are finding more and more that facilities are contacting us and saying, hey, would it be okay if we use the international nurses to precept our new grads? And I was like, sure, you can. That's fantastic. look, I mean, I know she came over for the MedSurg unit, but she's really doing such a phenomenal job. We would like to cross-chain.
this individual nurse for, I've had OR requests, I've had ICU, I've had PCU, and the answer is always yes. I mean, we want to grow with the program and have this person be successful and feel confident in tenants fostering.
Right, right, that makes sense. You might have already started talking about this in your last answer, but how does domestic staffing complement international?
So when you look at domestic staffing, it's kind of what we alluded to in speaking about the pandemic. Some of it is planned, as obviously international nursing is planned, but a lot of it isn't. when you're looking at domestic staffing, a lot of it is reactionary to whatever deficits you have in your staffing pool at that particular time.
Speaker 2 (16:27.662)
International is saying, are my long-term deficits? Where do I need, I'm not successful at recruiting or study recruitment here. I have high turnover, I've got retention issues. know, a lot of systems are really focused on retention at this point in time. So how does that international nurse fit into there? It's not a quick fix, we know that, we've discussed it.
So there's not truly competition, I don't feel. It's a different strategy versus how do I get my patients through today versus how do I continue my throughput for a long range plan.
I think, Beckie, maybe in some parts of the country where there are multiple health systems within one market and there's a limited domestic supply, that's really where international becomes part of the workforce solution, is there are just too many health care facilities, you know, and not enough nurses in that market. So how do you grow your domestic supply in that market? International will be a way to build on the number of nurses that are available.
Yeah, that's the piece. We're all fishing in the same pond, right? Definitely. In certain areas and the pie is only so big. I would not disagree with that. And that has been strategic, I would say, our Carolina market, for sure.
An off the cuff question, but what makes a good international nurse? Who, we also have nurses listening and they're thinking about it, what are some of the traits that would make a good fit?
Speaker 3 (18:01.964)
Well, I think the baseline for a nurse is empathy, but also quality of experience is really important. So a great international nurse maybe has had experiences in more than one country.
Many of our clinicians do go to other countries to gain that experience, not only in the clinical ability, but also in their English language proficiency, if English is not their first language. So certainly not only being able to pass the English language requirements, but be able to understand what a patient's family is asking for or needing to understand. So that's why I think the time it takes to get an international nurse to the United States is actually beneficial.
Because through that journey, the clinician is really thinking about how do I prepare for my transition to the U.S.? What do I need clinically? Where can I go maybe to gain that experience? And how do I strengthen my English language ability? And certainly that's where O'Grady Payton comes in is watching where our clinicians are as they come through the journey and making sure that we arm them with the tools that they need to be successful when they get here.
Makes sense. And then another off the cuff. Is there a particular role department type of work that you've seen international nurses be the most successful or is it pretty much across the board kind of plug in as if regular, you know, domestic staff and just integrate into the normal course of business?
So, I mean, we have international staff in almost every specialty, I would say. When looking at it, obviously the bulk of our needs tend to be in our mid-surch tele area, which is what, it's just where our core vacancies are. So.
Speaker 2 (19:51.214)
Yes, they're successful. are the nurses because it's the bulk of what we have, but we have NICU nurses. We have L &D nurses that are phenomenal, that we get great, you know, feedback from our surgeons. I would, I don't know, Jeannette, I've been pleased with all of our placements.
It's very rare that we, I occasionally you may have a mismatch and it's not a good fit, but we find another department where they're more successful, but that is really the exception and I can really only think of less than a handful that haven't.
And certainly, Beckie, you know the orientation is something that's needed. You can't bring international nurses into the United States and not give them the orientation that they need to be successful. Tenants being phenomenal at that partnership is understanding, you know, it takes a couple, it takes a significant number of weeks, usually eight to 12 for them to be fully proficient and really feeling like they're confident practitioners, which we want for them.
Communication is key there. The nutrition aids team working directly with the clinical managers at the facility ensuring that if anything arises that we're jumping on it, know, we're remediating, we're giving the nurse the support that they need and moving forward.
Yeah, yeah, tenants being great at that is if they have a concern early on contact us. We'll jump in. Our clinical team will help the nurse leader understand whether that gap they're seeing is normal or not normal. Because remember, there are things that are normal in a transition to practice in a new country. So just helping the nursing leader understand that early has been very helpful in getting ahead of any issues that might come up through the orientation period. But that's why the partnership truly is
Speaker 3 (21:40.144)
invaluable, I think, to both of us is it just we're a call away on both sides.
Great, I mean that really teed me up for my next question about partnership and Beckie if you were going to give advice to anybody who's looking for a partner, what would you ask them to look for as they're sort of deciding who might be the right fit for them?
I would say having someone who truly understands the nuances of what the international nurse needs as well as getting the nurses here, what the process looks like. You don't have to be a whiz at retrogression, but you need to have a partner who is. So having a partner who understands all facets of international nursing, think is very important.
Secondly, probably as important, is ensuring that the vetting process and the support process for these nurses to come over and be successful is really key. Unfortunately, in a past life, I've had folks that weren't successful because all of those things weren't done.
So that is key. Those two things are the most important. A partner that understands the process and a partner that provides that support to both the facility and the nurses.
Speaker 1 (23:06.998)
That makes sense. And obviously we value your partnership and the relationship that you and Sinead have cultivated over the years. Sinead, guess maybe the question back to you. What makes Beckie such a great partner and tenant?
think it's Beckie's understanding of what an international clinician needs and her ability to communicate that very effectively to her market leaders. I think you've helped us choose those markets wisely to ensure clinician success. The last thing any of us want is for somebody to come from another country with their kids and spouse and them not to be successful. I think knowing that that's the ultimate goal with our patients
in mind. That's what truly makes it successful, I think. You we're all focused on what is that patient experience and how do we arm the international clinicians so that they give that really effective patient care.
And then I would say...
you know, we're very collaborative. looking at, OK, we have a market where we really want to expand. We've done this recently in two markets that have just struggled with labor in general. How can we expand our international footprint? you know, working with Sinead and saying, hey, let's let's brainstorm and what can we do? So we've done two live events where Sinead and her team came in, actually assisted the managers and the hiring directors.
Speaker 2 (24:38.352)
with interviewing the nurses and it was a live event for the nurses and it really was such a great turnout. For one of those also we had a Grady Payton nurse who was still at the facility who really was our spokesperson and so looking at how can we collaborate and perhaps do something new in the international space that's going to be beneficial for everyone moving forward and impactful.
Those have been great.
Yeah, yeah. real ton of energy.
that is a lot of energy. Yeah. Excitement. Well, ladies, we've covered a lot today. We have talked about what international nursing is in general, how it fits into a workforce strategy, especially as we're talking about a long term strategic planning, discussed a little bit about visa retrogression, why it's important to still maintain that pipeline even during it, as well as talking about the importance of that environment for an international nurse and making sure
that it is a warm and welcoming one so you can ultimately retain them as a permanent staff. Is there anything else that we haven't discussed today that you'd like to mention?
Speaker 2 (25:47.822)
I think we've covered most things. think the key is knowledge of what it takes, partnership and collaboration.
Great sound bite, thank you.
I think I'd agree with Beckie. I will say maybe just one parting piece of information. There are several ways that you can bring international nurses into the US. Tenants' relationship with us is really to bring in nurses through AMN Healthcare. We assist their markets to onboard and integrate those clinicians and ultimately they convert to tenant staff. For tenant, that's what makes the most sense.
is having a partner to help them through that process. Healthcare systems can bring in nurses directly as well, but what I would say is most critical in that instance is to ensure that you have the support systems in place in order for those clinicians to be successful, because without that, an international program can have its challenges. So just really ensuring that you have a great partner, regardless of whether it's direct hire or attempt to perm, is really important.
Good point to punctuate. Well, with that, ladies, thank you so much for joining today. Had a great time talking with you. Yes, excellent. And thank you all for listening and join us next time on Elevate Care. Thank you for joining us today on Elevate Care. If you found this episode valuable, please consider sharing it with a colleague and subscribing to our show on your favorite podcast platform. You can learn more about this episode and our show on our website at amnhelfcare.com.
Speaker 2 (27:04.376)
Thanks for having us.
Speaker 1 (27:25.922)
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