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When Roshni Pandey (above, left) arrived at UVA Health in April 2022 through the PassportUSA Program, she had over a decade of nursing experience. She’d worked in one of the largest hospitals in Nepal. She was highly skilled and knew her way around an operating room. But she was in an unfamiliar place, with new processes and procedures, technology she’d never seen, a language she often struggled to understand — and she was all alone.

“I was the only Nepali. I didn't have my friends. I didn't have my family in Virginia. So, I was on my own working in this new country. Everything was new for me,” Pandey says.

Roshni was the first international nurse to join the operating room (OR) team. She had a lot to learn. But so did the team who would be training her.

It was Nursing Professional Development Specialist Ruth McMullan, MSN, RN, and Nursing Education Coordinator Jose Dumlao, MSN, RN (above, right), who were tasked with leading onboarding efforts for Pandey and the other international nurses who would follow. They realized quickly that they were going to have to take a new approach to their training methods and tailor the program for each international arrival.

Bridging the Cultural Divide

“When we were interviewing them, we were blown away because that advancement of technology is very different. Something as simple as an electronic bed may be new to them,” says Dumlao.

“We also learned there are big differences in how OR nurses function in another country compared to what we do here,” adds McMullan. “The scrub role was very similar, and that didn't take much training for them to get up to speed. But the circulating role, the more administrative role, was really new to them. The documentation is slim to none in the countries they came from, and electronic documentation is nonexistent. At UVA, all of our OR nurses are expected to do both roles.”

This is why Dumlao and McMullan decided the best way to prepare international nurses for the OR was to include them in the Perioperative Training Program and train them as if they had no OR experience, even if they’d worked in an OR overseas. “We give them a full six months to get acclimated,” says McMullan. “We’re able to clue into the things they already know, what we can expect of them, and what we need to show them or what they want more exposure to. This way we’re not wasting their time, but we’re ensuring they’re competent by the time they’re on their own.”

A Little Kindness Goes a Long Way

In six months, new international nurses receive one-on-one and classroom training. But they also get a crash course in American culture and a home away from home, thanks to the extra steps Dumlao and McMullan have implemented to make them feel welcome. There is a meet-and-greet upon their arrival to introduce them to the team and show them around Charlottesville, followed by social events in and out of the hospital with their OR colleagues and other international nurses. 

“Our ultimate hope is once their three-year contract is up, they will remain with us. The only way we can do that is by making their orientation as enjoyable as we can, so that they want to stay here at UVA, where they feel at home,” says McMullan.

For Pandey, the kindness and support she received from her colleagues made a big impact on her decision to stay. “There were a lot of people who helped me through my transition,” she says. “Having someone there for us, who will listen and do what’s best for us, made this experience much easier.”

It was such a positive experience for Pandey that she decided to share it with friends. “I told my friends from back home about the work culture here and they interviewed and got selected. I have two friends from Nepal at UVA now, and two more are coming in September,” she says.

These word-of-mouth referrals are a good indicator of success, according to Dumlao. “It's quite fulfilling to see that they're inviting more people to join us,” he says. “That's a statement that we are really a welcoming and very accommodating environment.”

A Model for Successful Onboarding

In total, the OR will welcome nine international nurses before the end of the year from the Philippines, in addition to Nepal. As dozens more international nurses adopt roles throughout UVA Health, the OR’s onboarding tactics have been a model for other nurse educators and unit staff. 

“The OR is a procedural area, so it’s a little bit different,” says Dumlao. “But there are things we’re doing that have become a benchmark for other units like the meet and greet. This is a learning experience for all of us.”

“That's the beauty in it,” adds McMullan. “Even us as educators, we're still learning and we're always changing our approach to meet the needs of different people.”