Registered nurses are critical members of health care delivery teams, providing essential nursing care to patients in hospitals, nursing homes, and increasingly in primary care and home and community-based settings. New York City has always enjoyed an abundant supply of new graduate nurses, due to the large number of associate and baccalaureate nursing programs in the city, and yet the industry is not immune to workforce challenges.
Top issues reported by the healthcare industry related to nursing:
- No clear pipeline for recruiting a diverse nursing workforce to provide services to a diverse patient population.
- High rates of turnover, especially for new nurses in their first year.
- Education provides little exposure or preparation for roles outside of in-patient settings.
How is NYACH helping?
NCLEX-RN Exam for Foreign-Trained Nurses Program
In collaboration with the NYC Welcome Back Center at LaGuardia Community College, this program provides a National Council License Examination (NCLEX-RN exam) preparation course for internationally trained nurses. The course focuses on both the English-language skills and nursing skills needed to pass the NCLEX-RN exam and become a registered nurse in New York State. This initiative is funded by SBS and NYACH.
For more information contact Neesha Rose at firstname.lastname@example.org.
Giana Saloman was born in Haiti. When she was 19, her older sister, a nurse, convinced her to go to school to pursue nursing. She worked as a Registered Nurse in Haiti for 7 years until 2010, when the earthquake caused her family to move to the United States to find safety, stability and opportunity for her then 3-year-old daughter. After years of unemployment and underemployment in the United States, Giana joined the National Council Licensure Examination (NCLEX-RN) for Foreign Trained Nurses program at the LaGuardia Community College Welcome Back Center and funded by the NYC Department of Small Business Services. This program integrates English as a second language instruction with NCLEX-RN exam preparation using the Integrated Basic Education Skills Training (I-BEST) model. Giana graduated from the program, passed her license exam, and now works as a School Nurse at a private school in Brooklyn.
Q: Why did you become a nurse?
A: When I was 16 years old, my mom had died. My older sister was a nurse and told me to go to school to be a nurse. In my country, you don’t need to pay for school. So I went. It was not difficult but I didn’t like watching people suffer; it took me two or three years to get used to it.
Q: What was it like moving to the United States?
A: When I moved to the United States it was very difficult because we moved into my brother’s house in New York; myself, my husband, and my daughter were sleeping in one room on the floor. We came on a visa and we couldn’t work because we needed work permits. So we waited 18 months without work and then in 2011, we got temporary protection status from the government and I just need to pay to renew it every year. When we got the permits in 2011, I went to school to get my CNA certification, Phlebotomy, and EKG but I couldn’t find work so for 8 months I worked as a Home Health Aide.
Q: Why did you decide to join this program?
A: In 2013, my sister who was with me in New York talked to me about the LaGuardia program. She heard about the program from a friend from LaGuardia who was a LPN. She convinced me to apply for the program- she said maybe we could study together. When we went to LaGuardia they said we could come in August 2013 and I don’t know, it was like God heard our prayers because it was really great.
Q: How was your experience in the program?
A: It was great because I think the teachers they know what they are doing. They really know. The thing that I liked the most is that there I can learn English. At this school, sometimes the teacher was speaking and I did not understand but in class we have Magda Kieliszek, our ESL teacher, and anytime we didn’t understand what the teacher was saying, she would explain everything. We weren’t too afraid to speak because all of us were immigrants so we were all the same. Tania Ramirez, the other teacher, gave us hope every time we were down because it was hard to understand. She would say ‘I know you can do it!’ It was very intensive but in my country it is like with motivation and determination- we can climb any mountain!
Q: What are you doing now?
A: I passed my NCLEX in July and Workforce1 called me on July 23rd, less than two weeks after, and they sent me on an interview and ProMed Agency was looking for a school nurse. I work in a private school full time. It is very calm and quiet and is good for me now because I am going to school to get my BSN at Medgar Evers College. I just started in September. My sister who did the program with me is working as an ER nurse in Jamaica Hospital.
Q: What impact did the program have on your life?
A: It changed everything. I was working as a Home Health Aide for 8 months, it was the worst months of my life, I left it and I was a CNA and was working for only $10/hour, now I am getting $30/hour.
The program improved my English skills and now at school everything is about research and about speaking English. Its okay- I got a good grade. I talked to my teacher and told her English is my third language and I know it is not good but I am not afraid to speak because Magda and Tania told me its okay- speak up because like everyone in the US is an immigrant so speak up! I told my friends that they could come to LaGuardia and they would help them!
Q: How does it feel to be employed as a nurse in the United States?
A: It is more than to be proud. It’s like your life is not the same anymore. I remember I spoke to Magda when I knew I passed my NCLEX and I didn’t care if I got a job or not, I was just so proud to be a nurse, only that. I think everyone, my brother, my sister, everyone is proud of me.
Q: What are your plans for the future?
A: I want to go on and get my masters in nursing after my BSN. I would like to work in the education field because I think I will like it. As a nurse everything changed- its not the same. You are proud of yourself. It’s something more, I think it’s why I wanted to continue my education. In the US education is respected and even with my accent my education is respected.
RN Transition to Practice (TTP) Certificate Program
The Registered Nurse-Transition-to-Practice initiative represented a collaboration between Lehman College’s School of Continuing and Professional Studies, the Greater New York Hospital Association (GNYHA), and the New York City Department of Small Business Services (SBS) to provide unemployed and underemployed licensed registered nurses an opportunity participating in a 6-month transition-to-practice program to better position themselves for hire.
The program consisted of six months of hands-on clinical training supported by a stipend. During this time, nurses received six hours a week of classroom instruction at Lehman and 24 hours a week of clinical training at a participating hospital under the guidance of a nurse preceptor. The classroom instruction focuses on critical thinking, communication, leadership, research skills, and other competencies identified by employers as critical yet often lacking in new graduates, while the additional clinical experience enhanced students’ competencies and confidence in a hospital setting. The program was success: 83 percent of participants were hired as RNs upon program completion. Ninety-two percent of participants hired by their partner hospital following completion of the program were retained 6 months after hire. Nurses who completed reported higher levels of confidence and competence as a result of the program.
The favorable outcomes from the RN-TTP program add to the abundance of research in support of nurse residency programs.
The Future of Nurse Residencies
To address the persistent concern from healthcare employers of high rates of nurse turnover, we plan to work with NYC hospitals to integrate a year-long nurse residency program into the first year of employment for new graduate nurses. Such an approach is intended to support sustainability, hospital buy-in, and to build a tangible return on investment for employers looking to improve the experience of new nurses.