Shearwater Nurse Leaders, Melissa Lacy and Jenny Altman, recently sat down over a cup of coffee to discuss U.S. nursing myths. We wanted to capture this insightful conversation on video for nurses around the world to learn from their experience.

Watch the full interview here:

In our conversations with international nurses, we’ve found that expectations of what nursing is like in the U.S. can be different than reality. We want to set our nurses up for success and help better frame accurate expectations. Here are 8 of the most common U.S. nursing myths.

  1. Nursing is easier in the U.S.

The truth of the matter is that nursing is hard wherever you are. Patients are sick. Work is busy. There are a lot of patients to take care of and often nurse:patient ratios can be as high as 1:5 – 1:8. Despite a tough environment the U.S. does have good support in nursing assistants, interdisciplinary teams and intentional  organization of units to avoid unnecessary movement.

The U.S. also has many healthcare options outside of the hospital in urgent care, clinics, home health, etc. That means the hospital usually has the sickest of the sick that require care. But that makes the work more rewarding, because you clearly see the impact you are having on patients and families.

  1. Technology makes my job easier

Electronic medical record systems are great for having all of the patient’s info in one place, but the day-to-day shift work of documenting assessments can be more time-consuming. If you haven’t spent a lot of time working on a computer (even in non-medical settings), working the functions of medical technology can be daunting. Practicing computer skills on any technology will benefit a user on medical technology.

One important advantage of technology is that it has given us better avenues to support patient safety. Good technology, especially around medications and patient monitoring, reduces human error.

  1. Doctors make all the decisions

Many nurses come to the U.S. assuming the doctors have all the answers and make all the decisions. In other parts of the world, doctors are hands-on with the routine care of the patients while nurses are there to assist. In the U.S., doctors are not present on our wards as much they are in the clinic.

Doctors expect nurses to be more autonomous and make decisions or recommendations for patient care. This allows the doctors to “check-in” on more patients, and nurses provide assessments to doctors on the changes in the patient condition. We recommend using the SBAR communication technique.

  1. A Master’s degree is required to advance your career

Many nurses want to come to the U.S. to get a master’s degree and continue their education. We certainly find value in continuing to advance education, but an advanced degree isn’t always required to be a fantastic, well-respected nurse. Advanced degrees are usually quite expensive, and we encourage nurses to be thoughtful about choosing a specific direction and payment plan to ensure you don’t accrue a ton of debt.

U.S. hospitals usually do a great job of ongoing education while on the job. There are many certifications required to continue practicing, additional skill competencies, and in-service educational sessions. This helps nurses adapt to the dynamic nature of nursing in the U.S.

  1. You won’t receive any support

It’s normal to feel some culture shock as a nurse who has moved to the U.S. When in a new and vulnerable environment, it’s also easy to assume no one is on your side. It’s important to remember, however, that our number one goal is to have nurses move here and become successful in their careers and patient care.

Good nurse leaders in the U.S. also don’t get to higher roles and expect everyone below them to do all the hard work. It’s the expectation that everyone is willing to jump in to serve a patient. No one is too good to meet a small patient need. No one is too good to get a patient’s mother a glass of water. That mindset makes us a stronger team and a stronger health care system.

  1. Asking questions makes you look incompetent

In some cultures, it’s common to keep your opinion and questions to yourself. And while we agree that being “slow to speak” has wisdom, in healthcare settings it’s important to ask questions. No one is expected to know everything in a new culture and work environment. If you don’t ask questions, there may be cause for concern that you can deliver safe and effective patient care.

Don’t be afraid to ask questions and get clarification, especially before you act on a patient. One effective method is to always paraphrase when you’re given a direction by a nurse manager or colleague. Paraphrasing provides a deeper understanding and gives the other person a chance to correct any mistake.

  1. Patient satisfaction isn’t as important as overall care

U.S. hospitals are measured and graded on how patients and families perceive their care and how satisfied they are. That can be a little overwhelming when you’re new and simply trying to deliver the best care possible. It’s important to learn to balance patient satisfaction with patient care. You can’t be so task-focused that you neglect being approachable and building trust.

Clear communication and excellent customer service is the best way to bring patient satisfaction to the bedside. Learn to smile, ask thoughtful questions, and genuinely listen to your patient’s desires – not just their medical needs.

  1. You can get to work whenever you want

Time is flexible in some international cultures, which is why we always stress to our nurses that in U.S. workplaces, being on time is essential. Most shifts begin with a team huddle or patient hand-offs and if you’re late to work, other nurses who have been working for 12+ hours are waiting on you.

Also related to timeliness, it’s important to take advantage of the breaks built into your shift. Twelve hours is too long to go without eating and resting your mind. Nurses who take care of themselves are better positioned to take better care of their patients.


If you’re interested in taking your nursing career to the U.S. with Shearwater Health, click here.