What’s It Like to Practice Nursing in Another Country?

Podcast Transcript

Carol Pehotsky (00:05):

Taking that first step into nursing requires a lot of bravery, but what does it take to take a giant step into another country, into another organization? What do we have to think about as nurses when we assess our interest and our ability to do something like that?

(00:21):

I'm joined today by Dr. Sheila Miller, chief nursing officer for Cleveland Clinic London, as we talk about everything you think you know about practice might change in an international setting.

(00:34):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care to advancing your career, to navigating tough, on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of Surgical Services Nursing.

(00:55):

Welcome back, everyone. I had been a nurse for maybe about three or four months when we welcomed to our nursing unit a nurse from China. And I- listen, I was brand new, barely figuring out things myself, fresh out of orientation and we didn't have residencies back then. (laughs) And i- this nurse who came with experience and so it- she worked nights with us and had passed all the boards, had done all the things, you know? You'll have to remember, this is a time before we really had a lot of training around diversity and inclusion.

(01:25):

And so getting to know her as a person, thankfully we had experienced nurses on that night shift as- 'cause it would've- we'd noticed she was getting really frustrated. And trying to learn from her about what could we all do to help her? What supports she needed. And really learned a lot in a very short period of time about how different her training was, but more importantly, how different the role of a nurse looked where she had originally done her career in terms of speaking up, the tasks that they did, the assessments that they did, et cetera.

(01:54):

And I'm, I'm sure that our managerial staff had figured that out too, but it was, it's really helpful for us as nurses to sit down and listen to her and figure out how could we help her, you know? We've had so episodes in this journey about speaking up, but suddenly it took a different flavor for us at that bedside and understanding that that was just not something she was used to doing, so how we could be her voice when she didn't feel comfortable, and then how to help her f- gain that confidence as a, I guess, someone with very rich experiences, but not necessarily in that aspect that had f- certainly for my colleagues, become second nature.

(02:26):

And over my career, I've been very blessed to get to interact with all sorts of experts who are international nurses, and really have learned each time from them about nursing is so important, but it, it takes a different flavor. There's different backgrounds and experiences that lend itself to nursing throughout the world.

(02:42):

So with that, it's my great pleasure to welcome today our guest, Dr. Sheila Miller. Sheila has a fantastic career that we're looking forward to hearing more about. Currently, she is chief nursing officer of Cleveland Clinic London. Sheila, welcome.

Dr. Sheila Miller (02:55):

Hi. Thanks, Carol, thanks for having me. I'm really excited to be here.

Carol Pehotsky (02:58):

I really wish we were recording this live, in person, in London. (laughs) But instead, I am in Cleveland in a studio, and you're being gracious enough to join us via Teams. So, what time is it there?

Dr. Sheila Miller (03:08):

It is about four o'clock here, just-

Carol Pehotsky (03:11):

Okay.

Dr. Sheila Miller (03:11):

... just a little... uh, just gone 4:00, as they would say here.

Carol Pehotsky (03:14):

(laughs) Very nice.  Yes. And we're, we're right at 11:00, so we ha-... So audience, we have not kept her up to an unreasonable hour. (laughs) She's nice and fresh.

(03:21):

So Sheila, I hope you'll start by telling us a little bit more about your career, and how ultimately it led you to take this amazing role overseas.

Dr. Sheila Miller (03:29):

Sure, I'd be happy to. So, I've been with Cleveland Clinic for quite a number of years in various nursing roles in the organization, both at regional hospitals-

Carol Pehotsky (03:40):

Mm-hmm.

Dr. Sheila Miller (03:40):

... at Main Campus and an enterprise role. So I've really had the opportunity to benefit from the variety of ways you can make a difference as a nurse-

Carol Pehotsky (03:50):

Hmm.

Dr. Sheila Miller (03:50):

... as part of Cleveland Clinic. So, one of the things I had always had an interest in throughout my w- career, was doing something on an international front. And when this opportunity came up in London, it was really good timing, not only from the perspective of my career, but also in terms of my personal life-

Carol Pehotsky (04:10):

For sure. (laughs)

Dr. Sheila Miller (04:10):

... which is, uh-

Carol Pehotsky (04:12):

Very important, yeah.

Dr. Sheila Miller (04:12):

... one of the things to consider is, you know? [inaudible 00:04:14] Yeah.

Carol Pehotsky (04:15):

Excellent. And so you've been, been over there for about how long now?

Dr. Sheila Miller (04:19):

So, I actually flew over to start my position here at Cleveland Clinic London on Valentine's Day 2023.

Carol Pehotsky (04:27):

Okay. So we'll just make it the year. All right.

Dr. Sheila Miller (04:29):

(laughs) Yeah. Ab- absolutely. Started work two days later.

Carol Pehotsky (04:33):

(laughs) And so, boy, you know, any time we, we change hospitals, we change roles, there's a lot to learn in that first year. And, and I can't imagine what it's been like in terms of your learning. Can you give us just a taste of some of the ah-ha moments, uh, coming into learning about nursing in London within the same organization, but within a totally different environment?

Dr. Sheila Miller (04:54):

Sure. I'd be happy to. So I think you have to start ww- thinking about that you have to set aside all your assumptions.

Carol Pehotsky (05:01):

Hmm.

Dr. Sheila Miller (05:02):

Everything that you think you know about how practice is carried out, may or may not be true. So even things as simple as using an electronic medical record, um-

Carol Pehotsky (05:16):

Hmm.

Dr. Sheila Miller (05:16):

... while at Cleveland Clinic London we do have an electronic medical record, as I sat for my registration, which includes a piece that you actually demonstrate skills, I, I was-

Carol Pehotsky (05:29):

Whoa! (laughs)

Dr. Sheila Miller (05:29):

(laughs)

Carol Pehotsky (05:30):

Really?

Dr. Sheila Miller (05:31):

Yes.

Carol Pehotsky (05:31):

Okay. (laughs)

Dr. Sheila Miller (05:32):

Um, I'm, I'm fond of saying it would've been fun if you weren't graded on it.

Carol Pehotsky (05:32):

(laughs)

Dr. Sheila Miller (05:36):

But during that process, I actually had to pour medications out of a bottle and document on a paper medication record.

Carol Pehotsky (05:44):

Oh, sure. (laughs)

Dr. Sheila Miller (05:46):

(laughs) So some of the, the things that you take for granted, that practice is similar-

Carol Pehotsky (05:51):

Mm-hmm.

Dr. Sheila Miller (05:51):

... though the practice of giving si- medication safely is similar.

Carol Pehotsky (05:51):

Of course.

Dr. Sheila Miller (05:55):

How you do that may be very different.

Carol Pehotsky (05:58):

Mm-hmm.

Dr. Sheila Miller (05:58):

So that example, I think, is a good one, as you look at many things and not just assuming you know how it's gonna be in, in that new environment. Let alone, how, to your point earlier about the nurse you worked with from China-

Carol Pehotsky (06:14):

Mm-hmm.

Dr. Sheila Miller (06:15):

... how s- the experience that someone else brings, uh, to the setting.

Carol Pehotsky (06:18):

Absolutely. And can you give us a sense of at Cleveland Clinic London, just how many different backgrounds r- you're welcoming in, in that organization in terms of your workforce?

Dr. Sheila Miller (06:30):

So at last count, we have caregivers from over 95 nationalities.

Carol Pehotsky (06:36):

Oh, wow. That's wonderful. (laughs)

Dr. Sheila Miller (06:39):

It- it is very wonderful and very rich.

Carol Pehotsky (06:42):

Mm-hmm.

Dr. Sheila Miller (06:42):

And it's really satisfying and rewarding to see those caregivers come together into this very special location. But 95 is, is quite a number.

Carol Pehotsky (06:55):

Well, and i- you know, we're, we're very blessed in our organization, but also in the United States to have access to different resources, different technologies. I wanna go back to your comment about how, you know, the heart of nursing is still the same.

Dr. Sheila Miller (07:08):

Mm-hmm.

Carol Pehotsky (07:08):

Can you give us some examples, you know, what you've seen in your first year plus, those, those 95 different nationalities, and how you are able to identify that heart of nursing and resolve maybe that difference in terms of how it has been approached by different groups?

Dr. Sheila Miller (07:22):

I'll talk about our shared value as nurses.

Carol Pehotsky (07:26):

Mm-hmm.

Dr. Sheila Miller (07:26):

As, as part of Cleveland Clinic, we know we have shared values as an organization, but nursing as a profession also has shared values.

Carol Pehotsky (07:26):

Mm-hmm.

Dr. Sheila Miller (07:33):

And you really see that in caring for folks, not only their physical health, but their emotional wellbeing, advocating for patients. I see that across caregivers. Trying to ensure that the patient and their family has what they need in order to regain their health.

Carol Pehotsky (07:53):

Sure.

Dr. Sheila Miller (07:53):

You know, valuing the quality of care that we provide as nurses, that's pretty universal, that wanting to do it the best you possibly can, uh, in-

Carol Pehotsky (07:54):

Sure, yeah.

Dr. Sheila Miller (08:06):

... service of patients.

Carol Pehotsky (08:08):

Mm-hmm.

Dr. Sheila Miller (08:08):

So that really, that stands out for me no matter where I see nurses originating from. That, "I'm here to make a difference, I'm here to make it better, and I'm very committed to doing that."

Carol Pehotsky (08:20):

The- the universal language of nursing. I love it.

Dr. Sheila Miller (08:22):

Yes.

Carol Pehotsky (08:22):

I'm sure there's a great research article in there, probably somebody's already written and I just haven't read (laughs) it yet. But-

Dr. Sheila Miller (08:23):

(laughs)

Carol Pehotsky (08:27):

... I think that's a great point for all of us thinking about, you know, no matter where you work, hopefully you have diverse populations of nurses coming together and really welcoming, you know, we're at our best when we can be ourselves. So th- I'm sure you-

Dr. Sheila Miller (08:27):

Mm-hmm.

Carol Pehotsky (08:39):

... do that every single morning of every single day (laughs) in London. Have you seen any examples where there's be- been maybe b- best practices varying from country to country, sort of bringing in nurses from different countries? An- and maybe there's a question about which one is the best practice, or, or where- what direction should we go in at your location knowing that people come with different backgrounds and experiences?

Dr. Sheila Miller (09:04):

Certainly, we see differences in practice, and I hesitate a little to use the word best practices, but we do see differences in practice.

Carol Pehotsky (09:12):

That's fair, yeah.

Dr. Sheila Miller (09:13):

And (laughs)-

Carol Pehotsky (09:14):

Yeah.

Dr. Sheila Miller (09:15):

... so what is the best practice in the end?

Carol Pehotsky (09:17):

(laughs) Sure, yeah.

Dr. Sheila Miller (09:18):

Because it, it almost ends up, um, going down a path of perhaps selecting one, and really the way we try to approach that is by being inquisitive and understanding why a practice exists.

Carol Pehotsky (09:33):

Hmm. Sure, learning more about that.

Dr. Sheila Miller (09:34):

So s-... Right. Where did this come from? What was the origin?

Carol Pehotsky (09:38):

Mm-hmm.

Dr. Sheila Miller (09:38):

And then to go through a process of, is there any evidence? It's a great opportunity to discuss across nursing teams, "Wh- wh- is there evidence that supports a particular practice in this that then doesn't choose between practices-

Carol Pehotsky (09:38):

Hmm.

Dr. Sheila Miller (09:54):

... from different areas of nursing, but actually says, 'Is there an objective reality, an objective body of knowledge around this?'" And then to try to determine, all right, so we have these different practices, what's the way that, that we're going to do this here? What fits in our setting, learning from all those, those different practices and perspectives?

(10:17):

So while it takes a little bit longer than making a determination-

Carol Pehotsky (10:21):

(laughs)

Dr. Sheila Miller (10:22):

... and saying, "Here's just how we're gonna do this."

Carol Pehotsky (10:22):

Right. (laughs)

Dr. Sheila Miller (10:24):

You, you get to a better outcome in the end, that hopefully as often as possible, everyone has an understanding of how you got there.

Carol Pehotsky (10:32):

Well, and what a great way to honor th- you know, bel- we- we just talked evidence-based practice at another episode. But again, going back to it's not just my way is better, your way is better. It's what has some evidence and possibly an opportunity to create some evidence if none exists?

Dr. Sheila Miller (10:48):

Absolutely.

Carol Pehotsky (10:49):

And hopefully you're sharing back some of those best practices with us in the US, because we certainly want, wouldn't want people to come in saying it automatically has to better- be better because it came from the United States, from London, et cetera.

Dr. Sheila Miller (11:01):

No, and, you know, being here in London, it's somewhat humbling to be in the place where the Florence Nightingale [inaudible 00:11:08] exists.

Carol Pehotsky (11:09):

For sure, yeah.

Dr. Sheila Miller (11:09):

And there certainly is a proud long history of nursing. And so, respecting where the practices came from, but always recognizing in the spirit of innovation-

Carol Pehotsky (11:21):

Mm-hmm.

Dr. Sheila Miller (11:21):

... and progression of the advancement of nursing practice, that we are open to, how do we do this better and better, and how do we join hands and make sure that we are all doing it the best way and contributing to that body of knowledge around nursing practice?

Carol Pehotsky (11:39):

Sure, and we can all take that back to wherever we're from, to make sure we're elevating care for patients around the world.

Dr. Sheila Miller (11:45):

Yes. Absolutely.

Carol Pehotsky (11:46):

So, you know, I, I have the good fortune of sitting down via Teams and, and meeting with our colleagues in Abu Dhabi and our colleagues in London about once a month to talk about perioperative nursing. And I've learned a great deal from them, including that there's often different roles involved in the delivery of healthcare than maybe what we're used to in the States. And when you think abou-... Ev- even amongst health organizations, right, we call (laughs) roles different things. But any roles that you've been introduced to that are unique to an international setting?

Dr. Sheila Miller (12:15):

I can. I- I'll start with first that you have to interpret some of the language. So you mentioned surgical services, and here they're called not ORs, but theaters.

Carol Pehotsky (12:15):

Yes. (laughs)

Dr. Sheila Miller (12:15):

So, first you have-

Carol Pehotsky (12:15):

The theater manager.

Dr. Sheila Miller (12:15):

... to interpret.

Carol Pehotsky (12:29):

Yes. (laughs)

Dr. Sheila Miller (12:29):

Um, in- instead of the emergency room, it's the A&E.

Carol Pehotsky (12:32):

Oh, okay.

Dr. Sheila Miller (12:32):

Uh, (laughs) so once... Instead of home help, it's district nursing.

Carol Pehotsky (12:38):

Oh.

Dr. Sheila Miller (12:38):

So wo- once you-

Carol Pehotsky (12:39):

Mm-hmm.

Dr. Sheila Miller (12:39):

... sort out the titles, many of the roles are the same. The, the biggest role that I would say that I see a difference in, is really in advanced practice.

Carol Pehotsky (12:50):

Mm-hmm.

Dr. Sheila Miller (12:51):

What you see in advanced practice, whereas it has become more mainstream, there are clear paths for advanced practice in the US, that's not as clear here-

Carol Pehotsky (12:51):

Mm-hmm.

Dr. Sheila Miller (13:05):

... in the UK. So it's a little bit more open of a field, and it reminds me of how I remember earlier in my career that someone would become an advanced practice nurse by getting additional education and/or experience.

Carol Pehotsky (13:05):

Oh, sure. As opposed to-

Dr. Sheila Miller (13:21):

Not necessarily-

Carol Pehotsky (13:22):

... a separate degree. Yeah.

Dr. Sheila Miller (13:23):

Correct. And, uh, a separate licensure or registration. So it's a, it's much more open and much more flexible for the, the nurse to be able to advance.

Carol Pehotsky (13:34):

Really?

Dr. Sheila Miller (13:34):

So there's good and bad to that-

Carol Pehotsky (13:36):

(laughs) Sure.

Dr. Sheila Miller (13:38):

... I, I think. And actually, (laughs) there is a, uh, conversation going on here as to if it should be more regulated by-

Carol Pehotsky (13:44):

Oh, yeah.

Dr. Sheila Miller (13:45):

... uh, the nursing body.

Carol Pehotsky (13:46):

Mm-hmm.

Dr. Sheila Miller (13:47):

You know, many other roles are very similar. The, the other one that I see is the, uh, anesthesia practitioner-

Carol Pehotsky (13:54):

Yes. (laughs)

Dr. Sheila Miller (13:54):

... that's not a nursing role. And you're probably familiar with that from-

Carol Pehotsky (13:54):

Yes.

Dr. Sheila Miller (13:58):

... the conversations with theaters-

Carol Pehotsky (14:00):

Yes.

Dr. Sheila Miller (14:00):

... where they, they're a- not a nursing role, but they do provide-

Carol Pehotsky (14:00):

Mm-hmm.

Dr. Sheila Miller (14:03):

... a lot of support in that theater/operating room space.

Carol Pehotsky (14:08):

Mm-hmm.

Dr. Sheila Miller (14:08):

Which is a role we don't see in the US.

Carol Pehotsky (14:11):

Well, and for any of our surgical or perioperative listeners, you know, another we run into is surgical technologists are largely not-

Dr. Sheila Miller (14:18):

Mm-hmm.

Carol Pehotsky (14:18):

... acknowledged outside of the United States, and so we, we find that inter- international settings, it's, it's a, it's a different group of caregivers, a lo- oftentimes nurses who are providing that at-the-table support. So one of the things that I try to do, and still a work in progress, I think, is it- it's so easy to assume that when I say something about staffing and somebody else will say something about staffing, we're not talking about the same things, right? But, but-

Dr. Sheila Miller (14:42):

Mm-hmm.

Carol Pehotsky (14:42):

... (laughs) like, getting older and getting wiser in this space, I've had plenty of opportunity to realize that wh- what I thought was a given was not. And so, taking a step back and saying, "Let's, let's get rid of all these assumptions and talk about here's what I understand this to be. Is that your understanding as well?" And then we move forward in our conversation.

(15:01):

What sort of examples do you have of that, or, or what's your approach to make sure that even though everybody's talking about using the same terms, that it's a clear understanding that that application of those nursing terms or those workflow issues, we're being very clear about so we're not starting off with assumptions?

Dr. Sheila Miller (15:19):

It really starts with understanding the role- what's involved in a particular role.

Carol Pehotsky (15:25):

Mm-hmm.

Dr. Sheila Miller (15:25):

That's where I find the most variation. And the example that I'll give you is in ICU nurses. So respiratory therapy management of ventilators is not something that is common or done at all-

Carol Pehotsky (15:40):

Ah!

Dr. Sheila Miller (15:40):

... here-

Carol Pehotsky (15:41):

Okay.

Dr. Sheila Miller (15:41):

... in, in the UK. So when you look at your staffing in your intensive care unit-

Carol Pehotsky (15:46):

Mm-hmm.

Dr. Sheila Miller (15:47):

... b- you have to build that into the role and into your staffing plan, because there's not another group that does that-

Carol Pehotsky (15:47):

Right.

Dr. Sheila Miller (15:56):

... that piece of care.

Carol Pehotsky (15:57):

(laughs)

Dr. Sheila Miller (15:58):

Another example would be, it- it's much more common here to have nurses mix IV medication that-

Carol Pehotsky (16:04):

Oh. Interesting. (laughs)

Dr. Sheila Miller (16:06):

And it's a skill that they've learned and they-

Carol Pehotsky (16:06):

Mm-hmm.

Dr. Sheila Miller (16:08):

... that they've done. So again, if you're looking at staffing patterns, you have to m- make sure that you first understand the work before you determine what the abs- staffing and le- and resource needs to look like.

Carol Pehotsky (16:21):

Sure. Yeah. And, and great advice for us no matter where we work (laughs) in terms of making sure that-

Dr. Sheila Miller (16:21):

Yes.

Carol Pehotsky (16:26):

... we're starting off (laughs) on the same foot before we move forward together. So moving over to the experience of, of a clinical nurse. Can you tell us a bit more about any work that- that's been done in terms of speaking up or shared governance, and what that's been like to-

Dr. Sheila Miller (16:43):

Hmm.

Carol Pehotsky (16:43):

... move forward with those two topics with nurses from such diverse backgrounds?

Dr. Sheila Miller (16:47):

Oh, that's one of the topics that's near and dear to my heart.

Carol Pehotsky (16:50):

(laughs)

Dr. Sheila Miller (16:50):

Uh, both the voice of the nurse in practice and in making a difference, and shared governance. What I'll say, and this to the best of my understanding, i- is true in m- much of Europe, is that shared governance is a newer concept.

Carol Pehotsky (17:07):

Oh, okay.

Dr. Sheila Miller (17:08):

So where most of the time when I would interview nurses in the US, they would have ha- had that content in school-

Carol Pehotsky (17:17):

Yeah.

Dr. Sheila Miller (17:17):

... they would understated what it meant and what that might look like in an organization, and even questions to ask in a- in an interview. That is a, something that is developing.

Carol Pehotsky (17:27):

Hmm.

Dr. Sheila Miller (17:27):

There actually is a CNO for England.

Carol Pehotsky (17:32):

Oh, okay.

Dr. Sheila Miller (17:33):

(laughs) Which is a little bit of the different thing, and I'll-

Carol Pehotsky (17:33):

Yeah.

Dr. Sheila Miller (17:36):

... maybe I'll, I'll go in a, a bit of a different direction for a minute.

Carol Pehotsky (17:41):

(laughs)

Dr. Sheila Miller (17:41):

Because of National Healthcare-

Carol Pehotsky (17:43):

Mm-hmm.

Dr. Sheila Miller (17:44):

... many things are more central-

Carol Pehotsky (17:47):

Okay.

Dr. Sheila Miller (17:48):

... than what I had been used to.

Carol Pehotsky (17:50):

Mm-hmm.

Dr. Sheila Miller (17:50):

Because of the National Health Service, so things can come out very centrally, and then there's-

Carol Pehotsky (17:51):

Oh.

Dr. Sheila Miller (17:56):

... a clear-

Carol Pehotsky (17:57):

So here's a new policy, gets pushed out. Okay. Yeah.

Dr. Sheila Miller (18:01):

Here- here's new clinical practice guides.

Carol Pehotsky (18:04):

Hmm. Mm-hmm.

Dr. Sheila Miller (18:04):

Here's what the CNO for the country says, and because it's national, there are a lot of workers that are immediately and more clearly impacted by that.

Carol Pehotsky (18:18):

[inaudible 00:18:18]

Dr. Sheila Miller (18:18):

So the CNO for England has actually come out and part of her agenda for nursing is to increase shared governance.

Carol Pehotsky (18:26):

Wonderful. Really good.

Dr. Sheila Miller (18:26):

Yeah.

Carol Pehotsky (18:28):

And I'm pivoting to speaking up. So what can we all do? I mean, we've talked several times about speaking up, but appreciating that where a nurse trains, where a nurse has had experience that may not have been the expectation, and so I, I can only imagine-

Dr. Sheila Miller (18:28):

Mm-hmm.

Carol Pehotsky (18:41):

... how uncomfortable that was. I'm sharing the story of my friend from all those years back and how uncomfortable it was for her. What are some things that you've seen work or that you, you and your team have tried to really help, that advocacy is at the heart of nursing, but really, how to find that voice in the moment?

Dr. Sheila Miller (18:55):

Yes, especially I think when you look at the power dynamic relationship-

Carol Pehotsky (19:00):

Mm-hmm.

Dr. Sheila Miller (19:01):

... that still exists between physician and nurses in many settings.

Carol Pehotsky (19:05):

Hmm.

Dr. Sheila Miller (19:06):

Aside from what we know in championing that very publicly, is looking for those opportunities that when it occurs to celebrate-

Carol Pehotsky (19:15):

Hmm.

Dr. Sheila Miller (19:16):

... very publicly-

Carol Pehotsky (19:18):

Reinforce- positive reinforcement. (laughs)

Dr. Sheila Miller (19:21):

Positive reinforcement. And in fact, not only do you not get in trouble, as it were for doing that-

Carol Pehotsky (19:22):

Mm-hmm.

Dr. Sheila Miller (19:28):

... you get celebrated and recognized, whether it be at a, a, a meeting with other leaders, whether it be in the department. In order to continue to reinforce that, yes, indeed, we really we- do want you to speak up when you see something bad-

Carol Pehotsky (19:28):

Mm-hmm.

Dr. Sheila Miller (19:43):

... is not safe that is going on.

Carol Pehotsky (19:47):

We've got work to do with that all over. (laughs) But it- it-

Dr. Sheila Miller (19:50):

Yeah.

Carol Pehotsky (19:50):

... it's a great point for all of us no matter where we practice. So we've had this great conversation for about 20 minutes now, and so hopefully some of our listeners are thinking, "Hmm, I wouldn't mind an international adventure." They- they're coming... hmm, maybe they're not even come from the United States, they're coming from different countries, or, or they're in the United States thinking, "I- I'm curious about international nursing."

Dr. Sheila Miller (20:11):

Mm-hmm.

Carol Pehotsky (20:11):

Wh- what would you say to somebody who's interested in that? What should they be thinking about? What should they consider before (laughs) making the big leap? And what are the benefits of it?

Dr. Sheila Miller (20:19):

So I think the, the first thing to consider is, you know, how it fits in your life and your career right now. I- it's not a small thing, so-

Carol Pehotsky (20:29):

No. (laughs)

Dr. Sheila Miller (20:30):

(laughs) ... thinking about is it something you feel up to at this particular time? Does it work well with your life, and quite frankly, there have been a couple of times in, in my career when I considered it. And I really waited until the time was right.

Carol Pehotsky (20:30):

Sure.

Dr. Sheila Miller (20:47):

So I think that's the first thing, because the truth of the matter is, is it's a big step.

Carol Pehotsky (20:52):

Yup!

Dr. Sheila Miller (20:52):

And the more prepared you feel-

Carol Pehotsky (20:53):

Hmm.

Dr. Sheila Miller (20:56):

... the, the better it will, will go.

Carol Pehotsky (20:57):

For that transition, sure.

Dr. Sheila Miller (20:59):

So, a- absolutely. So I think starting with that. The benefits are many.

Carol Pehotsky (21:05):

Mm-hmm.

Dr. Sheila Miller (21:05):

Um, you get to meet a lot of wonderful people. You get to see practice in different ways. It broadens your experience, not only-

Carol Pehotsky (21:05):

Mm-hmm.

Dr. Sheila Miller (21:14):

... from a profe- as a professional, but also personally. I, I think if someone's deciding that they're going to take an international assignment, thinking beyond the, the things you would think about for any move, like, you know-

Carol Pehotsky (21:14):

Mm-hmm.

Dr. Sheila Miller (21:29):

... where you're gonna live, and what your com- commute is like.

Carol Pehotsky (21:31):

(laughs) Yeah. (laughs)

Dr. Sheila Miller (21:33):

But, (laughs) but thinking about the organization you're going to. Does it fit-

Carol Pehotsky (21:37):

Mm-hmm.

Dr. Sheila Miller (21:37):

... with your values?

Carol Pehotsky (21:38):

Sure.

Dr. Sheila Miller (21:38):

Do you feel at home there? You know, do you feel like you're a part of and you're aligned with what they're about? And, and then I think it's al- it's really important to prepare for, there are gonna be times when it's gonna be really hard.

Carol Pehotsky (21:53):

Yeah.

Dr. Sheila Miller (21:53):

(laughs)

Carol Pehotsky (21:54):

Yeah, I can imagine. (laughs)

Dr. Sheila Miller (21:56):

You know, and you're gonna say, "You know, I, I knew how this worked," whether it's a professionally again, or in your personal life. You're gonna say, "I, I knew exactly how this worked at home, and I can't seem to get this-

Carol Pehotsky (21:56):

Hmm.

Dr. Sheila Miller (22:05):

... to work here."

Carol Pehotsky (22:06):

Oh, sure.

Dr. Sheila Miller (22:08):

And then an- and to figure out what, how you'll manage through those moments when that happens. Um, the great side, it really helps you understand how resilient you can be.

Carol Pehotsky (22:20):

Hmm. Mm-hmm.

Dr. Sheila Miller (22:20):

Uh, which really builds, I think, your ability to, to be, uh, better and better, both as a nurse and as a person.

Carol Pehotsky (22:29):

Yeah. I, right before (laughs) the COVID pandemic, a, a colleague of mine moved from Cleveland Clinic Main Campus to Cleveland Clinic Abu Dhabi, and was so excited about the adventure and, and just staying connected to her though a ti- time where she truly could not come back. And a lot of-

Dr. Sheila Miller (22:29):

Mm-hmm.

Carol Pehotsky (22:46):

... her family was back here, and, and just... But admired so much how she grew, and still managed to stay connected to us, not synchronously, obviously, (laughs) it was Facebook, it was Teams, it was email, but really the- the work that she did to make sure she still felt connected, and that we could still-

Dr. Sheila Miller (23:02):

Mm-hmm.

Carol Pehotsky (23:02):

... support her even though we were 90 countries and hours apart.

Dr. Sheila Miller (23:07):

And that is a wonderful time that we live in, that we have that ability-

Carol Pehotsky (23:07):

Yeah. (laughs)

Dr. Sheila Miller (23:11):

... to stay connected. And that if you plan the time just right-

Carol Pehotsky (23:11):

Yip. (laughs)

Dr. Sheila Miller (23:15):

... you can actually even, uh, even have personal contact.

Carol Pehotsky (23:18):

There you go. Excellent.

Dr. Sheila Miller (23:20):

Yeah.

Carol Pehotsky (23:20):

Well, you've given us a lot to think about, and listeners, if, if you are listening from around the world, let us know what your experience is like. What, what did we miss in this co- in this very brief conversation that you would share to other nurses who are, who are thinking about doing international nursing, or practice insights you've sh- you've seen over your time across the globe?

(23:41):

We will now, though, switch to our speed round so that our audience can get to know a little bit more about Sheila as the amazing human being she is. So we'll start with, what's something you wish you knew as a brand new nurse that you would share with nurses today?

Dr. Sheila Miller (23:55):

You know, Carol, one of the things I think back at- on is I wish I knew how better to ask for support.

Carol Pehotsky (24:01):

Hmm.

Dr. Sheila Miller (24:01):

I think there were times I struggled through things that there was help available that I didn't ask.

Carol Pehotsky (24:07):

Hmm.

Dr. Sheila Miller (24:07):

So that would be one of the first things that I would say to a new nurse, "Ask. People-

Carol Pehotsky (24:11):

Yeah.

Dr. Sheila Miller (24:11):

... are here, they wanna help you. And don't be shy about asking for help. We all need help sometimes."

Carol Pehotsky (24:17):

That's great advice, especially when you think about, you know, sometimes as a new grad, we feel like we need to come onto the units helping instill confidence because we know all these things, when really, we don't. (laughs) And, and everybody needs that help. Thank you, that's wonderful.

(24:30):

And especially now that you're in another part of the world, what are you doing to take care of yourself? How do you unwind? What are the things you do for you?

Dr. Sheila Miller (24:40):

One of the things I always did to unwind was actually go out in my yard.

Carol Pehotsky (24:46):

Mm-hmm.

Dr. Sheila Miller (24:46):

So I've had to adapt that-

Carol Pehotsky (24:46):

(laughs) Sure.

Dr. Sheila Miller (24:46):

... a little bit, since now I'm in a flat. But I, I called my mom one day and said, "Guess what? I bought plants for my outside patio."

Carol Pehotsky (24:54):

Yay.

Dr. Sheila Miller (24:54):

Because I, it really that ability to co- connect with outside and nature, it really helps me to unwind and, and to, to, to distract from whatever stress I might be feeling. So that, that's something that works for me.

Carol Pehotsky (25:08):

Wonderful. Well, Sheila, I can't thank you enough for joining us today.

Dr. Sheila Miller (25:12):

Thank you so much, Carol, it's been so enjoyable. And I-

Carol Pehotsky (25:12):

(laughs)

Dr. Sheila Miller (25:15):

... I really, it's been a great adventure to be here. I'm so excited to be here. And, uh, I'd encourage anyone who's thinking about it to really put some thought into it. It, it's well worth it.

Carol Pehotsky (25:26):

Wonderful. Thank you.

(25:31):

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts, or want to share your stories? Email us at nurseessentials@ccf.org.

(25:51):

To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing.

(25:58):

Until next time, take care of yourselves and take care of each other.

(26:05):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.