Community Care From Around the World

There was a national nursing shortage prior to the COVID-19 pandemic, which only tightened the availability of qualified nurses. Healthcare systems have had to think more creatively about how to fill these gaps and, in the fall of 2020, GBMC looked to other countries for nursing support.

Jill Wheeler, MSN, RN, Director of Infection Prevention, Specialty and Inpatient Surgery, Wound/Ostomy/HBO, and Claire Cafirma, MSN, RN, CNOR, Director of Perioperative, Interventional Radiology, Endoscopy, co-lead GBMC’s partnership with Passport USA, which has brought 31 nurses into the workforce to date.

“These nurses have superb skills,” Wheeler said. “Once you get them up to speed on the electronic medical records system, they are good to go. Although acclimating to a new working environment can be challenging for international nurses, we’ve had zero failures. It continues to be a top priority for GBMC to broaden our diversity and step outside the box in finding ways to tackle the current nursing shortage.”

Nurses are on a three-year contract through the agency and can choose to stay with GBMC after the contract ends. The process to bring a nurse to the U.S. varies but can take anywhere from 12 to 18 months. For example, GBMC has committed to hiring 47 nurses but only 31 are currently here. They pass the same credentialing tests as nurses in the U.S. are required to, and they also must pass an English proficiency exam.

The transition to working in the U.S. can be challenging, but new nurses at GBMC have an extra layer of support built into hiring and onboarding in Claire Cafirma. Fifteen years ago, she was in the same position.

Cafirma, the eldest of four daughters, was a single nurse working in the Philippines when she applied to work overseas. While waiting for a response, she worked in Saudi Arabia where she met her husband (also from the Philippines). She was pregnant with her first daughter when she got the call a job was open. She returned to the Philippines for two weeks to process her visa and her husband stayed in Saudi Arabia. She arrived in the United States in 2007 to work at another hospital in Baltimore.

“It was difficult to come here, pregnant, with no one here. I had a baby by myself. It was very challenging,” Cafirma said. “We receive English instruction from kindergarten in the Philippines, but when I came here, I really couldn’t understand how people talk, even just ordering food. It was a challenge.”

For most nurses, the way care is provided is the same as it was in their country of origin. Aside from language, which can be a struggle, the biggest professional barrier is learning the electronic medical records system. Outside of work, going through this transition alone can be scary. Aside from housing provided by the agency, nurses aren’t offered much on arrival.

“The whole hospital, including our Board of Directors, have really embraced welcoming the nurses,” Wheeler said. “We have a Welcoming Committee, and the Philanthropy Department gave them gift cards to the GBMC Volunteer Auxiliary’s Nearly New Sale to stock up on essential items. Everybody has been on board in welcoming them to ensure they are successful while they are here and able to provide the same level of patient care we expect from all nurses.”

One of GBMC’s recent hires, Blessing Liberty-Echewodoh, RN, has been working in the GBMC PACU for about six months. She agreed learning Epic took a while to master, but the transition overall was good because of her unit.

“The transition wasn’t a very easy one, but coming to GBMC, I must tell you, it wasn’t bad,” Liberty-Echewodoh, originally from Nigeria, said. “I told everybody I met it was like coming to a family; everybody tried to help you transition well. They were all there and you could see that these people had your back. They allowed me to make my mistakes so, sincerely, transitioning to GBMC wasn’t a bad one for me.”

It also helps to see nurses like Cafirma who have not only come from other countries and stayed but been successful in their careers.

“I’m here and I am one of the international nurses. I know how it feels,” Cafirma said. “You work hard, and you get recognized. It’s a diverse workforce and there’s a lot of opportunity.

“I can speak for nurses from the Philippines. We don’t usually feel empowered because normally the doctors are the boss. But here, we can speak up, have a questioning attitude, we have autonomy.”

At GBMC, they also feel seen.

“One thing that has particularly touched me at GBMC is the team spirit,” Liberty-Echewodoh said. “You could literally touch it. When people ask if they can help, truly they are not just saying it, they mean it. It is overwhelming.”

Meet Blessing Liberty-Echewodoh, RN, PACU

Blessing has been a nurse for 23 years, the last 10 of which have been in critical care and anesthesia care. She came to GBMC about six months ago from Nigeria through GBMC’s relationship with Passport USA with her husband and three children. In just a short time here, she has made a positive impact on patients and her colleagues.

What’s the first thing you do when you wake up in the morning?


I pray. If I have to be on duty, then I have to jump out of bed to get myself ready for work.

What do you do to decompress?


My family means the world to me, and I just love to spend time with them. I love to listen to music, but I don’t get to do that a lot these days. I try to get my mind off whatever is putting stress on me, and I pray, I tell God about it and most times, by the time I work through my feelings, I feel a lot of relief.

What was the last gift you gave someone?


I spoke with a patient last week. She had an issue that was bothering her emotionally and she ended up confiding in me. By the time she was ready to go, she said, ‘This is the best gift anybody gave me in recent times. You don’t know what you did by sharing those experiences with me.’ It meant a lot to me.

Who are you picturing when you take care of patients?


I must tell you something, before I came to the U.S., I knew I was coming to GBMC and that mission statement really touched me. I find myself many times, even when I’m not at work, going over those words. It keeps coming back to me. For example, when patients leave and you have to wipe down and clean everywhere, it comes back. How would you feel if you had to be the one lying on this couch, and it wasn’t clean? How would you feel if your child had to be put on this and it wasn’t clean?

Each time I see a patient, if it’s a child, I start picturing my children immediately. If it’s an elderly person, I start seeing my parents. That’s just the way it is. It’s like my father sitting there, my mother sitting there, my husband. That’s the truth.