I am working as a registered nurse in a long-term care facility with short-term rehabilitation services. I work PRN while I am attending graduate school and mostly work in the short-term rehab unit. I oriented a foreign-graduate nurse from India who I feel is not safe. On her first day, I asked her aspects of her education, I wanted to know what she already knew and what I can work with to help speed up her knowledge. I came to find out that nursing in India is very skill-based which includes inserting IVs, urinary catheters, applying oxygen, administering medications (but without knowledge of the medications' actions...only the doctor knows the medical knowledge). I was asking her questions about medications and she seemed to know only the blood pressure medications or heart medications. I asked her if she took any pharmacology course in India or here to prepare for passing the NCLEX-RN and she said she did not need to take a course like that to apply to challenge the exam. She admitted she only studied the medications that she knew will show up on the exam based on her preparation materials. She also added she has been trying to clear the NCLEX-RN or NCLEX-PN exam since 2014. She doesn't understand basic anatomy, physiology, pathophysiology, and dose concentration. Her technical skills are also lacking and she struggles to complete dressing changes, IV medications, etc but that can be learned. Skills are just hands-on exposure but I can't tolerate that she doesn't have the medical foundation to do this job. She doesn't know pathophysiology and that scares me. I just feel like she is a medication tech which is not what her role is clearing the NCLEX-RN exam. I have yet to see her complete a physical exam but I am doubtless she can complete it well since she has told me she did not need to do a hands-on competence course to evaluate her technical skills. Moreover, she has voiced she does not assess patients as her duty as a nurse in India since she mainly gets the doctor when the patient looks toxic. I have raised these concerns to the ADON and DON. I have told them that this nurse does not understand medications and that she is unsafe. I am scared for my patients. I am scared that in her role as a skilled-based healthcare worker she will not know when the patient is deteriorating. She will not voice her concerns to the doctor because she is not familiar with the clinical picture of the patient and maybe even uncomfortable being assertive to advocate for her patients. Today, I asked her what is swelling in the legs would be called, she did not know "edema." I just can't imagine that they have lowered the standards to the NCLEX-RN because of a pandemic. I suggested that she try the night shift because it was a slower pace and she would have time to understand aspects of nursing but she was not willing to do that. I guess if someone has experienced this, let me know what you think..
