A World of Opportunities

Some nurses aren’t content to limit their careers to just the 50 states. Instead, they receive a calling from beyond our borders and find that international soil welcomes their skills.

Why are these nurses so eager to take their talents overseas? Some are drawn by the opportunity to experience different cultures, others by a higher standard of living, and still others by the desire to simply serve wherever they are needed most. Here are the stories of three minority nurses who answered three very different calls for overseas service–and how you too can broaden your career horizons to practice nursing on a global scale.

Serving in Afghanistan–by Way of Germany

“I wanted a job that had some excitement.” That’s how Lue Daniels, RN, explains her decision to work at Landstuhl Army Hospital, a U.S. Army facility in Germany. Before taking her nursing career across the Atlantic, Daniels worked in a med/surg unit, an air-evac unit and in a mental health ward. The varied skills she learned in each of those stateside positions are all serving her well in her current international role.

An African-American nurse from San Antonio, Texas, Daniels serves as a case manager for Army personnel injured in Operation Enduring Freedom, the current offensive in Afghanistan. Her responsibilities range from making sure soldiers have the necessary paperwork and transportation to letting families back in the States know the status of their injured loved ones.

Daniels learned about the opportunity through a military Web site. Although she has only been in Germany since January, she says her nursing skills have already grown from the experience. For one thing, she’s learned to ask many more questions than she would normally do in a civilian setting.

“Sometimes you hear things that the patient may not have told the doctor,” she explains. “You have to get them to open up and encourage them to get their problems treated. Soldiers are a different type of patient. They want to go back to their duty even if they’re hurt. I talk to them about the reasons why it’s important to fully heal before going back.”

Daniels is learning German but says language isn’t a barrier. While she works in an English-speaking hospital, she lives “on the economy,” the military term for living in a local, non-American community.    

“I love my house and my neighborhood,” she says. “Language isn’t a problem because so many people here speak some English. The German people are very helpful.”

In addition to her daily encounters with American Army personnel, Daniels also has the opportunity to work with many local people, as well as people from a variety of nationalities and cultures.

“Working in a military hospital, you meet so many people from so many different backgrounds,” she says enthusiastically. “You meet people from all over the world. They want to know about you and you want to know about them.”

In such a culturally diverse international community, racial prejudice is rarely a problem, Daniels adds. “During my time here, no one has paid any attention to my color. I can’t say that [the issue] is not there, but I can say that it hasn’t mattered for me. What has been more important has been my relationship with my patients.”

Unlike some of the other nurses at the hospital, Daniels works as a civilian; she is not a member of the military. But here too, she is quick to point out, the fact that there are two different types of nurses is not an issue.

“We all work hard,” she maintains. “The biggest difference is that the military nurses may be called out at midnight when I’m home sleeping. They are on duty all the time.”

Being a civilian also affords her more time off to travel. She recently spent a weekend in Paris.

In light of the current world situation post September 11, Daniels feels that the opportunity to care for American soldiers who are fighting the war against terrorism is perhaps the most rewarding aspect of her work.

“I never dreamed of a job like this,” she says. “But I know the reason I can do this job is because of them, my patients. The reason I can jump on a plane, fly over here and not worry is because we have soldiers and sailors serving here and putting their lives on the line.”

Submerged in Another Culture

Dorson Purdy, RN, has some words of caution for nurses who are thinking about taking their first international job: “Once you come [overseas], you may not want to go back.”

Purdy, who is African American, speaks from experience. He left his Louisiana home for a two-year assignment in Saudi Arabia. That was almost 15 years ago. Except for a recent extended visit home, he’s been nursing in the Middle East ever since.

Purdy’s original motivation was to experience a new culture. He says he’s always considered himself a wanderer, a trait he credits to a National Geographic subscription he received when he was a child. “I didn’t come over here to change the world,” he explains. “I came to learn about it. This [experience] is very educational and I enjoy it.”

Most of the other Americans he encounters in his work feel the same way, although it’s not universal. He has seen some nurses return to the States after just a year. But others keep coming back.

“The culture is so different here,” Purdy notes. “When people [from the U.S.] first get here, they tend to go into a slight depression during the first three months. If they make it through that, they perk up and decide it’s not so bad.”

Having the flexibility to adjust to a completely different culture is key, Purdy believes. “Many people who take jobs in foreign countries aren’t ready to leave their familiar American culture behind,” he says. “They want to bring it with them. In the States, we do things a certain way and there are things you can do without restrictions. Over here, there are some restrictions on behavior and dress. Some people find it just too difficult.

“It takes some people longer to realize that they are a guest in another country,” he continues. “If you’re a guest in someone’s home, you behave accordingly. It’s the same situation.”

Even though he’s a world away from the American South where he grew up, sometimes the same prejudices he experienced at home show up in his current workplace.

“There is less [racial bias] among the local people,” Purdy says, “but some of our countrymen bring some of the same [bigoted] ideas with them. Some people will never change.”

While he has experienced some problems, Purdy is quick to talk of lifelong friendships he has made with white nurses thanks to the closeness of the American community abroad.

“Once you go overseas, the community becomes smaller and you tend to rely on each other. You get to know people better than you do at home. You develop a new understanding about people,” he says.

Purdy recently spent some time nursing in the U.S. and that simply confirmed his decision to return to Saudi Arabia.

“Nursing in the States has become a business,” he complains. “Nurses are more and more under the gun, working under almost impossible conditions and expected to perform their absolute best. Over here, I can give the kind of care I want to give, the kind of care I went into nursing to provide.”

Purdy says he has given up some higher salaries in the States to stay abroad, although the salary he makes in the Middle East usually allows him a better lifestyle, due to the lower cost of living compared to the U.S.

“Once people come here, they tend to come back,” he adds. “It’s not a bad life.”

To Go or Not to Go

Nurses working abroad often get tax breaks as well, according to Linda Mackey, a recruiter with Helen Ziegler and Associates of Toronto. The firm serves as a placement agency for nurses interested in jobs in Saudi Arabia, the United Arab Emirates and Canada. Purdy is one of their clients.

“The biggest financial benefit of going to Saudi Arabia is that your earnings are tax free,” explains Mackey. “You don’t have to pay taxes in the United States or in Saudi Arabia. Housing and utilities are paid for, so you’re only responsible for your food and telephone. It’s easy to save money.”

Purdy has found international assignments both with an agency and on his own. He says the advantage of using agencies is that they handle the paperwork needed to work overseas. Plus, going through an agency is often the only way to get a job in a foreign country, especially if it’s your first one. Once you get over there, it is easier to find jobs on your own. Before accepting his current assignment, Purdy found a job independently in Yemen.

“It’s hard to find out about [overseas] opportunities when you’re in the States unless you use an agency,” he says. “Once you become part of the ex-patriot world, doors open for you.”

While many minority nurses find success and satisfaction working in foreign countries, Purdy stresses again that this career route is not for everyone. Even with an assignment where there are plenty of other Americans around, being so far away from home can result in feelings of isolation and loneliness. People who are good at functioning independently are the ones who are most likely to be comfortable in this environment.

“One of the things you have to have is confidence within yourself,” Purdy advises. “You have to be able to be alone with yourself and be okay.”

Mackey has found that the nurses who tend to thrive in international jobs are those whose primary motivation is to experience another culture. “Nurses have to have a recognition that they are going to a very different culture,” she emphasizes. “Financial benefits are great, but it’s more important to view this as an incredible opportunity to meet people from different backgrounds. If you go with that frame of mind, you’ll do well.”

Angels of Mercy—in Two-Week Increments

For many nurses, the taste of international nursing first comes in small doses. It may be a two-week trip to a Mexican village sponsored by their church, or a working vacation in Asia.

For Maria del Rosario (“Rosie”) Valdez, RNC, PhD, her first overseas trip was a welcome opportunity to expand her research. She had followed the work of Lorna Schumann, a fellow faculty member at Washington State University who has been making regular trips to Honduras over the last three years.

“I was very impressed with Lorna’s work,” Valdez says. “I had heard that Honduras had a major problem with HIV, which is my area of interest. I decided to go there and find out for myself.”

She accompanied Schumann on a ten-day trip in the spring of 2000. While there, she worked at a health care clinic and interviewed HIV-positive women. She was curious to see how the disease is handled in a region with such sparse resources.

“[The people there] are simply trying to live with an illness that has taken over their lives,” Valdez recalls. “They have very limited resources and rely heavily on faith.” She says she returned from the trip with a little less tolerance for the American tendency to whine. “These people waited hours just to see a nurse.”

While Daniels and Purdy are working in paid positions overseas, many of these short-term international assignments are unpaid. Nurses who volunteer for them are expected to pay for their trip and even purchase the medical supplies they will be using.

Valdez financed her trip with some leftover grant money after she told her funding agency about the chance to broaden her research base. The agency was very excited about including some international data, she says.

Schumann adds that cost is a factor that sometimes prevents student nurses from accompanying her on her trips. “We’ve had garage sales and all sorts of things to raise money,” she comments. “It’s somewhat difficult. Some nurses just pay out of their own pocket and don’t try to fundraise.” Schumann will be teaching nursing in Pakistan this fall.

Going Global

If you’re looking for nursing opportunities overseas, the world is literally open to you. While the Middle East, Europe and Africa have always welcomed American nurses, new doors are opening now in China and other parts of Asia. For nurses willing to volunteer their services, developing countries are always receptive.

Mackey says most foreign assignments require only an associate’s degree and two years of nursing experience at a medium to large acute care hospital. Most contracts are for one or two years, although shorter ones can sometimes be arranged for senior-level nurses.

Schumann advises nurses to begin exploring international opportunities by attending international health conferences and getting involved in international nursing associations. Networking opportunities abound at conferences held by groups like the International Council of Nurses, the Transcultural Nursing Society and Sigma Theta Tau International.

Dorson Purdy feels that minority nurses too often shy away from opportunities to work abroad. In his own travels, he has met several nurses of color who embarked on rewarding international careers after raising children. He offers this advice: “Don’t be afraid to spread your wings.”