Sandra Gruenig, Registered Nurse and Clinical Coordinator at Rapid City Hospital, didn’t plan to enter the nursing profession. Sandra originally completed her degree in engineering while she was living in her home country of the Philippines. As it often does, life sent her in an unexpected direction. She married an American citizen and moved to the United States, where she wasn’t able to find work in her field. While working in an assisted living facility she began to consider returning to school to become a nurse.  

If  you had asked her earlier what profession she’d choose, nursing would have been one of her last answers. She had a lot of misconceptions about the profession that changed when she started the program. “I used to think of nurses as just the doctor’s assistant, but it’s much more than that. You really are a team,” Sandra said. “You’re the doctor’s eyes and ears when they aren’t there, and nurses are the people who spend the most time caring for patients.” 

RETURNING TO SCHOOL  

Sandra was accepted to the South Dakota State University School of Nursing in Rapid City. She said it was a challenge to overcome some obstacles. “In the Philippines, most of our classes are taught in English by the first grade, so when I got here I knew how to speak English,” she said. “But it was intimidating, at first, to try and express myself. I felt like it took twice the effort just to comprehend all the information I was getting, or sometimes my coworkers would make a joke and I wouldn’t really understand it.” 

Sandra was able to use her experiences to help a group of new Filipino nurses at Monument Health adjust to new equipment and processes they weren’t used to. “They were having a hard time with things like using infusion pumps to measure flow rates. They would tell me they didn’t really use those. They were used to calculating flow rates manually.”  

Helping and working with those nurses provided a new lens for her and other managers to look through. “Understanding the training people received, and how they approach things differently, helped us understand what to expect and taught us how to prepare new nurses who were trained in other countries.”  

EXPLORING HER NEW CAREER 

Sandra joined Monument Health directly out of school but wanted to understand how other health care systems operated. She spent half a year working as a traveling nurse with the University of Nebraska Medical Center, and she credits Monument Health for supporting her traveling and exploring what opportunities were available. “I did not really leave Monument Health, but I stayed a PRN for a time and I went traveling,” she said. “I planned to come back, but I also wanted new experiences and wanted to know what’s out there, probably for my own satisfaction, and they were really supportive of that plan.” PRN is taken from the latin pro re nata, which means “as the situation demands” or “as needed.” PRN nurses do not work full time but rather work as needed and as their schedule allows.  

She said culture shock isn’t only for people coming from other countries. “It’s not just the difference between the United States and the Philippines. When I went to Nebraska, their culture was very different.” Everything, from the way doctors and nurses interacted to how they did things changed significantly from what she was used to. “When I got back to Monument Health and people were talking about being short staffed, I was like, ‘You think we’re short staffed? This is not short staffed.’” 

LOOKING BEYOND PASSION 

Sandra said Monument Health has become a more supportive organization over time because the health care system has faced and adapted to many challenges, particularly regarding training and preparing caregivers who come from other health care systems. She said experienced managers go a long way in helping people feel at home. “I think managers have a better idea about what to expect and what challenges there are. We’ve learned the questions to ask to find out what new nurses need when they come in from other organizations.”  

Sandra encourages people who want to get into nursing to understand what is motivating them to do that. “When you ask somebody why they want to be a nurse I feel like many people would say, ‘Oh, because I’m passionate. I want to do this job.’ Passion is an important part, but nursing is a lot of work and requires a lot of patience, and they need to think about if that is something they want.”  

She noted the importance of being able to see the patients as people and feels like that can be easily overlooked. “That patient is also a mother, a sister, a brother or someone else important to another person. Ask yourself, if it was your family, how would you want them to be treated, then work to give every patient that level of care.” Sandra’s patience and dedication to her patients has been a constant over her career. In 2021, she received a daisy award after a patient nominated her for her compassion and care.

Benefits of having international nurses 

Foreign-born professionals make up a sizable group of the nation’s health care workforce. More than 2 million health care workers in the United States immigrated from other countries, and physicians and registered nurses represent more than half that number. Our nation’s health care system relies on the expertise and perspectives of foreign-born health care professionals to function. Immigrants make up a larger portion of the health care field than they proportionally do for other sectors. Diverse perspectives help us to improve the quality of the care we can offer to the communities we serve. Whether they received their education outside the United States or started on a new path after arriving, the health care professionals who immigrated here are invaluable, not only to our health care system, but to the communities in which they live.  

–Nicole Kerkenbush, Chief Nursing and Performance Officer 

What is a DAISY?   

Monument Health recognizes the hard work of nurses and their support teams through two different awards, the DAISY and TULIP. 

The DAISY Award is a nationwide program presented in collaboration with The American Organization of Nurse Executives (AONE) that rewards and celebrates the extraordinary clinical skill and compassionate care given by nurses every day. It was established by the DAISY Foundation in California in memory of J. Patrick Barnes, who died at age 33 of an autoimmune disease. DAISY is an acronym for “diseases attacking the immune system.” Nurses can be recognized by patients or by the patient’s family, and other caregivers for their outstanding service. 

TULIP is an acronym for, “Thoughtful upbeat loving individuals caring for patients,” and the TULIP Award recognizes outstanding members of Monument Health’s nursing support teams. Nursing support includes positions such as Nurse Aides, Certified Nursing Assistants, Emergency Department Technicians, Psychiatric Technicians, Health Unit Clerks, Dialysis Technicians, Clinical Assistants, Cardiac Monitoring Technicians, Activities Assistants, Medical Assistants, Certified Medical Assistants, Medication Aides and Restorative Assistants. The TULIP award is specific to Monument Health. 

Twelve nurses and nursing support caregivers in Rapid City are selected for each of these recognitions each year. They are also honored in Custer, Lead-Deadwood, Spearfish and Sturgis.