Beyond Borders: A Malaysian Nurse’s Odyssey In The Heart Of Swedish Health Care — Sandra Laxmana

Fostering a culture of openness and positivity, free from blame, is crucial for retaining staff in health care settings, says Sandra Laxmana, a Malaysian nurse currently working in the Swedish health care system.

This year, International Nurses Day falls on May 12, 2024, and I find myself reflecting on my transformative journey as a Malaysian state-registered nurse navigating the Swedish health care landscape. It is a narrative that is rich with challenges, personal growth, and ultimately, profound fulfilment.

Before my arrival in Sweden, I dedicated two decades to honing my nursing craft in Malaysia and Saudi Arabia, adapting seamlessly to diverse cultures and health care environments.

My tenure in Saudi Arabia, where I swiftly acquired the Arabic language while on the job, imbued me with a sense of linguistic confidence that would prove invaluable in the years to come.

However, my transition in Sweden proved to be a humbling experience. While I anticipated the need to learn Swedish, I underestimated the extent of the challenge it would pose.

This timeline offers a clear depiction of my two parallel journeys: education and the nursing profession. Picture courtesy of Sandra Laxmana.

Integrating into the Swedish health care system demanded far more time and dedication than I initially imagined. There were moments when the overwhelming nature of everything, from language acquisition to navigating cultural differences, tempted me to consider returning to Malaysia. Yet, through perseverance and resilience, I chose to press on. 

Arriving in Sweden in mid-2014, I embarked on a dual path of academic pursuit and language acquisition. Continuing my online Master’s studies with the University of Liverpool and attending Swedish for Immigrants classes, I faced the daunting task of learning a new language at the age of 42.

Despite moments of doubt and homesickness, I remained steadfast in my determination, fuelled by a clear sense of purpose.

Engaged in the pursuit of my Master’s thesis, I undertook a series of interviews at Akademiska Sjukhuset, a university hospital in Uppsala. During my time there, I had the privilege of meeting Marie Foconi, one of the head nurses I interviewed.

Little did I know that this encounter would lead to a pivotal breakthrough. Marie, a head nurse in the Cardiothoracic Intensive Care Unit (CICU), recognised my hidden potential right from the start.

What followed was groundbreaking: an opportunity that had not before been offered in her unit. Immigrants had not been given the chance to learn Swedish while engaging in practical sessions tailored to the professional language of one’s field.

Marie’s vision was unprecedented — she proposed a learning opportunity where I could simultaneously learn Swedish and engage in practical sessions tailored to the professional language of my field.

This was a game-changer, because, despite possessing the necessary skills for the job, many immigrants struggled due to language barriers.

Marie understood this challenge well. By seamlessly blending an unfamiliar language with familiar job tasks, she made learning not only easier, but also faster. My defining moment, unexpected yet profoundly transformative, was all thanks to Marie Foconi’s keen insight and innovative approach.

Marie’s invitation to join her unit and learn the intricacies of the Swedish language within a hospital setting was a turning point. With unwavering commitment, I immersed myself in language learning while actively participating in the daily duties alongside Assistant Nurses, recognising the necessity of practical experience alongside language acquisition.

Though my primary goal was language acquisition, I found myself seamlessly integrating into the work environment.

In 2016, just three months after I began voluntarily shadowing Assistant Nurses to learn Swedish, I took a significant step forward in my Swedish nursing career. Passing and completing the formal Swedish for Immigrants course, I applied for and transitioned into a full-fledged Assistant Nurse (AN) role in the CICU.

My journey toward integration was further propelled by academic pursuits. Upon completing the Swedish for Immigrants course, the next crucial step was enrolling in the Swedish as a Second Language course.

While maintaining my full-time role as an AN, I pursued Swedish as a Second Language online at a reduced pace of 50 per cent, extending the duration of my studies to balance my professional commitments with educational endeavours.

In 2020, I completed the Swedish as a Second Language course, leveraging the language qualification to gain admission to Luleå University of Technology for a one-year online Bridging Programme for Internationally Registered Nurses.

Given that my Malaysian nursing certificate wasn’t fully recognised in Sweden, this bridging programme was essential for my professional advancement.

Juggling full-time work and studies, I navigated the challenges with resilience, supported by colleagues and supervisors who accommodated my schedule, ensuring that my workdays did not conflict with my educational pursuits.

In 2021, upon completing the bridging programme, I transitioned from an AN to a Swedish Registered Nurse in a sub-unit within CICU called Cardiothoracic Day Care Unit, stationed there for six months.

In the same year, I embarked on a one-year specialisation programme in ICU nursing at Uppsala University, temporarily stepping away from clinical practice to focus solely on academic advancement.

During this time, I was being paid a basic Registered Nurse salary, allowing me to fully dedicate myself to my studies. Despite linguistic hurdles, I persevered, more determined than ever to complete the programme.

In 2022, after completing my university studies, I commenced my role as an ICU nurse in CICU, marking the culmination of an eight-year journey since my arrival in Sweden.

Over the past six years of working, I have remained dedicated to the same unit since the start of my nursing career in Sweden as an AN.

This continuity has been a blessing, allowing me to witness my professional growth from its humble beginnings. The transition from my previous experiences in Malaysia and Saudi Arabia to Sweden has been enlightening, particularly in terms of the workplace culture and patient care approach.

In our unit, I have found a thriving work environment characterised by transparency and open-mindedness. Despite being the only Asian member of the team, I have encountered no significant challenges.

Our workplace fosters a culture where employee welfare, both at work and home, is prioritised by our supervisors. Clear communication channels enable us to voice our opinions, provide input on practices, and address concerns without fear of reprisal.

This inclusive atmosphere ensures that everyone’s voice is heard and valued. With that being said, we operate as a cohesive unit, with everyone readily offering assistance to one another.

We excel at supporting and uplifting each other, fostering a conducive and harmonious work environment.

In Sweden, there exists a low power distance culture, which required some adjustment on my part. Here, nurses address supervisors and physicians by their first names.

Uniforms are uniform across the range of medical personnel, with the only distinguishing feature being colour-coded tags indicating roles such as physicians, nurse, unit secretaries, physiotherapists, and so on.

During physician/ patient rounds, a standardised template is employed by physicians and nurses to ensure comprehensive assessment, particularly for critically ill patients.

During these daily sessions, both the physician and nurse convene to formulate a care plan. Nurses utilise this time to seek clarification or pose questions regarding the patient’s treatment or condition. The input, from a nursing perspective, is highly valued by physicians. These rounds resemble collaborative discussions, offering an invaluable learning opportunity for all involved.

The environment also offers a secure space for professional development. Nurses are equipped with the necessary knowledge and guided by established protocols, granting them considerable autonomy in executing a wide array of tasks that would typically fall outside their purview.

There exists a designated list of medications that nurses can administer without direct oversight from physicians, and they are entrusted with the responsibility of adjusting inotropics and vasopressors as needed.

Additionally, nurses are encouraged to apply critical thinking in providing care, knowing they can promptly communicate their decisions to physicians. In the event of errors, incident reports are filed without attribution, fostering a culture of accountability rather than blame.

Human errors are acknowledged as a natural part of the learning process, promoting honesty and transparency among staff. Near misses and mistakes are openly discussed and investigated, facilitating continuous improvement and adaptation within the system. 

Our annual appraisals provide a platform for open dialogue, empowering employees to voice concerns without fear of retribution. Such an inclusive approach enhances staff wellbeing and ensures that our workplace remains dynamic and resilient.

In my experience, my supervisors have consistently been equitable, demonstrating an understanding of my need for extended vacation days and making efforts to accommodate them whenever feasible.

Regarding compensation, I must say we are fairly remunerated, particularly for weekend shifts that commence from Friday afternoon, as well as for public holidays and so on.

However, there is no denying that nurses could do with a better salary overall, considering the demanding nature of our work and the level of expertise required.

My journey from a language learner to a respected health care professional epitomises the opportunities for growth and advancement within our unit.

As I contemplated my next career move, my supervisor presented me with the chance to become the nurse in charge of organ donation within our unit. This opportunity has taken me on a journey across Sweden, attending workshops and meetings with all expenses covered by my employer.

Meeting ICU nurses from various regions around Sweden and experiencing different Swedish dialects have been an enriching experience for me. I’m thrilled to have embarked on this path, where I continue to glean new knowledge daily.

Fostering a culture of openness and positivity, free from blame, is crucial for retaining staff in health care settings. Malaysian nurses returning from overseas often face challenges, although they possess invaluable insights that can drive positive change.

Instead of being feared, these nurses should be embraced as agents of improvement, having experienced more effective practices abroad.

The prevalent power distance in Malaysia can hinder progress, as leaders may resort to authoritarian approaches rather than fostering collaboration. A punitive system that seeks scapegoats only perpetuates fear among staff, leading to obscured systemic issues.

In essence, the success of any health care system hinges on its ability to empower and engage its workforce. By prioritising transparency, accountability, and mutual respect, we can cultivate a workplace culture that thrives on innovation and continuous improvement, both in Sweden and beyond.

Sandra Laxmana is a Malaysian nurse currently working in the Swedish health care system.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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