In an environment where the impacts of the COVID-19 pandemic are still being felt through staffing and burn out levels, Kristin Jarangue uses her global connections and her universal belief in wellbeing to create a positive environment for her team and thus her patients.

Beginning as a volunteer, Jarangue is now the Manager of Clinical Services at Virginia Mason Franciscan Health. Her husband and sister also work with her there.

For her multifaceted work to meet healthcare needs for the Federal Way community and beyond, Jarangue is our Hometown Hero for February 2024.

After moving to the U.S. Jarangue had to start her career over. She did so and more for the chance to provide care to the community of Federal Way.

In the Philippines she was an Assistant Professor where she was a clinical instructor in the College of Nursing, which kept her very busy. When she moved to the United States in 2011, Jarangue said she initially didn’t plan to continue to work, but “there was nothing to do.”

She wasn’t eligible to work at first due to her immigration status on a spousal visa, so looked around for places to volunteer that would have some familiarity in a new place. For her this meant a Catholic hospital.

“I found St Francis, which was a walking distance to my apartment, and that’s how I started volunteering,” Jarangue said. She was assigned to volunteer in admin services for nursing and began work as a form collector around the unit.

Jarangue realized she wanted to do this work professionally again, but despite her extensive professional experience in the field. “I went back to zero pretty much, from being a more experienced nurse in the Philippines, I moved here, and then I was back to zero,” Jarangue said.

“It was a pretty humbling experience for me,” Jarangue added.

Washington state has made progress since then in streamlining the process for recent immigrants to transfer equivalent professional licenses and education.

One of these changes was to have Washington join the Nurse Licensure Compact (NLC) in April 2023 via Washington Substitute Senate Bill (SSB) 5499.

The purpose of joining the NLC is to allow RNs, LPNs and VNs to practice in any of the other NLC member states without having to pursue other licenses.

That same bill also influenced a revision to the licensure guidelines for internationally educated nurses that took effect in December of 2024.

Internationally educated nurses can now receive their license to practice in Washington if a credential evaluation service verifies the equivalence of the international program that they completed. They also must demonstrate English language proficiency and pass the National Council Licensure Examination, according to Washington Administrative Code.

Jarangue not only credentials as a nurse but also shared that she’s always been drawn to leadership roles and was the president of the nursing student organization in college. When she was an assistant professor, she was also the supervisor for the level two teachers “at a very young age, it was pretty challenging,” Jarangue said.

Despite all of this experience, being in a new country made it hard to keep that confidence at first.

Jarangue shared that she used to feel intimidated. “I’m like, ‘Oh, I’m Asian, and I feel like my English is not well.’ Even coming into this role, I was like, ‘Am I expressing myself correctly?’ I feel like there’s some language barrier…But my educator has always told me, ‘Kristen, your English is fine. Kristen, you’re expressing yourself fine,’” Jarangue said.

After gaining authorization to work and after her license became active, she was interviewed for a position and she began on the night shift.

She completed her residency and eventually moved to the day shift as her family grew, then to care management. Although it was a very humbling experience to have to start her education over, Jarangue said that had no regrets for that part.

“I feel like it molded me to be ready to where I’m at right now,” she said.

Jarangue is still active in her college community in the Philippines where she occasionally speaks at events and each year she gives back to the children in her community there.

Staffing challenges

Now Jarangue uses her global experience and knowledge of the industry to make sure patients in Federal Way receive the best care.

St Francis hospital is dealing with the same pressures as healthcare institutions across the country as hospitals are still recovering from the impacts of COVID-19.

Washington State’s projected shortage of Registered Nurses (RN) by 2037 is 22% according to the most recent data from the Health Resources and Services Administration.

In evaluating the issue locally, one report found that several factors are contributing. These include burnout and interruptions to the career development pipeline during the height of the pandemic, low wages especially at smaller facilities and an increase in overall demand, especially for middle-skill jobs.

Although her job focuses on clinical experience for patients, Jarangue focuses a lot of her energy on the staff’s wellbeing to deal with the issues outlined in these reports.

“When I came in 2022 we were all just recuperating from all that…oh my gosh, the turnover when I came in, I did not have enough staff, a lot of people were leaving,” Jarangue said.

Her team hadn’t had a manager for six months and many people were telling her they wanted to leave. When she started in the role Jarangue said she told the team: “Give me time. Give me three months to fix this.”

“To be honest with you, it’s not me, it’s just that if your staff feels that you’re working together with them, everything’s going to fall into place,” Jarangue said. “I can’t emphasize enough that if your team is happy, if they’re well, supported, it reflects on everything else.”

Jarangue also focuses on making sure nurses are set up to communicate and support patients in the diverse Federal Way community.

“These nurses are very flexible,” Jarangue said. “We train our newer nurses with the concept of transcultural nursing.”

That looks like teaching staff to be adaptable and flexible with cultural differences and also making sure her team ask for support when they need it.

Jarangue said they would ask questions like, “Is this new nurse comfortable with this conversation?”

“If not, [we] support but we also coach. You want to make sure that they’re comfortable come the next time that they’re on their own,” she said.

Some of these cultural differences involve language. “We really use the translator equipment that we have….but I’ve learned that a lot of people are not comfortable using that translating system…they still kind of want their family to translate,” said Jarangue. She explained that in this type of situation, they find a balance between respecting this need but also using the tools at hand to make sure medical information is being translated properly since family members may not know how to translate that type of information.

“It’s hard for us to cross that boundary and say ‘Hey we have to use this.’ But then, if you explain to them, they understand,” Jarangue said.

Other examples include differences in cultural norms around death and dying, and even how to respond when a patient won’t take advice from a female nurse and wants a male nurse to give them their instructions.

Jarangue spoke highly of the entire team at St Francis who are “like family” and gave a special shout out to the nurses.

“I feel like the spotlight really needs to be back to our nurses with all this going on recuperating from COVID and all the changes,” Jarangue said.

“They need a lot more respect… there’s just a lot more mental health issues right now…We’re seeing a lot sicker patients in the hospital…I feel like our healthcare people need a lot more credit,” Jarangue said.

“We have to take care of these people so that our future generations, you know, also benefit from that.”