Carrying Puerto Rico With Me

By: Dr. Luis E. Caso Vega

Every Hispanic Heritage Month, we celebrate culture, history, resilience, and the many contributions Hispanic and Latino communities have made to the United States. For me, those celebrations are deeply personal. I am Puerto Rican, and my professional journey changed significantly when I transitioned to the mainland United States in 2016.

My journey is not what many people would consider a typical internationally educated nurse experience. I am a U.S. citizen. I did not need a visa or immigration sponsorship to work in the mainland United States. I practiced in Puerto Rico under my Puerto Rico registered nurse license. Yet when I moved to Florida and pursued licensure there, I encountered processes that looked very familiar to those experienced by nurses educated outside the United States. My education had to undergo third-party credential evaluation, and I had to demonstrate English proficiency through the TOEFL, among other requirements.

So, yes, I consider myself an internationally educated nurse, even if my story does not fit neatly into the traditional narrative.

That experience taught me something important: crossing an international border is not the only way a nurse can experience displacement.

Sometimes the border is cultural.

Sometimes it is linguistic.

Sometimes it is the moment you realize that the credentials, knowledge, communication style, and professional identity that made perfect sense in one place are interpreted differently somewhere else.

My transition from Puerto Rico to the mainland shaped how I understand the experiences of internationally educated nurses, but it also taught me to look beyond the label of “IEN.” We often discuss internationally educated nurses as if “internationally educated” were a complete identity. It is not.

We arrive carrying multiple identities with us: race, ethnicity, nationality, language, gender, sexuality, socioeconomic background, religion, disability, age, immigration status, and countless other experiences. Those identities do not disappear when someone puts on scrubs.

And they do not operate independently.

This is where intersectionality becomes especially important.

A nurse entering a new healthcare system may simultaneously be learning unfamiliar workplace norms, translating complex clinical conversations into a second language, navigating stereotypes about an accent, understanding new documentation expectations, supporting family members across borders, and determining whether it is safe to disclose other parts of who they are.

Two internationally educated nurses can therefore enter the same hospital, on the same day, with similar clinical experience, and have profoundly different transitions.

My own experience helped me recognize this in ways that a textbook never could. I knew nursing. I knew emergency care. I knew how to care for critically ill patients and function in high-pressure environments. But professional competence does not automatically create cultural belonging.

There are subtle lessons people rarely include in orientation.

How assertive are you expected to be?

When does confidence become interpreted as arrogance?

How does an accent change the way others perceive expertise?

Whose communication style is considered “professional”?

Who receives mentorship without asking for it?

Who is expected to assimilate rather than contribute something different?

These questions matter because transition is not simply about whether a nurse can perform a skill or pass an examination. Successful transition is also about whether nurses are given genuine opportunities to belong, lead, contribute, and remain authentic while doing so.

Over the years, I have become increasingly uncomfortable with the idea that internationally educated nurses should simply learn to “fit in.” Of course, nurses entering a new country or healthcare system must learn its regulations, standards, clinical expectations, and cultural context. But adaptation should not be confused with erasure.

Organizations should be asking a different question: What can we learn from the nurses joining us?

Internationally educated nurses bring more than labor to a healthcare system. They bring languages, clinical practices, cultural knowledge, different approaches to problem-solving, resilience, and perspectives shaped by caring for patients in different environments. In increasingly diverse communities, those experiences are not peripheral to healthcare. They are an asset.

For me, this is also where diversity, equity, inclusion, and belonging move beyond organizational language. DEI becomes meaningful when it influences who receives opportunities, whose expertise is recognized, whose voice is heard, how bias is addressed, and whether differences are treated as deficits or as strengths.

Serving as Secretary of SIENNA gives me an opportunity to connect these lived experiences with a broader commitment to internationally educated nurses and nursing allies. SIENNA represents something I wish every nurse navigating transition could experience: a community that recognizes that adaptation and belonging are not the same thing.

During Hispanic Heritage Month, I think about herencia, heritage, as more than something we inherit from the past. It is something we carry forward.

I carry Puerto Rico with me in how I speak, how I care for patients, how I lead, how I build community, and how I understand nursing. Moving to the mainland expanded my professional identity, but it did not replace what came before it.

That may be one of the most important lessons we can offer nurses navigating a new country, culture, or healthcare system.

You can grow without abandoning where you came from.

You can adapt without becoming invisible.

And you should never have to erase part of yourself in order to belong in nursing.

About the Author

Dr. Luis Caso Vega serves as the Board Secretary and C0-chair of the Public Relations Committee of the Society of Internationally Educated Nurses and Nursing Allies (SIENNA).