Nekhana Bitman wasn't happy.
The 86-year-old Soviet immigrant was ready to check out of Baltimore County General Hospital. But since she didn't know any English, she couldn't tell the medical staff what she wanted.
Enter Alla Kirnos -- a smiling, blue-eyed nurse from the Soviet Union -- who translated for Mrs. Bitman and explained to her that, although her eye problems were better, the doctor was concerned about her heart and suggested she stay.
Mrs. Kirnos is one of five Soviet Jews chosen to be part of a new pilot program at Baltimore County General. The program "Nurses in Transition" helps Soviet-trained nurses become familiar with the American health-care system. The 240-bed hospital, which has suffered a shortage of nurses in recent years, is coordinating the program with the Jewish Vocational Service.
"We get a fair number of Soviet-trained medical people," said Bobbi Perlman, senior job developer at the Jewish Vocational Service, which approached Baltimore County General with the idea. "We have been working with several hospitals, but none other has started a program for such a large number of people in one field."
The 16-month program offers 40 hours a week of on-the-job training. When they started in April, the five nurses had a two-week intensive course on medical terminology and hands-on training before being assigned to shifts supervised by hospital staff. This summer, the nurses will take special classes on the history of nursing in the United States, assisting doctors and areas of specialization.
Supervisors hope they will be able to pass the state nurses licensing exam in 1992 and stay at Baltimore County General.
"We will have put a lot of time and effort into this," said Elizabeth Dunne, the hospital's director of clinical nursing who helped select the five nurses from a group of 15. "We certainly hope they would want to join the staff here.
In addition to providing a new pool of nurses, Ms. Dunne noted that the program's graduates would be able to serve as translators for the growing number of Soviet Jews in Baltimore County who came to the hospital.
Before Mrs. Bitman met Mrs. Kirnos, the elderly patient made her needs known by pointing to a Russian word on a piece of paper with an English translation beside it. That way, the nurse would know if she was hot or cold, hungry or in pain.
"She was so happy to see me, because she could not explain what she wanted to the nurses," said Mrs. Kirnos, who came to Baltimore from Kiev in March 1990.
Mrs. Kirnos, like her four colleagues, loved being a nurse. But because of her inability to speak English and the differences between medical care in the United States and the Soviet Union, she doubted she would be able to resume her career.
"My husband and I were so happy when I got into this program," she said. "He had dreamed with me about my wish to be a nurse here."
Sherri Edwards is one of the American nurses who supervise the Russian women. Ms. Edwards said she was initially surprised by the immigrants' upbeat attitude.
"They are always so pleasant -- which I had a hard time getting used to," she said. "They want to go out and work. They don't complain, and they always have a sweet smile."
One reason for those smiles may be the advanced state of health care here. The nurses say working conditions are much more pleasant in the United States than they are in their homeland.
"There's a lot more technology here and much better medicine," said Larisa Rubenshteyn, who worked as a manicurist when she first came to Baltimore. "It's harder to be a nurse in the Soviet Union. We had many more patients."
Mrs. Rubenshteyn and her colleagues said that patients in the Soviet Union did not have private rooms. Nurses worked with old equipment and cared for as many as 60 patients.
The nurses say their biggest challenge is learning English. All take English classes at night or plan to start soon. Their supervisors say they understand better than they speak -- but conversation is improving since they have begun working with American patients.
"Every patient asks where are you from and if you could tell a little history about your immigration," said Valentina Vorgul. "When we speak English, the patients are patient with us."