Thursday, August 14, 2008

An introduction

I used to work as a general medical practitioner in the Philippines before coming to the US. Having said that, I can safely say I know very little in everything medical. I am not a specialist, so I do no really know much. I admit that.

Now allow me to brag some. I graduated with BS Biology degree from UP Diliman, had 97%ile ranking in NMAT, got a scholarship for Medicine in Fatima (my parents were very happy!!! Free tuition, books, board and lodging, including free review books for boards), got pregnant at age 24, struggled to finish Medicine despite having a baby and a husband afflicted with CHF, graduated 1st among 200++ Med grads but without honors, had my internship at EAMC, passed the boards without landing in the top 10 (my school would have wanted me to land in top 1 so they subjected me to 1 yr of (useless) review classes.

Despite some friends (and other patients I had later) who would have wanted me to go through IM residency because of "my brains"m (what brains they were talking about, I have no idea), I wanted to be in OB-Gyn. Less morbid. Less problems with patient compliance. Less headaches. More surgical skills. But at the time I was going to apply, the QUERT (qualifying exam for residency training) came into effect. So the powers that be in the DOH now had a say where their babies could get into for residency training. I did not know anyone in DOH. Can you guess??? That's right, I ended up not going into residency. Later on I got pregnant again and became a widow, so that now I had two kids to support, and I was alone (save for my Nanay and sister, that is).

I practised in a very busy clinic in Makati that was like urgent care type serving patients from annual/pre-employment medical exam types to common community illnesses to NSDs and D&Cs. Nothing medically/surgically complicated. Some of the consultants working there have actually offered to back me up if I applied for residency in the private hospital they were affiliated with. But with two kids to support, the salary I would get just would not cut it. So I stayed moonlighting for 5 years, with Quality Assurance Management on the side. (If you are familiar with JCAHO, you must know about quality assurance.)

I got to the US with a BSN from Philippines. Got a job as a Medical Transcriptionist and saved some money for NCLEX. Passed NCLEX and got a job at a nursing home. Stayed there for barely two months (never enjoyed it) and got a job at a hospital. Rehab unit.

It was a good introduction to the hospital culture here, with all the high-tech equipment and the new people, new set of policies and rules.

I got bored after a year, applied at the ER and got accepted. Now on my 5th month. First two months were spent during day shift I applied for night shift) and it was like hell...I got rattled because, even as I was still trying to learn the ins and outs of flow of patients here, the rules and policies, etc., they were throwing Category 2s and 1s at me, and I got too busy I was ready to scream when they would tell me I had another patient to get (uhhh...can I chart first on my other two patients?). Finally, against my first preceptor's recommendation to prolong my orientation on days (for purposes of exposing me to more cases), I was started on my orientation on night shifts. After a week there I was really considering applying for another job (even medical transcription), but as I was slowly released to be on my own with only a resource nurse to go to for questions, I became more comfortable and the clinician in me re-surfaced. My doctor-thinking came into play in trying to predict the management of patients, so that I easily got into the flow of when to start IV's and EKG's etc., without fear of being scolded by the MD for doing so without an order. Well, actually, the reason I was hesitant before to just jump into action was that I was not sure what my limitations were as a nurse. Apparently, the nurses here have enough autonomy, and even if the MD did not order, let's say, an IV line, it would be pretty safe for me to start one and draw blood (then dispose of them if they would not be used anyway). No big deal.

Because of being more comfortable, my resource nurses (usually the charge nurse) have observed the marked improvement, that everyone now says they are hearing good things about me from other CNs. Even my clinical manager and ED educator told me, "Finally, it has kicked in! I told you so."

So now I am enjoying the ER. It is quite a good exposure in my plan to pursue the MD license. Somehow, I am getting an idea of their treatment protocols, how the ED MDs proceed with consulting for possible admission. I am also getting a chance to review things indirectly, and I find myself doing the critical thinking again. Interpreting lab results mainly, in correlation with the presenting symptoms/complaints. However, my main disappointment is that I do not see the imaging results (the MD's see the images and make their "wet readings" then wait for official reading from offshore -- Australia, I heard). The official results usually come up the next day when the Radiologists of our hospital are able to officially read and sign electronically to make the report available on the computer.

I will be off orientation by the end of August. Some patients are quite needy, but most of the time it is the usual abdominal pain, chest pain, altered mental status that I see. Sometimes those brought by EMS are not really high categories. I have learned once again the art of being cool in the middle of this chaos.

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