Behavioral patient

I inherited AF from an outgoing nurse. I went in and introduced my self. Patient wanted some medication before going to the BH hospital ce. MD did not want to give her any as she was not anxious when she came in. Then she began saying things like, "Ok, I don't even want this lady in my room. Please." in front of her mother. I did not even get a chance to do some therapeutic communication.

I swear, if this was my child, and she does this to me, I am gonna slap her on the face and ground her for at least a week. More so if she does this to a stranger who is trying to be helpful.

Glad the EMS personnel came right away.

Brat.

That's why I never considered to be in Pedi.

On my First Month of Orientation

One thing I love about my hospital is that we have a very good orientation program. Having been exposed to Quality Systems Management while I was in PI, I could see my hospital addressing the elements of a quality system. And knowing so, I have the confidence to voice out any dissatisfaction in a constructive manner, for purposes of quality improvement (it is always a good reason) which will have patient satisfaction as an end-result.

First week of my training was spent working on my competencies, mainly the paperwork. Second week, I had my Basic EKG interpretation training, a prerequisite (aside from BLS- Basic Life Support) for ACLS, which I took and passed yesterday (yehey). Of course I have been going on duty with my wonderful preceptor. Whoever told me ER nurses here ate their young, well, I do not see that happening. I have the most wonderful preceptor (even better than the one I had in rehab, I would say). I'd say we do have a good chemistry. I had exposure in the triage room, and I actually am contemplating on sending copies of the triage flow diagram back to the Philippines for nurses to learn. I had a case of AMI (acute myocardial infarction) on my first day there, which was the highlight of my day.

Next I should sign up for PALS (Pediatric Advance Life Support), then sometime before the end of my first year, I plan to have the TNCC (Trauma Nursing Core Curriculum, if I remember it right) at least.

I have been trying to involve my kids to at least know how to do basic CPR...I gave them a lecture before, along with video viewing, several months ago. Yesterday, I kinda gave them a quiz, asking them what to do if they see me on the floor unconscious and unresponsive...Ben gave the best answer, then I recounted to them how they should approach it.

I told them they might someday consider ER nursing, but then I said they might not like seeing blood and what not, but both the boys seem not to fear that at all...hmmmm...we surely need more male nurses...

I will sign up for ENA (Emergency Nurses Association) on the next payday.

Emergency Department - my new area

OK, I dunno why I looked for new openings in other departments...maybe because at the rehab, we usually would be RIF'ed (reduction in force when the census is low), or maybe because I was getting bored with the routine no-challenge type of work there (the only challenge was physically because we RNs also needed to help the techs prepare the patient for the rehab day -- i.e., bathing and dressing of patients, which could mean from the independent hip replacement patient to the bedridden stroke patient).

In any case, I looked in the employment opps in our website -- OR nurse. I guess I applied too late. One of my co-workers applied ahead of me and got accepted I guess even before I got the chance for my resume to be reviewed...OK...on to other opps...

Behavioral Health...nah...I always fear for my own sanity. I believe there is a very thin line between sanity and insanity, and that can easily break when you are surrounded by pathologic personalities.

CCU (Critical Care Unit)...too morbid for me...I have never liked taking care of very sick people...that would be too stressful.

MCH (Maternal Child Health)...I would have loved to be here but they required current OB-Gyn experience in any of the areas in L&D and Nursery. I have experience, but whether they are current per their standards, I don't know. I don't even know how to use the fetal monitor, but I can do it manually, including manual monitoring of labor. But they do it here with machines. I heard from another Pinay nurse (old-timer) that they wanted the experienced nurses because they were desperate to find ones who needed minimal training, as they were expecting 400++ deliveries for the month of May. Oh well...

ED (Emergency Department)...well, it's not exactly the kind of stress you would have in CCU, but the kind of cases, the variety, the surprises, the critical thinking, the more practical applications towards my own life...the similarity with my past experience while I was a GP in the Philippines, I guess I don't have much to fear. There may be different equipment that I needed to learn, but I am quite a gadget junkie so equipment do not intimidate me, nor computers. The one thing that almost stopped me from trying that one was the circulating reputation of the ED personnel: that they eat their young. Well, I guess that is not entirely different from the scenario I suffered in the hands of senior nurses when I was undergoing my clerkship and internship rotations before getting my MD license in the Philippines. Given the past circumstances of my life where I have had humbling experiences, and have come to accept that whatever I know now or understand now just made me realize how little I actually do understand (as in, God's work is just so amazing I cannot pretend that I understand exactly how He designed the human body), I have learned to get along well with people, and have converted several toughies into softies when they interact with me. Not that I suck up, I just make them realize I am not someone who will challenge them or intimidate them, that I will willingly accept whatever they can and will teach me and I will be very appreciative of that, because I know I DO NOT KNOW EVERYTHING.

Well, despite the warnings I received from friends and co-workers, I went ahead and applied. Not sure that I would like it. But I did think that if I would get stuck in rehab for another year, I would get stagnant mentally and skills-wise. ER, on the other hand, is such a very good experience to have, because after a year or so (or even less), I can find work virtually anywhere. One thing that attracts me to nursing is the TRAVEL NURSING opportunities, and the per diem rates. The hospital closest to me always have ER openings, both for per diem and regular positions. ALWAYS. And since ER nurses are in demand, I will never fear of becoming RIF'ed. Rather, I might always be called to fill in for one who calls out. Plus, I want to get all those certifications that are a requirement of other in demand departments -- ACLS, EKG interpretation, PALS...

I got an interview, and there was instant feeling of being at home. I had positive vibes with the two interviewers (manager and educator). I got the job (well, according to one of my co-workers, ER's are always desperate for nurses). After learning more about my past experiences, they even went as far ahead as me probably being a mentor, taking the TNCC and other higher trainings. (I was thinking, hey...slow down...one at a time). Anyway, maybe I looked confident enough that they became confident about my abilities, although I was quite upfront about the lack of abilities for the more complicated cases that really warranted a hospital (not clinic) visit, but they knew I could be trained. Ain't that the most important trait anyway? --- trainable. Another area they were concerned about was the use of the new computer system. I assured them I was, as a matter of fact, a superuser back in rehab. I was one of the few who had to walk others through the new system, simply because training for that was a breeze to me.

I started 1st week of May, when I was suffering from severe allergy that I almost feared I would be very vulnerable if I worked in the ER because my skin was so damaged (and on this very day I am posting this, is the first day I saw and felt my skin come back to an almost normal state that now I can expose it to air without sloughing skin and itching). It was a nightmare allergic attack-turned to atopic dermatitis event. Luckily, today I realized I am not that immunocompromised, and I can continue to enjoy the ER.

Why I like it: some days are busy, some days are not. Never boring. Variety of cases and people. Critical thinking developed. My clinical skills will be put back into practice, and they will probably benefit from skills I gained in IV insertion and blood draws (I used to stick even neonates without much problems). What I hated when I was a GP in PI was that I did not develop the skills needed to respond to emergencies such as stroke and acute MI (heart attack), and that I did not really learn much beyond treating common community acquired illnesses, etc. I wanted more...although I would not be the one who would actually treat (doctors would be) at least I would be exposed as to how they do it here...I can easily learn the why's. I can easily follow the rationale for the treatment because of my background, but learning their protocols will be great. I might in the end consider taking the USMLE, or maybe become an NP, who knows?...But this ER experience will surely be a gem in my resume...

Contact Allergic Dermatitis that turned into a NIGHTMARE!!!

Are you like me, who, after having immigrated to the US, have encountered a lot of new things to which you react (i.e., allergic to)?

During my first year in the US, it was the year of exposure to new trees, new bacterial/viral strains, etc. That first exposure made my immune system create a counter-attack force for future re-exposures...

On my second year I had a brief episode of urticaria, which lasted 3 days. I could only think of having eaten Chinese food as a culprit. I used Benadryl and Aveeno oatmeal baths to help soothe the itching.

On the third year, I suffered another episode of urticaria for almost two weeks. Aveeno oatmeal did not help much to soothe. I was glad it was over by the end of the second week.

Fourth year here, I seemed to have succeeded avoiding re-exposure to whatever triggered my urticaria (I avoided gardening).

This year I attempted gardening during the first nice weekend of spring, and suffered from a new type of allergy that led to the nightmare depicted on the photo. As of this posting, the whole event is now on its 5th week. Yap! That's how long I have been suffering from this predicament.

As I mentioned in my previous post, I was suffering from dishydrotic eczema and was on prednisone treatment. I was at the last days of my prednisone taper when my allergic dermatitis started.

See my slide presentation for the series of events explaining the whole thing. I will keep updating this slide show as I progress.



UPDATE:
The flare-ups of my skin inflammation apparently was caused by my alternating use of petroleum jelly then lotions (which I would dare use once I felt my skin was getting better). Upon my derma's suggestion, I stopped all lotions or special soap for sensitive skin and stick to petroleum jelly, soak for at least 15 minutes in shower or tub (to engorge my skin cells and close the cracks), then slather a thick layer of the petroleum jelly to trap the moisture. Also, he prescribed desonide lotion which I had to apply to affected areas twice a day. I did that, and the desonide use had immediate effect on inhibiting the itching and inflammation of my arms/hands, and with showers twice a day at least, using the (self-prescribed) hot water treatment (counter-intuitive, the treatment regimen was effective for me. I believe that the increased rush of inflammatory chemicals like histamine, bradykinins, interleukins, etc. overload the receptors so that after the initial sensation like that of being scratched when in fact it was heated water, comes pain, then relief from itchiness for at least 4 hours (so finally I would get at least 4 hrs of straight sleep). Increased sleep boosts health and immune system. Less irritation (use only petroleum jelly) and more hydration of my skin (showers soaks)...finally my skin was back to normal after 6 months. When I mean back to normal, there is no longer that thin layer of skin with fast turnover, which was very very prone to losing moisture.

Well, during the first few months when I thought I would never get my pre-morbid skin, I was getting depressed because not only could I not wear tank tops/shorts without being so self-conscious, I also was not sure if there was ever an end to that suffering. I also felt so vulnerable since my skin was not intact and I was working at the ER (skin is the biggest organ of defense, so I felt defenseless). I even recorded songs for my hubby (although I did not tell him then that those were in case my skin issue would lead to my early demise eventually).

Now, I am happy with my skin, even if I still suffer from itchiness and cracks every time I go on duty at the hospital and have to wash my hands often.

Dishidrotic eczema

It all began when I started working as a nurse in April of 2007-- the soap (I thought) irritated my skin so that at the end of my shift, I would drive home constantly scratching on my hands. I developed maculopapular rashes by May 2007 and sought an appointment with the Employee Health for an alternative soap (upon my Manager's suggestion). Okay, so I used a gentler soap, but continued to use the hand sanitizer (which seemed to be better despite making my skin red; it did not cause itching).

However, I did develop dryness, flaking, and eventually cracks on my skin. Once you have skin cracks, washing (especially with hot water) was agony. I almost was quite phobic of handwashing, and was using the sanitizer more. I also decided to use an OTC soap that was moisturizing, without the approval of the Employee Health. My symptoms were controlled, although I still got dried flaky hands on duty days. I also went to my family doctor and asked her to write a note that I can show at work that I was to avoid the hospital soaps to control my dishidrosis (aka pomphylox).

Then I was contacted by EH, and was asking if I was doing ok with the soap, to which I said yes. And that they would send a whole box, which I received that week. My manager told me to keep the used up bottles in the utility room so they could count. Oops...so I started using it again. My condition worsened again, and I would get cracks during duty days, which would heal during days off. It was torture every time I washed my hands or used the sanitizer because of the cracks! Despite use of lotion, I could not help the progression of my condition.

Then our manager started implementing a handwashing program, targeting 50 handwashes per shift! I tried to stick to it as much as I could, which led to soreness and swelling of my fingers, it was just too painful to even bend them because of too much swelling, and forcing to bend led to cracks and bleeding. Too thin because of flaking, my skin would also bleed at the slightest touch of a side of a paper...That bad. The EH nurse arranged for me to see the Workplace Health doctor. Nothing new prescribed aside from what my family doctor did. Nothing new suggested; just keep trying new soaps until I found one that would not exacerbate my condition. I did, but I still had the problem. After a week, I called the EH nurse to arrange another visit, because I could no longer sleep straight with all the itching and pain and severe dryness, and this time, even 5 days off did not result to healing. I knew the soreness/pain was due to infection already. I felt like amputating my fingers...

A nurse practitioner saw me the next time, and I liked his approach. He listened well, suggested specific creams/soaps, treated the infection and gave me prednisone and topical steroid. As expected, it cleared up. I was quite happy, but he had reservations, because he knew (and I knew) that eczema can flare up again, and is a chronic condition. We would have to see whether once off prednisone, the use of mild soap and cream would help control the issue.

These are before and after shots (not all have corresponding photos, though.)

row 1, cell 1
row 1, cell 2
row 2, cell 1
row 2, cell 2
row 2, cell 1
row 2, cell 2
row 2, cell 1
row 2, cell 2
That crack was extremely painful!!!
day 3 of commencing antibiotics
row 2, cell 1
row 2, cell 2

I was happy to be finally free of pain, and during the final followup, I had no problems anymore...but then at the end of my shift, when the EH nurse called me to remind me to have follow ups with her, I told her it was starting again...but then I had some more prednisone tabs to finish, and one more week of topical steroid cream plus the barrier cream to apply...

I was hoping the problem would go away, especially that I would have one week off before I make the transfer to ER...

PalmTX

Sometime in January 2007 when I was busy preparing and submitting resumes and getting ready for interviews, I bought this PDA because of the hype I have been hearing about it being a necessary tool when you are a clinician (doctors, nurses, etc.). I was excited when I got it, downloaded several (medical and nursing) freeware, and bought programs online to download (nursing procedures, drug guide, etc.).

The reality is, I barely use it. Most of what I do at the hospital as a Rehab nurse can be easily learned hands-on. I have used it more to remind me of appointments, etc. But to remind me to follow up on something? No. It takes a lot of time to type (and I do not want to carry around a keyboard to attach to it.

It would probably be of more use if I were a doctor or NP who had training including the application of PDA in the practice.

It can be used to store photos and music, though, but I go to work basically to work, not to boast about how cool my gadget is...And even if I could, in theory, use this to browse the web, first I would need access to hour hospital network (how would I justify that when we have access to the internet using our own work station?). Second, the screen is small that I really would prefer the desktop whenever I could use it.

I am thinking at this time of selling this, but I do not know if any of the doctors at the hospital would be interested. They seem not to be too computer savvy and I have not seen any of them techie enough to carry such gadgets. Or maybe they are using Blackberry already...

PalmTX

Chitika Owna

Maybe I should sell it on Uncle Henry's...or ebay...or amazon...anyone interested here???

What I would want to replace it with is Nokia N810. It uses Linux (not Windows) so it is more secure, has less trash and is faster. It has built-in Skype, webcam and mic so you can use it for VoIP applications and talk to others (free if it is another Skype user, minimal fee if landline). You can browse the internet, including playing youtube videos on a screen with satisfactory resolution and size. It has a good-sized slide-out keyboard. It even has built-in GPS (additional purchase of $120? if you want the voice guide as well, although I already received a GPS from my husband last Christmas that he bought on sale).

Well, I am quite the gadget-lover, although I do not see myself geeky in any way (not in the same breath as my hubby). I had been trying to avoid posting about them on my blogs, for fear of sounding like I am boasting. But hey, sometimes you read about these gadgets you never heard of before, and become interested, so why not? It is quite nice to hear about a gadget you have been considering of getting if you get the info from someone you trust --- another consumer -- both the mediocre and the geeky types. So this post and the next few ones will probably focus on what I/we own and have experienced using.

Nokia N810

Chitika Owna

And yes, I feel that some of my ad affiliates would be more applicable for posts related to these gizmos. I figure, if I can earn additional revenue posting about a gadget I actually own and have used for some time, it will not be too bad.

Why do some people easily dismiss a case as something so simple???

As I was saying in my earlier post, it was a toxic duty day.

I had a patient: in rehab for deconditioning following a colectomy after infection of her bowels post polypectomy. History of COPD, asthma, anxiety. She had a skin graft on her abdomen, with graft donor site from her thigh. Both had dressings. It was my first day to take care of her.

Early in the morning I changed her dressing on the thigh. She was so sensitive there, but I was gentle enough for her not to scream.

Around 10 am, she complained of abdominal cramping. Her colostomy bag usually had minimal output, since she also had very very poor appetite, per the report I received from the night nurse. Her prn meds for abdomen-related symptoms only had dulcolax supp ...what the??? What for? She does not use her rectal ampulla anymore. Everything goes to the colostomy bag. Even if you stimulate the rectal vault, that would not help. Possibly it was a protocol order entered by a nurse.

anyway, though there were other protoco laxatives, given the complicated nature of her condition and her colostomy, I wanted to make sure it was okay for her to receive a laxative. The doctor okayed. So she got it, and after a while, she felt better.

Lunchtime, her children came, and while her lunchtray was there, they were encouraging her to eat more. I dropped by to check on her...She was hyperventilating and complaining of neck pain. She wanted to lie down on the bed, and promised to eat. I got her pain pills, and in the process, checked if she had anything for anxiety. I wondered whether it was real anxiety or psychological only, as in acting like a baby in front of her children...in any case, I gave the pain pills and antianxiety. I also asked a CNA to help me lay her down on the bed using the Hoyer lift.

She was already calmer when we were transferring her. Upon laying her down we made her turn side to side to remove the pad that we used for lifting her. Soon after that she turned pale, eyes rolled upward, skin got cold, and she was unresponsive. We called a code.

Briefly she responded to my call while I was trying to measure her BP. She was breathing, quite a different pattern, though. Not as rapid as prior to lying down, but quite rapid and shallow. But we were afraid she was having a stroke or a seizure, although there were no such history. BP initially I could not get, but at second attempt was 80/50, with tachycardia. Then the two nurses from 5th floor came and saw that the patient was already responding and pinker. They easily dismissed with CONFIDENCE, after asking me what the diagnosis was, that it was probably a vasovagal complex. I could not easily dismiss it. Delta team came (EMS) and continued monitoring and evaluating the patient, while I went out to talk to the doctor. Delta team rep followed and talked with the doctor. Initially, we were asked to just monitor the patient. But Delta team went back to her, then I followed, and learned that she had another episode, BP going down, O2 sat could not be measured because she was too cold. They finally decided to transfer her to the ER, and started a mask and IV.

I notified the doctor. I called the ER nurse to give report about the patient they will be seeing. As I gave report and reviewed the history, I saw she had an episode of torsades in November 07. That was probably it, I said.

I stayed an hour and 1/2 more to catch up with my charting on my 6 patients that day.

I received a call this afternoon as an update on that patient. It turned out she had a pulmonary embolism. Nothing that I had done (basically medications administered) could have caused it, I was assured by the unit secretary.

But I wonder how she is doing now??? The therapists in our unit who have worked with her have said that she is not a candidate for rehab.

BUT THE THING THAT REALLY IRKED ME: Those two nurses who so quickly dismissed it as vasovagal syncope. NEVER EVER consider something to simple in a complicated case unless you have observed the patient for some time after the event.

Those nurses were orienting at the same time I was. I have been working more than 6 months now in rehab, but never acted like I know everything. I know a lot more and deeper than they do because of my medical background and experience, and I could not ever allow myself to think in such simplistic terms, especially where life is concerned.

I wonder how many are like that????

It was a very toxic duty today

I work at a Rehab unit...so most of my patients are stable, undergoing rehab to get back to their optimum function. If they do get unstable, we send them to the ER, and if ER deems appropriate, the patient is sent back to acute care units (Med-Surg, ICU, etc.)

I love Rehab. For many new nurses, they will probably get bored in this unit, because they are eager to learn new things, eager to put into use what they learned from school, and eager to hone their skills. Here in rehab, there are not such skills you will learn. You basically give medications, period.

I love it because you see the patient's progress from debilitated to well. Fast.

I love it because I have had my taste of "toxicity" from my days of medical clerkship and internship, in the Philippines, both private and public hospitals...overworked, no pay. Very stressful...I learned a lot, but for now, when I have a family to take care of as well, I do not like to have more stress. I like it when I go home and just forget about work. I like that I do not ever fear of going to work in the mornings.

The story would have been different if I were single.

6 months into the RN experience

Well, nothing that exciting, really...

(KK, this post is dedicated to you.)

I started out in a Rehab Dept (after 2 mos of being in a nursing home, that is). Big hospital, 45-50 minute-drive but it is worth it. Very pleasant environment, where I get the respect, and none of too much expectation. I am quite frank and humble about my limited nursing experience, anyway.

Rehab nursing offers very little opportunity for learning nursing skills outside of giving meds, occasional IV therapies/insertion, occasional special wound treatment. In other words, it is not TOXIC (a term med students/residents coined in PI for duties that really drained your energy). Boring, if I may say, but, as I told my manager, I am past the stage of wanting to immerse myself in "toxicity" as I have had that during my medical clerkship/internship. Do I miss it? Not really, especially during this period of my life when I have a family to attend to, and wanting enough time to enjoy life with them.

My penchant for computers came in handy during the transition to a new computer system. Needless to say, learning the old system on the job was a breeze, but the new system we have is Windows-based (and you may guess that, like Windows, it has a lot of garbage that came with the package, and a lot of holes that needed patching). Since I was one of the very few staff personnel with ease in using computers, I was chosen among the "superusers." Higher rate, less back-breaking job, more interesting, but that is a temporary phase. As soon as everyone gets more comfortable navigating the system, I won't have much use as a superuser.

Back to being a Rehab RN, the best thing probably is seeing the patients progress from debilitated to fully functional (within their limits) status. I get to know them better as well. However, most of them label us nurses as "pill nurse" and sometimes I am being asked whether I am a CNA or an RN.

I do have some thoughts of perusing USMLE-review books...

Endorsement and Verification

Well, I have received my license from Vermont BON, then I proceeded to do the verification through Nursys as instructed on Maine's BON re endorsement. Nursys could be done (supposedly) online or by mail. Because I wanted to expedite things, I chose to do the online thing.

Well, my name was not in their database...yet. The reason (according to FAQ) is that for new nurses, it usually take 4 WEEKS to get the info into the system!

I figured it might be better to go through the snail mail route. I had cashier's checks prepared for both entities concerned, mailed the snail mails for both agencies. the one going to Maine BON contained not only the application form, copy of my license, and the fee payment, but also certified copies of my TOR and RLE. I hope I missed nothing.

Now I will just wait for approval for endorsement, then I would be all set to work as a nurse here with a temporary 90-day validity license as RN.

Problem is, I want to visit my mom in Canada (with my older sister) first before I go working full time. I have submitted an application to the PCGNY for renewal of my passport. As soon as I receive it, I will schedule a flight to Burnaby.

LP 14: A La Espanyola - Panaderya

Panaderya, hurnuhan, pan de sal, pan de coco, pan de limon, biscocho -- it is obvious that these terms are of Spanish origin. If there was a certain Spanish influence in our foods that touched my life greatly and early, it was the staple bread and rolls that we Filipinos have during breakfast and merienda, the ones typically sold at the bakeries just around the corner every two or three blocks in a relatively congested area in Metro Manila.

My father started "working" as a tricycle driver in MM, and was delivering baked goods (especially pan de sal) to houses in the wee hours of the morning. The bakery was in Bagong Pag-asa in Quezon City where I lived as a child. My father had this dream of putting up his own bakery someday, and he took me once on a "tour" of the bakery, which was then using the old-fashioned brick-style oven that was as big as a wall, with a hole big enough to maneuver a baking pan easily.

My father was able to raise enough money to buy his own oven (the modern-style made of metal, not brick), and some baking tools like the wooden dough cutter, and a dough boat (yeah, the bakers knead dough as big as 4 big pillows combined, and had muscles and bodybuilt that could qualify for bodybuilding competition). Since it was meant to be for commercial purposes, everything looked big to me, and I kinda stereotyped baking doughs as a manly thing.

At first we only made pan de sal, with our workshop within our apartment unit, but there was such a great demand, we expanded and had to rent another apartment unit along a busier road, and also put up a general merchandise store. We added and added more staple breads and rolls, and had a display of baked goods which were pang-masa that typically would include ensaymada, Spanish bread, pan de coco, monay, pan de limon, pianono (?) ( a jelly roll-type of bread although this one we made then had no jelly; I am not sure what the filling was, but it was one of my favorites), "kababayan", biscocho,

I have received my certificate!

I got it...from State of Vermont. It felt kinda weird to see my name Lxxx Txxxxxxx, RN (instead of the Lxxx Gxxxxxxxxx, MD). I will get used to it, I know.

Next step: Apply for endorsement to the state of Maine BON, with application also for verification via Nursys.

Meanwhile, I should prepare my (functional) resume...

I feel daunted...I admit. How will the US nurses perceive and treat me (a previous foreign MD). Well, if I indeed feel that they are discriminating against me and making my RN life miserable, I just might consider pursuing the MD path, and later look them in the eye and...(let your imagination run).

I have just passed the NCLEX

Now I am just waiting for my certificate. I want to take ACLS/PALS certification programs but they require I attend the prep first. That would amount to $440.

I wonder if I can apply for a job even without a certificate yet?

I should prepare my resume and think about applying.

UPDATE 09/29/06

I have read in a forum that some hospitals provide free training for these certification programs. Maybe I should just look into that first and save the $$. I badly need it anyway.

What's next?

I posted this question in a forum thread for MD-RNs and and also at a yahoogroup for my batch in MD-RN program:

Can anybody give me an advice on the best next step? My NCLEX was filed in another state, and I plan to seek endorsement to my current state, but my certificate will come later pa, around one month daw. Does anyone suggest that I seek employment right away while waiting for my certificate and even prior to seeking endorsement? As what (e.g., patient technician??? or should I just submit application for purposes of getting my name on file?) I am still holding on to my MT job only to see me through the waiting period, but I wonder if I should be doing something else with my time (like do you suggest I take some refresher course, or do they usually offer training in hospitals to fill in the gap in your knowledge? Or are these issues safe to discuss with the HRD? Kasi, 3 years na akong walang exposure sa clinical/hospital setting, parang napupurol na ako).

Answers:

I'm sure that with the shortage of Nursing in so many states (including Maine) that you will find some hospitals there that will be willing to give you some hands-on training while waiting for your license. It does not hurt to ask HRD's as you have the upper hand with an NCLEX out of the way. Of course if you can get the basic certifications (even from Red Cross) like BLS/CPR (would help). You are a gold mine for these hospitals so they will accomodate you and many of these hospitals have their own orientation and training period as long as you tell them the areas wherein you are not confident.
Looking ahead and if you dont want to take USMLE, CRNA might be an option (but it takes a longer path). I have a sister-in-law who is an NP and they do well also.

with a followup:

This advice is golden. Consider seriously the CRNA route manang. Its longer but certainly its going to be rewarding in the long run. On getting a job as a nurse, wag ka ng mag floors (para short cut), ask around for hospitals that need ICU nurses. There are hospitals that accept even fresh graduates for ICU, this is after training them for 3 months. Shop around, network with filipino nurse managers, and do this for 1-2 years. During your stay in the ICU, pass the CCRN, mani na lang yan sayo dahil MD tayo. Most CRNA school prefer CVICU experience (kasi dito me Swan cath, intra aortic baloon pump, lots of pressors, arterial lines etc.....) trabaho mo parang intern sa Pilipinas.

After 1-2 years, you can apply to CRNA school, mandatory kasi 1 year ICU experience. Impress them during interviews. You need to pass din pala the GRE (kayang kaya to! dont worry bout it! kung kaya nga ng mga 40 year old na puti mas kaya mo!). The CCRN is a certification for Critical Care Nursing, kayang kaya din ito. Same principle din ang application for schools, parang MLE apply broadly and early so you have more interviews.

Now for tuition fees, you can loan them. School is around 2 1/2 years parang residency na walang bayad. With the salary the CRNA makes, sus wala pang kalahating taon bayad na loan mo. Tutal when you are doing ICU experience, me sweldo kana, medyo mataas pa nga ata ang rate mo kesa floor nurses, pwede ka ng mag-ipon, if you dont have family restrictions, overtime ng overtime para makaipon at makabawi!

After school theres a certification exam, boards ba...Again, we've been there, your experience as an MD should help you. Of course this is not to say you dont have to study. This is serious stuff for them, so take it seriously din.

I know you can make it! Proud of all the MD-RN's who take up this route!

The thing about being an NP, oks lang pero sa halos same time commitment with school pero lower pay parin siya compared to CRNA, there's also the issue of respectability. We'll yeah this is just me. I figured kasi kung pareho lang ang pagod e dun kana sa mas more compensated ka.

Mahaba nato.....Sige manang congratulations and goodluck to your future endeavors....

Another advice:

I do not know if pareho ang situation natin, but when I passed the NCLEX last year I cannot get my licince as wala pa akong SSS no at tourist lang ako so with the Notice fron the BON that I passed I walked in to some big Medicval centers and asked if they could pititioin me and when finally one of them responded and had thier corporate lawyer work on my application, I got my work permit and that is the time I got my licence, mentime I took PALS, BLS and NRP to wjile my time.

I have looked into certification programs for ACLS/PALS...and of course, employment opps in nearby hospitals and their requirements.

It is unofficially out!

gotta have a new plan for a new career...

BANIG TV SHOWS

I was singing videoke with my kids this afternoon, then suddenly the image of Banig performing and winning in the International Star Search popped into my head. I had the idea of trying to see a video of her in You Tube. So I saw this video.
It was fun to see her evoloving through the years, up to age 16, then I wondered what has become of her after that.
A search for Banig videos did not give me much, until I checked out the other videos uploaded by doubleplayent (who uploaded this one), and I got a glimpse of Banig the Diva.
I wish there were videos of whole songs that she sang during those moments as shows in this video clips. They will surely give me the goose bumps.
I checked out banigonline.com but it seems outdated. I would like to have a Video CD of her albums (if there is any, instead of just an audio CD).
Banig has truly grown up to be a very sultry pop singer. I won't be surprised if she had now become a wife/mother. Any white (or black) male will surely have the hots for her, given her looks and talents. I noticed also from the links in her (outdated) website that there is a Japanese site (though I could not understand) devoted to her, so it is indeed a possibility that she finally made her vows.
Googling her name either as Banig or as Josephine Roberto did not help much in my search for an update on her.

A Filipina MD turned researcher

I feel so proud of being an online friend of Dr. Florita C. Henderson, another MD (worked as GP in England before she married her then boyfriend, an American). She now lives in Iowa, and has been working in Univ of I as a researcher. Her first paper where she is the first author (there have been papers where she had been a contributor, of course) is:

Proapoptotic effects of P. aeruginosa involve inhibition of surfactant phosphatidylcholine synthesis

Click on the link to see the abstract as featured in Journal of Lipid Research. Mabuhay ang mga Pinay!

Congratulations are also in order for her being a new mom since June, having given birth prematurely (probably out of work-related stress) to a tisay (Hay, inggit ako!)

I hope I can someday find a research-related job where I can apply my medical knowledge, so as to avoid a mediocre career. The main problem is my location...rural Maine? Malabo...

I had my second road test today...

The first time I had my road test, I had so many goof-offs. Well, I knew I had little practice. I had enough long-distance (well, 15 miles is long enough for me as a permit holder) driving practice, but I knew I needed more exposure to the busy streets downtown. As expected, I failed the first. But my in-laws said they, too, had to take the test either two or three times before they had their licenses. Okay, that made me feel better. I was not alone. My friends also had to take the road test twice or thrice. My MIL believes nobody gets it the first time.

Okay, so it was my second time today. I still did not have much practice, and truth be known, I had little enthusiasm practising in the interim, because I was still trying to squeeze in time to study for NCLEX and take care of the family and help Gary with the kitchen.

I was ready to fail again this time. We went out two hours earlier than my schedule for a brief practice downtown, and some practice on parallel parking and pulling up. During my first road test, I did good on parallel parking, although I mostly used the side mirror and rearview mirror, which I had been using perfectly in backing up. After I failed that test, the officer told me to always look behind over my right shoulder while backing up ALL THE WAY until I stopped. Oops, Gary never corrected me on that. I had to retrain myself to use the "looking my right shoulder to see the back" method, which I only did this morning, when doing the backing up straight and parallel parking. So many tries and frustrations. We finally went to the office 10 minutes prior to my schedule. The officer was there waiting for someone. When Gary got off the car to talk to him, he came back to me, telling me that the officer had to test one other applicant before he could attend to me. So I had to wait.

I had some anxiety vented off during the waiting time, I actually got teary eyed. I was ready to fail because I knew I had little practice, but I could care less because I had to pass my NCLEX more than this within a limited time (I have up to Sep 5 for that, while I could re-take the road test as many times as I need to. Maybe that waiting period and venting did some to calm me down. I was a bit laughing about some silly nonsense we were talking about, like our cat Midnight. By the time the officer was ready for me, I was a bit more calm.

I tried to relax, and I did...somehow. I avoided hyperventilating and concentrated on other motorists, much in the same way I would drive when with Gary. Went through the same downtown streets which were busy with construction and all cars coming from every direction. I managed to stay or end up in the right lane, stop where I should, wait where I should (sometimes over did it, being too cautious, but that was no big deal to the officer). I had some forgivable mistakes when I forgot to turn my right signal on when he asked me to pull up behind a car on the right (where he asked me later to back up straight until he told me to stop). But I did remember to signal when I did the same thing (pulling up) in front of the office when we finally went back to it. I did remember to let another car into my lane before proceeding, remembered who had the right of way, etc. , etc.

I PASSED!!!! I now hold a temporary license and have to have my picture taken before Sept 10th for the license.

HOORAY!

No, I won't spend the following weeks trying to acquaint myself with the roads and the town. I will stay at home and study for NCLEX (that is one item ticked off my to-do list). I have rescheduled that for Aug (because I had been dividing the past month between kids and garden and kitchen building, the past days being spent mostly on mudding and sanding. Gary applied the first coat of primer today. I (and the kids) still have to clean the whole house to rid it of the fine dust particles that have landed on most surface and which will linger for quite some time in the air. Particularly affected was the living room, which is most contiguous with the kitchen. Since I did not (and had none anyway) cover the furnitures with linen, we have to vacuum them all, wash the removable covers, remove the furnitures , vacuum the floor, wipe and mop it before putting all furnitures back in. Then I can study for NCLEX.

It's so good and considerate of Ana to offer to have the kids with her so I can study during days.

NCLEX ATT

Betcha by golly bow-wow-wow!  Natanggap ko na ang NCLEX ATT ko!  I received the email from Pearson-Vue, and the ATT was attached, valid from 6/7/2006 to 9/5/2006!

Nangangatog ang tuhod ko!

I have to take a break from blogging, and concentrate on review.  Work in the mornings, review in the afternoons.

I might even stop working in the garden, but that is quite a good diversion after long hours of studying. 

Arrgh!  I do not really know what to do!  I hope to finish at least the Saunder's Comprehensive Review within a month, then practise answering test questions the rest of the time.  The earlier I finish, the better.

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VR bloopers

Initials are the VR draft - regular are the corrections

jammed fibers ill 600 mg - gemfibrozil 600 mg

denies drinking alcohol. The hernial legal drug use - denies drinking alcohol or any illegal drug use

apparently her vehicle guardian - apparently her legal guardian

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