What's Next?

Hey folks,

First of all, my last post was Jul 2010. I've dealt with my issues in nursing but heck, I maintain my stance.

Anyway, congratulations to the new RNs out there. I'm dedicating this post to my best bud's lil bro who recently made it to becoming a bonafide RN.

It's OK, you guys are still in cloud nine but let me give you a head-start on how things work after passing the NLE.

FIRST THINGS FIRST

You might be wondering, 'what now?' Yes, what's the next step a new RN should take after passing the board exam. A lot comes into mind: NCLEX, IELTS, EXPERIENCE, take BREAK. Well, it's up to you and whoever are calling the shots in your life, but I'll give you a brief overview of just some of the possibilities.

Scenario 1: J dela Cruz was told by his parents to take up nursing as it will lead to a fulfilled life abroad and possibly the chance of migrating permanently with some of their relatives. J has no idea of what just happened, all he knew is he took up nursing and pass the board exams.

Well, if you're like J in scenario 1, I would advise you to have a serious talk with your parents on what your next move should be. If MIGRATION is what they had in mind then you should next determine -- where? If it's NZ and AU for you well, you're in for a very expensive ordeal and sucks for you since NZ and AU are promoting their education system. In short, you cannot cross from PH to NZ or AU being an RN because they do not recognize our licensure nor do they acknowledge our BSN program. They have this so-called 'bridging program' (IRON in AU) which trains an Filipino RN to be compatible with their system. Take note that not because you took the bridging program means you can stay there. You may want to refer to their websites and study the option on your own. Some consultancy firms would suggest the student pathway (which doesn't require you to be an RN in the first place) -- so far, after having read a lot, I find this pathway to be the safest as well. And Canada? Well, they have a CAP now, 1000 nurses from all over the world each year. Good luck to that.

Hey wait, what about the US? Oh yeah, there's the United States. Good for us since their system is very compatible with the Philippines. All you need to do is take the NCLEX and find an employer. Surprised? Yes, just the NCLEX. You see, the NCLEX provides the evidence needed that you passed the American standard and is safe to practice as a nurse in their country. Take note of the following however:
1. If you take the NCLEX with California, they do not issue a license unless you have an AMERICAN SOCIAL SECURITY NUMBER. You can't have that while you're here in PH. If you pass the NCLEX with them and can't get to the US soon, you might be in for some head-ache since you'll have to coordinate to transfer your score.
2. I-140 visas (the one issued for nurses) are hit hard by the retrogression. If your employer files for a petition say now (Feb 2011) chances are, you leave for the US in 2016. Good thing is, it's an IMMIGRANT visa; again, providing that the employer is still active until then.
3. Each state in the US has different requirements. In my case, Illinois, I was required to undergo CES thru CGFNS before I was granted eligibility to sit the exam. some states may require you to go through CGFNS for Credentials Evaluation while some may not. Also note that not all states issue a license.
** Licenses maybe renewed but not having one means that even if you pass the NCLEX, your score will expire.

Wait, what about that so-called CGFNS?
Least to say that CGFNS exam is almost unnecessary these days. An agency even told me that the most useful portion of the CGFNS would be the Credentials Evaluation, something that you could have without taking the exam. And yes, not all states require CGFNS or CES to qualify for NCLEX.

Scenario 2: I don't want to immigrate, I just want to be an OFW.

OK, if that suits you well here's what I know so far:
Singapore requires 3 years of experience and I mean full time experience as paid nurses. For most middle eastern countries, most require a minimum of 2 years. Female nurses have an advantage over male nurses since most employers in the Arabian peninsula are seeking female nurses. Being of Islamic affiliation is also a help so for our Muslim friends out there, the process (I think) maybe expedited for you.

Some notes

Regardless of your plan, this period (the time you are waiting for your physical license) is the best time for you to map out your plans and have serious talks with your parents or whoever it is that sent you to nursing. If someone sent you to nursing school without knowledge of how to go abroad, now is the time for you to do your research.

I would advise you guys to gain hospital experience as soon as possible. The competition is tough but that's how it is. Life being an RN is not easy, you get far less than what you bargained for but that's the one you have; making it this far, it's too late for regrets. Having hospital experience gives you an uncanny edge regardless of your credentials.

At this point, I would not advise you to take the IELTS. Why is that? You don't need it now. IELTS is needed if you plan to push through with NZ/AU/UK/Canada. IELTS usually have a validity of 2 years but for those countries (except Canada), they're only considering it for 1 year I heard somewhere so you need to do your research well. You don't need it for the Visa Screen. You have an alternative, TOEFL iBT. But if you have no concrete plans for now, don't take this exam, you don't need it and it expires very quickly.

For now, work on your plans and as soon as you get your physical license, work on getting an ANSAP IV therapy certification, this is a must for most hospitals along with BLS.

Volunteering? Yes but study your chances first. I had training and volunteering for almost a total of 5 months before I was hired as a staff and that was thanks to persistence. It maybe wise to prepare for the NCLEX while applying for hospitals. If you can't work yet because there aren't vacancies then you should work on the NCLEX because preparing for the NCLEX (or any exam for that matter) while being engaged in the hospital is very difficult.

I wouldn't advise you to deviate from nursing if the thought has crossed your mind. I've been an RN for 4 or 5 years now, I have only been lucky to have been hired shortly after I applied and experience wise I'm a little short of 2 years from training. I spent 2 years doing nothing, 1 year to prepare for the NCLEX. Somehow, I cannot shake the feeling that I would be abroad now had I taken on hospital experience as soon as I got my license. But like I said, too late for regrets now.

Well, what's next for you?
Clock's ticking.

- Josh

Superiorirty Complex

I'll be writing something down here about my work today.

I have a friend, a colleague actually and I've always known her to be a jolly person. I have seen her laugh and giggle all the way through a tough crunch back when we were in the medical ward and I swear to all that is holy that I have never seen her more pissed than she was today.

It started as a usual day, a happy almost perfect day in the pediatric ward. And while we were performing our role as linen staff (one of the jobs rolled into nursing) someone expected but dreadingly uninvited walked in and disrupted our peaceful day in the ward.

He was... someone important and for most guys in the field, who would be important enough to disrupt our routine? Yeah, you probably guessed it. ;D

He started asking questions in a very rude way and before my friend even begun answering his queries, he had another question in mind. Now, I don't know what in the world is wrong with this guy, but for someone in his stature to actually treat a nurse in that manner is just out of the question. I mean, I don't care how many pro bono jobs he did for people but I sure don't like the way he treats nurses.

Now, going back, it seems that our colleagues in the field seemed to have over-stepped their boundaries in the nurse-doctor relationship (oops! did I just drop that?!). Well yes, going back to the topic at hand, It seems to me that some of our beloved doctors have forgotten that they are working with nurses, not nurses working for them. Yes, and I would like to emphasize on the word with.

You see and I am sure most nurses out there will agree that while doctors are team captains, they still need a team to work with; and that team is comprised with lots of nurses. While MDs are obviously more versed than RNs in terms of know-how, it is the RNs who are directly involved with the patient. I mean, and not referring to my current floor, I honestly do not see most of the APs monitoring vital signs every hour, suctioning oral secretions, or changing diapers, no! They don't do that, they figure out whats wrong with the patient and get people, nurses included to work for the improvement of the patient. Yes yes, I understand, they didn't sign-up to do that but hey, nurses also didn't sign up as secretaries and doormats for these doctors as well. We signed up because we wanted to go abroad! (oops! just kidding!) Nurses may not be the one prescribing treatment plans but hey, its not only the MDs whose necks are on the line, RNs have licenses too, and at least by that, we deserve to be treated as professionals not as trash. (photo from Batman, the Dark Knight)

Now, I understand that in advanced countries, the relationship between MDs and RNs did not develop to be this devious. There is a danger presented by the concept of MDs being superiors than RNs and MDs working in a healthy relationship. Author Malcolm Gladwell perfectly illustrates this faulty relationship in his New York Times bestseller book, Outliers: The Story of Success and termed it as "Culture of Honor" where according to his research, the Philippines rank among the top five countries with a strong sense of 'culture of honor'. So what exactly is this culture of honor? To give you the concept in a nutshell, it was exactly what happened to my friend this morning when the not so friendly doctor made his rounds. She (my friend), trying her best not to anger the doctor who she perceived at that time was someone who could have her head served in a platter, talked in a calm and almost submitted manner to the doctor and just took in everything he said, even saying "thank you" when the doctor left. And there you have it, culture of honor. So, how is this relationship detrimental? Well, in a sense, nurses, particularly new ones such as myself are afraid to challenge the orders the doctors are making even if we are sure, something is wrong.

I've been told by one of my supervisors (and God I hope she's not reading this) that I'm growing to be a bit rude by losing the 'mam' and 'sir' titles when I address my colleagues and by calling doctors with their first name. Well, go on and read Outliers and you'll understand the importance of calling people by their first names in effect to working efficiency rather than emphasizing on seniority and title.

Hope you enjoyed my post and God bless,

- Josh

Life as a Pinoy Nurse

During the last NLE (the board exam for nurses in the Philippines), about 90,000 (yes, 90K) BSN graduates braved the local boards hoping to get a foot forward in their plans to work abroad.

In the not-so-distant past, there were less than ten thousand examinees taking the qualifying exam; but for some reason, this BOOM in nursing is attributed to it's considerable demand abroad. All over the Philippines, there had been a significant decrease in the number of enrollees in every nursing school, and there should be for a very good reason.

I entered nursing school in 2004, I was under the impression that if I passed the NLE, I'd take the NCLEX and fly away as soon as its over. Those were the days when we had about 10 sections comprising of no less than 35 students each. GREAT! But hey, before any of you readers out there think of saying to your newly out of high school friends "mag nursing ka nalang", better stay a while and read through what nursing is really all about and let me give you a quick list.

1. Nursing is not for the poverty-stricken public.

I know, you've seen the dramatic tele-novelas of a pretty young girl abused and she took up nursing, graduated, became a nurse, met the love of her life, went abroad and became thick rich! Well, thats not the case, in nursing, you will be spending a great deal of money just to make it to graduation and unless you come from a family that could help you with that, might as well look for another field.

2. Nursing is not a pass-port out of the country.

Again my friends, do not be fooled! In the not so once-upon-a-time years, nursing was a sure hit to get employers on your heels and to get a passport to other countries offering more opportunities for nurses but hey, it's 2010, the world is in crisis and good luck to you in finding an employer who's willing to pay for your ticket. EVEN if you do possess a visa to the US, it's not a working visa, so think again.

3. Nurses are trained to save lives and kiss asses.

Yes my dear friends, kiss asses, your eyes aren't fooling you and between the two, saving lives and kissing arse, you're more likely to end up with the latter. Although I must admit, there is a priceless reward when you contribute to saving someone's life.

4. Nurses undergo a lot of training.

Most hospitals have a list of requirements for nurses before being accepted into TRAINING. Basic Life Support, and Intravenous Therapy is just for starters and I would recommend just getting the two of these. There will be a lot of other courses out there but they will just be a decoration for your portfolio. BLS + IVT, thats about 3,000 pesos off your pockets and if you're a fresh nurse from the local boards, thats a lot of money. Oh and the PNA membership, another 500 pesos.

5. It's not a lucrative job.

Whoops! Are you a bread-winner hoping for a better life as a nurse? Well, you won't be getting it any time soon. Unless you have someone to back you up in a hospital, you'll be climbing up the ladder slowly. Training, Volunteering, N1 or floaterhood, probationary, and finally! To be a staff! Training costs a lot of money, in my case about 5,000 pesos (100+ USD), for a chance to experience being exposed to different areas in the hospital. 5,000 pesos and you get to go to the hospital without pay; it's like attending school again. Hmmm what else? Oh, thats about 8K now plus IVT and BLS. What about the period of volunteering? Well, you get to work for free. And floaterhood? You get to work 5 days per cut-off with the minimum wage. Probationary? You get full schedule minus the benefits. And staff? Well, you get less than 15K per salary. YES! All that trouble for LESS than 15K! And agencies will ask for no less than 150K during your applications.

6. It's a time killer.

Wanna grow old? This is the job for you. Well, in my case, I spend no less than 10 hours every day in the hospital stressing myself out. I learn yes, but when I think about it, why did I do this again?

7. It's an expensive choice for a chance to go aborad.

Other than the afore-mentioned expenses, you of course, want to work abroad and the land of opportunity, the United States is a very tempting option but before you say yes to the enduring profession in which I hope to have opened your eyes to by now, I would do you a favor of telling you about the expenses you will be having when you decide to go for the US.

1. The NCLEX, application, exam proper, etc. It's a very expensive examination for a Juan dela Cruz nurse who will be taking it. It cost me about 600USD in total, apart from the review.

2. IELTS/TOEFL IBT. This costs about 150 to 200 USD.

3. VISA SCREENING. About 500USD.

Hey! What about other countries? well, get experience first. About 2 years is the minimum, IF, you can endure the schedule and salary that is.

So, whats it like to be a nurse here? I'd say I sacrificed about a year of my life now, and I still will be doing so for more years to come.

Listen buddy, if the list I mentioned above earlier wouldn't cut for you, don't go into it. If you're a highschool kid looking for a career in the future, I'd advise you to look elsewhere. Nursing requires a heart for service, something I had to look for during the 1 year period I have been working as one and I still haven't convinced myself that this is my life, the life that I chose, the life that I will be living. So, if your parents are telling you to go into nursing and you don't have a clue, now you do. You might want to discuss this with them

God bless,

- Josh