Thought my day started with luck because I was only TECH-ing (worked as tech instead of a nurse) this day when suddenly a venous pressure alarm gave me an eerie feeling.

High venous pressure with no signs of clot! I tried detaching the venous lines to check the patency of the venous access—100% patent; I turned on the pump and let the venous line drain on the bucket to note any obstruction or clot—good flow; I flushed the system but this time around, venous pressure even skyrocketed. Finally, I returned the blood to fully see the chambers for any clots—na-da!

But there’s more, the blood in the arterial line was lighter than that from the venous line which already gave me a hunch of dialysis access recirculation but the high venous pressure was a first for me!

So I asked the crystal ball (google),

“Does dialysis access recirculation cause high venous pressure alarm?”

Then, the great AI immediately answered,

“Yes, dialysis access recirculation can indeed cause a high venous pressure alarm on a dialysis machine because when blood is recirculating back into the venous line, it creates a resistance to blood flow, leading to an elevated pressure reading at the venous needle site.”

Explanation:

Blood Flow Dynamics:
When a significant amount of blood is recirculating within the access, it means the blood is not efficiently exiting the access through the venous needle, causing a buildup of pressure in the vein.

Stenosis as a Cause:
The most common reason for recirculation is a narrowing (stenosis) in the vein near the access site, which impedes the normal flow of blood.

When dialysis access recirculation happens, a portion of the already partially dialyzed blood flows back into the dialyzer, reducing the overall efficiency of the dialysis process and potentially leading to inadequate waste removal from the body.

Dialysis was not efficient anymore so, treatment was cut early, patient referred to the access center and discussed with the techs to cannulate a new venous spot next treatment, farther away from the stenosis (pt was on buttonhole).

And that was my kind of Friday the 13th. Definitely one for the books!

The post Dialysis Access Recirculation on Friday the 13th appeared first on Nurse Germz.

The Closing shift literally just means the last shift in a dialysis clinic. If it’s a big clinic that consists of two dialysis nurses, one is assigned as the opener while the other one as the closer. The small clinics may also have a different arrangement where the opener dialysis nurse works alone in the morning, joined by the closer dialysis nurse noon time who will then close the shift until the last patient.

As a float dialysis nurse, I get to experience both. I had my first closing shift in my big training facility last Monday then float to a different clinic yesterday, Wednesday for another closing shift. Is there any difference?

Time Shift Difference

Time is the huge difference between the two. One clinic is a 24-chair facility while the other is just 18-chair facility. The bigger clinic is always manned by two dialysis nurses so both come in at almost the same time with a 12-hour shift for the opener while 16-hour shift for the closer. The smaller one, on the other hand, can be manned by just one nurse with both having 10-hour shift only; 5am-3:30pm for the opener while 12nn-10pm for the closer.

15-hour Closing shift

Monday, 5am to 8pm. Starting my week at the bigger clinic, as the closer dialysis nurse, I extend hours until the last treatment. This covers all three shifts for the day.

From my previous post about a day in a life of a dialysis nurse, I handled only two patients since I shared the POD with another nurse. This time around, I did full POD so 4 patients for first and another 4 for second shift while 1 patient for the 3rd shift. We had 4 patients for the third shift so I was only paired with one closer PCT.

Turnover: Fast-paced!

It was a fast-paced shift doing both PCT and nurse roles. I hardly had any chance glancing the time. I’m lucky if I could take the first break on time but wait till turnover comes where most of the tasks are expected to happen: taking off first shift patients, setting up machines, putting on second shift patients, assessing second shift patients, preparing and administering medications. And when I thought I was done and can finally take a lunch break, my first patient of my second shift was already coming off. So it has been 4 hours already?

I checked the remaining time of my other patients to check if I have time to squeeze the quickest lunch I could make but seems it was too late already. After taking off my first 2nd shift patient, I had to prepare the chair and set up the machine again for my last third patient and in a few minutes, the rest of the machines will alarm for treatment completion.

Missed Breaks!

Exactly 4pm, all second shift patients have gone home and my third shift patient was finally hooked. As soon as I increased the blood pump to the prescribed BFR accompanied by words, “Anything else you need?,” I immediately eye signaled my other nurse that I’ll take a break. No words needed. It was understandable! We both forgot to take lunch but since she was going home soon, she just finished her remaining tasks, instead and let me take mine.

Once back, I was faced with the remaining tasks: close all treatments in CWOW, prepare the next day first shift packs, print the routine lab and medication labs. And Ohe, it was Monday, physician do rounds so, I had to carry out all orders. It was my first closer shift too, so I restocked all lacking supplies in our nurse’s station.

Leg Pain!

I went home around 8pm with the sun still up! I can remember how painful my legs and calves were. Walking back and forth in a big clinic is not a joke. Putting on and taking off 4 patients in every shift is manageable since I’m only at one place but doing the assessment and medication around the clinic is what I haven’t expected to be that tiring.

10-hour Closing shift

Wednesday 12nn to 10:30pm. The second day of my 4-day workweek was in a small clinic, 18 chairs. I join the opener nurse during turnover and only cover half of second shift and do third shift alone.

Turnover: Slow-paced!

I don’t have assigned patients here. I only do nurse’ tasks so, the shift here is slow-paced. Too slow, I was able to finish one whole module in starlearning. The AA gave me a new patient documents to be carried out in CWOW as soon as I arrived, but still, too slow, I finished it in 10 minutes.

On the other hand, the clinic is full staffed so nurses do need to help during turnover except for third shift when I am assigned with one patient while 8 for 1 PCT. Patients here do not arrive at the same time, the earlierst arrive at 3pm with gaps of 15 minutes in between and the last one can arrive as late as 6:45pm for a 3-hour and 30-minute treatment that will be done just before 10:30pm.

So, as soon as the first patient arrives, I prepare the medications of all 9 patients. Afterward, I get to log the nursing binder ahead–temperature check and medication count. And it was still 4pm, 6 hours ahead till end of shift. My patient’s chairtime on the other hand is 4:45pm then, I’ll be waiting for all patients to arrive and do assessment and medications.

Full Breaks!

By 7pm, I am completely done, do the last chlorine check and go to my dinner break. By then, I wait till each patient finishes, close each treatment in CWOW and back with starlearning. My last task is pour deoderizer in every drain at my side and I am done.

Dragging Shift!

No matter how relaxed this clinic can be and just perform pure nurse tasks, the cons is late end shift. The gaps between patients were too huge and it was too impractical. So, I’d prefer the fast paced clinic and not notice that it’s already time to go home than staring at the clock ticking and waiting to go home.

The post The Closing shift | Float Dialysis Nurse between Two Clinics appeared first on Nurse Germz.

Exactly 9 months ago, July 25th, I started working as a dialysis nurse in my training facility 5 minutes away from my apartment. Two months later, September 12th, I was transferred to a different facility 35 minutes away to fill in since the regular nurse resigned. Today, April 24th, 2023, I’m back to my training facility.

To make the story short, I arrived in the US with a job offer in a dialysis clinic that is closed. So ever since I’d started working here, everything has been temporary. Neither the training facility is not my permanent clinic nor the second clinic I got transferred which is now filled in that is why I’m back to where I started.

The clinic where I swore not to go back because of experiencing self doubt and developing impostor syndrome yet now, I’m here.

Monday 5am, First day high!

One of the advantages working here is it’s a big clinic so, it’s always 2 nurses for 24 chairs. Plus, I’m with my co-pinoy nurse so it’s not bad for a first day. We share one pod so, we are assigned 2 patients each.

So, as soon as I came in, I go straight to the machines to set up and prime compared to the other clinic where I go straight to the nurse’s tasks. Machines take a long process of conductivity, testing, recirculation and connecting to CWOW (or computer), so I want to make sure to do this first and get on to the rest.

Mondays have 3 shifts so the closer nurse is expected to arrive 30 minutes later. As soon as she arrived, I tried asking the different roles. She explained that the 5am nurse do the nurse roles while the 5:30am nurse set up the machine but it was too overwhelming so I just wanted to focus what I have started and we switched roles, instead. She logged the nursing binders, fridge temp, medication count, glucometer testing then, withdrew heparin doses.

6am, First shift Patients arrive

First day is first day, at exactly 6am, doors open and patients started coming in yet I was not even completely done. We divided the patients and I chose the last two with chairtime of 6:30am and 6:45am to not feel too pressured. But since all patients arrive at the same time, my heartbeat started racing as they settle in their respective chairs.

The first patient I put on has an AVG, the access that I always find challenging. If the access is problematic, I have not reached a point yet of being able to troubleshoot it smoothly. Unluckily, I got my very first challenge, although patient calmly oriented me about it, the pressure, fear of failure, anxiety were all piling up affecting me to focus and do it properly and I didn’t. Thankfully, the patient was not all that toxic and even reassured me that everyone is also having the same difficulty so I have nothing to worry. But I stuck at a way farther area and I knew I couldn’t do it. I asked my co-nurse for help and the patient told me that the ones who could do it are the PCTs. I moved forward to my co-nurse’ second patient to make use of the time wisely instead of watching her troubleshooting it and she ended up asking help with the nearby PCT.

Then, I am faced with the very reason I dreaded to come back to this clinic. The toxic teammates who never run out of words belittling someone who cannot do what they can in a suave manner. And I was right beside her, bulls-eye listening. So, I thought it’s Monday, morning, everyone can be expectedly cold.

7am, Assessment and Medications

After sticking patients, I proceed to assessing first and verifying prescribed HD orders set on machine to all 10 patients while the rest were for the second nurse and the LPN then, prepare whatever medications left which is Mircera, a prefilled erythropeitin syringe. I go back to my 10 patients and give their due medications and document in CWOW accordingly.

8am, First Break

While I was busy finishing my tasks, the second nurse started preparing the packs for our second shift patients. And since her patients will be done first, she went to break first and I followed right after.

10am, Turnover

Turnover came. I reclaimed my diginity to my failed AVG attempt when he commended me of pulling out needles without feeling anything, mood started to lighten up. My two patients have not arrived yet, thereby late and one of them is a bit problematic who chooses PCT over a nurse to stick him and I am in for another challenge again. In a few minutes, I’ll be asking help from the same person who stick my first patient. While waiting, I started assessing patients.

As soon as my patients arrived, my co-nurse oriented me to just prepare everything because they’ll only stick the needles. So, I did and I kinda mentally prepared my lines when I finally approached her,
“I’m so sorry but the patient requested you to stick him.”

If there’s a perfect definition of a dual personality, this got to be it when she surprisingly transformed to a different person,
“Are you ok if I’m just going to stick the needles?”
“Ohe sure! It’s all ready!”

11am, Second shift

I continued assessing patients, verifying HD orders, preparing medications, giving out medications, documenting in CWOW then, closing the first shift patients. We had to input our post assessment before patient’s treatment can be closed.

Compared to my first few days here when I was still training, I can now remember patients easier. They don’t print flowsheets anymore so in order to distinguish patients, I go find their machine numbers in CWOW and verifing by asking the patient themselves. And when I go back to the station to prepare the medications, my memory is now better to remember all 10. I am more of a visual learner so I remember them as to where they are and not entirely their names.

1pm, Lunch Break

This time, I took the break first. I went outside to eat my lunch but just inside my car to get away from the work ambience.

2pm, Turnover

When I got back, my co-nurse’ first second shift patient was all done and her second was down to 2 minutes. I told her to go to break and I’ll take off her second patient. She oriented me that patient is, “Mej Bleeder” which I literally understood as mild bleeder but a totally opposite. Ohe well, I managed. I used to get anxious with bleeders too during my first few days and had a taste of messy blood all over the arm chair.

For this day, there is a new PCT who came off from training but is yet to take the final exam too so all her patients were left to us. Aside from taking off my co-nurse’ patient, I also helped take off the LPN’s who joyously said, “I appreciate you!”

4pm, Third shift

My shift is only until 4pm but I stayed longer to get familiar of the daily tasks in preparation for my next duty because by then, I’ll be with another regular nurse (not pinoy) and full 4 patients for both first and second shift. I made sure to close all second shift patients first before I listed down all the daily tasks of both 5am opener and 5:30am closer and ask anything I could think of–process of bleaching, routine laboratories including the difficulty of putting on patients and their attitude.

This clinic is more on the technical skills of a PCT while where I came from was more focused on the RN skills so I also had a fair share of giving her how-tos of the different outliers of target weight adjustment and reporting. The last thing I did was prepare packs for my next duty patients just in case.

It was almost 6pm when I went home!

The post A Day in the Life of a Dialysis Nurse | Doing both PCT and RN roles appeared first on Nurse Germz.

To the 7 years I’ve worked as a dialysis nurse in the Philippines–half a year training as a dialysis nurse, 6 years working in a dialysis hospital setting then six months in a dialysis center, I thought I’ve seen all until the day I almost called 911.

PH vs US Dialysis Set up

This may sound cliche but you never truly appreciate something until its gone.

Documentation. It may have started superficially as how I selfishly wish to transport back to my home country sitting comfortably documenting on paper rather than standing for hours, transferring from one computer to another in a big dialysis facility.

Shift hours. How the same staffs manage to work here for the whole day up to 16 hours long doing 3 shifts when back in the PH, I believe one and a half shift is the most we can do.

Staffing. I remember I used to request more technicians to help the nurses during transition in the PH since usually it’s just 1 technician for the whole shift. Well, wish I could take that back because now I’m in US, I am indeed surrounded by patient care technicians and how the numbers have literally switched like it’s just gonna be you (the only dialysis nurse) then 3 to 4 PCTs.

Working back then, was not that risky since you’re surrounded with dialysis nurses and everyone can be held accountable (which is a fair share) while here, everyday is like walking on hot coals, hoping you can keep eye to each one of the floor staffs who are working under your license. Any false move, it’s just your license who’s gonna be on the line.

Patient Ratio. And so does patient ratio, we used to complain back then of being assigned to 3 patients in a hospital setting in the PH but here in US, the maximum nurse to patient ratio of a dialysis nurse is 1:16. I’ve tried working alone with 18 patients, 3 PCTs and I was still expected to help as PCT during turnover.

Although, we mainly do just the assessment and administration of medications, the liability of all staffs in the floor is on me not to mention, the lives of all the patients hooked to their respective dialysis machines.

Physician on Duty. The job should have been lighter if there is a standby physician on duty just like in the Philippines but unfortunately, there’s none. Unless the nephrologists, PAs or CNN-NPs do their rounds which only happens once a week for MWF and TTS patients, the floor is all yours to handle.

Then, it came to my realization that, all throughout my dialysis nurse experience in the Philippines, I was with fellow licensed medical staffs. So when there’s an emergency, there’s everyone who could help me out or I can simply activate CODE blue then comes the Residence on duty and the more experienced ICU nurses to respond.

But On The Day I Almost Called 911,

I was all by myself. The PCT called out, I responded and saw an unresponsive patient. I was looking at the machine, the arm, all lines were disconnected so, at the back of my mind, “how can I actually get this patient back immediately?” because if there was, it’s as easy as pushing fluids forcefully.

It took me a second to get back to my senses then I looked back at the patient and saw the feet were down so together with the PCT, we placed the feet up. Patient was still unresponsive, my next action would be to instruct the PCT to raise the feet up high (haha this only remained as a thought and was never able to instruct her) while still looking back at the patient, not responding and finally, shouted 911 (in a question form, I can remember how funny it sounded.lol) and just when I was about to pull back the chair flat to do compressions, patient is finally back.

A big sigh and relief, “He’s back!”

All these happened quickly in around 3 seconds.

The Biggest difference

…is the Pay. A year’s salary of a dialysis nurse in the Philippines can be earned here in a month only.

But is it worth it? Well, journey with me in my fourth month of my three-year-contract as a dialysis nurse to find that out together.

The post The Day I almost Called 911 | Dialysis Nurse appeared first on Nurse Germz.

I think the first step to do to smoothly transition to US is to settle all important stuffs in the Philippines. These are the things that need continuity even if you reach the US soil.

1. Special Power of attorney or Authorization

The top of the list is to make an SPA to solve almost all of your problems as soon as you arrive in US because most likely, you won’t be done settling all your documents before you leave. Doing so saves you time and a headache.

PRC Nurse License

PRC for example is a bit strict in this part. Only PRC holders are able to use authorization, if not, you need to make an SPA that needs to be original and specific to every task and not written as general such as for filling out forms, submitting or claiming.

Bank Accounts

Your bank accounts on the other hand, especially for checking accounts or if you have properties with ongoing monthly payments, banks usually have their own SPA form. So, visit them and try to inquire.

Government offices

Don’t forget about your government contributions, if you plan to continue or not; make sure to settle these in the Philippines. If yes, then Switch to online payments. If time does not permit you to do so, then SPA is the solution.

School / College

Also create some if not SPA, authorization letter can suffice for your highschool or College OTRs claim just in case you need to submit new copies for endorsement. Especially for NY or NMI that do not undergo CES or CGFNS, these are the stuffs needed for endorsement other than license verification.

2. Online Accounts

SSS/Pagibig/Philhealth

If you have plans to continue your contribution in the Philippines, you need to convert your accounts to online. Just in my case, I am kind of lazy in this part that I haven’t used or open my online account since I created it way back in 2013. Turns out I needed to update a lot of stuffs in order to make use of the online account and some requires you to do it in their Physical office. SSS and Pagibig, for example.

Bank accounts

Online accounts require OTP in order to sign in. Although some provides OTP in the app, itself, however, password expires every now and then and you are obliged to change it which asks for OTP. In this part, you have a lot of options to choose from. (1) One is if you need to leave your sim and have someone open it for you, (2) Two is you can set your sim to roaming to be able to continue receiving text messages in the US. However, there might be areas in US that might have low signal or may depend on your sim card.

Mine, for example, is TM and the roaming does not work most of the time compared to the Globe sim of my dependent which until now is still working. Good thing, I have a relative who recently visited so I was able to leave the sim. So, option 1 worked for me.
(3) Three is not really an option but you can try inquiring about this since I’ve read that you can change your number to an international number. I tried doing so here in US but it’s kinda a hassle because of the time difference and also international calls are not free here despite of the free toll advertisement.

3. Phone / Sim

You have to open line your Phone. On the other hand, there are phones that don’t work here in US because of bandwidth that also includes iPhone. So if you’re planning to buy a new one, just spare and do it here.

For the sim which you can use data in US, my sister bought a sim in Shopee that she was able to use here in US. It was so easy to activate. Though you can’t use it for text or call messages, using mobile data is a big help enough to get you adjusted during the first few days. Activate this as soon as you arrive at the airport.

4. SSN

For SSN, I’m not sure if it’s right to share this but what I did is I used the address of my relative in US where I stayed during my first few weeks. I did it because I’ve heard of horror stories about getting their SSN delayed because of the agencies receiving too many mails of the number of immigrant nurses they have. So, to spare them a headache, I went the other way around. They say, you can’t use a residence address but that time, I’ve also heard some receiving their SSN in their residence so I pushed through with my plan.

In the end, I received my SSN in 1 week and my Green card in just a month.

5. Apartment

It’s also best to start looking for an apartment ahead in the Philippines especially if you are already aware of your final facility. I was a bit passive in this part since I received help from my relative in US. By the time I arrived here, the process was not smooth since a lot of times, we have to start over. It was summer that time so almost all of the apartments are full. Everything here are online so you can easily search a lot of sites such as apartment.com, zillows and etc.

6. Car/Autoloan

If your agency is affiliated to Advancial, then you can start processing it ahead too in the Philippines. You may not receive a pre-approval certificate yet since you have not arrived in the US but at least you’re already one step ahead by passing all the requirements needed. Also, inform ahead of credit card application. So by the time, you arrive here, everything will be smooth. Watch my video here.

7. Pocket Money

For the pocket money, there are a lot of things to consider.

First is your airport budget, do you need to buy a meal during your layover.

Second is your transportation from airport to your accommodation. They don’t pay cash here so try to refill your uber app at the airport. Or if you can refill it ahead in the Philippines using your credit card, the better.

Third is your clothing. Depending on which season you arrive here, especially winter or fall, try to buy a thick coat ahead so you are good to go as soon as you step out the airport. Buying here takes a lot of effort, since you need to go to a store that needs transpo plus your dollars pocket money is bought using your hard earned Philippine peso so, everything here will be indeed pricey.

Fourth, bank deposit. Most banks have a minimum balance of $500 but you can deposit as low as $25 I think as long as you can reach the minimum within a specified time because their is a penalty once you go below it.

Fifth, your apartment deposit. My transaction with my current apartment was not really good like they were thinking twice if I could afford the monthly fee. So, they’ve charged me a monthly deposit plus a security deposit that totaled to $3000+. Thankfully, I received the $2500 relocation reimbursement in time for the payment.

Sixth, if you have a credit card, do not close it yet because it can be a good emergency fund in case you run out of cash in US. Also, debit cards can be used as well here which we were able to use in doing groceries and etc.

Seventh, you can do loans as additional funds. I did a bank loan and SSS loan. I even tried Pagibig loan but time did not permit since there were discrepancies in my account and I needed to fix those first before applying for loan. My thought here is, as soon as I start earning dollars, paying the peso value wouldn’t be that much anymore.

Eight, for food budget, bringing canned goods is your way to go. You get free 2 luggages of 23 kgs so pack as many as you can. You can also bring tuyo or bulad as long as it is properly packed.

8. Stay at Relative’s house

As much as possible, it’s always a practical way to stay at a relative’s house for an easier transition. I did that for 3 weeks in exchange of my 4 days hotel. My ticket was still reimbursed, I just filled out a travel request form.

They weren’t really strict as to the duration I should be with my relatives. In fact, I myself was the one who initiated and keep them updated of the things I did.

So, if you do have some relatives, inform your case manager who will transfer you to the onboarding manager and make arrangements.

Once you arrive in US, here are the 11 things to note:

The post 8 Things to do Before US Departure For Filipino Nurses appeared first on Nurse Germz.

It seems like it was only yesterday that I was preparing for NCLEX and tearfully waiting for a good pop up . I was thirty that time! Three years passed, now thirty three, I’m finally here in US.

2020

I can clearly remember, year 2020 in the middle of pandemic when I got my petition approved, I was having a hard time complying all the documents for Ds260 submission. Almost all of the government offices that time were functioning in only a handful of staffs for less COVID exposure.

The thought of it was like a pause of everything. The most dragging year I’ve experienced, everything seems so slow. When I’ve waited 2 years to take the NCLEX, adding another would seem be never ending.

But who would have thought that in the same year, I’d also be making the most important decision in life—to get married still within my 30-year mark.

I guess for nurses who are in a relationship, planning to get married, bringing your family; any major family decision is necessary and should be part of your checklist. The earlier, the better for a clearer mind and a healthy mental state as soon as you arrive in US.

This got my case 6 months delayed but it was all worth it. I wouldn’t even know how to survive if I flew alone here.

2021

The year I got documentarily qualified was also a significant year for my work in the Philippines. The major project I was on was opening a standalone outpatient dialysis clinic of the hospital. I was too absorbed with it that I had to put the expedite request on hold until it was done. Four months later in May, when I was finally ready to expedite my case, USEM stopped approving requests.

My decision of putting my application aside tormented me that even in just a few months, it was as if I’ve wasted my lifetime opportunity. So, the next time, it comes knocking again, I made sure to be ready. I resigned from my hospital dialysis nurse job. I worked as a full time Virtual assistant to save for my US Visa application funds and at the same time, a dialysis nurse reliever at the side for a continual experience.

For the remaining months, it was a never ending story of expedite request letter exchange to NVC. Four times to be exact. All were denied. The last one I sent was November and I didn’t receive any reply after that.

Did I give up? Nope, it was nearing the holidays so more of like, “I got preoccupied.”

2022

After a year of waiting, I finally got the interview date. I was in a mall, in my scrubs with a pink head. Yes, I was too preoccupied that I excitedly dyed my hair pink for the new year forgetting about my application. Too bad, it didn’t last for a month since I needed to turn it back to its natural color.

The same thing with my interview date, it was a quick turnaround. My supposedly February 11 ID was cancelled and moved to May 20th. 3 months of waiting in agony due to sputum.

But just when I thought I surpassed everything after I got my visa approved and issued, I was in for another yet surprising event.

The day before my flight, I received an email about its cancellation. What happened next?

Obviously, I did resolve it a few hours before the flight. I had to be in that same flight since my dependent flew ahead of me and I had to arrive in the port of entry either earlier or together with him. We had the same connecting flight so I got no other option that time. Thank goodness it was all done.

But was it?

My US Journey

If I get to turn back time to change the things I’ve experienced and struggled during my USA Visa application in the Philippines, I wouldn’t. For those have helped me prepare of the real struggles of what I am yet to face—the reality of an OFW nurse.

And my US journey didn’t end on the day I arrived in the country. It just got started.

It’s been only 3 months yet I can’t anymore count the challenges and difficulties I encountered. Even up to my online memories of friends and families, co workmates. The things I am supposed to be holding on, to where I started, photos, videos but my facebook and instagram account got permanently deleted including my Nurse Germz facebook page with 14K followers. I may sound superficial but in this digital age, who keeps physical photo albums when you can do it online?

And I stumbled upon this verse from Job 8:7,

“Your beginnings will seem humble, so prosperous will your future be.”

God wanted me leave everything behind and start anew. To remain humble because I totally agree, we can get to be a full of oneself of all the experience we had in the Philippines. I, myself for example, when I’ve headed a dialysis unit.

All I had to do and so is everyone else is to trust God. From Jeremiah 29:11,

“For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.”

Now, whatever is happening to me right now, the struggles of being a dialysis nurse here in USA, the never ending reality of shortage of nurses, I know this is part of the plan. I just needed to trust God and let him guide me as I make it through.

Life Reset at 33

On September 9th, the day after my birthday, I was informed of a transfer to a different clinic, 35 minutes away from the apartment. I was on for another challenge.

Any plan is never clear at the start and so is God’s.

I never understood the transfer which was hard to accept at first because I was getting used to the routine of the former clinic. Fast forward today. Almost two months after, the work environment is definitely way better. The staff shortage will always be there but in a whole different work atmosphere.

God pulled me from where he sees me struggling! And that’s what all matters!

The current facility may be temporary as my permanent facility is still closed but whatever happens next, I know God got me!

This is Nurse Germz. Thirty three years of age! Three months as a dialysis nurse here in US driving 35 minutes long to the clinic. (Haha should be included, a milestone for me)

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Come, as I take you with me in discovering nursing career!

The post My US Journey: Life Reset at 33 appeared first on Nurse Germz.

You are now in your most important phase in your US Visa application, the Embassy Interview.

The embassy Interview is somewhat just a formality. They just want to make sure that it is you who’s really be the one travelling there, all your documents are complete and that your employment in US is real. In other words, they want everything set and prepared once you arrive in US. But this doesn’t mean you don’t need to prepare for it.

So, I made a booklet on steps and E3 practice Interview Questions

Print page 1 in one bondpaper while page 2 and 3 in back to back. Staple in the middle and you got the booklet.

Downnload here free EMBASSY INTERVIEW TIPS BOOKLET

Here’s also a video about tips on how to ace E3 Embassy Interview

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Having the chance to enjoy US with my relatives before embarking to the real world of an OFW dialysis nurse is the best thing, one fun detail I want to share is getting to experience their theme dinner meals on particular days of the week.

Today is Thai Thursday, also the no-cooking-for-dinner time since they either buy food out and consume at home or eat out. Well, supposedly but since their fave Thai restaurant is closed for summer, they have to look for an alternative. The chosen one is Indian restaurant, Cafe Masala, so I guess, it’s gonna be a kind of Asian Thursday for today’s dinner.

Cafe Masala

Cafe Masala is their go-to Indian restaurant that gets more full packed in lunch than dinner. It’s been months since they’ve been here so the first thing they’ve noticed is the number of staffs working that mainly consists of the owner and probably the wife only.

But people are willing to wait…

Let alone the planning of theme dinner meals, I can tell that people here are more interested with the experience rather than what the food’s main purpose is–to pacify one’s hunger. Every bite or portion of food devoured is a mouthful of appreciation. Cafe Masala, on the other hand, is the best place for that.

Upon entering, the owner immediately greeted us with a huge smile but with a bit of worry explained by the following words, they are understaff and might take long. As a first time of everything here in US, it’s definitely not a big deal and I am willing to wait for the experience. But for my relatives and the rest, it’s the food, good service, accommodating staffs that contribute to the overall worth-to-wait experience.

There’s not a single chance of not reminding us of their short staff, uttering an apology and saying thank you for waiting every time the owner comes to our table.

Then, a new set of customers arrived, I unintentionally overheard the owner greeting them and informing them that serving of food may take long due to their short staff. The newly arrived diners immediately answered, sure no problem without even thinking twice.

Cafe Masala Menu

Naan Bread

It’s not my first encounter with Indian food and the Roti Canai is one I can brag of, however. It is not in the menu but instead, Naan bread then I later found out, Roti Canai is from Malaysia. (LOL) Both are flatbread, and there isn’t much of a difference in terms of taste but the appearance. Naan bread is indeed flat like thin pizza doughs in pieces while Roti Canai’s size is monstrous and shrinks to flat once you get a piece of it.

Chicken Samosa

Where there is sweet, there must be spicy, and where there is red, there must be green and that’s all I could explain the sauces that Chicken Samosa is paired with. It looked like an empanada from the Philippines. This is the first dish served as the appetizer and it lived to its purpose–food before the main dish or more like a food to distract us.

Funny how our appetite contradicts to our willingness to wait when the owner wasn’t even able to catch a glimpse of it after coming back from a nearby table to check us out just a few minutes after serving it. A triumphant smile radiated the owner’s face while a humiliating one in our side.

Don’t forget to save some dips for Naan bread.

Indian Iced Tea

The whole Indian food experience wouldn’t be complete without trying the Indian Iced Tea. The word, “sweet” is added in the menu but the taste for me is definitely the opposite, not a bad thing ofcourse. The taste signifies the tea’s authenticity along with the spices. And I’ve literally eaten residues, which is from turmeric, for sure.

Beef Biryani

Another familiar dish is Chicken biryani which I might have tasted during my Singapore trip but can’t anymore remember the taste, however. We opted for the Beef biryani since we already ordered Chicken Samosa, so to add variety. The dish is good for two and so I had it shared.

The taste was all too familiar like I have eaten a piece of home since it came with rice. To my excitement of actually having rice part of the meal, I was this close of ordering another still for shared of course but a few seconds before finishing my part, I was full. So, yes the dish is indeed good for two. The dish also resembles Beef rendang which both have curry.

The surprising part was, all these didn’t even reach $40 and those were a lot of dishes and a full blown of satisfied appetite. How else a satisfied customer pays but with a good satisfying tip as well.

That’s all for now. Join me in my journey of blending in with the Americans. Till my next foodie venture!

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Free download of NCLEX resources to Nurses who are about to take the exam, those who are still planning to and most especially those who failed and will take again.

I passed the NCLEX three years ago. I took it twice and I am paying it forward. The current batch of nurses who are processing US application as of the moment is unbelievably fast and most have flown to USA in just a matter of 6 months.

I am part of the earlier batch and the journey has not been that smooth and swift but I am happy that US opportunities for Filipino nurses is getting more and more improved. So, I am giving free download of the basic three resources that worked and helped me pass NCLEX the second time.

Retaking the Exam

For retakers like me, you may have failed the exam but good news is, you’ve passed the first time jitters. Take it as an advantage. You’ve already been to the examination area, you’ve been exposed to the whole process and on top of that, you’ve taken NCLEX itself and that’s one less thing to worry about.

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What you should do now, is to prepare in a whole new different approach. Since whatever you did last time, unfortunately, it didn’t work.

Kaplan NCLEX-RN Prep

Free download Kaplan NCLEX-RN Prep

The first book (it’s actually PDF) that I read after failing the exam was Kaplan NCLEX-RN Prep. Treat NCLEX as a battle and as they say, “To win, Understand Your Enemy” and Kaplan can help you with that, to get to know NCLEX more.

I tell you, I was way more confident after going over the whole book. It is divided into 5 parts. The first part is all about NCLEX-RN Exam overview and test taking stragies. Second is Content review and Practice. Third is The Practic test, Fourth, the Licensure Process and the last part is NCLEX exam resources. It’s like a walkthrough of the entire NCLEX and not the typical book about diseases, treatments and the nursing process because it discusses the content according to how NCLEX is made.

Mark Klimek

Free download Mark Klimek Lecture Notes

Listen to Mark Klimek Audio here

The second resource I used was Mark Klimek. He discusses just the principles that can be applied to all other diseases and treatments. This is exactly what you need. It is an audio recording that comes with its corresponding notes that contain blanks where you fill those out while listening to the discussion. He can definitely assure you that you need not study all the diseases because his discussion and notes are enough and you’ll be amazed yourself.

Uworld

Free download Uworld Qbank PDF

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Once you are familiar with the NCLEX blueprint by Kaplan and the principles by Mark Klimek, it’s time to do some practice tests. Uworld is like the closest thing to NCLEX which is even harder than the actual exam. It’s a good way of setting your midnset so that in the actual test, everything will be just easy peazy.

LaCharity Prioritization, Delegation and Assignment

Free download LaCharity Prioritization, Delegation and Assignment

Prioritization, Delegation & Assignment type of question is the most reliable indicator that you are more likely to pass the exam. It’s not the SATA because SATA can still vary from easy to difficult type of questions.

Prioritization, Delegation & Assignment is like the terminal type of question and once you’ve reached this part, you’ve proven that you are equipped with the nursing knowledge and now, you are on the process of applying your critical thinking skills.

Dealing with Exam Anxiety

The last thing you need to deal also is exam anxiety. Despite having the advantage of experiencing the exam, anxiety is always there, this time having the fear of failing it again. So, find anything that can help divert your anxiety while preparing for the exam.

After using all 3 resources and fighting my anxiety, I passed NCLEX in minimum 75 questions in 2 hours last 2019, 3 months after I failed the exam.

Now, it’s your turn. Sending you my advance Congratulations!

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Performing a heparin free dialysis procedure can be a daunting task especially if it’s your first time so how much more if the facility you are currently in is using a dialysis machine that might not be a heparin-free friendly. Fortunately, I’ve got a video for that to make it easier for you but first, here are things you need to know first about.

What is Heparin Free Dialysis Procedure?

From the name itself, this does not involve the use of heparin, instead, it will be all about intermittent saline flushes. Depending on the facility’s protocol usually, it’s 50cc/15min.

Heparin Free Dialysis Procedure Indication

This is indicated for patients who are at risk for bleeding therefore, heparin is definitely a no-no. If you are working in a hospital setting, this is a common thing for first time patients during their first few dialysis sessions.

However, you can also encounter this in a regular or typical setting for patients who have low platelet, who have incoming surgery or who are post-op.

Risk for clotting in dialysis circuit

The challenging part is, heparin free dialysis procedure increases the risk for clotting in the extracorporeal / dialysis circuit. But, of course there are always ways to prevent that. One is a priming heparin bolus, don’t worry the heparin will be only circulated within the bloodlines. Another is rinsing the dialyzer and bloodlines in the middle of the session especially if patient is in SLED that takes around 6 hours.

Now let’s go straight to how we are going it. Here’s a video focusing on intermittent saline flushes in both Bbraun and Fresenius machine.

Hope this post helps. To familiarize more the Fresenius dialysis machine, here’s how-to priming and setting up Fresenius 4008s. You can also checkout my Youtube channel for more videos of dialysis and my journey in discovering nursing career.

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