gaslinq

:nono:Hi there. Congratulations on passing your USMLE requirements. However, I do have to disagree with you about your attitude towards ADNs vis-a-vis your perceived lofty BSN-RN-MD status. I noticed that you are not a "second courser" but rather had BSN as your pre-med which certainly differentiates you from the other MD-RNs out there (myself included). While I can understand your frustration with the system , I would like to caution you about being too vocal about your complaints and to advise you from flaunting your (hard-earned, I'm sure) higher education and looking down on those whom you feel are less credentialled than yourself. Your MD degree means nothing now since you are in a different field. It is your skills and nursing degree which matter now. I found that out the hard way. Believe me, I have a kilometric CV which I thought would knock potential employers off their feet and send them scrambling to hire me. It would, if I were applying as a physician but since I had no nursing experience, no one has hired me up to now. If you want to prove yourself as being "better" than the locally-produced ADNs, take further studies. There is an MD/RN-to-MSN program being offered by a reputable university in the US (PM me if you want the details).Find employment in the field of Nursing education. Or work on your intern-matching. Improve your CV by working on your research component (PI graduates are sadly deficient in this). I am an NP graduate and in one of my classes I had to shadow a Family Nurse Practitioner for a day. The most valuable lesson I learned from her (Thank you, Lynn,from Menomonee Falls, WI) was that first and foremost, a Nurse Practitioner is a NURSE and Nursing means caring. Although I am still in the medical field up to now, I feel that my nursing training has helped me to become a better doctor. Whichever field you will end up choosing, please make sure that your second degree complements and benefits the first one. And please, bear in mind that continuing to have a chip on your shoulder and manifesting a superior attitude at work gives MD-RNs as well as Filipino nurses a bad name. Suzanne, I apologize to you in behalf of my compatriot. You have been a fair and compassionate moderator. The fact that you reacted sharply to the previous post shows that it is a very important issue to you and that you have been profoundly affected by it. It is your reaction that prompted me to break my long silence and comment on this issue. Best regards.

You can take the NCLEX without the SSN but the California BON will not release your license until you have a SSN. They may ask you to explain in writing why you do not have a SSN and you can say that you are not yet legally entitled to have one.You do not have to take the NLE in order to qualify for the NCLEX. You may also have to explain in writing why you are not licensed but you can always say that you haven't taken the exam yet or that you do not intend to practice nursing in the country. As for the fingerprint card, you may be able to get one at the US consulate in Waterfront Hotel, Lahug. Sometimes they run out. They may ask to see your PRC ID before you can enter the consulate. You can have your fingerprints taken at the NBI office near the Capitol building. Hope I was able to help.

Hi! Same thing happened to me a few years back. The hospital had a change in administration and decided to rescind all job offers (something to do with preferred agencies) after approval of my I-140. Don't feel bad, you're not alone. After all, it's their loss. They're losing a good worker PLUS the attorney's fees and processing fees that they invested for your visa.

Thanks for the prompt reply. I guess I have to go back to the drawing board and look for another employer. I should have clarified about the visa number. I know I don't have a visa number yet. I meant that a visa number was available, otherwise, the I-140 would not have been approved. You're right, the hospital probably did not pay the visa bill which is why the Packet 3 never arrived. However, the law office never informed me about this.

I have seen one episode of Lidocaine toxicity and ,believe me, it was catastrophic, to say the least. It is not advisable to give more than 7 mg/kg of Lidocaine at one time. Epinephrine can be added at 1:200,000 concentration to delay the systemic absorption of the drug and at the same time, to be able to easily detect intravascular absorption (there will be immediate tachycardia). As jyk said, peri-oral numbness as well as a metallic taste are usually signs of impending toxicity. CNS toxicity is manifested by restlessness, tinnitus (ringing in the ears) and more often than not, is mistaken as inadequate anesthesia, leading the person performing the procedure to ADD more anesthetic, aggravating the situation. One must never perform procedures under local anesthesia without preparing for the possibility of such a reaction. It is unfortunate that more and more procedures are being performed in settings where there are no equipment available for airway management and cardiac resuscitation as well as trained personnel.

Dear Suzanne, I don't quite know where to post this since you are in so many forums (I mean that as a compliment to your dedication). Anyway, I have a bit of a problem. I was in the United States in December of 2004 to look for an employer and file for adjustment of status since I had all the requirements ( NCLEX-RN, visa screen). I posted my resume online and was contacted by several prospective employers. The one that I was particularly drawn to was a very nice lady who quickly got me an interview with a hospital in Northern California which immediately gave me a job offer and even facilitated a tour of their hospital. Anyway, retrogression set in on January 2005 so I was advised that the best option would be for me to return home and go through consular processing, which I did. The agency as well as the law office were very efficient and accomodating. The I-140 was approved in June 2005 and I already had a visa number. My papers were sent to the National Visa Center and I was told to await Packet 3. Last month, I was informed that the hospital had a new director of recruitment and that she was no longer honoring job offers tendered by the previous director even though the hospital had already spent for the I-140 processing as well as the lawyers fees. The agency as well as the law office tried to reason with her to push through with the paperwork since we were already so far along in the process, to no avail. What should be my next move. I'm afraid that, since the I-140 is practically invalid considering that the sponsor has backed out, I will have to start from scratch. I feel that it was such a waste of time and effort on everyone's part. If I had stayed in the US and filed for AOS, I would have had my green card by now. I also feel bad that I had turned down SO MANY job offers including one that I really liked because the people in the agency, hospital and law office were so nice and accomodating to me. Now, I feel awkward about approaching these prospective employers again. Is there any way that I can continue the process with a new employer? I am normally very level-headed but right now, I am still reeling from the shock. I would really appreciate any advise from you. You have been so helpful to everyone here.

Congratulations, REP! Of all the people on this board, you are the one who are most deserving of your good fortune. Your optimism, fortitude, perseverance and willingness to help others with their queries and concerns serves as an inspiration to all those who are undergoing the same process. This is just the beginning.You and your family will be embarking on a journey which will sometimes seem daunting but your positive attitude will surely pull you through.Best of luck to you and your family.

I took the GRE last year 21 years out of college and scored 1200. There's nothing to be afraid of. Unfortunately, I couldn't get into CRNA school due to some technicalities despite my extensive experience and high GPA/ GRE but I'll keep trying. Don't give up.

Remember that when intubating a live patient, most of the time, you will be giving a full-dose muscle relaxant unlike with a mannequin. It's more of technique than strength. Take your time, find the right table height that works for you, position the patient so that the oro-naso-pharyngeal access is ideal, use the blade that you are most comfortable with and it should not be difficult for you.

It seems a shame to already have the epidural in and not use it during the procedure. Yes, you can give anesthetic through the epidural catheter and thus decrease the need for volatile agents. The key word here is TITRATION. Since you already have a working epidural, you can use less concentration of the volatile agent and since you already have a volatile agent, you can also decrease the volume and/or concentration of the epidural agent . You can also use low concentrations of intravenous agents like Propofol without the corresponding need for high dose narcotics since analgesia (and muscle relaxation) is already provided for by the regional. For hip surgery, though, I would think that a purely regional technique should be enough unless the patient needs airway support for positions other than supine. Combined regional/general technique is more suitable for upper abdominal procedures wherein a purely regional technique may require such a high level as to compromise the patient's ventilation and cardiovascular function due to the sympathetic blockade while a purely general technique would deprive the patient of the pre-emptive analgesia and excellent post-operative pain control provided by an epidural catheter.A combined technique will not only assure a good airway and ventilatory support but will also enable one to use a lower concentration and volume of local anesthetic preventing a profound sympathetic blockade. However, as with combined/spinal epidural (see separate thread regarding this), the use of both regional and general techniques exposes the patients not only to the benefits of both but also to the RISKS inherent in both techniques. Therefore, do not attempt to use this technique unless you are adept and managing the complications and/or side effects of both regional and general anesthesia.

I have been doing CSEs (combined-spinal/epidural ) for about 6 years now and I love the technique. Advantages include: 1) immediate onset (this would be a great boon to labor patients); 2) ability to control the level when using hyperbaric solutions (great for labor, orthopedic, and perineal surgery ); 3) less risk of toxicity since you avoid the large volume of local anesthetic needed to get an epidural going. Disadvantages are mostly related to the fact that there is a dural puncture ,i.e., risk of infection, postdural-puncture headache (although unlikely since the spinal needle used is G27 or higher). I have never encountered a case where the catheter was inadvertently inserted into the subarachnoid space through the dural puncture but theoretically it may occur (although how an 18G catheter can enter a 27G puncture is hard to imagine). The operative word here is combined. I like to give just enough anesthetic (0.5-2 cc) through the spinal to get a low level of block then increase the block height by using the epidural. This can be really beneficial in the L&D area when the surgeons are itching to get started. You can give just enough spinal anesthetic for them to catheterize and prep the patient for C-section without inducing hypotension , then give the rest through the epidural. By the time they start cutting, your anesthetic will have set in. Another advantage is that you get the motor block and good muscle relaxation from the spinal plus the post-operative analgesia that can be given through the epidural. Remember ,though, that while the technique may have the benefits of BOTH spinal and epidural it also carries the RISKS associated with both so don't try it until you are proficient with BOTH techniques

You can get your California Board of Nursing application online at www.rn.ca.gov. Fingerprint cards can be obtained at the US embassy in Manila or your local consulate and you can have your fingerprints taken at your local NBI office. It will take about 4-6 months before your ATT arrives. Then you can schedule your exam with Pearson-VUE. The problem with California licensure is that once you pass your NCLEX, you have only one year to get your license and you NEED a Social security number to get your license. If you cannot satisfy the requirement for licensure within that year, your application will be considered abandoned and your files destroyed. With the new retrogression policy of the US State department, it will take years before you can obtain work authorization (needed for social security number) so it would be next to impossible to get your licensure requirements within one year.

I agree with Suzanne and Rep that nurses from the countries affected ahould not get discouraged and just go ahead with their processing as if the visa rules did not change. Many of my friends who passed the December nurses Board exam in the Philippines are reluctant to file for immigration because of the new rules but I keep telling them that this reluctance will only delay them more. Waiting for the rules to change will not accomplish anything. If you file now, then you're one day ahead. Keep your hopes up.

I recently took the TSE and got a 50. I think the problem is that people tend to spend time thinking of the "correct" answers to the questions. The secret is NOT to concentrate too much on impressing the examiners by getting the "right" answer but on impressing them by answering clearly enough for your words to be understood no matter WHAT your answer is. Don't speak too slowly and deliberately though. It may sound as if you are reading a scripted answer and that is definitely a no-no. TRY AGAIN AND GOOD LUCK THIS TIME.

As far as I know, the temporary license is issued when your application to take the NCLEX exam is approved by the Cal. BRN. Once you pass the exam, the temporary license (interim permit) expires. So, since you have already passed the exam, your interim permit (if you applied for one) is no longer valid. Regarding licensure verification, I believe Suzanne answered the question when she said that Cal. BRN cannot send licensure verification if you are not licensed. You should choose the ICHP verification. That will satisfy the ICHP requirement for "licensure verification from state board" as well as "passed CP/ NCLEX exam") I hope I was able to clear things up. If you want to know more, just post your email address and I'll send you a PM.

Dear Suzanne and Sophiesylvie, I'm sorry for the misunderstanding. I meant that you can request California BRN to send ICHP verification of your having passed the NCLEX-RN examination and not license verification. You can request that by phone or by mail. They will require you to send a copy of the letter to then (BRN) as well as your candidate reference number and a small fee for mailing expenses . This should take less than a month. Suzanne, you have been so helpful to everyone on the site. I take my hat off to you. The whole immigration process is so convoluted and difficult to understand for foreign nurses and it's good that you are around to guide us. More power to you

Dear Suzanne and Sophiesylvie, I'm sorry for the misunderstanding. I meant that you can request California BRN to send ICHP verification of your having passed the NCLEX-RN examination and not license verification. You can request that by phone or by mail. They will require you to send a copy of the letter to then (BRN) as well as your candidate reference number and a small fee for mailing expenses . This should take less than a month. Suzanne, you have been so helpful to everyone on the site. I take my hat off to you. The whole immigration process is so convoluted and difficult to understand for foreign nurses and it's good that you are around to guide us. More power to you

dear Sophiesylvie, ICHP will not accept documentation that does not come directly from the California BRN. Please try to call or write the California BRN to request them to send said documentation to ICHP. I believe they charge a fee for this service.This will then satisfy two requirements for the visa screen, namely "license verification from state" as well as "passed CP exam" . I hope I was able to help. gaslinq

dear Sophiesylvie, ICHP will not accept documentation that does not come directly from the California BRN. Please try to call or write the California BRN to request them to send said documentation to ICHP. I believe they charge a fee for this service.This will then satisfy two requirements for the visa screen, namely "license verification from state" as well as "passed CP exam" . I hope I was able to help. gaslinq