jaypee88

Hi. I am an ER Nurse in Queens NY. I want an opinion from my fellow Nurses regarding this letter or mine to my Clinical Nurse Manager. The letter goes like this; October 22, 2008 The goal of my letter is to know if patient's safety was compromise and to enact future policies that would address future occurrence and also to enlighten the undersigned some policies regarding the assigning of patients to each areas in the ER. Last Tuesday night during my night shift duty, I was assigned at Area 2 with my attending MD. After the shift change, I noticed that my attending was busy with a critical patient's transfer to another hospital. This was concurred by Charge Nurse who told the undersigned that MD spent about 4 hours just to send the patient to another hospital. During that period the following was my patients and a little story about what is happening to them; 1.Patient A - patient came around 7:30pm brought by ambulance, EMS gave the following meds, epinephrine x 1, solumedrol IM 125mg, and albuterol + atrovent x3. EMS failed to get a line form the patient. A report was given to attending and ordered MG Sulfate 2grams and Solumedrol 125mg IVP. Line was made and meds given IVP. After 1 hour there was little improvement and nebulizations were given x 8. During this period there was little improvement on the patient. Luckily patient was never intubated , was given to admitting for admission around 5am. Patient was sent to room around 7:20am at the end of my shift. 2.Patient B- 83 old female admitted to MICU for respiratory failure on bi-pap at 60%. Patient was transferred to MICU around 2AM. 3.Patient C - female admitted to telemetry with a diagnosis of CHF exacerbation. 4.Patient D- 38 year old patient admitted to telemetry with diagnosis of hepatic encelopathy, with troponin of 0.63 and was put on cardiac monitor. 5.Patient E- patient with uncontrolled HTN came with systolic pressure of more than 200. Patient was eventually d/c around 4am after BP stabilized at 140 systolic. 6.Patient F - female patient with complaint increased BP and headache d/c around 4am after negative CT of the head. 7.Patient G- a patient with c/o of severe abdominal pain RUQ, medicated with morphine 4mg who was d/c around 4am. 8.Patient H- patient came around 11pm c/o of R leg pain with redness and itching. Patient eventually admitted with diagnosis of R leg cellulitis after waiting for 4 hours to be seen. 9.Patient I - Mentally challenged patient with c/o of runny nose, fever. Patient was seen after 3 to 4 hours. ABT zosyn given. Bp dropped and was given 1 Liter of NS. For reevaluation 10.Patient J - Male patient came with c/o of right groin pain. Sonogram done in the am, sent home around 6 am with Augmentin 875mg BID and with diagnosis Right Epididymis. 11.Patient K- Female patient with complaint of asthma attack. Nebulization given with albuterol and atrovent x 3 sent home with MDI pump. 12.Patient J - patient came ETOH with back pain, refused treatment but otherwise stayed in the ER and went home after 7am. 13.Patient K- patient came around 5am with c/o of increased BP medicated with clonidine 0.2 and procardia XL 30 MG. 14.Patient L- Male patient arrived around 4 am, c/o of abdominal pain. Labs sent and was seen two hours after patient came. During that period of shift the question is was there a time that patient's safety was in danger considering the following; A.All the admission, including the MICU and two telemetry was being monitored by the nurse in charge of the area. B.The attending MD was busy with a critical patients transfer to another hospital. C.The attending MD appeared to be very tired of the work, was seen by other MD's and also this writer to be falling asleep during writing of orders and deciding who is to be d/c and to be admitted. D.The d/c of where done after this writer informed the nursing supervisor that there was backup of so many patients to be seen and re-evaluated and an intervention was made. E.The help from other nurses what limited to blood draw and faxing of nurse to nurse report. The charge nurse at that time was the finest among the four charge nurses in the Emergency Room. Unfortunately, she was the only one present that shift and the other senior nurses who should have behave professionally and resolved the problem did not do anything to alleviate the problem and was contended in helping blood draw which an elementary skill for nurses. I hope and pray that my letter would be addressed and I am willing to sit with anyone to plan and implement a corrective action that would improve the assigning of patients based on patient's acuity. :argue:

I got my CES report recently. It took CGFNS people to evaluate my documents in 7 weeks after they have receive my license from my country. My countless follow-up with a combination of endless e_mail and phone call and several encounters with unproffesional costumer service resulted in 7 weeks of waiting time. Luckily I am in United States right now that I was only calling their office via domestic calls only. Imagine you are outside this country and trying to get in touch with them. If there are rude costumer service there are also good people at CGFNS. A certain Brian was very polite and accomodating. He help me and my wife with the report. As for those people who have not got their report yet here is my advise to you; 1. Never be afraid to call their costumer service and demand for your report to be finished in their prescribed time. They promise 4 to 6 weeks and so be it. They should finish the report as promised. 2. Send them e_mail eventhough they are not responding. I was able so send them at least 50 email. I got no reply. 3. Do not lose hope. We are doing this thing because we want to be legalized here in the United States. Other people goes here in this country and remain illegal. We Nurses follow the law. GOD is with us. 4. And last is whatever your religion is, I advise you to pray. Pray that someone above will intervene and make it possible. :)

Hi guys. Just want to know from you guys out there about your experiences with CFGNS CES. It has been 5 weeks and 3 days since we have completed our requirements and still no report as of the moment? I need some questions for you to answer. 1. How many weeks exactly when you guys received your report form CGFNS? 2. If your report comes out after the prescribed period of 4 to 6 weeeks. What was their reasons for the delay? Thank you and I will appreciate it much if you would reply soon. Jaypee

Dear Carvanaragon, Congratulations! That is really fast. We hope we can duplicate what you guys have done. From where are you? We are from Parañaque. We really want to communicate from you guys. What's your e_mail address? Mine is [email protected]. We need people like you to enlighten us from time to time. Lots of people give us ideas, but their's are not verified and misleading. We only need informations that are correct and verified to guide us. During those processing you undergone, have you ever use an agency to help you? What agency did you use? Would you suggest one? Thanks and again congratulations. John and Mariel

Dear Suzanne4, We are really happy that you guys are replying back to my post. We are very much gifted that some people we did not even know have time to guide us in our quest for better opportunities away from our country. We quess we have to really slowdown a little bit. About those English examinations. We are planning to take IELTS examinations this coming April. Right now we are reviewing for the June local board examination and we are enrolled at Kaplan for NCLEX review. Would you suggest IELTS or TOEFL for Visa Screen Certificate? Again, thank you guys for the reply. You are all angels to us. John and Mariel

carvanaragon, Thanks for replying. Maryland Board of Nursing(MBON) does not require us to be licensed in our country in order to qualify to take the NCLEX examination. We have written them about this matter. We are really in a hurry to take the NCLEX examination for us to join a Novice Program in one of the Hospital in Maryland. The program will start this July 2005 and our local board(Philippine Licensing will take place this June 2005. John and Mariel

Dear Suzanne4, Thanks for replying. We really appreciate it much. We will be graduating this March 2005. I have read your reply and it was very informative. There is one thing I want to you to enlighten us and that is on local licensing requirement.You know we are really in a hurry to be employed in the US as soon as we graduate. We have been in a communication with a hospital in Maryland and that they have a Novice Program this comning July 2005. Per requirement of the Maryland Board of Nursing , they don't require us to be licensed in our country in order to take the NCLEX examination. If they don't require us to be license , I assume that CGFNS CES will also don't require us to be license inour country in order to be evaluated. We are really in a state of confusion whether we would take the local board examination(Philippine License) that will take place June of 2005. It will be too late for us take advantage of the Novice Program our hospital(Maryland) is offering (July 2005). Again , the information I want to solicit to you is that can we get a Visa Screen Certificate even if we dont have a Philippine local license? Thanks and God Bless. John and Mariel

Thanks for replying. ILA-OPI means This is from Maryland Board of Nursing: Graduates of any other nursing school MUST demonstrate oral English competency by passing an oral English examination. The Maryland Board of Nursing accepts either the Oral Proficiency Interview administered by Inter-American Language Associates (ILA OPI) with at least a score of 3, or the Test of Spoken English (TSE) with at least a score of 50. The Board does not accept the Test of Spoken English as a Foreign Language (TOEFL), MELAB, or the IELTS for the purpose of meeting this requirement.

January 10, 2005 Hi, We are graduating Nursing students from the Philippines and we plan to take the NCLEX examination at Maryland this June 2005. We are holders of multiple tourist visa. We have received already our RN-NCLEX application packet from Maryland and we are just waiting for our transcript to be released before we can start processing our papers. We have an immigration lawyer already that will help us. A hospital is already waiting for us to be fitted in their latest Novice programs. Per requirements of Maryland Board of Nursing there are only several papers they need in order for us to be qualified to take the NCLEX examination and the following are: 1. CES evaluation 2. TSE or ILA-OPI 3. ATT When we asked the intended hospital for requirements before we can be admitted and sponsored, they said that they just need MD RN Licensure. I believe that in order for us to work and be legal is that our lawyer must file a change of status for us. 1. The question is, do we need a Visa Screen Certificate before our lawyer can process our papers? 2. Can we file a Visa screen certificate even if we are only graduating students? 3. Is a local Philippine License a pre-requsite to a Visa Screen Certificate? 4. Do you think we have to clarify this matter thoroughly with our immigration lawyers? Many thanks. John and Mariel