Background: Dialysis Nurse hired by a dialysis company year 2019 with 3 years of contract in exchange for green card visa sponsorship. I plan to write about my dialysis nurse journey separately so this blog would focus more about the things most immigrants working in the healthcare field undergo in general.
Disclaimer: All the things narrated here are based on my actual experience. It is not made in affiliation with any company or whatsoever.
It’s been a good three years since I arrived in the land where dreams are made to happen – United States of America. It has been a roller coaster ride since then – so much so that I wasn’t able to blog in the past year – that, and the advent of the pandemic. So I’m here just gathering my thoughts from overwhelmed emotions of how time flew and of how I was able to survive the contract.
Ever since I blogged about how I passed the NCLEX and how I processed coming here to the US, I’ve been getting random questions about what to expect when you start working here.
Well, to be fair, not everyone have the same experience. Plenty of factors affect it. Obviously, it depends on how you adapt as a person, who you are coming here with, who your workmates are, your support system, and your lifestyle. Although I have had experience working abroad prior to coming to the US, I still felt lost initially as they entirely have different practices that you got to follow. The nursing concept will always be the same but the execution of interventions would sometimes vary.
So few terminologies that you need to know. You may be assigned to a Chronic or Acute setting. If it’s in Chronic setting, you get regular patients coming to treatment on a set schedule. If it’s in Acutes, you treat patients admitted in the hospital. Basically, chronic makes you more familiar with people and patients you work with whereas acutes are always a new face.
Depending on your company rules, full time status means working 32-40 hours per week, typically 12 hours a day, 3x per week. Part-time means working 20-24 hours per week, 12 hours a day, 2x per week. PRN means “as needed” which has a payscale tier. You get PRN 12Hours per month, you get paid less. You get PRN 32Hours per month, you get paid more. So it’s all up to you.
In my case, I was assigned to a Chronic setting as a full time employee and later on, I applied as a PRN employee on Acutes as a second job (’cause we hustle like that!).
So to begin with, first year. 2019.
Very excited to work! Although I remember being stumped by the onboarding process. I arrived January 25 but didn’t start working until February 19 because of the onboarding process. It is a basic initial hiring step that allows employers to do a background check on you. I came from a far flung province in the Philippines so it really stressed me out when the verification team came back to me and informed me that they couldn’t get ahold of anyone from my previous employment references. From then on, I learned to always give the HR/Admin and my references a head’s up every time I apply for a position just so they would check their emails or pick up a random international phone call middle of the night. I find it better to always use my closest senior as a reference over the busy supervisor. Took me a week to sort it out but that’s a tip!
Before I was allowed to train on the floor, I was asked to come at an earlier date to have my blood drawn and do basic tests like Ishihara test (color vision test), mask fit testing (especially now that most places require workers an N95 mask), and turn in my vaccination records. If you are like me who grew up in the Philippines and knows well that we are mandated to take all the shots since we were kids but don’t know where to find your records, just mention what you think you already have shots for so they could do a serum test and look for antibodies to confirm you already have immunity to it. The basic thing one should always mention is a history of receiving BCG shot. This is the Anti-TB vaccine that most Filipinos get due to the rampant cases that we have in the country. Most of the time, we react to TB skin tests and would likely be required to answer a questionnaire wherein we state that we did get the BCG vaccine when we were young. Or if you did take TB-medications in the past, this is where you place it in detail as well. In addition to this, you might be asked to get a most recent chest x-ray just to be sure your lungs are clear.
Finally on the treatment floor but wait! To make sure all staff follow standard practices, employers would require you to take online classes on top of your orientation week. In most cases, these classes are followed by quizzes which depending on your institution, would either determine your training length or employment status. It varies but for starters, try passing the quizzes. Most of them would allow you to retake it until you get it right. The thing with these online classes and quizzes is that, they are painfully long. Took me almost a month to get done with everything! Also, they are recurring. Meaning, you can get done with a module this month and get assigned with a new one the next month. It’s the health system’s way of ensuring that you are up to date with the latest health and company updates. In a hospital setting, there might be skill checklists that you need to undergo quarterly like CPR renewals or verbal intervention classes but all of these will be incorporated with your schedule and will be made available at no cost.
In a perfect setting, you should be able to train until you are ready but in a healthcare setting, there might be a skillset that you won’t be able to do hands-on until the situation presents itself. An example would be troubleshooting a certain machine. If the machine never acted up during your training with a preceptor, then all you have is a manual on how to fix things and try not to panic when you’re by yourself already and it suddenly breaks down on you. The good thing is, if you’re new, most colleagues will be willing to help you and walk you through troubleshooting.
When I was hired, the job title I signed up was for a Charge Nurse position. I wish I knew what I was getting myself into because the training alone made me doubt about coming in the US. During processing of papers, we’re always quick to say “Okay” just to get the job but seriously, we should make it a practice to know what we’re getting into. As always, there’s the diversity of the staff, from attitude to experience to nationality. Initially, I have to prove myself to people I work with for them to trust and respect me whenever I delegate tasks. It won’t happen overnight but it will eventually happen after a couple of arguments and push backs. We all know how to treat newbies, don’t we? Then there’s the patients. I started in a chronic clinic setup so my patients are regulars. They’ve been receiving treatments in the same clinic for as long as I’ve been a nurse and they know how to observe best. They can tell when you’re nervous, when you’re new to something, when you’re slacking, or when you’re not providing your best care. Hey, really couldn’t blame them, it’s their health after all. Some rude patients have seen me cry on the spot, the non-compliant ones have seen me stern, and the rest have just witnessed me slowly getting molded into the job description. The best advice I could always give is to keep your cups half-empty. Regardless of how experienced or knowledgeable you think you are, there is always something you don’t know. Always take the initiative to learn and don’t be afraid to ask no matter how dumb you think the question is. Your license is at stake every single day that you clock in so make sure you are doing the right thing.
It was a cycle of learning and getting comfortable with the job during my first year. It took me 6months before I finally got comfortable with my job and resolved to finish the contract. Not going to lie, I was low-key saving for a breach fee because I really was doubtful about myself. All those times I run to the restroom to cry, I couldn’t help but think about quitting and packing my bags home. I remember always saying, being in America is like putting a kid in a battlefield and all of a sudden that kid is expected to be their own adult – it’s scary.
Second year, 2020.
The advent of the pandemic. Well, it was called CoVid-19 but it wasn’t until first quarter of 2020 that it became a global threat. Just when I was getting comfortable adjusting to the US and my job, a pandemic hit. Great! I was out and ready to explore a second job outside of the chronic setting but with vaccines and mode of transmission being on the early stage of research, I took a pause and just continued working on the same job. Surprisingly, I am on my 2nd year and it was actually not that bad.
Eventually, I got along really well with all of the staff and patients. It’s different when you’ve established a good quality rapport — work won’t feel so heavy.
The people you work with could make or break your day. I was blessed to be part of a team whose teamwork is legit. Sure, there are tiny problems we deal with but we always try to reconcile and put patient’s best interest first. Many times, as a Charge Nurse, you become a factor on how you shape your team. You must delegate strategically and try not to be biased with whoever staff you’re close with. Similarly, you must also be able to help them when they badly need a hand on busy days at work. I learned that regardless if you’re the leader of the group, you should still be able to do basic tasks. I try to help whenever I can and whenever I’m not swamped on paper works even if it’s just disinfecting machines, throwing the trash or pushing patients on wheelchairs.
One thing I learned though is that, unlike my Filipino co-workers back home, I can’t hang out right after work with my colleagues here. Most of them are tied to school and family responsibilities after work and the single me would sometimes find myself coming home to a glass of wine by myself. Friends and family from overseas keep me entertained, though. That, plus the quick travels and sight-seeing from neighboring states. You have to do what keeps you entertained to keep you away from sadness and that’s exactly what I did.
If there’s one thing I took advantage of that year, it’s the extra shifts. The good thing about being employed by a big company is that they have branches everywhere which is always in need of a nurse. There’s always an offered extra bonus $$$ when you sign up for it so I did that on couple of nearby clinics. I was gearing up my savings for my own apartment and a new car. It’s true what they say, if you just have the patience and perseverance to work more here in America, you’ll be rewarded accordingly.
And oh, you get yearly evaluations on your work Anniversary. In my work place, I get to sit down with my direct supervisor and we discuss how the year went – what I accomplished, what needs to be improved more. Along with this comes your pay scale adjustment. This is when you can ask for an increase especially if you know you performed well. But this is also when they’ll offer you more tasks and/or promotion. Keep in mind, sometimes higher pay entails bigger responsibilities.
Third year, 2021.
Second wave just ended and the pandemic began to slow down. I was finally able to find a second PRN job. PRN meant as needed basis. I could work anytime I want so long as I am free but the disadvantage is that you don’t qualify for the benefits of where you PRN at. Before I applied, I went back to read my contract with my current company and made sure that there’s nothing that says I’m not allowed to do another job. This generally shouldn’t be their concern but I just wanted to make sure. I was wanting to work another job with a different institution to get better comparison on how chronic and acute setting work here in the US. At this time, I honestly wasn’t just after the pay. I was planning my next move after I finish my contract. I’ve had a lot of friends who weren’t able to finish the contract and instead opted to pay their breach and worked at another hospital but I really don’t want to spend a huge amount of money. Everyone does things differently so you have to go with whichever you’re comfortable with. I wanted to plan things so that was my strategy, put one foot in the hospital to see if I like it and if not, maybe I’ll just continue working for my current company and try tackling higher positions.
It was a different environment in the hospital setting. You get more help from co-nurses and the workload, particularly paper work, was honestly not heavy as the chronic setup. But like any other jobs, there are pros and cons. One thing is that I am no longer used to doing on-call and night shifts. Another is it took me some time to get along with plenty of machines and equipment. It’s a new level of learning and while it’s always stressful to adjust to a new job, I was thankful at that time that I got to experience it. Let me know in the comments below if you wanted me to do a more detailed blog of the comparison between acute and chronic dialysis setting.
But to continue, the biggest challenge is balancing the schedule and your sleep hours. Nurses typically work 3x/week, 12hours/day here in the US. I thought I would be able to use 2 out of my 4 off days at ease and dedicate it to working PRN on a different institution. Until I realized how tiring it was. I initially worked 2 jobs 5 days in a row for months and saw myself picking up less shifts as time goes by. It was tough. I hear and have met Filipino nurses who never takes a day off in a week and I just don’t know how they do it. I couldn’t help but applaud them. I’m young and on my early 30s and I am always tired. I’m being a typical millennial Tita, I guess.
So what have I learned in this period of my career?
The more you work, the bigger your tax is! Factor the fact that you’re single. Married nurses with dependents coming here are cool with the taxes but for someone single like me? I always end up saying, “This is what I hate about ‘Merica!”
Work-wise, chronic setup was becoming a routine to me and I do like the challenge (and pay) that acute setting offers so it wasn’t that hard to decide on how I want to proceed with my career after my contract ended. My advantage is that for the three years that I’ve stayed, I developed the confidence that I know the chronic setting well enough to be able to work in various clinics on different States. In addition to that, I didn’t have to pay any breach and I got good reviews from my bosses knowing I served the time asked of me.
There were definitely a lot of times when I wanted to quit but everytime I think of how close I am to finishing it, I give the thought a rest and just focus on getting my job done.
Unlike other countries who only petition strict employment visa, majority of the nurses who enters the US through an employer is granted a Licensed Permanent Residence status. It’s also called the green card. You get this card typically within a month of your arrival here in the US. Unless stipulated in your contract, you are mostly free to switch jobs and should not be forced to work for the same employer who petitioned you so long as you pay the breach fee agreed when you signed the offer. Similarly, green card holders could jump into a different employer/hospital any time — during contract or after contract. Your stay here in the US doesn’t depend on your employer. You got the freedom of 10 years to be a resident here and it is renewable. Although on the 5-year mark, you can always apply for citizenship and be a permanent American. As for the breach fee payment type, based on friends who quit, companies worked with them on a pay scheme wherein you divide the payment so you would be able to afford to pay it or simply say, installment basis. America is known as the land of the free and that applies to choosing where you feel safe and comfortable working.
*Sigh*
Three years went by quick. Typing this feels so surreal but here we are.
Please let me know in the comment section what other experiences you’d like me to share and I do hope you enjoyed reading this blog.
Missladyfritz 
Leave a comment