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.