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Wednesday, September 30, 2009

Inspiring Story: My Stroke of Insight

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Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another.

READ MORE





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Tuesday, September 29, 2009

Health care firm offers jobs to ‘surplus’ nurses

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FILIPINOS’ HOSPITALITY, along with the abundant supply of licensed nurses, have pushed a Singapore-based medical tourism hub to set up the first health care knowledge process outsourcing (KPO) facilities in the country.

"The Philippines has an abundant call center and human resources while the Filipinos have the necessary language skill and are known globally for their emphatic and caring nature," Geoff Spiller, managing director of Life Stage Communication, said in a press briefing yesterday.

Life Stage Communication is the local unit of Singapore-based Fly Free Health Group of Companies, which is said to have provided the world’s first comprehensive business-to-customer and business-to-business medical tourism hub, which is a one-stop destination where health, travel, leisure and lifestyle converge.

Checkout  Nursing Jobs Philippines






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Sunday, September 27, 2009

NLE / Nclex Mp3 Nursing Lectures Download

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Mp3 Nursing Lectures Download

I know that this list of mp3 downloadable nursing lectures is already posted over the right lower corner of the site.  The site is jam packed with notes, lectures, practice test, etc., I decided to re-post past articles that I find essential in passing your exams.  If you can just find time to browse the site, you will find alot of information to help you pass this November 2009 Nursing Licensure Exams NLENclex Exams, IETLS Exams and CGFNS Exams.




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Saturday, September 26, 2009

In US, Filipino Men Stay Home as Nurse-Wives Work

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New America Media, News Feature, Anthony Advincula ,
Posted: Sep 21, 2009 Review it on NewsTrust

BAYSIDE, NY — Back in her native Philippines, Rosette de Real, was a full-time mom and housewife. Most of the time, she stayed at home, cooked meals, washed and ironed clothes, and took care of their two young children. Her husband, Ronaldo, worked to provide for their family.

In a tradition-bound, patriarchal culture, Rosette described their gender roles as typical in most Filipino families. She was the homemaker and her husband was expected to be the breadwinner.

“Before he was the ‘boss’,” Rosette, 33, said jokingly in Tagalog. “It just happened naturally,”.

But since they immigrated to the United States in 2006, there has been a dramatic reversal in those roles. Rosette is now a registered nurse who works for a nursing home, while her husband Ronaldo has been managing the household chores.

Although the shift seemed inevitable because Rosette has a more stable and high-paying job, their decision on who should work and who should staying at home when they got to this country, didn’t happen spontaneously. It took them some rigorous planning and many long conversations.

“We discussed everything about it — even when we were still in the Philippines,” she said. “We certainly weighed all the options that we got.”

Ronaldo, 40, who was standing next to her and getting ready to head out and pick up their eight-year-old daughter from school, agreed and listened silently.

Rosette came to the United States first to make sure she had a job waiting for her, passed the NCLEX – the nursing licensing examination – and finalized a one-year contract with her previous employer. Six months later, as soon as she got settled, her husband and kids joined her in the United States.

“Of course, the transition from a working to a stay-at-home father was difficult for me,” Ronaldo recalled in a soft-spoken voice. “I was so used to working every day that my body had desired so much for it.”

At first he struggled and, despite their agreement, he worked for Chrysler while Rosette got a job on the graveyard shift and took care of the kids during the daytime. They ruled out the option of getting a babysitter because they were concerned that the money they earn would only go to the babysitter’s wages.

While it put him back on his usual work routine, Ronaldo felt sorry that his wife never had time to rest and do things for herself. He then gave up his job and became a full-time house dad.

“They are my kids, now three of them. I have to sacrifice. If we were still in the Philippines, it would have been easier to get a nanny, or the grandma of my kids could always take care of them. But things are different here,” he said.

The shift in gender roles that the De Reals are experiencing is not uncommon among Filipino couples, especially those who have settled on the East Coast, and most often the female spouse works as a nurse. While the data is largely anecdotal, many from the Filipino community say the number of such cases is significant.

Clarita Ramos, a waitress in a small Filipino restaurant on West Side Avenue in Jersey City, N.J., said a group of Filipino men who are mostly married to Filipina nurses would often hang out early in the afternoon for snack.

Before the clock strikes 3 p.m., they would go their separate ways, Ramos observed. Some of these men, she added, would walk to a nearby school to pick up their kids, and others would most likely head home and drive their nurse wives to a hospital or a nursing home for another long night shift.

“There is an oft-repeated joke among Filipinos here that if you meet a Filipino man at the grocery store with kids in tow, especially in the middle of a working day, and you ask him what does he for a living, the common reply will be, ‘My wife is a nurse,'” said Narna Macasaet, a Filipina immigrant.

Macasaet, who had a tourism degree, went back to the Philippines last year with her daughter, then two years old, and took several nursing courses there. She now is preparing for the U.S. licensing examination for nurses.

Some experts say this role reversal is not only happening among Filipinos, but in many other immigrant communities as well. These immigrant women, who have become the sole providers for their families in the United States, broke the traditional family roles.

“Immigrants, including women, are expected to serve and make money, so I am not surprised about this role reversal,” said Prof. Gary Okihiro, who teaches for the Center for the Study of Race and Ethnicity at Columbia University.

A recently released New America Media poll, “Women Immigrants: Stewards of the 21st Century Family,” reiterates that many of these women are radically altering their roles in their private lives.

“While few may have fit the image of submissive women in their home countries to begin with, almost one-third report having assumed head-of-household responsibilities now that they are here and share equally with their husbands in making decisions from household finances to more intimate concerns, like family planning,” pollster Sergio Bendixen said in the report.

As women have "left" the village, the report states, they have also brought the village with them.

While it is a manifestation of a “good adaptation” process into mainstream U.S. society and “a depiction of the universal values of equality between men and women,” Okihiro believes that “it could also be dysfunctional.”

“Men can be offended. Unfortunately, when they lose their self-esteem, it can result in spousal abuse,” he said, noting several studies showing high rates of domestic violence among South Asian working women whose husbands react negatively to the role reversals.

Lafayette Caliolio, a Filipino immigrant who resides in New Brunswick, N.J., concurred. Men who are compelled to stay at home must deal with their own cultural stereotypes, he said.

“Personally, as a man, I think it is degrading to stay at home while my wife is working. And, just by thinking of it, boredom will make me crazy,” Caliolio, 40, said in a mixture of Tagalog and English.

Lafayette and his wife, Ruth, work as nurses in Flushing, N.Y. They both take the night shift and stay at home with their two kids, 14 and six years old, during the day. When it is time for them to go to work at night, a babysitter takes care of their kids.

But Ruth, 41, prefers that one of them stay at home.

“It is not practical. Because both of us are working, we pay higher taxes, and the quality of time that we spend with our children is being compromised,” she said. “But if we work together, like in our current situation, the positive impact on our family, economically, is very clear.”

When asked which parent should stay at home to attend to their kids, Ruth supported her husband’s ideas. “For me, as a Filipino, it’s awkward to see my husband as a full-time homemaker. That’s not our culture.”

Angie Abella, a manager for a New York-based staffing agency that recruits foreign nurses, said that role reversal among Filipino nurses is also dependent on their visa status and family living situation.

“We have to realize that a lot of these families get their visa petition from their nurse spouses. If the nurse wife is still on a work visa, she can’t just quit her job to take care of her own kids,” she said. “Also, if the kids are quite young, the husbands have no choice but to take care of them. Babysitters are expensive.”

From her conversations with Filipino nurses, Abella said that a simple agreement about their domestic situation could alleviate the gender role-based conflicts that may arise between couples.

Back in Bayside, Rosette de Real agrees:

“I know that it is not easy for Ronaldo to be at home, even though we talked about it, and we prepared ourselves for it,” she said. “Sometimes he would tell me, ‘Every time I want to buy you fresh flowers, do I still need to ask the money from you?’ But I am very lucky that he is considerate and understanding.”

SOURCE



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Friday, September 25, 2009

Cambridge Practice Tests for IELTS 3 (Download Mp3)

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Cambridge Practice Tests for IELTS 3 (Download Mp3)

Supplemental PDF File for
Cambridge Practice Tests for IELTS 3 - Cambridge IELTS 3.pdf







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Thursday, September 24, 2009

RP chosen for new healthcare KPO hub

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MANILA - First, there was business process outsourcing for college students. Now, Filipino nursing graduates who are looking for work and a chance to increase their skills further can do so by joining the knowledge process outsourcing (KPO) arm of Life-Stage Communications (LSC) Fly Free For Health.

Geoff Spiller, LSC joint managing director, said the LSC-KPO arm functions the same way as a call center but with a more specific focus on the heath needs of their clients. He said the company is looking to hire at least 100 Filipino health professionals in the next six months who will work as "medical butlers" and provide borderless healthcare to clients.

Spiller said the Philippines has several advantages not found elsewhere that makes it perfect as a KPO hub for the company.

"The Philippines has call center expertise that doesn’t exist elsewhere. It's got ample human resources who have good English language skills. Finally, there are so many nurses who are looking for jobs," he told abs-cbnNEWS.com during the company's launch on Wednesday.

Spiller said the KPO medical butlers are highly-skilled individuals who all have medical backgrounds. "They are going to be talking to customers who will ask them all sorts of questions. You have to have the basis to give information and refer the customer to the right person," he said.

Dr Wei Siang Yu, founder of Fly Free For Health, said the convergence of technology and global value chain management has made the evolution of healthcare business process outsourcing possible. He said the company's value chain of services, including medical concierge management, borderless multi-disciplinary management and borderless collaborative care, could help drive new patient leads, loyalty and repeat transactions for medical facilities.

He said the company also specializes in development of international medical tourism destinations, particularly in Southeast Asia and countries such as Korea, India, and Australia.
.
Spiller said the company is looking for an office in Pasay City for its first KPO center. He said the company is partnering with RA Gapuz Review Center, the largest review center for nurses in the Philippines, to offer KPO courses to willing students.

“These introductory courses are going to be a revolutionary step for nurses who are seeking alternative paths to nursing practice. We are confident that nurses in the Philippines are going to be very competitive in the global market of borderless healthcare,” said RAGRC president Dr. Mia Gapuz

http://www.abs-cbnnews.com/technology/09/10/09/rp-chosen-new-healthcare-kpo-hub




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Wednesday, September 23, 2009

Pentagon NLE Notes (Download)

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Pentagon NLE review notes

For those nurses who are taking the November 2009 Nursing Board Exam NLE, the above Pentagon NLE Notes might be useful to your guys. I just came across this while looking for good review materials to help those nurses taking the Nov 2009 NLE.

For those of you who knows a good documents or study materials, please post a link in the comment section so that we can help nursing taking their NLE this coming November. Please comment below on your thoughts and suggestions.

If you want to be informed through email regarding November 2009 NLE Results, please subscribe to us by filling in your email address above. NOTE: You email address will be kept private and will not be distributed to spammers.


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Monday, September 21, 2009

30 more Filipino caregivers to leave for Japan under JPEPA

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09/21/2009 | 02:52 PM

Another batch composed of 30 Filipino caregivers will leave for Japan on Sunday under the Japan-Philippines Economic Partnership Agreement (JPEPA), the Japanese Embassy in the Philippines has said.

This is the second batch of Filipino caregivers to undergo intensive language and skills training before assuming employment in hospitals and health institutions in Japan.

The first batch of 270 Filipino candidate nurses and caregivers hired through JPEPA, under the framework on the Movement of Natural Persons, left last May.

According to the Philippine Overseas Employment Administration (POEA), the health workers will initially undergo an onsite language and culture training for six months in five designated language institutions in Tokyo, Osaka, Nagoya, and Hiroshima before they can start acquiring the necessary knowledge and skills from hospitals or health care facilities in Japan.

Under the school track scheme, they will then take two to four-year school courses in caregiver schools.

The POEA said qualified Filipino nurses will be allowed to take the Kangoshi (Nursing) Licensure Examination in February 2010. Candidate caregivers, on the other hand, would still need at least three years of work experience in Japan before they can take the Kaigo-fukushishi (Caregiver) National Certification Examination – which allows passer to continue working in Japan.

The health workers are provided with an allowance during their training. But if they fail to pass the Japanese standards, they will be sent home immediately.

Japan and the Philippines signed the JPEPA in September 2006. Following heated debates, the Philippine Congress approved the agreement in 2008, thereby allowing for the freer flow of trade and investments between the two countries.

Under the agreement, the Japanese market will have greater access to Philippine produce while Japanese exporters will be able to supply certain electronic products to the Philippines at low or zero tariff. Japan, for its part, will then accept Filipino nurses and health care workers. - GMANews.TV

http://www.gmanews.tv/story/172795/30-more-filipino-caregivers-to-leave-for-japan-under-jpepa


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Saturday, September 19, 2009

202 Useful Exercises for IELTS (Listen, Download)

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202 Useful Exercises for IELTS (Listen, Download)

Download the 202 Useful Exercises for IELTS PDF file




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Tuesday, September 15, 2009

Becoming Canadian: Citizenship (Immigrating to Canada - Options to Work Abroad For Nurses)

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Watch the first video of the Becoming Canadian series. This series is sure to open your mind and touch your heart.

WATCH VIDEO



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Pilot call center employs nurses as agents

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Life-Stage Communications (LSC) Thursday launched its pilot call center operations utilizing the huge population of nurses in the country as its agents in providing healthcare solutions of local and international clients for its accredited hospitals in the Asia Pacific region.

Geoff Spiller, managing director of LSC, said they will start with the operations of the world’s first borderless healthcare knowledge process outsourcing (KPO) in two to three months and expect to get 100 agents or its so-called “medical butlers” composed of registered nurses within six months at its Pasay location.

Spiller said that hospitals and medical facilities are being accredited as their affiliates and would be included in the pool of facilities that their medical butlers can refer to for the help of patients.

Dr. Wei Siang Yu, founder of FlyFreeForHealth concept and pioneer of medical tourism, said they have 100 major hospitals affiliated with them.

Locally, there are three to four major hospitals that they are in contact with to be enrolled in this service marketing operations for medical and healthcare needs.

Wei said that the global market for health care is estimated at $100 billion and still growing especially with health care reforms happening in the U.S., Europe and Asia.

But the problem is that hospitals are not integrated with health information and down the value chain.

The group’s proposal is to tie up health and lifestyle value chain noting that the Asia Pacific region is expected to get the influx of medical tourists.

LSC has already tied up with the RA Gapuz Review Center, one of the country’s review centers for nurses, as its partner for the medical butlership training.

Spiller said they have decided to put up pilot project in the country because of the proven hospitality of Filipinos, particularly the Filipino nurses. “The current system has no unified concierge that would put healthcare and lifestyle together,” Spiller said.

http://www.mb.com.ph/articles/219947/pilot-call-center-employs-nurses-agents


Are you looking for a nursing job? You might want to checkout   Nursing Job Search You can search through thousands of nursing jobs online


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Monday, September 14, 2009

Becoming Canadian: Combating immigration fraud (Watch Video)

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Transcript for “Becoming Canadian: Combating immigration fraud” video

WATCH VIDEO

Video length: 2:30 minutes


Canada is the destination of choice for a quarter of a million people each year seeking a new home. They’re attracted by the prize of Canadian citizenship; a strong democracy and a stable government. Our immigration system is fair – by law — to each and every newcomer.

Unfortunately, some newcomers are victims of scams – duped by immigration fraud artists. Irma Luque, Ricardo Miranda and their son Christian left Chile a dozen years ago for a new life in Canada. They now live in Toronto as permanent residents, but achieving that status was very hard. They put their faith in a Canadian Consultant who offered them work and visas. This consultant charged the family five thousand dollars U.S, and kept them waiting for years – yet he delivered no results.

Ricardo Miranda/ Immigration Scam Victim

“I feel bad. I can say nothing. Because maybe this guy call the police or call immigration. I don’t know. You know, I’m scared about my family.”

This family is not alone. Every year, many newcomers – isolated from home and friends, with limited language skills – are lured by false promises of high paying jobs and guaranteed visas by unscrupulous immigration representatives.

Robin Seligman/Certified Immigration Lawyer

“They just want to make a buck and at the end of the day people have to understand they will lie, they will do whatever they have to get their money.”

There are lots of scams. Ads in publications from around the world offer jobs and settlement in Canada – for fees reaching into thousands of dollars. Crudely constructed letters — note the starfish background – claim to represent the government of Canada.

Many deceptive internet sites promise visas and employment at very high cost – one features a Wooly Mammoth – not exactly a Canadian symbol.

No one can guarantee you a visa to Canada or move you up in line. But when you need help, there are many good immigration consultants. Just make sure they are accredited.

Citizenship and Immigration Canada provides free advice and visa application forms on its Website.

Anne Arnott/Director General International Region

“You cannot lie on your application and still go to Canada. If we find out there is a lie you won’t be going anywhere. Or if you do end up in Canada we will take steps to remove you.”




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Sunday, September 13, 2009

Top Ten Reasons To Become A Nurse

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1) Pays better then fast food, though the hours aren't as good.
2) Fashionable shoes and sexy white uniforms.
3) Needles: "Its better to give than receive"
4) Reassure your patients that all bleeding stops...eventually.
5) Expose yourself to rare, exciting and new diseases.
6) Interesting aromas.
7) Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
8) Do enough charting to navigate around the world.
9) Celebrate all the holidays with your friends- at work.
10) Take comfort that most of your patients survive no matter what you do to them.

SOURCE: Top Ten Reasons To Become A Nurse




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Canada's Immigration & Citizenship Website: Go Directly To Their Website

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All you nurses out there who are planning to work or migrate to canada, I suggest you go directly to Canada's website and not use recruitment agencies.

Canada's Immigration and Citizenship Website is at http://www.cic.gc.ca/english/index.asp

For those of you who have lots of questions on how to apply and bring your whole family with you and migrate to Canada, go here http://www.cic.gc.ca/english/immigrate/skilled/index.asp

To take the test and see if you are eligible for a working or immigrant visa, checkout this link http://www.cic.gc.ca/english/immigrate/skilled/tool/index.asp

I know alot of you nurses out there are finding ways to go abroad other the the US because of the current retrogression crisis. Canada is one of those country that are actually a good alternative if you want to bring your family with you. To calculate for your fees, checkout https://services3.cic.gc.ca/efee/efee.do?lang=en and try to compare with travel agencies or recruitment agencies because you will save alot of money applying directly. For all of you who wants to work as nurse in canada, I suggest you process your papers now!! Be also aware of Immigration Fraud, thats why I strongly suggest you go directly to Canada's Immigration Website.



Please if you have comments / Suggestions or corrections, please leave a comment below. I have have mistakes here and there, nobody is perfect. I'm just here to help in whatever way I can.





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Friday, September 11, 2009

Retrogression Update: Whats New And What To Expect

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October is the start of the fiscal year and that means that 140,000 visa will be available again for the employment base 3rd preference category (EB-3). What usually happens is that nurses with approved I-140 petitions who have priority dates before May 2003 may see some progress in their application.

Meanwhile, President Obama mentions in his speech that the changes of immigration reform being passed by the US congress this year is not likely to happen because he has alot of top agendas that he wants to finish first like the healthcare, global warming and the financial crisis.

I know all you nurses that have already an approved 1-140 petition are probably already used to this retrogression update and some have even given up on their dream to work as a nurse in the US. Don't loose hope.

If you have comments / suggestions, dont hessitate to leave a comment. Always nice to hear your reactions and suggestions.


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What is Obama's Healthcare speech About?

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US President Barack Obama has made one of the most important speeches of his presidency, as he faced Congress over his plans for healthcare reform.
Mr Obama said that failure to introduce reform had led the country to breaking point and it was now time to act.
He said he planned to improve health insurance for those who have it and to create an insurance exchange to extend cover to those who do not.
Republicans said Mr Obama's plans would make healthcare much more expensive.

Listen to his speech at http://news.bbc.co.uk/2/hi/americas/8247207.stm






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Thursday, September 10, 2009

BPO Company offers nurses alternative to leaving RP

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FILIPINO nurses may opt to stay in the country to work as “digital medical butlers” for a medical knowledge process outsourcing (KPO) firm that will put up training facilities and a contact center to service clients abroad.

In a briefing on Wednesday, Wei Siang Yu, Fly Free for Health Group of Companies founder and chief executive officer, said the company’s Philippine subsidiary, Life Stage Communication, will put up facilities in Manila and Davao in the next six months, through which registered Filipino nurses can assist patients online.

“Instead of nurses leaving the Philippines to work in a hospital outside the country, Filipino nurses can now stay here and still tap the global, borderless healthcare and medical tourism market,” Wei said.

“They can just communicate with their patients via the In-ternet,” he said.

Wei said the company will invest between $2 million and $4 million for the two facilities, and will initially hire about 100 registered nurses.

He said the Philippine facility can attract potential clients from 50 healthcare institutions and organizations from all over the world that are affiliated with Fly Free for Health.

Fly Free for Health is in talks with five major local hospitals, he said, adding that they hope to seal partnership agreements here within the next six weeks.

Wei also said state-led healthcare reforms in countries such as the US and Singapore, as well as aging populations, will likely increase the viability of medical outsourcing. He said this will benefit more Filipino health professionals, who are in demand due to their English-language skills, good education and innate hospitality.

Eleanor Artemia Gapuz, RA Gapuz Review Center president and chief executive officer, said about 400,000 nurses in the country were unemployed last year and the popularity of the profession can add 20,000 more nursing graduates a year. While Filipinos abound in skills and talent, working visas for nurses in foreign lands are still very limited, she said.

“Filipino nurses have to look for alternative opportunities besides working abroad, and working as a medical butler is a good one,” she added.

Cited as among the domestic industries that showed resilience amid the economic slowdown, the Philippine business process outsourcing (BPO) industry expects to grow between 20 percent and 30 percent this year, and employ more than 450,000 people by yearend. This sector grew 26 percent last year with revenues of $6.061 billion.

Officials of the Contact Center Association of the Philippines (CCAP) projected growth of between 15 percent and 20 percent for call centers this year, while the Business Processing Association of the Philippines (BPAP) expects nonvoice, such as animation and back office operations, as well as KPOs to grow over 100 percent this year.

http://www.manilatimes.net/national/2009/sept/10/yehey/business/20090910bus1.html




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Obama Healthcare Speech Live

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Tonight the President Barack Obama will make clear to Congress exactly what he would like to expect in the health insurance reform legislation that gets sent to his office.

You can watch Obama healthcare speech live at Whitehouse Media Center.




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NLE/ NCLEX Pharmacology Flash Cards for Board Review

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Wednesday, September 9, 2009

5th Philippine Nursing Opportunities Conference, Expo and Job Fair (PNOCE) 2009

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Join the biggest, most comprehensive and pioneer event for Filipino Nurses this year – the 5th Philippine Nursing Opportunities Conference, Expo and Job Fair (PNOCE) 2009 at the Mandarin Oriental Suites, Gateway Mall, Araneta Center this September 18-19, 2009 (Friday and Saturday).

Be guided in your nursing career! If you’re a NURSING STUDENT, UNDERBOARD, BOARD PASSER or ALREADY WORKING as a NURSE, this event is for you! Consider the following benefits of attending the 5th PNOCE and Job Fair.

What benefits you can get on the 5th PNOCE and Job Fair?

1. Wealth of information on test taking strategies to successfully pass the local Nurse Licensure Exams, NCLEX, CGFNS, and IELTS exams (which are not as easy as people think) and how to prepare and successfully pass the exams.
2. Information on various institutions offering specialized Nursing trainings / seminars to further hone and improve Nursing skills and knowledge to be globally competitive, particularly internationally-recognized training programs for Nurses
3. Government updates on latest trends and destinations for Filipino Nurses from DOLE and POEA
4. Work / job opportunities locally to polish and prepare Filipino Nurses for a global workplace
5. Work and visa opportunities for Nurses (US, Canada, Australia, New Zealand, UK etc.)
6. Update on the US retrogression
7. Business and investment opportunities while studying Nursing or while waiting for the opportunity to work overseas …. and more!

To learn more and register, please visit http://www.philnursingexpo.com

For inquiries please call Ms. Emma San Juan

Tel No: (+632) 473-3628
Telefax: (+632) 508-8803
E-mail: emmssanjuan@yahoo.com | info@philnursingexpo.com
Mobile: 0921-3792810

Are you looking for a nursing job? You might want to checkout   Nursing job fair You can search through thousands of nursing jobs online


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Tuesday, September 8, 2009

Lots of NLE Questions and Answers in PDF Format

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Friday, September 4, 2009

Just By Being There: Nursing Beyond Limits’ In A Time Of Crisis

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(Keynote speech at the Midyear Convention of the Association of Nursing Service Administrators of the Phils., Inc., August 20, 2009, Fiesta Pavilion, Manila Hotel, with the theme “Nursing Administrators: Leading Beyond Limits”)

STANDING here—rather, trying to stand here because I just checked out of The Medical City for a bad back; forgive me if I seem a little intimidated before such a powerhouse group of health-care professionals. I refer to nurses, who are constantly in the front line of health care.

It is with nurses that patients are longest and most directly in contact in the patient’s most vulnerable state: administering drugs, taking blood pressure and temperature, monitoring the progress of our ailment and recovery, paying heed to our discomforts.

In mentioning powerhouse professionals, I refer also to doctors, whom I have observed the nurses sometimes consult.

What is evident is that it is nurses who are constantly observing the effects of the treatments prescribed, I guess to check if they are right, if they are working as expected, if they are too much or too little. And always and ever, attending to the patient’s constant need to feel less discomfort in this part or that, feel less pain. Standing as a constant assurance that whatever the hour someone who knows cares. The best nurses have this ability to make you feel like the only patient on the floor.

So naturally I am thrilled, although barely able to stand before those in whose hands, just a few days ago, I surrendered my fate: my fate as an invalid and my only hope of getting well, along with the doctors of course.

I am sure the doctors in the audience are chuckling and other members of the audience who are not nurses are amused.

Do not be. I am serious, for what I have just related is, if not the only, certainly the most prevalent and direct experience of medicine, medical attention and any other facet of health care that a patient has.

And it is the patient, after all, who stands, or rather lies in hospital gown, at center stage of the universal drama of human ailment and health care. Whenever the curtain rises on this drama, the spotlight is longest on the patient and his nurse.

Always has been, since Florence Nightingale

This was so since Florence Nightingale injected her presence into a man’s world and demanded more humanity from military surgeons on the battlefield, as they decided with cold detachment who was too hurt to go on living and who was worth the trouble of saving.

What of the rejected, and what of those whom the cure was killing more surely than the disease? It was for them that Dame Nightingale created modern health care and entrusted it to women.

From Dame Nightingale to Mother Teresa, the nurse’s code has been the hard and iron duty to be soft with those who are hurting, to be firm with those who are malingering, to watch at every step the progress of an illness or recovery so that nothing but wellness is irreversible; always and ever to care for as long as there was a living spark there. While there is life there is need for care, and if there is no more hope of recovery, there is always the imperative of nurturing every living moment that remains. Because life, however short it is expected to be, however long its suffering must extend, deserves a nurse’s total care. It is the patient, who may often be difficult and sometimes impossible to like because discomfort makes him so, who is the main focus of the nurse’s attention.

When the all-powerful French Cardinal Richelieu, the contrabida in The Three Musketeers movie, went to his dying king, it was not as a doctor to cure him but as a nurse to give him comfort, feeding him, from time to time, a teaspoon of raw egg. So it was not as a doctor that the great cardinal came to the king, to assure him that he would make him well as he had made him great, but as a nurse to comfort the king in his dying.

At this hour, I should be at my radio show, Karambola, laughing at all the problems of bad government. But this is a serious audience of people with serious commitments and concerns. And you are not in a laughing mood.

I don’t blame you.

The richest countries in the world lack nurses but no effort is made by them to make it easier to recruit our nurses, who are, far and away, the best. Instead, many nurses have to depend on unscrupulous recruiters here and worse employers abroad. The attitude abroad seems to be, let the nurses go through the eye of a needle and a gauntlet of overwork and underpay and other discriminatory practices, and then maybe, just maybe, let them stay on as second-class citizens.

Meanwhile, Philippine recruiters squeeze the nurses for more than they can afford before they leave, sometimes for nonexistent jobs abroad. Then they tie them down to financial servitude for the duration of their exile. Meanwhile the country’s foreign-exchange reserves grow from nurses’ remittances so politicians can change their ill-gotten gains to dollars for their junkets abroad.

Our country sorely needs more nurses; but going by the law of supply and demand and considering how poorly nurses are paid, you would think we had more than we know what to do with. I will let the private hospitals explain for themselves why this is so. But, coming from government, I can tell you the government has no excuse not to pay nurses more. The government is swimming in money. Look at the expected revenues, and look at the budget. There wouldn’t be a budget deficit if government were smart enough to spend more money on nurses than it throws away on bad projects for the kickbacks.

And, let me tell you, coming as I do from government, that the private sector could pay nurses much more if only the government stopped squeezing the private health sector for more and more taxes, and gave the sector as many tax exemptions, tax holidays and outright financial grants and easy credit as government does to so-called foreign and local pioneering enterprises. What is so pioneering about selling gasoline and yet government allowed Shell and Petron to escape taxes through a tax-credit scam that the government is too slow to prosecute up to now.

Poor national health care and the plight and proper place of the nursing profession in health-care reform, all these are problems to which the fastest and best solution is to throw money at them. Insufficient training of nurses after graduation? Subsidize their training with cash grants to the nurses and tax holidays to the training hospitals.

Ineffective nursing education? Throw more tax holidays and financial assistance at nursing schools; devote more funds to the stricter monitoring and regulation of teaching practices and educational standards in the nursing schools.

Is it wise to throw money at problems? Of course it is, as the most serious economists today recommend in the global crisis.

But if we do not have all that much money to throw around, we surely have more than enough to “devote to”—that is the proper phrase, “devote to” and not throw around—one of the highest priorities of government: the national health.

‘Beyond limits’

The theme of your convention—“Nursing Administrators: Leading Beyond Limits”—imposes on yourselves a part of the formidable challenge of national health care.

There’s no glossing over, no understating, the problems that our health care sector faces; much less the very real limits that tie the hands of those seeking to solve them. But since you have so bravely undertaken to go beyond those limits, I will try to walk with you down a road that’s hardly taken.

First of all, let me congratulate those of you who have opted to stay behind in this country, when we all know that the overwhelming majority of people studying to be nurses do so in hopes of landing better-paying jobs abroad.

I do not begrudge them for seeking not just greener pastures but pasturage of any description.

Nor do I conclude that those who chose to stay do not need the better pay that nurses get in First World countries.

Those who stay, attend to the sick over here. But they suffer the frustration of not being able to do as much as their training would allow them. Too few people can afford the quality health care that our nurses are equipped to give. And government isn’t spending enough to bridge the gap between increasing health care needs and the diminishing capacity to meet them—on the part of the Philippine health care systems, doctors, nurses, hospitals, clinics and on the part of patients.

Universal health care would create a whole new universe of nursing opportunities right here in our country—and government can afford it, if it only stops stealing.

Those who chose to leave, on the other hand, trade off family for better opportunity—many times so as to help family back home. What they get instead is years of loneliness and hardship, as they struggle to cope with a higher standard of living with what remains of their pay after the recruiters get their share.

These are tough choices.

Consider: a nursing graduate who lands a job in a small private hospital would be “lucky” to get a salary of P10,000 a month. The usual entry level is P8,000. Recently, as a result of the enactment of the amended salary standardization law, nurses in government hospitals are now entitled to a salary range of between P14,000 and P18,000; better but far below starting rates for Filipino nurses who make it to the US, the UK, Canada or, heaven forbid, the Middle East.

Little wonder that most nursing administrators are reeling from the fast turnover of newly trained nurses; no sooner have nursing administrators finished training one batch than another foreign-based recruiter poaches them.

Ironically, even as more and more nurses are being graduated, trained, and then recruited abroad, most hospitals—private and public—have the same complaint about not having enough qualified nurses. In short, we seem to have an oversupply of under-trained nurses. So we have too many “nurses” in quotes and too few nurses without quotes to go around. Many of the good ones are poached by foreigners.

Frustrating paradox

This paradox arises from a frustrating situation: the nursing employment “boom” in other countries fueled the rise of so many nursing schools in this country, including not a few diploma mills. This June, 32,000 aspiring nurses passed the board exams. Where will these go, when there aren’t enough hospitals that can give them adequate training?

Ideally, you shouldn’t shortcut the training of a nurse, and a young nursing graduate is expected to post many months and hundreds of man-hours in the wards, the emergency and trauma rooms, in ICU and surgery. But comparatively too few get the chance.

In hospitals where such training is taken seriously, there are even more frustrating trends. As soon as a nurse finishes the ideal period for training, the headhunters descend on the hospital to harvest them.

We see here a net resource transfer from poorer to richer countries. Long before nurses can be deployed abroad to earn enough to repay recruiters and remit their better wages to families back home, and thus make the brain drain worthwhile in other respects—long before that can happen, they are poached by foreign countries that did not spend a cent on their education and training.

I can commiserate with the exasperation of nursing service administrators who have struggled mightily, these past several years, to keep the critical balance of human resources in our health care sector, the relentless foreign poaching notwithstanding.

From this background, then, arise the most serious challenges facing the nursing service administration in the country:

First, the challenge of maintaining, always, a high quality of health care despite limitations in terms of physical facilities, financial resources, and the lack of adequately trained nursing staff given the quick turnover.

Second, the economic crisis that has made things worse for everyone all around; forcing budget cuts in state hospitals and cost cutting in private ones, and setting further back hopes of salary upgrades for nurses. Worse, costly and too strict medical insurance forces most people with serious ailments to forego treatment, thus adding to the difficulty of caring for them when they are too far gone.

Third, the mismatch between supply and demand, not just in the number of nurses, but also in the kind of job and career opportunities that are opening up to our nursing graduates. Even as thousands of them are needed in the lesser cities outside the great metropolitan centers and worse yet in far flung areas that have never been reached by any decent health care program, there aren’t enough nurses to go around.

I am not suggesting that nurses should sacrifice personal income for outreach services. I am saying that the national government, which throws tens of billions at sure-to-fail, never-intended-to-succeed projects, just for the commissions, could throw more money at making health care reach more people, even to the farthest corners of our country.

On the third challenge, most of you are aware of how medical tourism, which the government is understandably encouraging, has drawn away many of our best nurses from serious health care to spa services pretending to offer real medical solutions to insoluble old age and wear-and-tear problems like cellulite, wrinkles and osteoporosis.

Don’t get me wrong, but it seems to me we can’t tolerate for long a situation where thousands of our nursing graduates are doing work as call-center agents or spa attendants or running small businesses because there aren’t enough good hospitals paying decent wages.

You should know that no country in the world could support a well-functioning public or private hospital system—or both—without universal health care coverage. In short, without government paying for most health-care services.

Pardon me if I seem to be in a griping mood. There just seems to be little in the local health-care sector we can see as a bright spot.

Some reforms

To be sure, we have seen the start of the implementation of a landmark law, The Cheaper Medicine Act. That reform didn’t come easy. The foreign drug firms were all over Congress. I objected to their presence. They said they had the right to be there because the offices of European and American drug companies are in Makati. They tried to “influence” me in quotes. I said I did not remember giving them the right and threw them out of Congress. It took all of 10 years to get the law passed and then another year to get it implemented.

Reforms in health care come hard but not, I dare say, slowly. Not if you have the political will and the sincere desire to help.

It didn’t really take 10 years to pass The Cheaper Medicine Act. There were many attempts over 10 years but only one night of fighting to get it passed. It didn’t take almost a year to get it implemented but just one morning of threatening the Department of Health to act.

So don’t believe anyone who tells you it takes time to make reforms. It takes one day, one will, hell, one person even—to lead the pack and win the day.

You want pay commensurate with service? Then join those of us who are telling government to stop spending on itself and start spending on the people—especially on people who make a difference such as health-care providers like nurses.

And doctors, of course; we can see how useful they are to nurses, such as in instructing them on what medication to give and in what dosages, as nurses go about the time-consuming, all absorbing task of direct, unceasing, person-to-person health care.

But even as you continue to push the envelope on upgrading nursing performance through rigorous and focused strictly health care training, I trust you’ll always remember that besides those skills, our people look to the nurse as the one special person who fills in all the gaps of a health-care system—whether it’s for a doctor who’s too busy to check on the patient as often as needed; a malfunctioning equipment for which they must improvise; or an ill-tempered billing clerk; or dirty facilities and dirty linen or lack of clean water in the hospital.

It is effective nursing administration that ensures a steady supply of the kind of nurse who, although really powerless to do everything the patient wants or needs, seems to make it all better just by being there.

And that, I think, is the core meaning of “leading beyond limits.” For beyond the limitations imposed by limited resources, limited manpower, limited this and limited that, is someone who fills the empty places by something intangible but evidently there: a constant caring for the patient who is, in every room if she can afford it, or in every space in a ward if he cannot, always at center stage in the unceasing drama of health care.

I return to where I started…to the nurse as she or he should be: competent, for sure, and always caring; gentle yet firm; seeing her profession as a vocation and not just a job. That is why a Filipino nurse or, for that matter, a Filipino doctor, working abroad are still a nurse and a doctor and not economic refugees.

It is the highest vocation of all, the equal of priest or religious, though I am told nursing is much more fun: the cure of bodies to the cure of souls.

SOURCE: http://businessmirror.com.ph/home/perspective/15352-just-by-being-there-nursing-beyond-limits-in-a-time-of-crisis.html



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Tuesday, September 1, 2009

Nursing Shortage: How It May Affect You

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Shirley Keck, a 61-year-old mother of five, was having trouble breathing one Sunday afternoon, so her daughter, Becky Hartman, rushed her to the emergency room at Wesley Hospital in Wichita, Kan.

Doctors there thought Keck had pneumonia and admitted her. But for the next seven hours, Hartman sat by her mother's bedside watching her condition deteriorate, and seeing her struggle for each breath. She said she repeatedly tried to get help from the nurses.

"I begged for help," she said. "We had plenty of time to get help, and we got none."

Keck did not have pneumonia. She was actually having a heart attack that was causing liquid to fill her lungs.

But because her primary nurse was overburdened -- allegedly caring for 20 patients, more than the hospital's own guidelines recommend -- the nurse didn't have time to observe Keck until she had to be resuscitated.

As a result of her heart attack, Keck suffered brain damage and was paralyzed. Her family sued the hospital and won $2.7 million.

Nursing care in America's hospitals has reached a critical shortage -- the worst in 50 years, according to Peter Buerhaus, the assistant dean of Vanderbilt School of Nursing, who has studied the problem. To make matters worse, just as there are fewer nurses, the population is aging and in need of more medical care.

More Nurses Needed, Fewer Available

Hartman said she didn't sue for the money.

"I wanted them, as I wheeled my mother into that courtroom, to see what their decision to run the hospital shorthanded cost somebody," she said.

So far, it is the only successful malpractice lawsuit against a hospital citing inadequate nursing. But amid an ongoing staffing shortage, it may not be the last.

Hospitals are under pressure to keep control of their bottom lines, and nurses account for a large part of their budgets. But a recent study published in the Health Affairs medical journal found hiring more nurses could actually save a hospital money in the long run. The study found 6,700 patient deaths and 4 million days of hospital care could be avoided each year by increasing staff of registered nurses.

However, training new nurses is the problem. Last year, nursing schools had to turn away 125,000 applicants because they didn't have enough faculty to teach them. Many nursing professors are retiring just when they're needed most.

"Today, we have a cruel and unfortunate development, said Buerhaus, who co-authored the Health Affairs study. "Our current work force will get older and older and retire in large numbers in the next decade just as we see the aging of baby boomers, all 80 million of them, beginning to turn 65 and consuming more health care."

To make matters worse, patients in hospitals today are sicker than 20 years ago. In the past, a nurse could take care of more patients because some of them were recovering from minor operations. But now, with so many outpatient procedures, an overnight hospital stay is a rarity.

"We have a much higher acuity level patient who requires a lot more nursing care and we have less nurses to provide that care," said Dr. Timothy Babineau, the chief medical officer at the University of Maryland's Medical Center.

Protect Yourself

The picture may be gloomy, but prospective patients and their loved ones can try to protect themselves by finding out a hospital's nurse-to-patient ratio. The American Nurses Association Web site lists magnet hospitals -- institutions recognized for excellence in nursing care, including good nurse-to-patient ratios -- at http://ana.org/ancc/magnet/consumer/locations.html.

According to the association, there is no magic number for that ratio because it varies depending on what tasks a particular nursing unit performs and whether they tend to work days or nights, when patients primarily sleep.

For instance, intensive care units need more nurses on duty than general medical wards. Ideally, an ICU nurse should have no more than two patients. But the association recommends no more than six patients per nurse in any unit.

Keck's family says it will continue to talk about what happened to her as a result of too few nurses, to ensure no other family has to go through what they experienced.

SOURCE: http://abcnews.go.com/WNT/Health/story?id=1529546



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