Differences between Canadian and USA nursing?

[Cinquefoil]

Considering working in both the USA *and* Canada.

Plenty of threads out there about the requirements for licensing etc in each place. But how about the differences and similarities in scope of practice? I read on one of the licensure threads that Canadian nurses have a broader scope of practice, and a greater focus on preventative care.

Really? Well, ya got me wildly curious.....how? What can Canadian nurses do that US ones can't and vice versa? Who spends more time on paperwork? What are the headaches of pt. advocacy/HR and which ones are different depending on side of the border????

Looking for a few donations

Thank you!

[Fiona59]

Any patient can ask for a second opinion and many do. Very few ever get the answer that you think they should.

Wait lists depend on which area of the country you are in. Remember geographically Canada is far larger than the US. Population wise we are very small. The hospital that I work in provides specialist care to the northern part of Alberta, BC, SK, all of the western northern territories. High risk pregnancies, opthamology, colo-rectal cancers, certain heart issues. These patients are flown down, provided with pre and post accomodation, surgery, etc. as no expense to the individual other than what they choose to purchase in local shops.

Personally, I've known people to be in and out of the ER for broken limbs in under three hours, admitted and operated within 72 hours for kidney stones, bleeding ulcers in under 16 hours. If it's an emergency you are looked after. Other procedures, that aren't life threatening go on the list. Hysterectomy--usually within 12 weeks of diagnosis, septoplasty -- 9 weeks, abortion under two weeks, lap choli (non-emegency - around 16 weeks, emergency, within 12 hours).

Patients are re-assessed while on the waitlist. Yes, there are waits for hip replacements and cataracts. But it's the nature of the beast, our population is aging. It is up to the surgeon who is handling their care to do the re-assesment and rescheduling. I've known people who have had their surgeries bumped because of a terminal patient needing surgery or a patient came to town as an emergency.

Do you see yourself working within the hospital? Because many of your questions really don't apply to nurses in the hospital. The surgeons I've worked with over the years listen to us and assess the information we've provided but ultimately, it's their call and dependent on what OR time is available.

Trotting down to the US isn't an option for probably 99% of the population. The majority don't see the US as the holy grail of medical care. They see it as a place where you can lose your shirt financially to the medical system.

Oh, and there is a way to jump the queue up here. Members of the military, RCMP, etc, and WCB cases do get priority for certain procedures. The reasoning being that they get back to work faster.

[Cinquefoil]

Thank you. That clears everything up beautifully.

I do see myself doing hospital work, and know that in the USA, while it wouldn't be my call to DETERMINE acuity levels, my judgment might lead me to ENCOURAGE the doctor to question their initial assessment if something seems off to me. In some rare cases, I might encourage the doctor repeatedly, to the point of being a pest :nurse:because doctors don't always notice everything, and sometimes have mental blocks around the area of listening:banghead:

Does that make sense? And does that sound congruent w/ the nurse's role in Canada?

[itsmejuli]

Fiona59 said:

@itsmejuli:

Convention always has recruiters there. Good place to network.

Exactly my thoughts Fiona59 ?

[itsmejuli]

I found it very interesting and comforting visiting my father in the CCU in Calgary after he'd had an MI. The CCU didn't have private rooms, fancy beds, state of the art tele monitors, nor the newest IV pumps and no Pixis. According to the charge nurse, who'd also worked in CCUs in the states, the patient outcomes in the Calgary CCU were amongst the top 5 CCUs in North America.

[ZippyGBR, BSN, RN]

Cinquefoil said:

So are you saying a patient is NEVER, under the Canadian plan, made to wait if a procedure or surgery is essential to their health?

Or are you saying that EVERYONE with the same health condition has to wait the same amount of time?

saying neither , much as in the NHS

is it an emergency ? can it wait for the first available ?, is it urgent ? or routine ?

PCI is a classic example or any surgical procedure

... if you are infarcting NOW and meet certain criteria you will be blue lighted to a cath lab and PCI'd there and then in the next available lab or by the on call team , if you need life or limb saving surgery you'll be in the OR as soon as there is a room clear and a suitable surgeon , anaesthtist and theatre team ... ( when I worked in theatres it was not unknown for 'extra' staff aobove the bare minimum to be robbed to open an extra theatre for a true emergency case ... how emergent - well I've moved a patient off the ambulance trolley directly to the operating table in the anaesthetic room ...

'first available' won't bump people but you'll have the procedure as soon as possible - e.g for the Operation you'll get a spot on the emergency list and the theatre scheduler will decide in which order the patient/ surgeon combination gets the OR(s)

'urgent' means they'll be slotting you in in the next week or two

'routine' means you join queue,

Quote

And if you're saying that, I'm just asking what happens if the emergent nature of their health concern increases during their wait period? Do they just get seen again and then get their wait time adjusted? Who adjusts their wait time? Do you have to fill out paperwork or just advocate to the doctor?

I guess overall I'm asking what the procedures for patient advocacy are like? And how do you apply to get a second opinion if you think it's warranted? Or do you have to go to the USA and pay for that?

again UK NHS answers

if someone's condition changes you discuss it with the Dcotor responsible for their care , or as the GPs tend to do direct admit to the on take team for the speciality

second opinion is there for the asking usually the next working day for inpatients , if you are happy to get a second opinion from a different doc in the same trust, or a day or two to organise a second opinion from someone from outside the trust...

[ZippyGBR, BSN, RN]

itsmejuli said:

I found it very interesting and comforting visiting my father in the CCU in Calgary after he'd had an MI. The CCU didn't have private rooms, fancy beds, state of the art tele monitors, nor the newest IV pumps and no Pixis. According to the charge nurse, who'd also worked in CCUs in the states, the patient outcomes in the Calgary CCU were amongst the top 5 CCUs in North America.

CCU is a critical care area , single rooms in critical care areas are for infection control reasons or billing not necessarily for safe and appropriate care

define' fancy' beds, I'm sure they were all profiling beds , most NHS hospitals are nearly all profiling beds now

iv pumps - do they work accurately ? is there service and spares support ? if yes to both then why replace them ?

PYXIs is a billing convenience, and to be honest from the descriptions I've heard I'm more than happy with bedside lockers and a drug cupboard ..

[Fiona59]

Gotta agree re the drugs. One a couple of our hospitals use them and a lot of the staff loathe them. Nothing wrong with a narcs locker and a count every shift. The computer system in our hospital spits out a narc count sheet q8h and it's easy to monitor.

[Fiona59]

Cinquefoil said:

I guess I was picturing myself in a situation where a patient (IMHO) has a higher acuity than that assigned to them by the system, and therefore needs surgery or a procedure sooner than the time assigned to them. What would I do, as a nurse, to address this and advocate for my patient?

Does this ever happen?

How do you feel more competent than the surgeon in determining patient acuity? The doctors round at least twice a day and are only a phone call away for inpatients. They come into hospital, have surgery and hit the assigned ward. If they come through emerg, it's rare that we see them pre-op for you decide their acuity. Scheduled surgeries, go through a pre-admission clinic, arrive on the day in the PACU, have surgery, and then go to the floor. The average hospital nurse has very little to do with the scenario you are imaging. Once they are post-op and in the bed, if there are problems, they are reported to the Charge and he/she deals with it.

Do you see yourself sitting in doctor's office monitoring patients as they arrive and depart?

[Pepper The Cat, BSN, RN]

Tests like CT scan, MRIs etc are also done based on need. An ER pt probably get priority over an in-pt, but sometimes an in-pt will get priority over the ER. It all depends on what is being ordered and why. We don't worry about weather or not the person's insurance will pay for it. But as a nurse I have little control over who is seen and when. Yes, I can call CT and say "hey, I really need this done soon" but I have little power to have my pt placed at the front of the line. Basically it gets done when it gets done - but everyone will get their CT scan, no matter weather they only have the basic OHIP (thats the universal medical insurance) or additional private insurance that gives them extra benefits (semi-private, or private rooms)

[whichone'spink, BSN, RN]

What is the hiring outlook like for a soon-to-be American nurse getting a BSN? I'm specifically interested in Alberta, but would like to know about the other provinces as well.

[itsmejuli]

My point was that the latest and greatest hospital equipment doesn't necessarily equate to better patient outcomes.

The CCUs where I was living in Florida were all glassed in private rooms with a small nursing station in front of the rooms.

[joanna73, BSN, RN]

Regarding the hiring...there are positions available for RNs in Alberta, but you will need to be very flexible. Many positions are casual or part time. it's not great, but there are more jobs in Alberta than most other Provinces. I left Ontario, because there are virtually no jobs there right now for RNs. More for LPNs in ON. I have friends in ON who, a year later, don't have a job.