Differences between Canadian and USA nursing?

Nurses General Nursing

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  • Specializes in Med Surg, Home Health.

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Cinquefoil

199 Posts

Specializes in Med Surg, Home Health.
Fiona59 said:
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?

OK, now I see where these answers are coming from. Thank you for explaining clearly.

So, no, in a hospital situation like the one you describe, I would have little input on pt need.

In a home health situation, would that be different? (would like to try Home Health in the way-off non-immediate future). Or, how about in long-term care for the elderly?

I'm just a med aide now in long-term care and I regularly advocate for patients to their Dr's (w/the nurse's oversight, guidance, and permission - w/over 100 pts she just can't do it all). So that's why advocacy is so strongly on my mind. However, in that setting, doctors may not see patients for months, and will seldom make house calls.

And no, I would not feel comfortable determining an acuity level. That is clearly and definitely a doctor's job, and whatever a doctor ruled, I would follow.

but I would feel comfortable persistently ASKING the doctor about their reasoning behind an acuity determination, and TELLING the doctor additional information which may or may not change their thinking, if my gut and the physical evidence suggested the need. However, in Canada, does that all go through the charge nurse?

My idea of being a nurse is that we are (or I will be, and you are), in addition to so many other things, a layer of filtration between the doctors' orders and the patients. Yes, we apply the orders, but if one looks "off" to us, we ask the doctors to tell us more about it. We still obey it, but not unquestioningly. Or, if we're REALLY freaked out by an order (giving 2L normal saline to a decompensating CHF patient, administering a med the patient is very allergic to) we refuse to carry the order out. But we do so at our own license's risk.

Is this understanding accurate?

I'm thinking about acuity levels/wait time in Canada as being like any other doctor's order....but it sounds like I'm not correct in thinking this way. Can someone explain the difference? Or is this question just very trivial to Canadian practice?

You'll have to explain slowly...I'm an American :lol2: But I'd much rather be having this conversation here and now with y'all than in the future with my new Canadian coworkers :rolleyes:

joanna73, BSN, RN

4,767 Posts

Specializes in geriatrics.

All nurses routinely act as patient advocates. However, aside from some of the special circumstances that Fiona mentioned in an earlier post, wait times are inevitable here. Canadians accept the wait times, because we are aware that everyone is entitled to universal health care. That value is deeply ingrained within our health care system. Everyone has a health card, everyone has access to basic services, and everyone waits their turn.

However, we do have some facilities that are privatized. So if you have the money, you can go to these facilities and pay. But the majority of our facilities are funded by the government, and are operated according to these values;

Accessibility (for all)

Portability. (You can move within Canada)

Universality (same standard for everyone)

Intersectoral collaboration (valuing team contributions)

Health Promotion (preventative care and education)

...And 1 more that I forget at the moment ;)

joanna73, BSN, RN

4,767 Posts

Specializes in geriatrics.

And yes, if we are not comfortable with a doctor's order, we absolutely question it. You are responsible for what you give as the nurse. We do not blindly follow Drs orders.

Cinquefoil

199 Posts

Specializes in Med Surg, Home Health.
joanna73 said:
All nurses routinely act as patient advocates. However, aside from some of the special circumstances that Fiona mentioned in an earlier post, wait times are inevitable here. Canadians accept the wait times, because we are aware that everyone is entitled to universal health care. That value is deeply ingrained within our health care system. Everyone has a health card, everyone has access to basic services, and everyone waits their turn.

So, if I'm understanding correctly, just as the average US health consumer who's able to pay for health insurance understands this as a necessary part of participating in the US system, the average Canadian health system participant sort of shrugs their shoulders over the wait because they see it as a necessary part of participating in Canada's system?

So, due to cultural attitudes, questioning the waiting period is uncommon?

Cinquefoil

199 Posts

Specializes in Med Surg, Home Health.

Just to be very clear, I'm not saying that waiting is a bad thing. I'd rather wait than not have at all, and I find the spirit being described (an acceptance of occasional personal inconvenience in favor of health care for all) inspiring!

joanna73, BSN, RN

4,767 Posts

Specializes in geriatrics.

Yes, because you are receiving top quality, FREE health care. We don't question wait times, unless it is imperative to try to jump the queue. That's the way it is. People are grateful that they aren't required to pay for services or Drs visits.

Cinquefoil

199 Posts

Specializes in Med Surg, Home Health.

Hmmm...I'm curious if this attitude applies to other aspects of health care as well....like patients riding the call light and families throwing a fit if you're not there in 2 minutes or less! LOL

joanna73, BSN, RN

4,767 Posts

Specializes in geriatrics.

Nah, LOL, we have high maintenance pts and families, too.

Specializes in Gerontology.
Quote

Hmmm...I'm curious if this attitude applies to other aspects of health care as well....like patients riding the call light and families throwing a fit if you're not there in 2 minutes or less! LOL

Oh no, we still get them.

And the families that want the doctor to fix a medical problem that Mom has had for 20 years while Mom is in rehab for her knee replacement.

Because, you know, shes in hospital anyway.

joanna73 said:
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.

Thank you for the reply. Sad that Ontario is so scarce right now. I think I'll stick to the West. As for most of the jobs being casual (or PRN as it's known in the US) or part time, it's the same situation here in the US. But for casual jobs in Alberta, would I still be eligible for benefits? Such is not the case in the US.

In any case, I'll find out more in May, when I plan to visit Calgary. Doesn't hurt to find out early.

Fiona59

8,343 Posts

Depends on the employer, but in most cases, casuals work without benefits, they get a % on every cheque for assorted things like paid stat holidays. But other than the CPP there's usually no pension plan.

LaughingRN

231 Posts

Specializes in ER.
joanna73 said:

However, we do have some facilities that are privatized. So if you have the money, you can go to these facilities and pay. But the majority of our facilities are funded by the government, and are operated according to these values;

Accessibility (for all)

Portability. (You can move within Canada)

Universality (same standard for everyone)

Intersectoral collaboration (valuing team contributions)

Health Promotion (preventative care and education)

...And 1 more that I forget at the moment ;)

The proud Canadian in me has to correct this

The Canadian Health Act, is the soul of health being a right. The act is used as criteria that each Province must meet to qualify for federal funding...There are 5 criteria (viewed interchangeably with "rights")

1. Public Administration: Health insurance plan is administered and operated by a non-profit public authority. It reduces the scope of private insurers (basically to non-insured services or uninsured non-resident people)

2.Comprehensiveness: The insurance plan must cover all health services provided by hospitals and medical practitioners. They cover completely...no deductible, no co-pays, no monthly bill.

3.Universality:The insurance plan must be applied in a uniform and equal manor to every Canadian regardless of age, sex, financial status etc...

4.Portability:This exists because Provinces (like states) retain their own level of government and Health insurance plans are provided provincially, not federally. Portability allows Canadians to move from one Province to another without the fear of having a gap in health insurance.

5. Accessibility:Each citizen is entitled to equal access in acquiring health care...This is the most beautiful one, it means that doctor's can't charge for extra services (co-pay anyone?), because that makes access unequal for wealthy vs poverty level folks. And that is just one example.....

Sorry to correct you, but sometimes I forget how beautiful our system truly is, and wanted to share it correctly with everyone:)

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