ICU nursing Australia vs The US - page 2

Hi, So I am a dual citizen, grew up in oz, but moved to the us after highschool and have complete my BSN here and am currently an ICU nurse. I am thinking of moving back to Queensland and most... Read More

  1. by   Sockeye
    In most of the decent units those things are protocol driven. The docs prescribe a protocol. It would be up to the nursing staff to implement it based on the specific requirements of patient under care. So lets say for blood sugar control the docs would give you Insulin drip order with the request to optimize the BSLs within 4-10 range. They would not be generally interested in how you achieve that as long as Insulin requirements were not dramatic (>15 units/h).
    In Calgary we had protocols for management of traumatic brain injuries where nurses could initiate fluid boluses, start Noradrenalin, bolus hypertonic saline when they see fit in order to achieve certain clinical goals (CVP, CPP, ICP, etc).

    Ventilation wise, we would be talking about an order to wean off ventilator. This is Brisbane now. It would be up to nursing staff to decide to ease up sedation to a level of tube tolerance, go down on FiO2/ PS/PEEP based on the gas exchange, transition from lets say SIMV to PS ventilation - generally bringing the patient to the point of extubation. And then, upon a medical review, receive an order for extubation and implement it.
    In contrast, Toowoomba hospital ICU would not let nurses make any changes to the ventilators at all.

    So again, everything seems to be very unit specific. Unfortunately, someone who used to a certain level of independence in practice would have a major culture shock borderlining depression when they come to a place where their expertise, experience, knowledge and skill set is not generally needed, and they are unable to practice to the full scope of their abilities, capabilities and desire.
  2. by   Fiona59
    Sockeye: I experienced this as an LPN moving from AB to BC. Basically treated as a glorified NA and not permitted to work in my specialty area after moving from a regional acute care facility to a small rural hospital. It's called protecting the turf.
  3. by   Sockeye
    Is there a way to answer private mesages? The board won't let me write to the people writing to me. Pls send your normal email with your message.
  4. by   JustBeachyNurse
    Quote from Sockeye
    Is there a way to answer private mesages? The board won't let me write to the people writing to me. Pls send your normal email with your message.
    Forum rules require 15 quality posts before you can reply to PM's. Only 9 more posts and you'll have access.
  5. by   ghillbert
    Agree that it very much depends on the specific unit - a great reason to remember when interviewing for jobs that you need to find out the culture of that unit as much as possible in detail as to what is expected & permitted.

    As a control freak ICU nurse, I preferred the Aussie model of doing everything for my patient. I greatly admire the expertise of the various team members such as respiratory therapists etc here in the US, but I feel that it makes the care a little more fragmented when you aren't 100% sure who's doing what sometimes. Of course this is minimized with good communication among the team.

    I agree that the US is probably further ahead in terms of professional issues and expectations, but overall ICU is ICU is ICU. The actual unit culture, management and colleagues will probably be the major determinant of your job satisfaction.
  6. by   sbeattrix
    May 22, '11 by K+MgSO4
    The hospital that I work in is one of the 2 trauma hospitals in the state and a tertiary referral centre. I know that we run a 6 month supported introduction for those from a different Crit care unit such as CCU or ED resus or those from overseas.

    I know that other experience is acknowledged but you are expected to do a grad cert within a year.

    Good luck with fighting with AHPRA it took 2 months to get my practising certificate for this year!

    Hi. K+MgSO4.

    Would like to ask what's your hospitals name.;-)
  7. by   K+MgSO4
    PM sent
  8. by   rpgun1
    Hello 184859 (Orig members blog/thread), I think what most people have written here is correct and i would have to agree. Im in a similar situation but doing it the other way around. Im an australian nurse wanting to work in the states (partner is american), however have heard numerous things and am left wondering. The only thing is - i have recently been doing some management work, i.e. i have been the bed manager and I have been Acting Nursing Unit Manager (manager of staff and allocation and co-ordination of floor, patient admission, as well as working in budgetary constraints) whilst the manager is away, and i would like to work my way unto being a permanent NUM of a ward.However what does one do and how does one with all that experience and more move up in the USA structure. I don't even know what their structure is like. I think i will have to probably start at the low level all over again and work on the floor and wait for opportunities to come up. Can any USA nurse give me some idea.?
  9. by   nixonk86
    I have worked in a large trauma referral ICU and a small district ICU and I'm mainly in agreement with what people have written so far;
    The doctor-nurse relationship is usually great as the doctors respect that the nurses know their stuff! I usually find ICU and ED to be the two places where nurses really run things.
    You will learn so much about vents and you'll be surprised how easy they are once you grasp the basic concepts, the hospitals I've worked at either run their own vent courses or send you to them and they also have vent workbooks and lots of people to help you with them. Once I'd done the advanced vent workshop I was able to change ventilation settings without orders (within reason).
    The pay is the same as any RN however if you have a Graduate Certificate in Critical Care or Intensive Care you'll receive a continuing education allowance and heaps of ICU nurses become Clinical Nurse Specialists which is a higher rate of pay (and I think less intense than being a CNS in the US but I'm not too sure about that).
    You don't have to have postgrad qualifications but in some states it can be difficult to get a job without a postgrad. Chances are you'll work in an ICU who will support your GC and you'll get study days and an allowance towards course fees. Most ICU nurses I know have a Graduate Certificate as a minimum and if you are new to working in Aus ICUs it would probably be a good learning experience for you.