ICU nursing Australia vs The US

imaginations · May 22, 2011

I'd be interested in hearing the answers to this. I'm a third year student nurse in Australia and I've just done five weeks of clinical between two different major hospitals (some of the biggest/most renowned in the state) in cardiothoracic ICU and neuro ICU respectively.

As you said, the nurses do manage the vents. I believe they learn a lot of this on the job however I manage their is also in services and preceptorship to assist nurses in learning these skills. I've picked up a lot of basic knowledge regarding the vents just by being a student and watching/learning from the RNs.

I believe the ratios are typically 1:1 for a vented patient and 1:2 for a HDU patient (ie. a non-vented and stable patient in the ICU). However I note this only from observation on clinical and not from any protocol or anything official. Some hospitals have 2:1 ratios for patients on things like ECMO.

I have noticed (and again, this is simply observation) that nurses enjoy a good amount of autonomy in the ICU and also enjoy the partnership with their doctors and easy access to their intensivists who are never very far away.

K+MgSO4, BSN · May 22, 2011

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!

masiagere · Jun 16, 2011

The unit i work in we have 1:1 on very rare occasions 1:2 non intubated,stable HDU pts.2:1 for ECMO pts. You get training in house and uni courses. The drs are within reach and can talk to them,ask questions about plan of cre or decisions that you are not clear about without any problems.

ICU_nurse · Jul 3, 2011

Hello there. I'm an RN working in ICU for the last 4 years. Hope I can answer afew of your questions

1. How similar is ICU nursing between the two countries?

That I can't answer because I've never worked in the US! However I have heard they are quite different time-management wise, due to the number of patients you have, the different technicians and assistants you have access to etc etc.

To give you something to compare to, I work in a 14 bed ICU in a regional hospital. Ratios are 1:1 for ICU patients (all ventilators/NIPPV/CRRT) and 1:2 for HDU. I am responsible for all the care provided to my patient over the course of my shift. I look after the drugs (all infusions, meds etc), the equipment (monitor, ventilator, dialysis, balloon pump, etc), patient needs (turns, washes, mouth and eye care) and social and family issues (talk to the family, answer questions, attend family conferences, be a "go-to" person, organise referrals for family such as social work, pastoral care etc). I will have the ICU team and the patients admitting team come to do rounds (admitting team rarely stay for long!), the physio will come to do some chest physio, reposition and help with splinting/passive ROM exercises etc). The Nutritionist will come and check our feed rates are correct and let me know of any changes. And thats about it, everything else is up to me!

I feel I have a lot of autonomy (this has obviously increased with the more experience I've gained). As our registrars and residents rotate through the unit pretty frequently (RMO's 10 wks, Reg's depending on what training theyre doing be it ICU/ED/Anaesthetics or a combination will be around for 3-6 months at a time) you find that in some cases you have more experience and or knowlege regarding ventilation than the medical staff (I know I've spent many a night shift giving the Registrars a crash course in BiLevel!), and they are quite happy for us to tweak settings as necessary (eg- ABG looks good, might turn my Fi02 down abit, next gas looks good too, might turn the PEEP down by 2...). However, I know of other (bigger) hospitals where they dont like it as much, and youre expected to discuss any changes you want to make before you do it. The autonomy in our unit came from our previous medical director (so ive been told); he really valued the nursing staff and their skills, and wanted them to feel empowered and able to feel responsibility and ownership for their patients (although ive also heard its beacuse the registrars were tired of getting woken up only to be asked "can I turn the Fi02 down, the PA02 is 120....." hehehe

2. Do australian nurses complete additional training for vent management is it in uni, or is it learnt on the job?

Learnt on the job. No training in ventilation as an undergrad. You learn as you go, and are supported (well, I know I was). When newbies start in our unit they're taught as they go, advancing frm NIPPV, to maybe a slow trachy wean on PSV, to a post-op on SIMV, to a sick pneumonia on BiLevel etc etc. Our unit runs afew different ventilation workshops (Introduction, Advanced 1 & 2) which people are tapped into, normally each one runs at least once a year (it all depends on money, time, resources, etc etc). Each one has worksheets which you fill out, and are marked and returned. My unit is lucky to have some very knowledgeable senior nurses who are just amazing with ventilation. Needless to say, their brains regularly get picked on night duty!

Advanced ventilation education is part of your post-grad studies. My Grad Cert had a respiratory topic, and ventilation was covered in that. Other organisations may provide short courses (like a one-day seminar) on ventilation. We currently have one that is run by Fisher & Paykel through one of the big hospitals in Sydney, which I've been told is really good.

3. How is physician / nurse interaction in the ICU ? (in my hospital it is very much a partnership, very respectful and unlike a lot of other floors in the hospital)

Where I work, we have a great working environment, all our members are part of a team. Consultants will ask your opinion, discuss your concerns, and generally are just interested to hear what you as the nurse caring for the patient, have observed throughout your shift. Having said that, it depends on the doctors you work with, their attitudes and experience, and the culture of the unit itself. That I think is different unit-to-unit.

If you're referring to something like the concept of "Dr's treat nurses as handmaidens" (a very outdated professional relationship), then no, our working environment is not like that. We are professionals and are recognised as such.

4. What is the pay like, is there any extra differentials for ICU nursing?

Pay rates are different in each state. They are negotiated by the state nursing union in consultation with the state goverment/office of industrial relations. Awards are negotiated every 3-4 years, at the end of which the terms, rates, benefits and conditions are up for re-negotiation. So it depends on which state you're thinking of working in (Visit QLD Nurses Union for more info)

In my current state, pay is via an incremental scale based on years of service, from Year1 to Year8+ thereafter (so your pay goes up for every year of fulltime service for 8 years, at which point your pay then no longer increases. Pay will only increase for an 8th year RN if the award is re-negotiated ie: we get a pay rise)

To get an idea of some numbers, I'm an RN5 (5th year of service) workin in the NSW public sector, and my pay rate is $31.75/hr. There are no bonuses or extra allowences for working in ICU, you are paid as to your year level (1-8). An RN1 in a dialysis unit gets paid the same as an RN1 in ED, as does an RN1 in theatres. You can, however, get access to the continuing education allowance, whereby you receive an allowance for having completed further formal education, for example a Graduate Certificate or Masters. For example, I completed my ICU Grad Cert, and get an extra 84c per hour, which is about $64 a fortnight (FT). This is different for every state, as awards are negotiated differently, so again check for the state you're interested in.

5. Do you need any extra certifications or qualification to be an ICU nurse in oz or is your bachelors and experience enough?

You can work in ICU if you are an RN, regardless of how you became registered (University or Hospital trained). However, your experience can count for alot. For example, you would be very hard pressed to find a unit willing to employ you if you have little to no recent acute care experience (eg- med/surg). Your current ICU experiece should be perfectly acceptable. Your potential employer(s) may want to know abit of detail about it though (which is the case for any job you apply for anyways!); how long? patient acuity? unit demographic? unit size?... etc

It depends on the unit that you work in as to how "essential" further formal education is. I started my post-grad studies when I was in my 2nd year of ICU (which alot of people said it was too early, but I had the support of my CNE's, NUM and senior staff who said go for it). I knew ICU was for me, I decided thats what my career was going to bed based upon, and went for it. Its not something that is pushed upon you, there are nurses in my unit who have been there for 10+ yrs who dont have formal post-grad qualifiactions. And there's nothing wrong with that! However, some units may have a more structured career development pathway that post-grad study forms a part of, and it will be expected that you will at least gain a grad cert within a certain time-frame of having worked there.

Of course, it also depends on your own career goals; do you need a Masters or a Ph.D to get where you want to go? Senior positions (such as NUM, CNE, CNS etc) will require you to have some form of post grad qualification. I know for my CNS pathway I needed my Grad Cert. Some CNE positions require education qualifications. NUMs may be required to gain management qualifications.

Hope that helps a little!

Mcadamia · Jul 4, 2011

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 likely working for Queensland health.
I know there are no RT's (respiratory therapists) in australia to manage vents in the ICU. I also have heard the ratios are 1:1 in australia where it is generally 1:2 in the US unless they are on a balloon pump, CRRT, fresh CABG etc. I have also heard that US nurses have a lot more autonomy when it comes to patient care? Is any of this true?
My questions;
how similar is ICU nursing between the two countries?
do australian nurses complete additional training for vent management is it in uni, or is it learnt on the job?
how is physician / nurse interaction in the ICU ? (in my hospital it is very much a partnership, very respectful and unlike a lot of other floors in the hospital)
What is the pay like, is there any extra differentials for ICU nursing?
Do you need any extra certifications or qualification to be an ICU nurse in oz or is your bachelors and experience enough?
Thanks in advance :)

Usually the ratio's are 1:1 with occasional units running 1:2 during meal breaks - but be aware we use a LOT less chemical restraint than apparently is used in the USA and some unit do not use, or rarely use physical restraints.

I work rural and remote so we mostly fly our vented patients out anywhere between 2 - 48 hours after intubation although that is weather dependent. We have between 2- 3 people on per shift for 5 patients (HDU/CCU) most commonly and will call extra in if there are ventilated patients - but even on that level it can be crazy busy!! (I think one of our craziest mornings was just two of us with an unstable ventilated patient that was SUPPOSED to fly out within an hour - four hours later when we STILL could not get a second line into her (VERY obese) RFDS put in two Intraosseous and flew her out that way

We are even more independent than many of the bigger hospitals simply from scarce medical cover - but it is challenging and often fun!!

Danish ICU · May 16, 2012

Hello there. I'm an RN working in ICU for the last 4 years. Hope I can answer afew of your questions
1. How similar is ICU nursing between the two countries?
That I can't answer because I've never worked in the US! However I have heard they are quite different time-management wise, due to the number of patients you have, the different technicians and assistants you have access to etc etc.
To give you something to compare to, I work in a 14 bed ICU in a regional hospital. Ratios are 1:1 for ICU patients (all ventilators/NIPPV/CRRT) and 1:2 for HDU. I am responsible for all the care provided to my patient over the course of my shift. I look after the drugs (all infusions, meds etc), the equipment (monitor, ventilator, dialysis, balloon pump, etc), patient needs (turns, washes, mouth and eye care) and social and family issues (talk to the family, answer questions, attend family conferences, be a "go-to" person, organise referrals for family such as social work, pastoral care etc). I will have the ICU team and the patients admitting team come to do rounds (admitting team rarely stay for long!), the physio will come to do some chest physio, reposition and help with splinting/passive ROM exercises etc). The Nutritionist will come and check our feed rates are correct and let me know of any changes. And thats about it, everything else is up to me!
I feel I have a lot of autonomy (this has obviously increased with the more experience I've gained). As our registrars and residents rotate through the unit pretty frequently (RMO's 10 wks, Reg's depending on what training theyre doing be it ICU/ED/Anaesthetics or a combination will be around for 3-6 months at a time) you find that in some cases you have more experience and or knowlege regarding ventilation than the medical staff (I know I've spent many a night shift giving the Registrars a crash course in BiLevel!), and they are quite happy for us to tweak settings as necessary (eg- ABG looks good, might turn my Fi02 down abit, next gas looks good too, might turn the PEEP down by 2...). However, I know of other (bigger) hospitals where they dont like it as much, and youre expected to discuss any changes you want to make before you do it. The autonomy in our unit came from our previous medical director (so ive been told); he really valued the nursing staff and their skills, and wanted them to feel empowered and able to feel responsibility and ownership for their patients (although ive also heard its beacuse the registrars were tired of getting woken up only to be asked "can I turn the Fi02 down, the PA02 is 120....." hehehe
2. Do australian nurses complete additional training for vent management is it in uni, or is it learnt on the job?
Learnt on the job. No training in ventilation as an undergrad. You learn as you go, and are supported (well, I know I was). When newbies start in our unit they're taught as they go, advancing frm NIPPV, to maybe a slow trachy wean on PSV, to a post-op on SIMV, to a sick pneumonia on BiLevel etc etc. Our unit runs afew different ventilation workshops (Introduction, Advanced 1 & 2) which people are tapped into, normally each one runs at least once a year (it all depends on money, time, resources, etc etc). Each one has worksheets which you fill out, and are marked and returned. My unit is lucky to have some very knowledgeable senior nurses who are just amazing with ventilation. Needless to say, their brains regularly get picked on night duty!
Advanced ventilation education is part of your post-grad studies. My Grad Cert had a respiratory topic, and ventilation was covered in that. Other organisations may provide short courses (like a one-day seminar) on ventilation. We currently have one that is run by Fisher & Paykel through one of the big hospitals in Sydney, which I've been told is really good.
3. How is physician / nurse interaction in the ICU ? (in my hospital it is very much a partnership, very respectful and unlike a lot of other floors in the hospital)
Where I work, we have a great working environment, all our members are part of a team. Consultants will ask your opinion, discuss your concerns, and generally are just interested to hear what you as the nurse caring for the patient, have observed throughout your shift. Having said that, it depends on the doctors you work with, their attitudes and experience, and the culture of the unit itself. That I think is different unit-to-unit.
If you're referring to something like the concept of "Dr's treat nurses as handmaidens" (a very outdated professional relationship), then no, our working environment is not like that. We are professionals and are recognised as such.
4. What is the pay like, is there any extra differentials for ICU nursing?
Pay rates are different in each state. They are negotiated by the state nursing union in consultation with the state goverment/office of industrial relations. Awards are negotiated every 3-4 years, at the end of which the terms, rates, benefits and conditions are up for re-negotiation. So it depends on which state you're thinking of working in (Visit QLD Nurses Union for more info)
In my current state, pay is via an incremental scale based on years of service, from Year1 to Year8+ thereafter (so your pay goes up for every year of fulltime service for 8 years, at which point your pay then no longer increases. Pay will only increase for an 8th year RN if the award is re-negotiated ie: we get a pay rise)
To get an idea of some numbers, I'm an RN5 (5th year of service) workin in the NSW public sector, and my pay rate is $31.75/hr. There are no bonuses or extra allowences for working in ICU, you are paid as to your year level (1-8). An RN1 in a dialysis unit gets paid the same as an RN1 in ED, as does an RN1 in theatres. You can, however, get access to the continuing education allowance, whereby you receive an allowance for having completed further formal education, for example a Graduate Certificate or Masters. For example, I completed my ICU Grad Cert, and get an extra 84c per hour, which is about $64 a fortnight (FT). This is different for every state, as awards are negotiated differently, so again check for the state you're interested in.
5. Do you need any extra certifications or qualification to be an ICU nurse in oz or is your bachelors and experience enough?
You can work in ICU if you are an RN, regardless of how you became registered (University or Hospital trained). However, your experience can count for alot. For example, you would be very hard pressed to find a unit willing to employ you if you have little to no recent acute care experience (eg- med/surg). Your current ICU experiece should be perfectly acceptable. Your potential employer(s) may want to know abit of detail about it though (which is the case for any job you apply for anyways!); how long? patient acuity? unit demographic? unit size?... etc
It depends on the unit that you work in as to how "essential" further formal education is. I started my post-grad studies when I was in my 2nd year of ICU (which alot of people said it was too early, but I had the support of my CNE's, NUM and senior staff who said go for it). I knew ICU was for me, I decided thats what my career was going to bed based upon, and went for it. Its not something that is pushed upon you, there are nurses in my unit who have been there for 10+ yrs who dont have formal post-grad qualifiactions. And there's nothing wrong with that! However, some units may have a more structured career development pathway that post-grad study forms a part of, and it will be expected that you will at least gain a grad cert within a certain time-frame of having worked there.
Of course, it also depends on your own career goals; do you need a Masters or a Ph.D to get where you want to go? Senior positions (such as NUM, CNE, CNS etc) will require you to have some form of post grad qualification. I know for my CNS pathway I needed my Grad Cert. Some CNE positions require education qualifications. NUMs may be required to gain management qualifications.
Hope that helps a little!

Hi Parko

May I take this opportunity to thank you for your long and detailed answer that has been very helpful to me and I'm sure also to many others out there too ... I much appreciate your time and your efforts on answering the the original posters questions. THANKS!

Kind regards

S

britgirl · May 17, 2012

yes picked up lots of possitive advice from this post:thankya:

Lorodz · May 22, 2012

from masiagere

3. how is physician / nurse interaction in the icu ? (in my hospital it is very much a partnership, very respectful and unlike a lot of other floors in the hospital)

where i work, we have a great working environment, all our members are part of a team. consultants will ask your opinion, discuss your concerns, and generally are just interested to hear what you as the nurse caring for the patient, have observed throughout your shift. having said that, it depends on the doctors you work with, their attitudes and experience, and the culture of the unit itself. that i think is different unit-to-unit.

if you're referring to something like the concept of "dr's treat nurses as handmaidens" (a very outdated professional relationship), then no, our working environment is not like that. we are professionals and are recognised as such.

as an overseas nurse, i was shocked by the autonomy of the icu nurses in australia. as i have observed, they are like 'doctors' in their own rights. maybe because of the depth of their knowledge that was gained from experience.

in the icu that i was allowed to observe for a week, the line really blurs between nurses and doctors, because everyone is part of the team. even chaplains write in the progress notes of the patient!

Silverdragon102, BSN · May 22, 2012

as an overseas nurse, i was shocked by the autonomy of the icu nurses in australia. as i have observed, they are like 'doctors' in their own rights. maybe because of the depth of their knowledge that was gained from experience.in the icu that i was allowed to observe for a week, the line really blurs between nurses and doctors, because everyone is part of the team. even chaplains write in the progress notes of the patient! [/left]

what is wrong with chaplains writing in the progress notes? nursing/ medicine is all multidisciplinary and if they have something to write they should be able to write.i think you will find the itu nurse in the uk has similar autonomy

Danish ICU · May 25, 2012

"as an overseas nurse, i was shocked by the autonomy of the icu nurses in australia. as i have observed, they are like 'doctors' in their own rights. "

lorodz...just out of curiosity: where are you from then?

if you are shocked by the ozzy autonomy, try a trip to icu denmark! the teamwork nurses/doctors are like heaven there :yeah:

but then we do all have a 2 year post grad icu education as required at the beginning of the employment - and during the post grad. education one is fully pay by the ward, so no loss of money - 100% gain for both parties. it's a great system. the end product is highly trained and specialized staff on all icu wards.

Sockeye · Jun 14, 2012

Interesting read.

I am ICU RN from Canada now working in one of the largest Brisbane intensive care units.

Pretty much everything said earlier is correct. I do however get an impression that North American nursing is somewhat superior (in terms of professional independence, philosophy and respect) to the Australian which generally follows the UK model of nursing. This is much very dependent upon each and every unit traditions and history. There are places where nurses treated as professional members of the same team, and there are places where you are looked at as a form of advanced domestic help of some sort. This is sad and hurts, but I guess if you don't have much to compare things with then you don't really know what you are missing.