American Nurses in U.K

Becky C · Nov 15, 2019

Which agency did you use when applying for your Job? Did you shop around with agencies before finding the one you liked?

kaitfinder, BSN, RN · Nov 25, 2019

On 11/15/2019 at 5:03 PM, Becky C said:
@kaitfinder
Which agency did you use when applying for your Job? Did you shop around with agencies before finding the one you liked?

Hey!

I definitely shopped around when looking for agencies, but I had the luxury of knowing not only which area of the country I wanted to work in, but which hospital specifically. From there, I found two agencies that worked with that hospital and chose one to apply through.

I would definitely recommend narrowing it down by area of the country you'd want to work, as there are many international agencies looking to "import" nurses from outside the EU especially (what with brexit) to the UK.

Try to find an agency that helps you heavily in the application process (both for a job, and for your visa). I had to interview with the agency, do a small mini-med calculation test, and then once passed I was given an interview with the hospital itself. This pre-screening process was important and I suspect the hospital took my interview more seriously as a result. I wouldn't say it's necessary, but definitely do your research. I had a Skype interview with the agency and the hospital as well as a few phone calls.

Make sure the agency is knowledgeable about the visa application process, as it is costly, unnecessarily confusing (UK Visa & Immigration's fault unfortunately), and can be very expensive if done incorrectly. Ask them for their general timeline for how long it will take to get a visa, and how they help you with the visa and applying to the hospital.

I worked with the international nursing agency NEU Professionals.

Becky C · Nov 26, 2019

@kaitfinder

I would love to hear about what you have learned so far from your experience. Any big differences with care that was an adjustment for you? Any helpful advice on things that you wished you knew before moving? Do you mind if I ask you which hospital you work for? If not, is it a bigger or smaller hospital. I also specialize in the Emergency room. I would love to pick you brain more about your experience.

Lilygirl · Dec 18, 2019

Kay, thank you very much for your help. I really appreciate your time. You are very thorough and helpful .

kaitfinder, BSN, RN · Feb 5, 2020

@Becky C

Sorry for the delay, the holidays were busy for me!

I've learned a lot, probably too much to be able to put into one post, though I have made several different posts on this topic through various different threads on this forum.

I work for a large, major hospital system in Oxford! A few adjustments: nurses have less autonomy and can do less skills here than in America. Some have told me this may just be the trust that I work for, however it is still widespread the U.K. over. For example, I was training at my old job in America to do ultrasound guided IV insertion. Nurses in the UK don't even touch ultrasounds except to use the bladder scanner. Doctors seem to do much more IV insertion here than nurses, and will regularly draw blood. This may just be because I am also at a teaching hospital. There is less emphasis on nursing assessments, and nurses seem to do more "technician" type roles. There is room to expand your skillset but you need to get further training/approval to do so, unlike in America where you are expected to know many skills off the bat. Nurses here, however, are allowed to stitch/staple wounds, which is not a thing in America as far as I'm aware.

There isn't too much advice I wish I would have known before moving, mostly because either I did my research and knew it beforehand, or it's just information that wouldn't have helped to have known! There are certainly lifestyle changes you'd have to make, but that's expected and knowing about them won't make a difference; you are living in another country after all. All of the really useful and necessary information that you would need before moving can be found online, so do your research! If you have any specific questions, let me know! I'm just not sure where to start with that one exactly. England is different, but it's still a first world, english speaking western country.

Emergency is both similar and different, and I think especially so in the hospital where I work. From what I can tell, most other emergency departments in the UK do not operate in some of the peculiar ways they do here; a lot of the changes they have made, however, appear to be to mitigate some of the issues they were having. For example, they do not do triage, but instead use a process called "streaming" which is a very short, limited assessment with the expectation that they will be seen faster initially and receive a more thorough nursing assessment in the back. Various other peculiarities like that. Additionally, (and I think this may be true for most of the UK) cardiac arrests are run in the community on site by paramedics and are only brought to the hospital if they were stabilized; therefore, you will see few cardiac arrests in ED, as most will only present in cardiac arrest if they arrest en route. Let me know if you have any other specific questions, though!

Best,

Kaitlyn

skylark, BSN, RN · Feb 5, 2020

I don't know where you are working, but that does not sound typical!

I had a LOT more clinical and assessment skills working in English A&Es, now I'm in the US in an ER I mostly just do blood draws and pass meds. I'm bored!!!

I doubt they skip triage as you suggest, but it could be an accelerated AVPU type fast eyeball assessment, to keep the momentum.

Patients have to be thru and out in 4 hours. So.momentum and throughout is key. You can't just leave people sitting in the waiting room for hours like you are used to.in America.

And I found that both codes and major incidents were run far more smoothly in the UK than in the US. Without all the drama. In fact one A&E I know runs codes in silence, with only the team leader talking. Unlike all the drama and shouting I hear in American codes. Roles are clear and teamwork is key in England. Here in Chicago its just a load of people running in circles, not knowing what each other are doing!!

kaitfinder, BSN, RN · Feb 5, 2020

@skylark

I think what it may come down to is what facility you work in? Where I worked in America, they really promoted nursing skills, and doctors did few skills aside from central line insertions, suturing/draining, etc. but many of the other skills (foley insertion, port access, IV insertion, etc.) were managed by nurses. Where I work in the UK, I feel like a gopher, mainly passing meds, barely even inserting IVs or drawing blood, rarely inserting foleys, etc. I'M the one that's bored, here!

They do genuinely skip triage as I have brought this up a few times with senior staff who refer to it as "streaming", do not apply any sort of triage classification such as what's used in the Manchester Triage. Instead, they have a form that assesses pain on a 0-3 scale and a small box with approx 250 character limit. Vitals are optionally taken at the discretion of the nurse. It does seem to be an accelerated assessment, but it makes me nervous because often nurses in the back are so busy they don't do a more in depth nursing assessment and will wait until they've been seen by a doctor.

Momentum is definitely key here, I agree, but the hospital I worked at in America did achieve a roughly 4-5 hour door-to-discharge time, although there was less push to do so since there wasn't the government mandated push as there is in the UK. I do know that many american EDs will have excessive wait times upwards of 6 hours, though. Where I work in the UK, our ED does hit the door to discharge 4 hour time approximately 80% of the time.

Where I worked in America, it was a smaller hospital and I felt roles were clearer in codes and run very efficiently. Here, I find that it feels like since they don't run codes as often here, people are stepping on each other's toes and there are often too many people present, and sometimes since there are many doctors (ICU doctors show up for codes because ED doctors and nurses apparently don't manage their own ventilators or codes), there can be stepping on toes between doctors. There is rarely, if ever, a scribe responsible for time-keeping and note-taking, unless it's trauma related. It feels much more disorganized to me.

GrumpyRN, NP · Feb 5, 2020

8 hours ago, kaitfinder said:
For example, they do not do triage, but instead use a process called "streaming" which is a very short, limited assessment with the expectation that they will be seen faster initially and receive a more thorough nursing assessment in the back.

7 hours ago, kaitfinder said:
They do genuinely skip triage as I have brought this up a few times with senior staff who refer to it as "streaming", do not apply any sort of triage classification such as what's used in the Manchester Triage.

This is similar to what we did in my ED. There is a triage but it is a quick one followed by streaming the patient into "minors," "majors," or "resus."

There is no point at all in doing vitals in triage on someone who has a minor injury. It tells you nothing and slows the process down. Majors and resus patients should have observations done as required when they are seen by the staff looking after them. The only time vitals should be done in triage is to decide whether to put someone into resus or majors. eg sepsis.

8 hours ago, skylark said:
And I found that both codes and major incidents were run far more smoothly in the UK than in the US. Without all the drama. In fact one A&E I know runs codes in silence, with only the team leader talking. Unlike all the drama and shouting I hear in American codes. Roles are clear and teamwork is key in England.

7 hours ago, kaitfinder said:
Where I worked in America, it was a smaller hospital and I felt roles were clearer in codes and run very efficiently. Here, I find that it feels like since they don't run codes as often here, people are stepping on each other's toes and there are often too many people present, and sometimes since there are many doctors (ICU doctors show up for codes because ED doctors and nurses apparently don't manage their own ventilators or codes), there can be stepping on toes between doctors. There is rarely, if ever, a scribe responsible for time-keeping and note-taking, unless it's trauma related. It feels much more disorganized to me.

Staff in ED should be ALS trained so that everyone knows their role. I agree a big part is to stop people appearing and only have those involved there. ICU should not be contacted until after the patient is intubated. ED nurses should be perfectly capable of looking after a ventilator. In my department we did not put out a call for a cardiac arrest, it was handled completely by ED and other specialties were contacted only as and when required.

When I was involved in a resus with new doctors I would turn around tell them; "The first person who say's "let's go people," gets punched." ? This rule also applied to any other nonsense shouted out on American or British medical TV programmes.

GrumpyRN, NP · Feb 5, 2020

7 hours ago, kaitfinder said:
I think what it may come down to is what facility you work in? Where I worked in America, they really promoted nursing skills, and doctors did few skills aside from central line insertions, suturing/draining, etc. but many of the other skills (foley insertion, port access, IV insertion, etc.) were managed by nurses. Where I work in the UK, I feel like a gopher, mainly passing meds, barely even inserting IVs or drawing blood, rarely inserting foleys, etc. I'M the one that's bored, here!

I agree, this seems to be area dependent. In my unit the nurses never did IV cannulation or took bloods as there were enough doctors to this. Catheters were definitely a nursing job. But again this was rare because we did not do these routinely. A big complaint from surgeons was that their patient needed a catheter pre op, and we would agree and point out that ED did not require that patient catheterised so why would we do it? The same applied to pre op ECG's. ED did not need it done, it would not change our management, so why should WE do it?

As an ENP I did a lot of suturing but I initially learned as a Staff Nurse, long before I became an ENP. We would do suturing to enable the doctor to get on and do other things.

I should add my ED is different from almost all other ED's in that we are a level 1 trauma center and see the full range of patients BUT we still manage to meet the 4 hour target. Over the winter we managed 96.3%. (If you decide to search for that it identifies which ED I worked for. But as I no longer work there it won't matter).

brin11299, EMT-I · Feb 13, 2020

@kaitfinder do you need a BSN to be a nurse in the UK or just an ADN? I'm looking to move over to the Bromley/South London area in the net year or so to be with my fiance (would be applying for a work visa).

Also, what are some agencies you looked at to move over to the UK?

Silverdragon102, BSN · Feb 14, 2020

BSN is required. Just check out the NMC website for requirements for those trained outside the UK

Candy82 · Feb 16, 2020

On 7/10/2018 at 3:02 PM, kaitfinder said:
Hey!
I'm a U.S. nurse in the process of getting licensed in the U.K.
I don't currently work there but am in touch with a hospital about standards of practice/care/jobs so I have a bit of information. Additionally, if you have any questions about the actual process of moving/getting licensed in the U.K. as a nurse, I'd be happy to share what I've learned over the past several months, should you decide to move and work there.
As far as just general nursing in the U.K., it seems to be fairly similar to what I've come to find in the US. Nurses seem to have the same scope of practice and autonomy, patient to nurse ratios (hospital based), and education level. One of the few skills I've come across that we don't do in the US that they do in the UK is suturing? To be confirmed though the extent to which a UK/non-surgery nurse would suture. As far as I am able to understand, the NHS, as it is funded by the gov't, has more limited resources, especially when it comes to money. As such, nurses might get paid slightly less and have access to fewer or less advanced resources. However, many of the NHS hospitals seem to work with universities/educational bodies and as such have very up to date and current healthcare practices. Also, if you work for the NHS you would likely encounter different types of patients, i.e. the difference between patients who can afford to or choose to pay for healthcare and those who cannot or do not.
I'm expecting to move officially by the end of the year, so if you're still around by then, feel free to shoot me a private message about it, or the process of getting registered.
-Kaitlyn

Did you have to take any additional exams like the NCLEX to receive your license?