Difference between nursing in the UK vs nursing in the US?

Silverdragon102, BSN · Nov 12, 2006

Maybe speaking a bit out of term but think this thread is getting a bit heated. It doesn't matter where we work in the world nurses have different roles and different way of doing things. Surely we can answer the OP's question without getting at everyone.

janelola · Nov 12, 2006

hear hear!:chair:

RGN1 · Nov 12, 2006

I'm a UK nurse who is also "legging it" across the pond. I'm leaving for many of the reasons that Janelola mantioned along with the congestion, draconian parking measures, stealth taxes etc.

Also I do actually know where the OP was coming from with the original comment where he talked about RN's being like CNA's. What I think was meant was the fact that here the RN is expected to take full care of the patient. For example, When I get my allocated 5 patients (I'm lucky enough to be in the private sector where my maximum caseload is usulaly 5) I have to do everything for them that shift be it washing them, making their bed, helping them with their meals etc etc as well as meds, careplanning etc etc. This is where I think the idea of the UK RN being like a CNA comes from because we have to do the whole lot. When I was in the NHS my role also included washing the bed area & locker too, cleaning up with the mop if anything was spilled etc etc!

However, I don't have a problem with orders because if a patient goes into retention I can just OK it with the RMO (resident medical officer) to put a cath in etc. Only occasionaly do I have to call their consultant for orders. I am certified to cannulate & take bloods but in the UK we are not taught to listen for heart or lung sounds (although I do listen to the latter if I'm concerned about fluid retention etc) however, bowel sounds are definitely part of my remit because we have plenty of gynae surgery on the unit.

allnurses Guide · Nov 12, 2006

I quite liked the original question because I have wondered what attracts UK nurses to the US.

Rn's roles in the UK are very practical, we have alot of hands on care. I love doing direct patient care such as baths, oral and eye care, doing and recording obervations (vitals) it gives me time to talk to my patients and get to know them. We do not do formal physical assessments such as listening to heart, lung and bowels sounds routinely although in my area if the nurses are concerned about a particular patient they will listen to chest and bowel sounds.

We are able to act on our nursing assessments so that if we feel a patient is in retention we will catheterise, we make decisions to remove catheters post-operatively. If we have patients who we feel needs naso-gastric tubes then we will pass them without asking the medics.

One poster asked about litigation and who would be sued. In the UK although things are changing at the moment legal action against nurses is not common. I do think this is changing but providing the nurse can give sound justification and rationale for the care provided it is part of the care we provide.

I love hands on nursing and the time I spend with my patients, in fact something like a complete bed bath and hair wash for a totally dependent patient is one of my favorites.

We give out the medications and use judgment to administer as required meds such as analgesia, angina meds, anti emetics.

Essentially UK nurses are hands on nurses who provide all aspects of patient care with the assistance of health care support workers.

Nurse to patient ratios can vary from hospital to hospital where I work we have 32 bedded wards and these will be staffed with 6 qualifieds and 2 support workers.

suehp · Nov 12, 2006

Also I do actually know where the OP was coming from with the original comment where he talked about RN's being like CNA's. What I think was meant was the fact that here the RN is expected to take full care of the patient. For example, When I get my allocated 5 patients (I'm lucky enough to be in the private sector where my maximum caseload is usulaly 5) I have to do everything for them that shift be it washing them, making their bed, helping them with their meals etc etc as well as meds, careplanning etc etc. This is where I think the idea of the UK RN being like a CNA comes from because we have to do the whole lot. When I was in the NHS my role also included washing the bed area & locker too, cleaning up with the mop if anything was spilled etc etc!
QUOTE]
That is the nice part of the job though isnt it - dont you think? I like being able to take care of the "whole" pt, washing them, changing the bed etc etc...this is basic nursing care at the end of the day and I personally dont think it should be beneath any nurse to be able to do it, (I am not saying that anyone is saying it is either) the question is whether you have time to help the CNA's to do it with the workload most nurses have.
The assessment process in the USA is different to the UK in that in the USA we listen to lungs/heart sounds and start IV's...these are the things that myself and other UK nurses have struggled with initially, so if you are one of those UK nurses on their way here - practise as much as you can while you are there to get heads up - it will be so much easier then when you get here.

suehp · Nov 12, 2006

I love hands on nursing and the time I spend with my patients, in fact something like a complete bed bath and hair wash for a totally dependent patient is one of my favorites.
QUOTE]
Me too - plus this is the ideal time to check your pt thoroughly all over for anything for breaks//bruising etc.

Skwidward · Nov 12, 2006

So do nurses in the UK not start IVs?

Are you allowed to give IV push meds?

A couple of you mentioned that you can give angina meds at your own discretion, does this mean that you have a standing/prn order from the pt's doc or are you able to prescribe these meds yourself?

madwife2002, BSN, RN · Nov 12, 2006

So do nurses in the UK not start IVs?
Are you allowed to give IV push meds?
A couple of you mentioned that you can give angina meds at your own discretion, does this mean that you have a standing/prn order from the pt's doc or are you able to prescribe these meds yourself?

Not all nurses in the UK cant start IV's but all nurses give IV pushes. I believe the reason that every pt in a US hospital has an IV cannule in situ is because the nurses put them in and it is not a doctors role-where as in the UK it has been a doc's role tradionally. So you will find that there are less of the pt population with IV access in the UK. I also heard recently that docs get paid more money in the US if the pt has IV access.

Fiona59 · Nov 13, 2006

Skidward: Not all nurses in Canada do these things. We may be trained to do them but it is ultimately the hospital's decision to allow us to do them.

Our hospital requires the RN's to be IV "certified" before they can start an IV, others have IV "teams" who can be called to do IV starts and usually work in the IV clinic.

IV push meds are rare on the general floor and also require the nurse to be "hospital certified" and even then it doesn't carry from hospital to hospital. Dialysis nurses in my hospitals can push but surgical nurses can't.

LPN's have IV certificates and can't start an IV because the hospital won't let them. Dialysis LPN's can do their own IV antibiotics but only on a diaysis floor, they can't do it if picking up extra shifts on the renal unit.

But the ability or lack of to start an IV doesn't define a nurse.

cariad · Nov 13, 2006

i am back,

skidward, i did not mean to be derogatory over your name, i only referred to you by your screen name to post back to your comments. the only offence that i took was the hearsay comment that you made likening uk rn's to cna's and i thought that was what i said.

i have worked in various american hospitals and some have the patient ratio anywhere between 5-7, sometimes we get aides who do a lot of patient care and sometimes, 5 patients but no aides or anyone else, and even have to reansport patients to x-ray, dialysis ct, etc. so ratios mean nothing if you dont have the back up from other staff.

uk nurses dont work with ratios, they work as a team, with aides helping the rn's as needed and vice versa. and as a uk nurse i assessed my patients cannulated pushed iv meds and acted a as phlebotomist sometimes and took the daily bloods. theres good and bad in both systems. right now i am in a hospital where we have good patient techs who do a lot for the rn;s. the lab draws all the bloods and the ratios are kept to 5. but i have worked in others where i have had up to 8 patients, no pharmacy no phlebotomist available and if we had a code we were the people who took care of it until someone came,,,,,,no rapid response team just a doctor and nurse from the er.

so things can be different from hospital to hospital.

uk nurses will give you the information that you are looking for, but sometimes things cant be compared as the entire health care system is run differently.

medsurgnurse, RN · Nov 13, 2006

yes i did take offence that you had heard and think that uk nurses are likened to cna's, i am in the us and do know that your training can be dedicated, but have seen some nurses take the 2 year course over many years, something that is not available in the uk. and as a nurse now in the us i dont see many decisions being taken by a nurse without a written doctors order. some of my examples would be whether to give a patient with angina some oral medication to relieve the symptoms, do an ekg on a patient with chest pain, whether to catheterise someone with urinary problems. these are a few examples.
and yes we do have cna's and no we do not have lpn.s there used to be a qualification called sen, but this is not the same as an lpn, they did 2 years training and just about do the same as an rn.
maybe i havent experienced enough in the us, but as i said previously if you didnt mean to be inflamatory, then ok, but to compare cna's and trained rn's rubbed me up the wrong way.
i am quite sure that if i posted on the us threads in the same way then i would get the same replys.

funny i didn't see that she compared you to a cna. i saw that she asked do uk nurses do more hands on care ( what we call primary care).

medsurgnurse, RN · Nov 13, 2006

In the UK we just have the one governing body, so it doesn't matter where abouts in the UK you live and work we all should follow the same rules. However hospitals will have local policies which can vary on what a nurse can do but there is also a lot of stuff we can do without orders from the doctor and local policies ie catheterise patients, dressings, remove sutures.
I originally was an Enrolled nurse and for a lot of my role on a ward was very similar to the RN but I was accountable for my own actions not the RN and a lot of the time I did exactly the same work as the RN the only differency would be management of the ward which did not usually involve the EN although depending on the ward and shift it was common to have a senior EN in charge.
RN's can now do a prescribing course which is very intense and once passed can prescribe everything which is in the BNF (British National Formulary).
I find it interesting to see how nursing changes in other countries and what nursing responsibilites are. But I do not feel just doing it one way is the right way although if doing a trial after discussion it works better then I can't see why it couldn't be adapted to the area you work in. We all have a wealth of experience which can and could enhance our care of patients and family

Thanks for a very informative answer. In the US to be a "prescribing nurse" requires a Master's degree and then passing a national advanced practice nursing certification test. The Masters programs are varied according to specialty. Geriatics, Pysch, Family, Women's health, certified nurse midwife, neonatal, pediatric. I could go on but you get the idea. These Masters programs require a certain number of years experience before enrolling.