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

[Skwidward]

Seems everyone's legging it from the UK to the US. What's the deal?

[twotrees2]

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.

so then in the uk you are really not giving meds on your own free will at your discretion as you are calling in a resident to9 make that decision rather than the actual doc - that is similair to us where we have to call but we mayget the on call vs the actual doc -

i had originally read it to say somehwere here ( dont recall actual post ) that you could give meds, foleys, ivs etc without consulting ANY doctor.

so which is the right answer -

[Tanvi Tusti]

so then in the uk you are really not giving meds on your own free will at your discretion as you are calling in a resident to9 make that decision rather than the actual doc - that is similair to us where we have to call but we mayget the on call vs the actual doc -

i had originally read it to say somehwere here ( dont recall actual post ) that you could give meds, foleys, ivs etc without consulting ANY doctor.

so which is the right answer -

You can only prescribe meds if like me you are a nurse prescriber. Non nurse prescribers work with PGDs which allow them to give certain meds, treatments without the authority of a doctor. Foleys can be used without the authority of a doctor, if the nurse thinks its needed. As a midwife I can start an IV without the authority of a doctor under a PGD. As a nurse presciber I can prescibe any drug out of the BNF without a doctors authorisation.

[RGN1]

It very much depends on which level of nursing you are at & in some cases which hospital you practice in. Only nurse practitioners, who have done extra training, can prescribe etc without some form of medical consent be it written or verbal. As a staff nurse I cannot prescribe any drugs or give them without a written order. I would also seek verbal consent to insert a foley on a female patient (except in a real emergency). I am not allowed to insert a male catheter! I can give IV's with a written order, I can cannulate - don't necessarily have to have an order (eg if a cannula tissues I can go ahead & resite without further orders). I can take bloods either with a verbal/written order or because I know it's part of the consultants protocol (eg all hips have FBC/U&E post op day 1).

I can go ahead & take an ECG without an order, in cases where I was concerned about rhythm it would be the first thing the doc would ask me to do anyway.

[twotrees2]

It very much depends on which level of nursing you are at & in some cases which hospital you practice in. Only nurse practitioners, who have done extra training, can prescribe etc without some form of medical consent be it written or verbal. As a staff nurse I cannot prescribe any drugs or give them without a written order. I would also seek verbal consent to insert a foley on a female patient (except in a real emergency). I am not allowed to insert a male catheter! I can give IV's with a written order, I can cannulate - don't necessarily have to have an order (eg if a cannula tissues I can go ahead & resite without further orders). I can take bloods either with a verbal/written order or because I know it's part of the consultants protocol (eg all hips have FBC/U&E post op day 1).

I can go ahead & take an ECG without an order, in cases where I was concerned about rhythm it would be the first thing the doc would ask me to do anyway.

doesnt sound different then here - we do the same - we get verbal or written unless ( we call it nurse practitioner here) we also reset IVs if they infiltrate without orders cause the original order is there so that is a given wed do that - we dont so ekgs - did in hospital without order ( but would get one after) but at the nursing home we dont even have a machine for it so we need the order to get the machine there lol. a lot of our docs have protocols in hospitals to follow hence no calling for an order we call them hmm been so long i worked hospital i forget oh standing orders - at the nursing home we just write doc when they come in we want this and that for standing orders and usually get it. we often will even cath someone in emergency ( haven't voided 2 shifts and get an order after without any trouble ( then we have further info - distended residual is etc,) one thing i do not get - why can yo not do male foleys?

[RGN1]

one thing i do not get - why can yo not do male foleys?

I have no idea! It's just an old traditional thing that I think has gone on into modern nursing for no good reason. I believe that if you work on a urology ward you are allowed to train to do so, I would also expect that goes for A&E/ICU too. However, if you are on a standard med/surg ward in most places you can't catheterise male patients - so they just have to put up with the discomfort until the doc is free!

Of course I expect things are changing, slowly, I'm sure there are hospitals now that do allow nurses to cath males but not in my area, at least not yet anyway. the biggest reason things might change though is the new cut backs on junior doc hours, I think they'll have to allow nurses to cath males in general wards or some poor blokes bladder's gonna burst!

[Silverdragon102, BSN]

prior to me leaving acute setting and working primary care a lot of senior RN's were being trained to catheterise males. I think the change to junior doc hours are going to be a killer on the nursing staff especially with all the cut backs at the moment

[thistlegirl]

I went on 1hr course to learn male cath, been doing men so long now think I would struggle with womens bits!!!

[Fiona59]

Men are by far easier than women to cath. Only one hole and unless there is a prostate problem (then get a lidocane gel order) its very easy to hit "gold".

[english_nurse]

dont you use the gel anyway as standard practice??

if not then all i can say is ouch

in my trust they were doing courses for nurses to train to do male catheters, however the students are now learning it as part of their standard training.

[Noahm]

dont you use the gel anyway as standard practice??

if not then all i can say is ouch

in my trust they were doing courses for nurses to train to do male catheters, however the students are now learning it as part of their standard training.

I trained in the USA and we weren't taught to use the gel. We practiced both male and female caths in nursing school and were always told that men were so much easier. Just watch out in case they have prostate problems and make sure that the cath is well in far enough before you inflate the balloon. I never understood why it is such a big issue in the UK.

[english_nurse]

fair point but i still say it though

no gel = ouch in my book

[Fiona59]

Of course we use normal lubricant. But Lidocaine gel has lidocaine in it and numbs on the way down the urethra, still slippery but not so sensitive. You need to get an order for it because Lidocaine is rx whereas lubricant is just there or included in the catheter trays.