Differences between Canadian and USA nursing?

Nurses General Nursing

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Considering working in both the USA *and* Canada.

Plenty of threads out there about the requirements for licensing etc in each place. But how about the differences and similarities in scope of practice? I read on one of the licensure threads that Canadian nurses have a broader scope of practice, and a greater focus on preventative care.

Really? Well, ya got me wildly curious.....how? What can Canadian nurses do that US ones can't and vice versa? Who spends more time on paperwork? What are the headaches of pt. advocacy/HR and which ones are different depending on side of the border????

Looking for a few :twocents: donations

Thank you!

Hate to tell you this but you are wrong on point number two. Here in Alberta we used to pay a monthly Alberta Health fee every month (around $42 if I remember correctly) for our share. It was eliminated by the government in a vote grab. It was used to make up on the transfer shortfalls from Ottawa.

I remember BC also paid a monthly premium. They still might for all I know.

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Specializes in ER.

Historically provinces have "broke the law" and the act has been amended... To the extent that you can look up "extra-billing and user charges regulations" on the government website, These extra charges get reversed pretty quick

On the plus side, I can't possibly be wrong on number two...It's a Canadian legal document...I didn't make it up off the top of my head...google Canadian Health Act, but I sure wish I could take credit for it.

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Specializes in ER.

Plus I meant to add

That Canadian health care isn't "Free"

It is paid through taxes...You can't count paying health taxes as extra billing.

Trust me, Until you live in the US and have to pay ridiculous monthly payments, ridiculous deductibles, and a co-pay on top of everything...you would laugh all the way to the bank with a 42 dollar a month tax.

And being in the unique position to be able to compare the levels of care and timeliness of care....I don't see much of a difference...

and apparently my family has "great" insurance

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LaughingRN said:
Historically provinces have "broke the law" and the act has been amended... To the extent that you can look up "extra-billing and user charges regulations" on the government website, These extra charges get reversed pretty quick

On the plus side, I can't possibly be wrong on number two...It's a Canadian legal document...I didn't make it up off the top of my head...Google Canadian Health Act, but I sure wish I could take credit for it.

Uhm, no.

Alberta and BC paid monthly healthcare premiums in defiance of the Act. I know I paid them and I've never ever had any of them reversed. Nor has anyone I know in either province.

http://www.cbc.ca/news/canada/calgary/story/2008/04/22/budget-alta.html

http://www.health.gov.bc.ca/msp/infoben/premium.html

I know having lived in both these provinces over the years and I've paid them as an individual and then later for a family through payroll deduction.

It was always a topic of conversation when someone moved from the Maritimes because back East they didn't pay the premiums. The west paid due to an imbalance of tax transfers from Ottawa. Alberta has considered re-introducing them because of the shortfall in health transfer credits.

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Specializes in Med Surg, Home Health.

BTW, am kudoing to thank you all for the wonderful information! All this is gravy for me

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Specializes in Gerontology.

Another big difference - no drug testing in Canada.

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Specializes in Hospice Palliative Care.
Cinquefoil said:

but I would feel comfortable persistently ASKING the doctor about their reasoning behind an acuity determination, and TELLING the doctor additional information which may or may not change their thinking, if my gut and the physical evidence suggested the need. However, in Canada, does that all go through the charge nurse?

My idea of being a nurse is that we are (or I will be, and you are), in addition to so many other things, a layer of filtration between the doctors' orders and the patients. Yes, we apply the orders, but if one looks "off" to us, we ask the doctors to tell us more about it. We still obey it, but not unquestioningly. Or, if we're REALLY freaked out by an order (giving 2L normal saline to a decompensating CHF patient, administering a med the patient is very allergic to) we refuse to carry the order out. But we do so at our own license's risk.

I just had to go back to this question - I think we are more secure with our licenses in Canada. I have every right to question and refuse a Dr's order if I am uncomfortable with it. I need to follow up with the Dr and explain why (and usually have a conversation which will change the mind of one of us ;) ) If I am still not comfortable I then document and speak to my supervisor -who can either come in and do it or contact the doctor. Rarely - but it has happened the chief medical doctor could get involved. The doctor could also be requested to come in and complete the order if he really wants it done. None of this would jepordize my license, unless I was being unreasonable about following a routine order - but I think that would end at my supervisor who would do the order and call me in for a talk about it and maybe a note in my file.) We view most doctors as our colleges and everyone is doing their best to care for the patients and we need each other to work in our roles for that to happen.

It would take an act of gross negligence to lose my license - or a drug problem that I refused to acknowledge and seek treatment for.

Going back to the issue of work and scope of practice - we work to our full scope in every province. I work with LPNs and Care Aides - who all work to their full scope as well. Most places work as teams - I have more responsibilities than the LPNs and CAs but they are all our patients, not my patients and your patients - if a call light is going off we all are able to answer it and whoever is not busy at the time will get it. Yes that means that the LPNs and CAs might get it a few more times than me as I am stuck doing paper work or giving a med (LPNs can give meds but not CAs) but it is expected that I do my share of the floor work as well.

In BC we still pay Medical Service Premiums - $60.50 for one person, $109.00 for a family of two and $121.00 for a family of three or more per month. Most employers who offer benefits offer medical and this is covered - so far I have been lucky and never actually had to pay for it as either I was covered by my parents, my husbands job, or my own job. Regular employees get benefits under our union contract - but casual staff would have to buy it themselves. 10 years ago it was $200 a month for a family - including extended medical and dental - but I don't know what the cost is now.

Okay enough rambling for now - just a few thoughts that struck me as I was reading this forum.

1 Votes
Specializes in Med Surg, Home Health.

Thank you, PeppertheCat. I'm curious if Canada doesn't do drug tests due to a reduced emphasis on criminalization, or??? And does Canada have diversion programs for impaired/addicted RN's? Or does that vary by location?

and THANK YOU melsch. These subtle distinctions are great to know, so when I start to work in Canada I don't come in as defensive of my license as I might in the USA.

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Specializes in Gerontology.
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Thank you, PeppertheCat. I'm curious if Canada doesn't do drug tests due to a reduced emphasis on criminalization, or??? And does Canada have diversion programs for impaired/addicted RN's? Or does that vary by location?

I honestly don't know why Canada doesn't drug test. Frankly, I was shocked when I learned from here that the US does! ?

And yes, there are impaired nurses and diversion, just as anywhere else. I don't know what our numbers are compared to other countries that do drug testing.

That would make a very interesting study I think!

1 Votes
Specializes in education.
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2.Comprehensiveness: The insurance plan must cover all health services provided by hospitals and medical practitioners. They cover completely...no deductible, no co-pays, no monthly bill.
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Alberta and BC paid monthly healthcare premiums in defiance of the Act.

No, charging premiums is not in defiance of the Canada Health Act.

This tenet of the Canada Health Act does not say that health insurance is free. It says simply that the provincial insurance plan must cover all insurable procedures and cannot charge "extra" for medically necessary care. In other words doctors and hospitals cannot charge the patient an "extra" fee.

Believe it or not there are people in Canada without health insurance. Many poor, indigent and homeless people do not carry health insurance in places where there is a premium charged - they usually get treated anyway and many others simply do not pay it or cannot afford it because they may be unaware that governments MUST pay it for you if you cannot afford it (Canada Heath Act). However, that doesn't happen automatically you have to apply for that assistance.

If you need care and have not paid your insurance premiums then you usually get the care you need and then you are billed for the unpaid premiums. Over several years this can be a sum that some poor people cannot pay. The government will even garnishee wages for unpaid premiums.

I prefer the system in those provinces where there is no premium charged at all as it avoids all these intricacies.

And don't forget immigrants. They are not eligible for the provincial health insurance until a residency waiting period has been satisfied. Often there are private insurance plans they can purchase to make sure they are covered.

And lastly I think it is important understand that Canadians believe as a society that everybody in the society benefits from universal health care. Even if you never have to use the system (unlikely) you pay for it like everyone else because it means that people who need it can get care when they need it and in the long run that saves money as little problems do not become big ones.

It means that families have access to good prenatal care and that kids and other vulnerable populations are not held hostage to deteriorating health simply because they do not have money to get treatment.

And it also means that there is no bureaucrat sitting in an insurance office some where making a decision about whether or not the procedure you need is "covered".

It is such a common way of life here that we have trouble understanding why people in the US do not get the concept of universal health care.

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Specializes in med/surg.
itsmejuli said:
I'm about to find out the difference, I just moved from Florida to Calgary, Alberta.

Welcome to Calgary! Hope you're enjoying our lOVELY Spring weather! :D

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Specializes in education.
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Another big difference - no drug testing in Canada.

I am not sure why that should be considered a benefit. Hopefully you are not coming to work while you are under the influence anyway - no matter what country you work in.

You see here in Canada we expect that people will police themselves and not come to work if they are unable to fulfill their responsibilities of public protection.

RN's are required under provincial standards to work in the public interest and maintain their own fitness to practice. If a nurse comes to work impaired then in the Interest of the public all the other nurses MUST report that nurse and ask them to leave. Same thing for a doctor. Any nurse who knowingly does not report an impaired doctor could lose their own license because they fail to report.

This kind of self regulation keeps everybody vigilant about working in the interest of the public.

And you cannot lose your job for doing this (reporting impaired coworkers) because we have unions --so drug testing seems rather irrelevant?

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