Differences between Canadian and USA nursing?

[Cinquefoil]

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 donations

Thank you!

[uRNmyway, ASN, RN]

Fiona59 said:

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.

Right, before I left Quebec, the party in power at the time was talking about increasing costs for healthcare. My understanding is that they were going to increase yearly costs, and you would have a limited amount of MD or ER visits per year. Anything more, you would have to pay like 25-50$ per visit. They were going to make exceptions for children, the elderly, and those with chronic health problems.

I haven't been following since I left though, so I am not sure how that has progressed.

[uRNmyway, ASN, RN]

Ok, so my take on this is kind of different, since like I have said in other posts, I worked in Quebec, which seems to be different in a few ways.

1. Quebec has pretty significant taxes, highest in the country last time I checked. So the concept of 'free healthcare' is flawed. However, you do have some pretty nice things in exchange. For instance, when I got pregnant, since I was working for an agency, I was put on CSST, kind of like disability. Got paid for being pregnant. Then, you get maternity leave paid for by the gvmt, either 9 or 12 months, depending on the percentage of your salary you want to get during that time.

2. Delegation is SO different. Where I was, they were just starting to phase in LPNs. Yes, CNAs did most of the bedside care in the ways of bedbaths or changing incontinence briefs or mobility assistance. RNs weren't above helping, we helped when we could. But CNAs did not do vitals, blood sugars, couldn't do anything with wounds. And I didn't always work with an LPN. Those days I did everything that wasn't covered by the CNA. We were also responsible for our own blood work and IVs, no phlebotomists. For the real hard sticks, we had a hospital-wide floater who could be called for assistance, but generally, all our own duties.

3. Salary. Again, Quebec is different. But a new grad, straight out of school, earned I believe 20.21$/hr for hospital when I graduated in 2007. Agency work does pay better. And due to the poor work conditions for hospital employees, agencies were rarely lacking in contracts. And cost of living was pretty high there.

4. Patient mentality. Yes, we don't have patients who are scared of their bill in Qc or Canada. We do get patients who are angry and upset at having to wait so long for care. "I've been in the ER waiting room for 18 hours, then was held in the ER shortly only to be transferred to this over-crowded, dormitory like ward?!" Also, American nurses who work in the ER will frequently comment on the stupid reasons people want to be seen, and how those people are usually under Medicaid or Medicare. Now imagine if EVERYONE has that kind of coverage.

5. Customer service. Very true, American nurses do have to do a lot more butt kissing than Canadian nurses. I'm not likely to get fired for an unreasonable request by an unreasonable patient. The hospital's reimbursement does not depend on client satisfaction. I guess that is the big difference in that regards. US-Client. Canada-Patient.

6. More community involvement. In Qc, they have CLSCs. Roughly translated, Localized center of community health. That is where you go for blood work ordered by PCP, or vaccinations, basic wound care. Many also have MDs who hold drop-in clinics for those with no PCP. This is also where you can go for family planning.

7. Availability of PCP. Due to lower salaries for MDs, specifically GPs, many can't find a PCP. Many GPs have full patient loads. You pretty much have to find one fresh out of med school, and even there, their loads fill up quick! For instance, when I had just graduated from CEGEP(college), the CLSC would no longer see me at their family planning clinic. I tried and tried to find a GP or OB for my yearly PAP. Every place I called told me that unless I was pregnant, they were not taking new patients at that time.

8. Child services involvement. Since my arrival in the US, I have heard more and more about people's fears of child services, specifically those in lower income brackets. Seems like there is more fear of their involvement if you bring your child in for injuries or broken bones or something (which is usually completely innocent, because let's face it, children are reckless and they get hurt!). I guess this has pros and cons. While I have never heard of anyone in Qc being afraid to bring their child to be seen for an injury or sickness, I have also seen many parents with major problems go home with their kids (like a newborn testing positive for cocaine in urine, went home with mom), or tried to report possible abuse, only to be told to ignore it because the DPJ (children services in Qc) just did not have enough manpower to cover all cases being reported.

9. Less emphasis on religion, so less judgment making. Ok, to be fair, I am in the bible belt right now, so I know I will see a lot more of that. But no one ever made judgments about abortion, or being gay. Heck, I've had a patient who was a former Media 'actress'. She was treated just like the rest. You also are less likely to hear anything about "Well I can't work such-and-such day, that is when I go to church, and I just can't miss church!"

10. Facilities and equipment. I suppose this must depend on specific facilities. Where I have worked, we rarely had enough VS machines for all the nurses. We still had beds from the old days of nursing (the ones that have the swivel lever to lift HOB and all). 6-7 nurses for the shift, 3 Accuchecks. Department that can hold 35-40 patients, 2-3 private rooms, reserved for isolation cases (I did work in one mother-baby department that was avant-guarde in that, all rooms were private, labor, delivery, and post-partum was in the same room).

11. Staffing. Med-surg floor I worked on had 7-9 patients per nurse on night shift. Day shift, usually 5-6. Evenings, usually 7-8. If you had an LPN working on your team, you had your 7-8 patients, plus were responsible for theirs. Staffing was usually inadequate. Mandating was very common.

12. Licensing. My nursing licence in Qc cost 411$ in 2012, for one year. Nursing licence for GA was 60$ for 2 years. Also, like I mentioned in another post, Qc is different for education, but you don't need a BSN to be licensed. The licensing exam consists of two days. One day is written exam, all short answer, a few with more elaboration needed. Other day is the OSCE, which is a practical exam. You get placed in a room, read a case situation, and interact with an actor/patient to show how you would react to a specific situation. Can be everything from wound care, to IV med prep, to breast-feeding teaching, to fall prevention evaluations. There is an evaluator in the room watching your every move, taking notes as you go.

13. Job availability. I know other provinces seem to have more issues with this, but Qc definitely still had problems with nursing shortages. That is OBVIOUSLY not the case in the US at this time.

[Zombi RN]

Quote

WOW!! Ummm... I might be heading to canada after this....

Yeah... my thoughts exactly, haha!

[katherine100, LPN]

Just a note. In the US if you are not satisfied with your care you still have to pay the bill..lol

[uRNmyway, ASN, RN]

Quote

Just a note. In the US if you are not satisfied with your care you still have to pay the bill..LOL

Um yea, in Canada too. They won't lower your taxes because you had a poor experience in the hospital. The hospital's reimbursement DOES depend on satisfaction in the US though, at least as far as Medicare/Medicaid is concerned.

[realnursealso/LPN, LPN]

Thanks so much for having an interesting, informative thread. This reminds me of the "old days", when I first became a member here, and I felt like I learned something.

[katherine100, LPN]

No. It typically depends on what what was the hospitals fault. Ulcers and recurrent admissions depend on reimbursement, not patient satisfaction. If you were not satisfied with nurses, doctors, a treatment or the food, you will still have to pay.

[healthstar, BSN, RN]

I think I discovered that my dream nursing job is located in Canada, happy work environment

[uRNmyway, ASN, RN]

\ said:

No. It typically depends on what what was the hospitals fault. Ulcers and recurrent admissions depend on reimbursement not patient satisfaction. If you were not satisfied with nurses, doctors, a treatment or the food, you will still have to pay.

My understanding was that medicare/aid reimbursement is affected by satisfaction scores, or maybe it will become that way. But either way, there is nothing like that in canada, much less at the paitent level.

[Fiona59]

healthstar said:

I think I discovered that my dream nursing job is located in Canada, happy work environment

We may get our breaks and our OT but we still have to deal with backstabbing coworkers, "not my job" types and favouratism.

The grass isn't greener on the other side of the 49th as several of my coworkers have told me. They went south in the '90s and came home.

[balsam]

I want to resurrect this very informative thread! I am thinking of moving to Canada, I've lived in US border state my whole life and have friends and family up there.

Anyway, I read in a few places that jobs are very hard to find in Canada vs. US for nurses. I can't really afford to be a casual/pt employee. I am sure it is geographically dependent, but I am more interested in non-urban settings.

[Silverdragon102, BSN]

balsam said:

I want to resurrect this very informative thread! I am thinking of moving to Canada, I've lived in US border state my whole life and have friends and family up there.

Anyway, I read in a few places that jobs are very hard to find in Canada vs. US for nurses. I can't really afford to be a casual/pt employee. I am sure it is geographically dependent, but I am more interested in non-urban settings.

You really need to decide where in Canada you wish to live and work. Generally because most places are unionised your starting point is getting in via casual and working way to full time.