Differences in US nursing vs the rest of the world

[irishicugal]

Hi all! Can I just say, I'm fairly new to allnurses but I LOVE it, it's the automatic app that Siri now wants to open on my phone which means I'm probably on it a little too much... I understand the majority of nurses on here are from the US and I'm learning the many differences between US and European nursing (Google is my friend for all the acronyms, I genuinely had never heard of a BSC, ACNP or UHC...) and someone on another thread mentioned that they didn't think we had enough autonomy in Europe (we certainly don't get the same level of respect or pay!) I certainly don't intend this to become an argument as to which is "better," I am just interested to learn how things are done in other parts of the world. I'll outline how things are done in Ireland, where I am, and if someone could compare how things are different I'd be really interested! Many thanks (oh yeah and I'm REEEEEALLLY sorry for the long post!!)

Training: We have a four year degree programme, and it doesn't matter if you have a primary degree beforehand, there is no such thing as an accelerated BSN. Diplomas and certificates were gotten away with in 2004. We don't have enrolled nurses or LVN's, everyone trains as an RN. Clinical placements make up the majority of your college, increasing amounts each year. Each placement usually lasts for 6 weeks and you work 35 hours a week. In your final year you spend 9 months working 12 hour shifts alongside a preceptor, and are paid minimum wage for this time. They will also spend some time on night duty. Students do have a placement co-ordinator but staff nurses are obliged to precept students and the student basically "shadows" their preceptor, and takes on nursing tasks with the supervision of their staff nurse. Because of the large amount of time spent on placement, orientation is very short as a new grad, you're lucky to get 2 weeks, and if you stay on at the hospital where you trained, you rarely get any orientation at all - after all, you've worked there as an undergrad for 9 months!

Additional training: for some reason certain skills aren't included in our training and you have to do another course post qualification. These include IV antibiotic administration, phlebotomy and cannulation, male catheterisation and fine bore NG insertion (ryles are fine but I think they're worried the guide wire in fine bore might puncture a lung....)

Metrics: I have to admit I've used google a LOT to try and understand some of your diagnostic values. We are taught a normal blood sugar is between 4.5 and 7.0 (mmol/l), then I see posts of blood sugars being "only" 40 and I'm like whaaaat? Also, our p02 and pC02 measurements are different, creat. levels etc, I don't know if I'd ever get the hang of it if I jumped across the ocean to you guys!

Nursing ratio: I'm well jealous of many of the people on here. Our "ideal" assignment is 1 nurse to 6 patients, but frequently it is 1:10 and on nights it is 1:12 or even 1:14. With that, on med/surg there is often only one HCA for 32 patients. Many HCA's cannot take vitals and just help with personal care and feeding. They are certainly not allowed to do dressings. Even those who can do vitals are not allowed to do blood sugars. Nurses basically spend 12 or 13 hours running around! In ICU the ratio is 1:1, but "ICU" means vented, anyone who needs pressors but isn't vented goes to HDU or CCU. In the ICU we don't have RT's, the nurses handle the tubing, suctioning, vent settings etc. There are no HCA's in ICU, if care is 1:1, that one nurse has to do everything with the patient. LTC seems to be about the same, 1:24 or 1:30 but 4 or 5 HCA's to back you up...

Meds: This is where I see the most difference. We are so backwards! What is this pyxis I keep hearing about? On med/surg you have a drug trolley and bring it into each 6 bedded room (most of our patients are in 6 bedded "wards" the private rooms are kept for isolation cases) and give out your meds. We have a stock supply of many drugs, anything else you just ring and get from pharmacy. Drugs aren't assigned to a particular patient, you use the same box of aspirin for everyone lol. I actually don't understand when you say "pulling meds" and "returning meds" back to the pyxis, can someone explain it to me? Our drug kardexes are paper, and we sign in when drugs are administered.

Ordering: This is another area in which I'm confused. Someone on another thread mentioned that they didn't do a drug screen because the doctor hadn't ordered it. If we want to send a drug screen, we do. If we want to swab a wound or order bloods we do. If someone looks like they're going septic we'll draw blood cultures, sputum and urine etc, and just send them to the lab - we don't need a doctor's say so!! We can't order X-rays unless we have done a course in X ray prescribing. Also in the ICU, we ask the anaesthetists (ours are all doctors btw, we don't have nurse anaesthetists here) to chart electrolytes in the PRN section of the kardex. That way, if K or MgS04 is down, we just go ahead and replace without bothering anyone.

Post graduate training. The majority of our nurses train as a Registered General Nurse, but primary training also includes Registered Nurse Intellectual Disability and Registered Mental Health Nurse. If you want to work in paeds, maternity (Registered Midwife) or public health afterwards you must complete an 18 month Higher Diploma which leads to an additional entry on the register. If you work in a speciality such as ED or ICU it is expected that you will also undertake a post graduate course, usually at least 12 months duration. You can use this course to count towards a Master's qualification. New grads generally do NOT work in a speciality area, you need to get a year's post grad experience in med/surg before you can undertake any of these courses. There are also courses in education (Registered Nurse Tutor) and prescribing (Registered Nurse Prescriber)

Oh my, I could go on and on and on with even more differences but I realise I've rambled on for FAR too long. I just find it very interesting! What do other people think?

[irishicugal]

I did hear a rumour once about drunks who come into the ED. We used to put them on mats on the floor "out back" so they could sleep it off, but someone turned out to have an SAH and died so now they're on trollies and have hourly GCS assessments. We heard that in the US many many drunks are intubated and placed in the ICU overnight and then discharged the next day... That's not true is it?

[irishicugal]

Thank you!

So, they are grandfathered in? Are they expected to get a BSN, or just, we don't do this anymore, but since you're already a nurse, you're good?

I kind of like that idea...

Yup, you're already a nurse and we're not going to take that away from you!! It's not fair to expect a 50 yo to get a degree, it's not going to change a thing about their practice!!

[Farawyn]

Yup, you're already a nurse and we're not going to take that away from you!! It's not fair to expect a 50 yo to get a degree, it's not going to change a thing about their practice!!

That's it. I'm moving to Ireland. I've done 13 patients at night before, psh, I can handle the ratios. I'm of Irish descent and my maiden name is shockingly Irish. I have freckles and love Guinness.

Where do I sign?

[MedicFireRN]

We heard that in the US many many drunks are intubated and placed in the ICU overnight and then discharged the next day... That's not true is it?

Not true around here, I can't speak for the rest of the US though

[irishicugal]

Not true around here, I can't speak for the rest of the US though

Must be an urban legend so! [emoji23][emoji23]

[irishicugal]

That's it. I'm moving to Ireland. I've done 13 patients at night before, psh, I can handle the ratios. I'm of Irish descent and my maiden name is shockingly Irish. I have freckles and love Guinness.

Where do I sign?

We'd LOVE to have you! [emoji178] we don't have school nurses here btw, except in boarding schools. And those ones don't give out meds that aren't specifically prescribed for the kid, iykwim. There are no pre prescribed protocols. You can't even give out paracetamol for a headache...

[bebbercorn]

We have intubated our fair share of drunks who "couldn't maintain their airway." (They usually start pulling at the ET tube as you're starting the propofol) My new ED typically does not do that, it's been culture specific for me.

[vandiola]

Registered nurses who didn't have degrees, diploma nurses and enrolled nurses could just top up their qualifications to degree level. There was/is no obligation to do so, but it's unlikely you will ever be able to move up the management/clinical ladder without a degree. There are a lot of nurses who chose not to top up and can not move from their band 6 staff nurse positions.

[dream'n, BSN, RN]

Only the intoxicated patients that are very unstable, such as in the middle of DTs and needing an Ativan drip or intubation, go to the ICU where I work.

Further information on Pyxis for you: when the nurse signs into Pyxis, he/she must pick their particular patient out of a list (most Pyxis' list all patients on the particular unit). This then allows the nurse to see only the medications that have been ordered for that particular patient, usually alphabetically by medication. That way a nurse cannot get say Metoprolol from the Pyxis for a patient that doesn't have that ordered. (Although not to be confusing, there is the ability for the nurse to override the system in an emergency). When getting a narcotic medication for a patient, the Pyxis will have the nurse count this medication in the Pyxis drawer and enter the amount. This helps prevent diverting of the drug by the nurse. Next when the nurse goes to administer the medication he/she uses a scanner gun to scan the patient's hospital band and the bar code on the medication label. If the patient, medication, route, timing, or dosage is wrong, the computer will question the nurse to review that he/she is correct in administering the medication at that time, at that dose, etc.

It does sound so much more complicated than it is. When giving medications this way repeatedly it goes much quicker. And it is safer for the patient.

[irishicugal]

Thank you for that explanation dream'n. I believe they are starting to bring in computerised drug administration in the uk, so it's probably only a matter of time before it comes across the pond! We do have a scanner for blood admin, it was brought in about a year ago. We scan the patients wristband to collect, administer, clock the vitals, and when it's finished. We thought it would be a PITA at first, but it didn't take too long to get the hang of it! Maybe if the Pyxis comes here it won't take us too long to get the hang of that too... [emoji3]

[irishicugal]

Also, restraints. We are legally not allowed to place any patient in restraints, even in ICU if intubated, or for kiddy procedures. Even in Acute psych they are allowed to restrain to subdue only and then the patient is placed in the seclusion room with refectory clothing. It's just not allowed. Period.

[walkingdeadhead]

Very interesting thread! Is the education in Ireland similar to that in Great Britain? Also, have you ever had travelers from the U.S.? I'm curious about how the transition would be.