Differences in US nursing vs the rest of the world

vandiola · Apr 6, 2016

I'm wondering that as well, venipunture (for labs) isn't even considered skilled. And male caths are usually much easier than female.

Venepuncture, so drawing bloods for whatever reason and cannulation. Afaik nurses can only place urethral catheters not foleys. I consider these advanced as we dont learn them in nursing school, you must do further training if you want to. I know nurses who have been practising 3-4 years and still arent able to do bloods or place male catheters. Its very frustrating not to be able to do these skills as a student.

vandiola · Apr 6, 2016

This is the most interesting thread!
Can you describe more about home health? Patient acuities, types of skills/procedures, job satisfaction?

Pts who receive district nurse services are more likely chronically unwell rather than acute, the point of district nursing is to prevent further hospital admissions. Most tasks consist of dressings, placing catheters, administering injections, referring to GPs, placing/upping syringe driver meds etc. I would say DNs seem quite happy, i'm probably generalising but a lot of nurses seem to enter community nursing because of the 9-5 hours and holidays off. If you work somewhere in London you may have to see upto 20 people in a day, which sounds horrendous to me.

MrNurse(x2), ADN · Apr 6, 2016

Great idea irishicugal! Love this thread. Very interesting. Would love to hear from the Middle East, South America Asia, other EU nations. Thanks again.

BSNbeauty, BSN, RN · Apr 6, 2016

I'm just really enjoying this thread.

BonnieSc · Apr 6, 2016

Regarding not learning male catheterization in nursing school--I'm guessing this stems from a time when female nurses didn't typically perform these (male orderlies, aka CNAs, would do it), which is more recent in Ireland than in the US from what I understand; and especially would relate to whether the nursing school was Catholic-affiliated. Not because it's considered a more difficult skill than female catheterization.

annabanana2 · Apr 6, 2016

I found it interesting hearing that American nurses need orders to do wound care. I work in home health in Canada and our docs don't know crap about wound care - they call us to ask us what we think! Often we'll just get a referral that says "wound care to left lower leg" or whatever and it's up to us to figure it out.

A thing that we also do but probably shouldn't is, kind of, send people for some lab work without the physician's order. The vast majority of our community GPs would rather we just do a wound C+S and send it in under their name than send the client in to the GP's office just so the GP can say "yep, that looks infected" and THEN have to send the client for a swab. It's much faster if we can just swab the client in their home based on clinical judgement.

Farawyn · Apr 6, 2016

I found it interesting hearing that American nurses need orders to do wound care. I work in home health in Canada and our docs don't know crap about wound care - they call us to ask us what we think! Often we'll just get a referral that says "wound care to left lower leg" or whatever and it's up to us to figure it out.
A thing that we also do but probably shouldn't is, kind of, send people for some lab work without the physician's order. The vast majority of our community GPs would rather we just do a wound C+S and send it in under their name than send the client in to the GP's office just so the GP can say "yep, that looks infected" and THEN have to send the client for a swab. It's much faster if we can just swab the client in their home based on clinical judgement.

Hahhahaa! They do that with us, too. Then write what we tell them, and Tah DAH! It's an order!

Pippynurseuk · Apr 6, 2016

I'm newly qualified (6 months in) and work in the uk as a community nurse doing home visits. (This traditionally was called district nursing but very few people have done the district nursing course so technically we cannot call ourselves district nurses). The bulk of our work is diabetic patients, wound care, end of life care and catheter care. We also give lots of injections for those who cannot administer them themselves, bowel care, care for post op patients who have been sent home with a drain, occasional iv antibiotics, picc care and whatever else is needed for housebound patients. The more complicated patients eg those with severe COPD are managed by community matrons.

From what I've gathered on here our work is more of a team effort. Rather than having our own individual patients we have a team of nurses for each particular area. On my team we have around 10 registered nurses and a handful of healthcare assistants. Our patients often complain that they don't get the continuity they would like. On average I do about 14 visits a day. We should be doing less than this but we are always short staffed. I have done 27 visits in one day! We do have a fair amount of autonomy, we get given our list of patients in the morning and then we pretty much plan our own day. We refer, if we think someone needs referring, we mostly decide which dressings to use, although if a wound is not doing well we refer to tissue viability nurses, we decide how often a patient should be visited, we order any equipment we think is needed, we take swabs if we think somethings infected, we send urine samples if we think it's indicated, no orders needed! Our GPs trust us and if we phone up saying we think Bob Smith has a uti can he have some antibiotics pls, Bob will get his antibiotics. (Not a real person btw)

healthcare assistants (our equivalent of CNAs) are a massive part of our team. Here they are not certified, it is all on the job training. However they're scope seems much wider here. They are experts on wound care, take bloods, give injections, catheterise and do certain assessments eg pressure risk, continence, and obs (what we call vitals). They will also arrange for patients to be admitted to hospital if needed eg if they suspect sepsis. Oh and I've been interested to read that in the US you don't always do sterile technique for wound care. Where I work every single dressing change is sterile technique, whatever the wound, every time, always, without fail. Would be interesting to see the evidence base for this, it obviously hasn't caught up with us yet.

From reading this forum our new grads seem to have an easier transition than yours. I think this may be due to the way we have our clinical placements. We do not visit as a guest with a clinical instructor, we get told where our placement is and then we go and work there for up to 12 weeks. We are there full time as part of the team (although technically we are supposed to be supernumerary) and here it is nurses who teach the students. It's not perfect and we don't always get to do loads of clinical skills, in fact as a first year I mostly made tea and toast and did obs, as well as lots and lots of personal care. However as you progress you gradually start to take on more of a nurse role until by the end of the 3 years most students are taking on their own team of patients with a nurse loosely overseeing and advising. However we are not allowed to give any medication without direct supervision until we are qualified and have our PIN numbers. Although we still feel pretty clueless when we qualify and the learning really starts after qualification I think perhaps we are better socialised into the world of nursing. Many people go on to work on wards that they have done a placement on. In community students on their final placement do patient visits on their own.

our training in my opinion is very fluffy and nowhere near as technical as training in the US. I don't remember a single class on lab values and I'm pretty sure that acid base balance was skirted over with "Well, ahem, quite complicated stuff, ahem, we won't go into it, you'll learn this if you ever go to work in critical care". The actual nursing knowledge learning is not particularly structured and tends to be whatever knowledge you can pick up on placement. Having said that, because we spend so much time on placement you do absorb more than you realise? We had very few tests and were mostly required to do either presentations or 3000 word essays. A lot of the course material covers research and the ability to critically analyse articles. Nowhere near enough time spent learning to critically assess your patients. We didn't get taught lung sounds or bowel sounds. Venupuncture and cannulation are not covered in school and are generally taught on your first job. There is no final big test to qualify, you finish your course, you've passed the assignments, you've done enough clinical hours....Ta da, you're a nurse!

The uk does have some very odd ideas, catheters for one, students are only allowed to do female catheters and most ward nurses only do female catheters. However in some settings healthcare assistants do female, male and suprapubic catheters. Rotating shifts, you do a mix of everything, nights, earlier, lates, long days, not many jobs where you are taken on for the day shift or for the night shift, you constantly swing between them. Students, not allowed to touch anything iv or take blood yet many have healthcare assistant jobs where they do do this. My schools particular oddity was that we were not allowed to do blood glucose testing but we were allowed to give that same patient their insulin!

edited to add...America...nursing diagnoses, what is that all about??? I'm glad we don't have those in our education!

irishicugal · Apr 6, 2016

Regarding not learning male catheterization in nursing school--I'm guessing this stems from a time when female nurses didn't typically perform these (male orderlies, aka CNAs, would do it), which is more recent in Ireland than in the US from what I understand; and especially would relate to whether the nursing school was Catholic-affiliated. Not because it's considered a more difficult skill than female catheterization.

From what I've been told, the reason we don't do male caths without the extra course is because of the danger of puncturing the prostate. It's a pain in the butt at 3am if none of the nurses on the floor have the course and you've to ring a poor intern to do it!

ETA: and oh yeah, the majority of hospitals are Catholic, even though they treat everybody regardless of religion. For many years, nurses were also nuns, the first nursing tutors were all nuns! And when they ran the show, the hospitals were spotless!!

BonnieSc · Apr 7, 2016

Oh, no way. That's not even a consideration. I've seen some "traumatic caths" where there's prostate blood, but there's no special skill taught for doing a male cath vs female (other than a few tricks/tips about angling the member and catheter to get over an enlarged prostate). I maintain it's just a tradition relating to modesty (that's how it used to be here).

Wound care: in general nurses are the experts in wound care in the US, too, and the doctors will leave it to us, except in specialized cases such as plastic surgery or necrotizing fasciitis.

Re: clinicals, it does vary somewhat across the country, but again in general, it is also the US nurses who do the bedside teaching of students; the instructors from school usually teach specific skills or supervise more broadly, but the students are assigned to specific patients and/or specific nurses and it's our job to work with them. Responsibilities build up over time, so that usually in the final semester or final two semesters, the students are taking a full load (or think they are). It doesn't sound like our clinicals are as different as they might seem.

Zelda, RN · Apr 7, 2016

This is so fascinating! I've always wanted to move to Romania, but I am not so willing to give up my autonomy as a nurse. Healthcare certainly isn't perfect in the US, but I do enjoy my autonomy - and getting to work in peds as a newish grad.

Libby1987 · Apr 7, 2016

Pts who receive district nurse services are more likely chronically unwell rather than acute, the point of district nursing is to prevent further hospital admissions. Most tasks consist of dressings, placing catheters, administering injections, referring to GPs, placing/upping syringe driver meds etc. I would say DNs seem quite happy, i'm probably generalising but a lot of nurses seem to enter community nursing because of the 9-5 hours and holidays off. If you work somewhere in London you may have to see upto 20 people in a day, which sounds horrendous to me.

Wow big difference! We see 5-7 patients/day. Lots of advance wound mgmt here, infusion therapy etc.

Do you teach your patients/caregivers how to admin their own IV infusions?