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?
Specializes in Mental Health, Gerontology, Palliative.
Not making this political as I will leave out the party but if a certain unnamed someone wins the election I might head over to Ireland, England, or Canada if they'll have me. I'm too afraid of spiders and snakes to try Australia :)[/quote']
Ours is a 3 n 1/2 years diploma, after you qualify you can work anywhere from maternity, wards, rural facility, psychiatry........ our general is literally general. One can specialize after 2 years experience. I am from Kenya. About the pay hmmmm..... my paycheck is chronically anaemic. Patient ratios?? hahaha when the procedure manual talks of two nurses working in harmony they forgot to mention you could be 2 in a sixty pt ward, we still have those WW2 style wards in most public hospitals.
The Australian system is more similar to UK than America. Don't understand a lot of things people from the U.S talk about on here lol.
In Australia, it is a 3 year bachelor degree to become an RN. During these 3 years, you have to do minimum of 800 hours of placement to meet registration requirements. The unis usually allow you to gain 850 hours (unpaid though). In UK it's double this! This leaves Aussie grads feeling really unprepared in their first job.
You our can also become an Enrolled Nurse or EEN if you go to TAFE (vocational college). This takes approx 18 months I think. They work under the RN and can't give IV meds unless they are endorsed to do so (although some hospitals still won't allow them due to their policy).
After becoming qualified as an RN, there's limited positions available for a graduate nurse if you don't have experience. So we have Graduate Programs, where you are employed as a graduate RN and work (paid) but you get additional support, education and you are transitioned in (although there's limited positions compared to all the grads every year, so it's competition to get one and over half of graduates don't end up getting one!). After a year experience, it's easier to move onto other jobs.
Cannulation and blood collecting are extra competencies that need a certificate before you are able to do them.
Patient ratio is usually 1:4 on mornings and 1:6/7 on afternoons. New laws are just about to be implemented though to ensure all hospitals have a 1:4 ratio (excluding ICU etc).
There are no nurse anaesthetists here either, wish there was though cause their wage looks pretty good in the U.S.! Only doctors here. We do have nurse practitioners though.
We have Assistants in Nursing (AINs) here, which is your HCA/CNA. There's usually 2 on each ward and casuals who float around. They make beds, ADLs, and empty IDCs. Their scope is limited.
We we also get paid a lot higher than UK nurses :) So as much as I wish I could have trained in the UK (I'm English), I'm happy to be working in Aus.
At my hospital we can use restraints if really, really needed for patient safety. We have to get an order for them from the MD and the order must be reviewed frequently. We also use the least restrictive restraint needed and there is alot of paperwork involved. Our least restrictive restraints are mittens that help prevent the pulling out of lines and tubes. We do have soft restraints we may have to use on the wrists and I've seen them placed approximately once every other year or so. We also have "Vail" beds, which are like soft cribs with mesh sides and a mesh top. I've never seen locked, metal restraints used, except for on prisoners that are handcuffed to the bed and are continuously monitored by law enforcement. We also can request sitters for 1:1 monitoring if needed.[/quote']
At my hospital, mittens are no longer considered restraints. It's pretty awesome and cut WAY down on documentation.
The Australian system is more similar to UK than America. Don't understand a lot of things people from the U.S talk about on here lol.
In Australia, it is a 3 year bachelor degree to become an RN. During these 3 years, you have to do minimum of 800 hours of placement to meet registration requirements. The unis usually allow you to gain 850 hours (unpaid though). In UK it's double this! This leaves Aussie grads feeling really unprepared in their first job.
You our can also become an Enrolled Nurse or EEN if you go to TAFE (vocational college). This takes approx 18 months I think. They work under the RN and can't give IV meds unless they are endorsed to do so (although some hospitals still won't allow them due to their policy).
After becoming qualified as an RN, there's limited positions available for a graduate nurse if you don't have experience. So we have Graduate Programs, where you are employed as a graduate RN and work (paid) but you get additional support, education and you are transitioned in (although there's limited positions compared to all the grads every year, so it's competition to get one and over half of graduates don't end up getting one!). After a year experience, it's easier to move onto other jobs.
Cannulation and blood collecting are extra competencies that need a certificate before you are able to do them.
Patient ratio is usually 1:4 on mornings and 1:6/7 on afternoons. New laws are just about to be implemented though to ensure all hospitals have a 1:4 ratio (excluding ICU etc).
There are no nurse anaesthetists here either, wish there was though cause their wage looks pretty good in the U.S.! Only doctors here. We do have nurse practitioners though.
We have Assistants in Nursing (AINs) here, which is your HCA/CNA. There's usually 2 on each ward and casuals who float around. They make beds, ADLs, and empty IDCs. Their scope is limited.
We we also get paid a lot higher than UK nurses :) So as much as I wish I could have trained in the UK (I'm English), I'm happy to be working in Aus.
That sounds VERY similar to ireland, no wonder so many Irish nurses go there! And yay for the ratios, we keep holding oz up as the "ideal" when we're trying to fight for better conditions. Not that I can complain, I'm in the ICU lol and it's always 1:1 here!
Ours is a 3 n 1/2 years diploma, after you qualify you can work anywhere from maternity, wards, rural facility, psychiatry........ our general is literally general. One can specialize after 2 years experience. I am from Kenya. About the pay hmmmm..... my paycheck is chronically anaemic. Patient ratios?? hahaha when the procedure manual talks of two nurses working in harmony they forgot to mention you could be 2 in a sixty pt ward, we still have those WW2 style wards in most public hospitals.
Do you have any aides or helpers or do the families do the personal care in Kenya?
It is difficult to compare apples and bowling balls. The US has outsourced most of our industries and has become a service economy. After gov't our biggest industry is healthcare where as EU and UK have socialized medicine (and maybe rationed?) here everything is based upon profit generation centers. How many physicians does a citizen usually have in the EU? Many citizens here have an entire repertoire of healthcare providers and their home medications lists are staggering.
I was speaking with a UK trained NP and she couldn't wrap her head around the US healthcare model with insurance, documentation, fee for service etc. I work in an ED and many of my pts come in saying: I couldn't get an appointment with my doc for 2 weeks and I don't want to wait.
Other differences are in EMS and how docs go in field in UK and (this will get alot of our paramedics here up in arms) about the training of paramedics in EU (I believe its at least 4 years and maybe 6) and are much higher in the food chain over there.
It is difficult to compare apples and bowling balls. The US has outsourced most of our industries and has become a service economy. After gov't our biggest industry is healthcare where as EU and UK have socialized medicine (and maybe rationed?) here everything is based upon profit generation centers. How many physicians does a citizen usually have in the EU? Many citizens here have an entire repertoire of healthcare providers and their home medications lists are staggering.
I was speaking with a UK trained NP and she couldn't wrap her head around the US healthcare model with insurance, documentation, fee for service etc. I work in an ED and many of my pts come in saying: I couldn't get an appointment with my doc for 2 weeks and I don't want to wait.
Other differences are in EMS and how docs go in field in UK and (this will get alot of our paramedics here up in arms) about the training of paramedics in EU (I believe its at least 4 years and maybe 6) and are much higher in the food chain over there.
I would object to the use of the word "ration" with respect to socialized medicine (and I use that term loosely, because systems vary and not all universal systems are government owned). Care is rationed all the time by private insurance companies in the US with profit being a motive not triage of health conditions the way it is in other countries.
I'm Alicia, a second year nursing student from Spain.
Since no one here has commented anything about how it is to study nursing in Spain, I'll do it.
Here, since 2009, we have a four year degree. Each year divided in two semesters.
First year is all general themed, anatomy, physics, physiology, pathology, biochemistry, nutrition, english and some more. But the last month of the schooling year we get to go to a public healthcare center. There we're only allowed to do the simple things like, take temperature, blood sugar, blood pressure, weight and measure patients, among other little things like prepare meds. Since the 120 of us go to different centers some get to do more than others, for example, I got to do home visits, do shifts in the er, do appoinments on my own and even vaccinated in adults and pediactrics, but some of my friends didn't get to do half of what I did.
Every subject has two different parts, a theorical one and a practical one.
This second year we're taught how to suture, bandages and plasters, different examinations and tests, how to use our hospital's operative system, etc. And from april to may we do a month long internship in the University Hospital. There we are divided in groups and each group goes to a different section.
Third year is even more nursing oriented, being some of the subjects English, Care and procedures on women, childhood and adolescence; Critical Care Nursing; Emergencies Nursing; OR and some others. First semester, from September to November we go to class and then November and December we do internship again in the hospital. Second semester is from February to May, we have school february and march and then to the hospital again till the end of may.
The fourth year we don't have any clasess or school but we have a year long intership in the hospital (8 to 12 hour shifts) and healthcare centers (8 hour sifhts).
Months January and June are exclusive for tests the first three years and in the last one we have to do a "TFG (Trabajo de fin de grado)", an end-of-degree project.
Our profressor are mostly male and female nurses, but we also have pharmacists, physicians, nutritionists, psychologists and psychiatrists.
Then, after you've graduated, you can either start working or do an exam called "EIR" to become an Internal Nursing Resident and do a two year specialty (being paid).
I hope this all makes sense since I'm not an english native speaker.
(oh yeah and I'm REEEEEALLLY sorry for the long post!!)
Tenebrae, BSN, RN
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