How does the US Nursing System works?

BSN Happyface · Mar 4, 2011

I ment to choose the discussion-icon on my message, NOT the Hazard-icon!!!!

noyesno, MSN, APRN, NP · Mar 4, 2011

Hi Nurse Lene, Norway,

I've only had a nursing license number for 5 days but I'll try to answer your questions to the best of my ability. More experience people feel free to correct me.

1. I pretty sure everything has to go through the doctor, except for NPs, they can prescribe things

2. You don't have to wait for 2 years to get a higher degree in nursing, some schools, however, require a a year or two of clinical experience before applying to their program

3. California has mandated nurse-to-patient ratios, some states have mandated staffing plans (based on patient acuity, needs, and available ancillary staff), and two states, I believe Illinois and New Jersey, require hospitals to disclose their ratios

4. I'm not sure about this one, I start my first nursing job in a week so maybe I'll have some insight then

5. Hospitals are pushing this whole "customer service" motto as of late, so I would think the nurse leader would do whatever they could to make sure their "customer" was satisfied, even though this is not a good thing because sometimes the "customer" isn't always right

noyesno

BSN Happyface · Mar 4, 2011

thank you very much for the information noyesno :) and i wish you all good luck in your first job :) and i'm looking forward to hear from you :)

lrobinson5 · Mar 4, 2011

I would focus on what state you might get experience in. Like the above poster said, there are nurse-patient ratios in California, but I'm not sure about how other states work. I do know that working conditions in California are among the best here in the US, and the state also has a lot of autonomy for Nurse Practitioners. However, I think there are other states that give more autonomy for NP's, such as opening their own practice without an Doctor.

As for wound care nurses, I am not familiar with the specialty. I believe they are like a NP and can prescribe things, but I am not sure, I would research it further.

Good luck!

nursej22, MSN, RN · Mar 4, 2011

1. a Certified Wound Ostomy Continence Nurse (CWOCN) can prescribe some wound care treatments. Obtaining this certification requires specialized training and passing an examination. This is available to a BSN.

An RN can recommend wound care, but must get a doctor's approval, mainly reimbursement purposes.

Any medication requires an MD or ARNP, and IVs are considered medication.

2. You do not necessarily need to wait 2 years for a post-grad degree, it depends on the program and school.

3. Usually budget drives staffing, and unfortunately it does not only correspond to patient needs.

#4 and 5. Depends on the facility, local and state laws.

BSN Happyface · Mar 4, 2011

thank you very much for your information irobinson5 :) i think the us nursing system is very interesting. here in norway a nurse can never have her own practice for example.

BSN Happyface · Mar 4, 2011

thank you so much for your information nursej22 :)

BSN Happyface · Mar 4, 2011

i must correct myself; a nurse or several nurses can maybe have their own practice, i'm not actually sure!

darkbeauty · Mar 5, 2011

A Nurse Practitioner(NP) can open their own practice is what was meant.

NPs are RNs(registered nurses) with a postgrad degree in either ANP(adult nurse practioner) or GNP(general nurse practitioner), etc etc.

jammin246RN · Mar 5, 2011

The US system for nurses was primarily founded on the precepts of Clara Barton (same time frame of Florence Nightengale, but was a mover and shaker during our civil war). Since Clara Barton didn't hold Dr's on a pedestal, we have a certain autonomy of practice. For example I can over ride a doctor's order if I do not find it in the best interest of the patient. I can't order new meds, but I can(and have an obligation to) refuse to give meds that I feel endager the patient. For example a patient has bp meds ordered... the patient's bp is 90/40, I decide to hold the meds. Many facilities do not allow doctors to give meds themselves since it takes away the layer of safety of a nurse, and another pair of eyes. All Meds must be ordered by the doctor, however the doctor can give an order that acts as a blanket order. For example... Physical Therapy to Eval and Treat, or Eval by Wound Nurse and Treat. Once this has been ordered the wound nurse can make a judgement call as to which creams/dressing changes/ointments to use and still be covered. Drs here can write standing orders giving the nurses a list of meds that they can order for any patient at any time for a specific problem, and the doctor agrees to sign off those orders. Nursing ratios vary from 4:1 med surg primary care up to 13:1 med surg. In most of the US there is no standard nursing ratio. Usually it is 6-8 patients per nurse on med surg, 4-6 patients per nurse PCU, and 2:1 for ICU. Trying to get anything changed in a system can be very difficult if not impossible no matter where you live. I would love to have you work in the US for a bit, could be fun!

BSN Happyface · Mar 5, 2011

the us system for nurses was primarily founded on the precepts of clara barton (same time frame of florence nightengale, but was a mover and shaker during our civil war). since clara barton didn't hold dr's on a pedestal, we have a certain autonomy of practice. for example i can over ride a doctor's order if i do not find it in the best interest of the patient. i can't order new meds, but i can(and have an obligation to) refuse to give meds that i feel endager the patient. for example a patient has bp meds ordered... the patient's bp is 90/40, i decide to hold the meds. many facilities do not allow doctors to give meds themselves since it takes away the layer of safety of a nurse, and another pair of eyes. all meds must be ordered by the doctor, however the doctor can give an order that acts as a blanket order. for example... physical therapy to eval and treat, or eval by wound nurse and treat. once this has been ordered the wound nurse can make a judgement call as to which creams/dressing changes/ointments to use and still be covered. drs here can write standing orders giving the nurses a list of meds that they can order for any patient at any time for a specific problem, and the doctor agrees to sign off those orders. nursing ratios vary from 4:1 med surg primary care up to 13:1 med surg. in most of the us there is no standard nursing ratio. usually it is 6-8 patients per nurse on med surg, 4-6 patients per nurse pcu, and 2:1 for icu. trying to get anything changed in a system can be very difficult if not impossible no matter where you live. i would love to have you work in the us for a bit, could be fun!

thank you so much jammin246rn :)

i think the agreement (blanket order) between the rn and the doc seems like a very good one. here in norway rns do not have that opportunity.

i must take the opportunity to say that the norwegian nursing leage seems to be positive interested in the us and the british nursing system :)

wish you a good day