Intimidated by USA nurses

RNperdiem, RN · Jun 16, 2015

In ICU, we do all of the bathing, linen changes and wound care ourselves. I worked years ago with a nurse from the UK, and she told me that the main difference she saw is that the US nurses tended to take care of 2 ICU patients with some of the work delegated to others like a respiratory therapist to handle the ventilator and dialysis nurses to do all of the dialysis at the bedside for critical patients. In her old job in the UK, the patients were 1:1 but more was expected from the nurse.

Dogen · Jun 16, 2015

A friend of mine who is an ICU nurse was traveling in the UK when her daughter developed appendicitis, and she had only good things to say about the care provided and the capability of the nurses she observed. Obviously there are going to be policy differences. For instance, she said that every IV med was double checked by a second nurse. Here that's not current practice, although we do double check certain things, like blood.

I worked with a nurse who had been a nurse educator in NZ and came to us after some years in Canada, and she said she'd found it easy enough to acclimate. She said the best thing she ever did was only use the generic name for meds because they're the same everywhere, while trade names differ. I don't know if that's helpful, but I don't have any other anecdotes to offer you.

HouTx, BSN, MSN, EdD · Jun 16, 2015

Howdy!

US nursing 'culture' has been heavily influenced by our litigious society.... everyone sues everyone, and there's no such thing as an Act of God. It seems like every time some new legal issue arises, it impacts nursing practice. Nurses are increasingly included in lawsuits, along with the physician, administrator, CEO, technicians, and every other living creature that the plaintiff encountered when s/he was a patient. So - the amount of nursing documentation, and the specificity required, is astonishing. It'll blow your socks off.

Every new initiative loads more 'stuff' on nurses. For instance, payment for services is now tied to "patient satisfaction" - so nurses are expected to follow Disney World scripts and make sure that 'service' is wonderful at all times.... yeah, we know it's dumb; a completely 'satisfied' patient could be dead 30 minutes later. There are many more examples . ..

But - Nursing has been selected as the US "most trusted profession" every year for the last 20 years (except 2001 when First Responders pushed us to #2), so the US public continues to love us. They don't want to pay us, but they love us.

If you really want some insight about the state of US Nursing - read just about anything by Suzanne Gordon. She tells it like it is - and has been doing so for quite a long time.

thenightnurse456 · Jun 16, 2015

I've worked with a few US nurses who moved to Australia and this is what they tell me the differences are. (I'm assuming NZ and Aus nursing is the same).

They do A LOT more charting and documentation. Like previous posters have stated, they are a very "sue happy" country.

They do a lot more undergraduate education (2 years pre requisites, 2-4 years nursing) versus our 3 year in total degree.

I found them very intelligent also, however they stated that they have very little autonomy compared to Aus nurses. Eg: one nurse told me she had to get an order to use a heat pack on a patient! They also told me they could never "nurse initiate" medication like we can in Aus.

They give a lot more IV meds and rarely give sub cut. The nurse I worked with was amazed I was giving subcut morphine and was perplexed when I told her we weren't allowed to give IV morphine on a general ward.

They have a tonne of auxiliary staff. Nursing assistants to do all hygiene and mobility, techs to draw blood, do ECGs, respiratory therapists to manage O2, nebs and vent settings.

Im sure it varies with every hospital but these seemed to be common themes.

nursingaround1 · Jun 18, 2015

I found Australian nursing very similar to NZ, but I've actually spent the last 10yrs outside the hospital, in boarding schools. Whenever I speak with my old friends back in NZ they say - don't come back. I hope they mean this is a nice way, but seriously, they tell me that it's not the same place I once knew. They say it's so busy, that documentation has gone crazy, and that they have to write about every single thing they do, and that patients are heavier - ie category 4 (full bed cares) because we're keeping people existing longer, with no quality of life. The said it's no longer the fun, healthy work place I left 10yrs ago.

Here.I.Stand, BSN, RN · Jun 18, 2015

We don't bite.

Re: hands on care, it depends a lot on where you work. I work in an ICU, and we have nursing assistants to *help* with hygiene, and mobilization, but nobody does it *for* us. (Based on what I see on AN though, more ICUs are doing without CNAs.) An RN/LPN working in long term care who might be in charge of 30+ residents is going to have much less time for basic care, and the CNAs do most of that while the nurse focuses on treatments.

If a patient is on 3x per week dialysis, a dialysis nurse comes and does it; but if the pt is on CVVHD, the ICU nurse will manage it.

We have RRTs who do most of the vent management, although the RN needs to know why his/her pt is on the settings they are. I used to work in a longterm acute care hospital where the RRTs didn't want the RNs touching the vents, but where I work now, we adjust the FiO2 all the time. Or like a few weeks ago I was caring for a pt with ARDS who was proned most of the time. The RRT had gone for a CT scan with another pt when we were supining her, and I'd known she needed more PEEP when supine, so I called him to tell him I'd turned it up from 16 to 20. (Just FYI, some of that is ICU-specific, not US nurse specific, if you've never worked w/ ventilators!) I wasn't going to wait the 30 minutes for him to come back; I was flipping her supine when *I* had the time to.

Last year sometime, and Aus. RN was asking about ICU care in the US, and it seemed like she said ICU nursing was a graduate degree. Did I understand correctly? Here it isn't. ICU specific things are taught on the job, and after working some time we have a critical care certification we can sit for.

We have lab techs draw blood; in my hospital ICU nurses do draw ABGs, although more often the RRT draws those. In my old LTACH the nurses drew all labs. We have an IV/PICC team who will place IVs on difficult-to-stick pts, but in the ICU they expect us to try before consulting them.

There is a famous/large hospital in my state, and according to the RNs I know who have worked there, the care is very departmentalized (is that a word??). They have teams for IVs, teams for blood, teams for wounds, etc. Another large hospital I've worked on had a whole pt education dept. Bedside nurses did a fair amount of teaching on basic stuff, but if they would be going home w/ a PICC line or wounds, were new diabetics, etc. they went to the pt education center.

We have wound/ostomy/continence nurses to consult with, and they give recommendations on care, but generally the bedside nurse does the treatments.

So making a short story reeeeeally long, the hands on stuff varies widely. :)

As for the hotel concierge, customer-is-always-right customer service mentality...I know nurses can be in difficult spots, but honestly we (general "we") teach people how to treat us. I personally provide the best classic nursing care I can, smile when appropriate, and be compassionate. I refuse to bend over backwards for unreasonable requests. Thinking of another thread here on AN, a pt was demanding the RN call the surgeon for an Rx for his eye vites, very late at night. That is not a reasonable request, and waking up a surgeon for unnessary requests is just plain dangerous for the next day's sugical pts. That kind of behavior is something I will not pander to. I once gave a pt a talking to for verbally abusing a CNA. I haven't ever been given scripts (e.g. is there anything else I can do for you? I have the time -- verbatim)...but I absolutely refuse to ever do it. It insults both me as a licensed professional, and more importantly it insults the pt's/family's intelligence. I always ask if they need anything else because I think it's good practice and helps make sure their needs are met, but I won't recite lines. That's for actors. :laugh: There is a member here on AN who told that his hospital's entire nursing staff refused, and management backed off. What are they going to do, fire all of their nurses? Again, we are treated how we allow ourselves to be treated.

madwife2002, BSN, RN · Oct 2, 2015

Nursing in the US is fine, it is easy to get use to but I did find less autonomy in the US than the UK

I have been here 10 years now, this is my home and I think I would struggle to nurse in the Uk now