US RN looking to work in UK -- ER

[kaitfinder]

Hey!

I'm a BSN and BS prepared RN with 2 years emergency department experience looking into working in the UK in the ER (as is my preferred specialty), and I have a few questions. Any and all help and insight would be greatly appreciated!

Does anyone know if the standard/scope of practice remains the same between US and UK? My biggest concern is being licensed to perform certain duties in the US (IV placement, foleys, wound care, advanced medication administration, running codes, etc.) and being legally disallowed from performing such duties in the UK, as these skills are just as valuable to me as the clinical knowledge/education that supports them.

As a whole, how do emergency departments in the UK differ from the US? Are they run much the same? The ER I currently work in affords the nurse a significant amount of autonomy, and I'm fortunate enough to work with doctors who respect and support said autonomy. What type of supportive staff is available? We tend to work closest with the phlebotomists, respiratory therapists, patient-care technicians, and in-house pharmacists.

From my research it seems UK nurses get paid less than equally prepared US nurses, but is there a pay increase for specialist areas like ED or ICU as compared to med-surg staff nursing in the UK? Is there a large need for ED nurses in the UK, or do those positions seem hard to come by?

Thanks once again in advance,

Kaitlyn

P.S. any further insight regarding RN practice in the ED would be greatly appreciated

[Gus_RN]

Also....

I think some of the questions most US nurses have revolve around autonomy. I've worked in 13 different ED's in the US - from small critical access ED's to large Level 1 trauma centers. While there is always a difference in how much we can get done before the patient is seen by an MD, there are some basics that hold true everywhere.

We place the peripheral IV's (cannulate the veins with IV catheters), not doctors.

We access implanted port a caths, not the doctors.

We DO NOT suture. MD's, PA's, and NP's can suture.

We give meds that are ordered by the MD, PA or NP - by "advanced meds" I am assuming the OP meant things like levophed (norepinephrine), dopamine, nitroglycerin drip, insulin drips, etc - critical or vasoactive or high risk medications that require monitoring and/or titration.

Nurses do not order medications but based on our nursing assessment and judgement we are supposed to report to the MD any changes in condition and it is pretty much expected that we ask/suggest what the patient needs, an example would be "Mr X in room 4 is still vomiting, can we order another 4 of zofran?" and not just say "hey, the patient is throwing up what do you want to do".

We apply splints.

We place foley catheters.

We do in and out catheters.

We set up chest tubes and assist with chest tube placements then manage the drainage systems.

We connect our patients to the cardiac monitors and monitor vital signs.

We do assessments on our patients - in the ED they are typically more focused not he area of complaint but do include listening to breath sounds, bowel sounds and the heart. There are some ED's where we are the first to see a patient and would need to report the absence of bowel sounds, wheezing, etc. to make sure the MD understood that seeing that patient is a priority. We also assess for peripheral edema, do EKG's and note the rhythm in our charting.

We review D/C instructions with patients being D/C'd from the ED if not admitted.

We do - in some hospitals - transport patients to radiology (especially in emergent situations when they need to go on a monitor with an RN - for example a patient that comes in with a possible stroke), RN's always have to transport patients to critical care floors on a monitor, and some hospitals don't have transporters so we have to take to the med-surg floors, also.

Most ED's have techs (a person that helps the nurse, usually with a background as a paramedic or EMT) that can do EKG's, transport patients, splints, in some they can do blood draws but only a straight stick not IV's, collect urine specimens, take things to lab.

We are also responsible for taking critical lab values from lab and reporting them to the MD.

I think "run a code" is just a phrase we use. Any ACLS trained person can run a code, however it is pretty much always an MD. However, it is the RN that pushes the meds in a code, runs the defibrillator, does the compressions (sometimes there are other trained personnel that can help, including a tech, or if you are working in a large level 1 trauma center with a lot of residents then the residents will get a chance to do them), and as any ACLS trained RN knows - it is a team effort and as a trained professional you are expected to make suggestions as the code progresses. I'm under the impression BLS, ACLS, TNCC, ATLS, PALS is the same everywhere.

Most ED's I've worked in have respiratory therapists that will do ABG's, will do breathing treatments, will come set up biped/cpap and ventilators. I've only worked in one ED where I had to set up my own ventilator. I've worked in 3 or 4 where I did my own ABG's and my own nebulizers.

I'm pretty sure nursing is nursing but sometimes I know I've heard things that nurses in the UK don't get to do much as far as skills.

This isn't meant to be an inclusive list - I actually have a checklist and drugs that US ED nurses should know if anyone is interested. It would be interesting to see one from the UK.

[GrumpyRN, NP]

What you have done there is list the nursing tasks/duties that we do in ED.

We do not have respiratory therapists so ED nurses set up BiPAP/CPAP/Ventilators.

ABG's is unit dependent, some nurses will, some nurses won't.

Nurses in the UK can suture, not just NP's.

Drugs are drugs. Each ED will have a stock of what they use and access to the ones they use less often. Nurses are expected to know all the drugs used. Would also be expected to give suggestions to docs.

When it comes to codes anyone can do CPR, only someone trained in ALS would defibrillate although if using an AED it is irrelevant who presses the button. As you say, ALS, TNCC, ATLS etc. are standard.

The one thing nurses don't do is listen to bowel/chest/heart sounds. This is a medical exam and not part of the nursing assessment. You would be expected to document SOB.

Chest tubes - yep, we do that too, and look after the drain.

Not sure what you are trying to say here but I don't see any great differences in UK and US from what you write.

[Nrsing101]

I worked as a RN in the UK but i am now in the US. to cut it short, you will do "hands on" in the uk like cleaning nappies without masks! Cleaning the room, serving tea. YES, THAT IS A REGISTERED NURSE. And you will lose your skill even as simple as documentation because they are simply narrating it.. doesnt matter if it is not medically appropriate words like HAPPY. Stethoscope isnt used regularly. Basically, RN job there is very limited to being like Florence Nightingale. There is more autonomy in the US and higher technology. This is the truth.. i tell you, no mask except for patients with PTB.

[GrumpyRN, NP]

I worked as a RN in the UK but i am now in the US. to cut it short, you will do "hands on" in the uk like cleaning nappies without masks! Cleaning the room, serving tea. YES, THAT IS A REGISTERED NURSE. And you will lose your skill even as simple as documentation because they are simply narrating it.. doesnt matter if it is not medically appropriate words like HAPPY. Stethoscope isnt used regularly. Basically, RN job there is very limited to being like Florence Nightingale. There is more autonomy in the US and higher technology. This is the truth.. i tell you, no mask except for patients with PTB.

You understand that this is a discussion about ED nurses don't you?

What is it with the masks?

Cleaning patients and making sure they are hydrated is called basic care. Possibly THE most important part of being a nurse. What is wrong with being "hands on."

The UK has a 4 hour target to admit/discharge ED patients so your exposure to having to cleanse patients is limited. (Yes I am aware that we have had a horrendous winter with longer waiting times).

We have discussed autonomy earlier in the thread.

See my reply to Gus_RN above, he has compiled a list of tasks that ED nurses do in the US but are also done in the UK so I'm not sure where the deskilling you mention comes from.

[skylark, BSN, RN]

I worked as a RN in the UK but i am now in the US. to cut it short, you will do "hands on" in the uk like cleaning nappies without masks! Cleaning the room, serving tea. YES, THAT IS A REGISTERED NURSE. And you will lose your skill even as simple as documentation because they are simply narrating it.. doesnt matter if it is not medically appropriate words like HAPPY. Stethoscope isnt used regularly. Basically, RN job there is very limited to being like Florence Nightingale. There is more autonomy in the US and higher technology. This is the truth.. i tell you, no mask except for patients with PTB.

What utter tosh!

Since moving to the US I have deskilled because I no longer -

set up CPAP or BiPAP

suture wounds

apply plaster casts

do my own ECGs

Assess pressure areas, hydration and nutritional status in the context of washing a patient

Perform holistic care

And why would you wear a mask to change a diaper? Seriously?

The "technology" that you refer to in the US is actually the same monitoring and IV pumps that we had in the UK in the 90s. The CPAP and BiPAP is even older!

If you don't want to care for patients, then don't be a nurse.

If you just want to play with "technology" and do charting then find a new career.

I'm sure your team in the UK is much happier without Mrs "Too Posh To Wash" slowing them down.

I loved working ER in the UK but it has zero job satisfaction in the US as all we do is blood draws and give meds.

[kaitfinder, BSN, RN]

What utter tosh!

Since moving to the US I have deskilled because I no longer -

set up CPAP or BiPAP

suture wounds

apply plaster casts

do my own ECGs

Assess pressure areas, hydration and nutritional status in the context of washing a patient

Perform holistic care

And why would you wear a mask to change a diaper? Seriously?

The "technology" that you refer to in the US is actually the same monitoring and IV pumps that we had in the UK in the 90s. The CPAP and BiPAP is even older!

If you don't want to care for patients, then don't be a nurse.

If you just want to play with "technology" and do charting then find a new career.

I'm sure your team in the UK is much happier without Mrs "Too Posh To Wash" slowing them down.

I loved working ER in the UK but it has zero job satisfaction in the US as all we do is blood draws and give meds.

I'd say the only thing we don't do in the US skill-wise from the list you've mentioned is suturing. The rest depends on what facility you work at. I do my own EKGs, assess skin integrity, monitor hydration, clean/wash patients as necessary. We do have respiratory therapists in my personal ED who assist with setting up BiPap but when they're unavailable or it's emergent (as it often is), it's up to the nurse to manage it. We also don't do plaster casts in our ED, using soft-to-hard casts w/ ortho referral. Our tech is horrendously old though, in the facility I work in, that's for sure.