US RN looking to work in UK -- ER

  1. 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
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  2. Visit kaitfinder profile page

    About kaitfinder, BSN, RN

    Joined: Dec '17; Posts: 16; Likes: 8

    17 Comments

  3. by   GrumpyRN
    You are asking a lot of questions that are difficult to answer. ED's or A&E's (NOT ER) differ in themselves. Some will give you more than others. Insertion of IV's and Foleys should be standard but it is extremely unlikely you would run a code unless you are in some small cottage hospital. You can still be ALS qualified and assist with this. Remember, you would be the junior nurse so would have staff above you.
    What do you mean by "advanced medication?" You give what is prescribed.

    How do A&E's differ from US? Don't know, never worked in the US. Someone on this site may hep you with that. I only have what I see on TV and that tends to get my blood pressure raised due to the usual 'physician as nurse' nonsense and the way that doctors talk to nurses on TV programmes.

    The autonomy you get will depend on the senior medical/nursing staff - I was an ENP and had complete autonomy but my colleagues had to go with what was prescribed by medical staff - ie, a doctor would say this patient is for wound dressing but it is usually the nurses decision what dressing is used. Wound suturing again depends on place. Nurses can suture but a lot of them don't.
    Just as a difference that springs to mind, you will not need a stethoscope in UK ED. Nurses do not sound chests unless they are advanced practitioners

    You won't have much to do with phlebotomist's - do your own bloods.
    Respiratory therapists don't exist - they are called physiotherapists. They tend to be utilised on the wards as you should not need them in ED. You look after your own ventilated patients until you hand them over at theatre or ICU.
    Patient-care technicians??? Whats that? Again you look after your own patients.
    Pharmacy will probably not have a great input into ED on a daily basis.

    Pay is what it is. As a staff nurse you are paid at Band 5. All staff nurses are paid at Band 5 no matter where they are. Working in ED, ICU are not seen as specialist unless you have a specialist qualification/role. Then you can move up the bands. Charge nurses tend to be band 6. There is no point whatsoever looking at US salaries and trying to do a direct comparison. Costs are different. Approximately 1 third of your salary goes to tax and national insurance but health care is free at the point of use.

    4 hour target in ED - 95% of patients discharged or admitted within 4 hours of attending ED. Very few ED's meet this. I was lucky enough to have worked in an ED that met the old 98% target.

    Finally, and most importantly, can you work in the UK? Do you have the qualifications, hours etc to get an NMC PIN number?
    This forum is full of foreign nurse who are trying to do that. It takes time and money and you have to pass an assessment.

    Good luck.
  4. by   Extra Pickles
    Grumpy I am personally not looking to be a nurse in the UK but I found this a very interesting and informative read! Thank you for posting it.
  5. by   skylark
    Just wanted to add another few thoughts to Grumpy's excellent comments.

    Wound care - in the UK its the nurses domain. Doctors don't do wound care. You will be expected to know the different dressing categories and when to use them, and don't even think about trying that darned WTD gauze if you want to keep your licence! You will usually do plaster casting as well, although the bigger A&Es do have technicians for this during the daytime.
    Suturing is usually a nursing role as well, although most A&Es will have protocols where certain wounds, (mostly facial) get referred on to Plastics for suturing. But the majority of A&E suturing is done by nurses.

    And there are no respiratory therapists, you will set up your own CPAP and BiPAP, and work with the docs on RSIs.

    As Grumpy mentioned, the 4 hour rule prevails and sets the pace. You will get into a rhythm, patients are triaged within 15 minutes, including labs and EKG, then seen by a doc within the hour. At 2 hours all results are in and they are reviewed. By 3 hours you should be getting a decision on discharge v admit, and they need to be gone by 4 hours.
    There have been several A&E closures in recent years, which means that the ones that still exist have far higher census numbers. Its not unusual anymore for departments to see several hundred patients each day, when they might only have seen 200 a decade ago.

    Nursing is a lot more 'hands-on' in the UK, and you will be changing diapers for incontinent patients, and helping to feed those that need it. Body fluid spills are cleaned up by nurses, and you will work as a team player, doing whatever is needed to keep the department moving. This might include pushing carts to xray, (they are called trolleys, btw) or emptying linen bags, or running to pharmacy. You work far more as a team, so when you coworker receives a new patient, you all dive in! One does the triage, another does the EKG and another does the labs, so that everything is done in the 15 minutes.
  6. by   GrumpyRN
    Yep, what skylark said.
  7. by   Wuzzie
    Quote from GrumpyRN
    Just as a difference that springs to mind, you will not need a stethoscope in UK ED. Nurses do not sound chests unless they are advanced.
    Grumpy, Very interesting synopsis but I have a question. In the US we use a stethoscope for more than "sounding chests". We also listen to heart tones and bowel sounds. It is part of our regular nursing assessment. We also use them to check blood pressures when a machine is not available or appropriate. How do nurses in the U.K. assess these things or is that not part of your duties?
  8. by   GrumpyRN
    Simple answer is, they don't.

    Listening to bowels sounds, heart sounds and chest sounds are all medical tasks. It is not part of the nursing assessment.

    If you are an advanced practitioner you may listen if it is part of your role.

    As an example; I was an ENP and listened to airway sounds for chest wall trauma but totally uninterested in listening to anything else.

    Using a stethescope to listen to BP - yes, although I wonder if this is still taught as the students coming through us did not seem to know about it.

    Would add, if ALS, TNCC, ATLS qualified part of that training was to listen for air entry.

    Hope that makes things clearer.
  9. by   Wuzzie
    Quote from GrumpyRN
    Simple answer is, they don't.

    Listening to bowels sounds, heart sounds and chest sounds are all medical tasks. It is not part of the nursing assessment.

    If you are an advanced practitioner you may listen if it is part of your role.

    As an example; I was an ENP and listened to airway sounds for chest wall trauma but totally uninterested in listening to anything else.

    Using a stethescope to listen to BP - yes, although I wonder if this is still taught as the students coming through us did not seem to know about it.

    Would add, if ALS, TNCC, ATLS qualified part of that training was to listen for air entry.

    Hope that makes things clearer.
    Thank you! Hearing about how nursing is across the pond is fascinating.
  10. by   kaitfinder
    Thanks for the information, it was very helpful! It's sometimes difficult to collate all of the information out there about nursing in various countries. What you've mentioned seems to be exactly on par with what's expected of nurses in the U.S. (at least in the ED I currently work in) with the exception of suturing, which is strictly a skill performed by doctors in the U.S.

    Another question for you, if you've the time: would you happen to know anything about the process of a foreign-prepared nurse getting hired in the U.K.? From what I've seen it seems there are two routes; getting hired through an agency/travel company or getting hired and sponsored by a hospital in the U.K. directly. I'm undecided (given the fact that I know little) about which path would be best to pursue, as there seem to be few reputable travel agencies and I'm not sure how I'd best go about trying to contact a hospital directly.

    In any case, thanks for your (and everyone's!) help/advice thus far!
  11. by   GrumpyRN
    Sorry, I can't help you I'm afraid but lots of people on Allnurses can.

    Go to "World Nursing" (you are here already).
    Go to "International Nursing" and "Nurse Registration" forums.

    You will (hopefully) find everything you need to know.

    Edited to add; You may even find information on the UK forum.

    Again, Good Luck.
    Last edit by GrumpyRN on Jan 5 : Reason: To add,
  12. by   Extra Pickles
    So many differences in nursing! Although I would have expected significant differences between the US and some other country's, I had no idea that the UK would be so very different from us. Interesting indeed!
  13. by   Gus_RN
    This site has a lot of information including agencies other than Continental Travel Nurse - travel nurse overseas – Nursing Across the Pond

    - which is the one most people are aware for US nurses looking to travel nurse to the UK. Also, from what I understand of the process, you need to be prepared to live over there for at least 30 days without a job while you take a class or a test or finish the process of getting licensed. I know it's changed recently but I'm still under the impression there's hoops to jump through once you get there and you don't get to work right away unless it's as a CNA (I don't know if they're called CNA's over there, just using the US terminology).

    There's also a facebook page for US nurses interested in working in the UK - they address getting two year work Visas.

    You have to have a job (a sponsor) before you go. You have to take an english (IELTS) as part of the Visa application process. I know with Continental you live with roommates (up to 4 other nurses) and pay part of your housing. It takes approximately 6 months to complete the process of getting everything done.

    I keep thinking about it but not sure I want to afford the paycut even for the opportunity.

    If you do it - please post about your experiences!
  14. by   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.

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