Please help!!!

Wow, you've asked a lot of deep questions here - I guess it's going to be people's own personal opinions. There are quite a few nurses in NZ and Oz that have lived and worked overseas which gives a greater understanding of 'world' nursing opinions.

I am from the UK, did my training there, but then only worked for one year as a newly qualified nurse. I then came to NZ and found things very different here. I don't really know anything about Australia.

My Mum is and ANNP in UK and she fills me in about the NHS, their new grading system for nursing pay, government 'target times' etc. She just did a prescribing course too.

As far as I know there are only a few ANP s in NZ working in the big teaching hospitals. I know that some independent midwives can prescribe too.

For your question number 1 - I personally think that having a central or national healthcare system gives people 'peace of mind', they know that in an accident or illness they don't have to worry about insurance, bills and they will get the same treatment as the next patient.

As a nurse you're not having to 'suck up' and be nice to Patient A because they have health insurance and are paying a lot of money.

My brother lives in Indiana and has lost his job, also his health insurance, he has Von Willebrands disease, fell over cut himself and couldn't afford to go to ER. I think that really sad. When I lived in CO my friend broke her wrist and before we could even speak to anyone the receptionist was checking out the insurance details, and my poor friend was in lots of pain - they made us wait until the company called back and said yes she could be seen.

Some people abuse the national system though and then because of that, there isn't enough funding and resources for all the treatments we'd like to give. They call ambulances when it's really not an emergency and people use the ER like a family doctor clinic, etc etc.

Like most 'businesses' people want to make money, cut corners, reduce spending and have huge profits - it must be tricky being at the top and juggling the numbers - I guess that's why I nurse and not work in HR.

The few American doctors I have ever worked with say they love the fact in NZ people aren't looking at how they can sue you, they say the patients appreciate the care you give them - they don't 'expect it', as I think paying a high insurance cost I'd expect a certain level of care and attention.

People that have been brought up knowing that there is 'free' healthcare are always shocked to hear how much operations and treatments really cost the hospital or 'tax payer'.

I like the National Healthcare system personally I think it keeps things 'fair'. In England the government have set target times and dates which puts a lot of pressure on nurses and managers but is supposed to have better outcome for the patients, like less waiting time in ER and shorter time to be seen and assessed for cancer treatments.

With NZ being a small country we have a national database for the patients records - which is good in an ER situation for assessing drug seekers or child abuse cases. You could look up peoples information from different towns. I personally don't like this system, it could be open to breeches in confidentiality. But then when you stop a child being hit or wounded again it's worth it.

Sorry if I rambled on. Good luck with your research.

SmithH75,

Thanks so much for your reply. The information you provided is very helpful.

MIDWEST US RN

Thanks for asking those questions because I am currently working on a project related to healthcare policies in another country. By any change, are you in a Masters program at the University of Iowa?

hehehe.. forgot to say as a reply to Q5.. the food is always awful and many patients go home malnourished as the hospitals contract out to companies who can feed and provide meals at the cheapest cost. There have been studies done in UK about weight loss in long stay wards. As a result of poor diet and eating, wound infection, constipation etc, etc. Patients stay longer and the cycle starts again.

I really don't think any country has it right, in NZ and in UK both have the option of 'going private' and have standard operations done quicker, for example hip replacements, knee arthroscopy etc. A friend of mine had private medical cover from his job, he got spinal cancer, saw a consultant, had MRI scans done, blood test etc all with his private insurance, and it cost a lot of money in £ - but when it came to chemotherapy he ended up on the ward with all the other 'regular' patients, as his private hospital didn't provide chemo.

Many people that can't afford to have private cover call it 'queue jumping' as people see the consultant and take his time up privately and then he can't work so many hours in the 'public hospitals'.

Also it's been known that a patient will pay just for private consultation and then have the surgery done in public hospital by that consultant.

I could ramble on about this for ages but I must get ready for work.

It's a beautiful sunny day and I really don't feel like going. :) - need to pay the bills somehow!

I'll try to answer your questions but I don't know if you will be able to use my answers. I'm a US nurse working in the New Zealand health system.

1. What are some of the advantages to having a centralized or national health care system?

Coverage available in the country (and in countries with which we have reciprocal agreements) with patient information available countrywide via a computer.

2. What is your opinion of the healthcare system in the US?

I think the health care system in the US needs an over haul, but not entirely convinced national health care is the way to go. I do find that care provided in the US is proactive, efficient and outcome driven. There is a huge emphasis on preventative care, as well.

3. How is the practice of nursing in Australia or NZ different from practice in the US?

I find that nurses in NZ are not encouraged to think for themselves and are much more reliant on waiting to see what the doctor says, then follow instructions. I think US nurses are trained to be more autonomous, and they anticipate what the doctors questions might be when calling a doctor with a concern, providing many more facts rather than conjecture. I find NZ nurses assessment skills lacking, and I think that goes back to an educational system that emphasizes theory rather than practice.US nurses are much more on a professional level with doctors Nurses in NZ are treated more as hand maidens to the physician, with time saving and work saving ideas that cost money taking a very, very low priority when it comes to spending money. I've worked in two different DHB's hospitals and there is no unit dose. Nurses run here and there a lot, just like US nurses used to do many, many years ago.

4. How limited is the prescriptive authority of APN's (MSN prepared) in your country?

Unknown

5. What are some of the problems with the healthcare system in your country?

The government controls the health care spending, hence, non-medical people are involved in the rationing of care. There are not enough services to properly care for people in a timely, efficient manner. While some may see this as an ultra-conservative approach, to me it appears to waste valuable time when it comes to diagnosing and treating serious illnesses, where time has proven to be of the essence, as in the case of treating strokes and myocardial infarctions. For example, waiting days for an urgent CT is unreasonable, or a week for an angiogram. I actually had a patient with a broken ankle who who needed surgical repair be cancelled 6 days in a row - and we are talking not having anything by mouth from midnight until 9PM that night when cancelled, to be made NPO again at midnight. This happens to elderly with fractured hips - just stop and think about the consequences of not feeding an elderly patient and keeping them on prolonged bedrest while their surgery is cancelled two and sometimes 3 days in a row! While there are nurses that will bash having private insurance and that that damages the ability of surgeons to treat all people equally, the system and growth of private insurance would not exist if the public system was satisfactory. There is also a lot of "this is the way we've always done it, so why change" attitude here. No doubt the surgeons that accept private insurance payments like having new equipment and available OR time and more pay. Perhaps some services aren't available at private hospitals, but the patient might benefit and be happier that diagnosis and treatment options have been expidited in a private hospital.