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.

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!