questions for fergus!

Hi sorry about the delay, but here I go!:)

Hello Fergus,

sorry you didn´t receive my e-mail. And thanks for reacting again!

Herewith my questions on nursing in Canada.

-In The Netherlands there is an ongoing discussion about nurses taking over certain medical tasks (eg. the trend towards installing nurse-practitioners). How is this in Canada?

We also use NPs and seem to be expanding their use as an effort to control costs (they are way cheaper than docs!). I work in a neonatal intensive care unit and the NPs function basically like resident doctors. The problem is there are not enough NP training programs or nurses to go into them. Regular nurses also seem to be doing more and more tasks that used to be doctors' only. We call them "transfer of function" tasks, like lady partsl exams, pulling chest tubes, etc.

-Related to that: what would you say is the main task of the nurse in Canada; the cure part (as above) or the care-part (nurses mainly taking care of patients every day needs such as personal hygiene, nutrition etc)?

I think it's a mixture and depends on where the nurse works. We have to get the medical stuff done, but then care about the patient especially emotionally. More and more, I think certain hospitals are hiring aides to do the basic tasks like baths.

-Do you work with different levels of nurses? (in The Netherlands you have roughly 3 educational levels of nursing schools, the major difference (in theory) being that a nurse on the highest level (which is what I am studying) should have the flexibility to oversee complex situations and to make decisions when there is no fixed protocol, also this level is more ment for management jobs).

We have LPNs (lisenced practical nurses) who undergo a year of training and do basic nursing care in certain areas (baths, dressing changes, etc.). I have only seen them in geriatrics and general wards, not in specialties. Then there are RNs. They can have a diploma or degree, but function the same on the job and make up the majority of nurses. Nurses in management tend to be RNs who have gone back to school and obtained a master's degree.

-What is the place of the nurse in a Canadian hospital, does she have a lot of own responsibilities (eg. arranging discharge)?

YES!!! Depends on the area again, but bedside nurses have a lot of responsibilities and autonomy in patient care. Where I work, nurses do discharge teaching, arrange transfers, run parent support groups, have standards for many bedside decisions (like weaning O2, starting feeds, etc).

-How is this in nurse-patient relations; formal or informal, do you get the chance to have a lot of personal contact with your patients?

My patients are all babies, so we keep it pretty informal:) I spend my whole shift with my 2 babies, so we have a lot of time together. When it comes to the parents, I usually keep things casual but professional. We do need to set certain barriers or some parents would become innapropriate, but we are friendly with all of them. We even have a picknick every year when parents and their children can get together with the staff after they have been discharged.

-Are nursing theories (such as Carpenitos diagnosis or Gordon Health-patterns) used to design the care your patients receive?

Yep, but it depends on when the nurse was trained! They are taught in programs today. We design our care around developmentally supportive care theory in our unit.

-In the Netherlands the trend is to shorten the duration of the inner clinical stay as much as possible and to let parts of the healing-process take place in rehabilitations centres or even at home. How is this in Canada?

We always try to get people out as fast as possible and try to arrange home care. It can be a problem because the government doesn't seem to fund it well enough.

-This trend has to do with cost savings (lack of money) for the health care services but also with long waiting lists for most surgical operations. How is this this in Canada?

We have waitlists for most elective surgeries (like knee replacements), and the length of time varies for the area of the country. It took my dad 4 months to get a knee replacement. Emergency surgery is done immediately and urgent surgeries have short waits and haven't been shown to increase mortality and morbidity.

-Last but not least: maybe you can tell something about the place you work& do you have an image of nursing in the Netherlands?

I work in an NICU, and love my babies. It's a large teaching hospital and a lot of fun most of the time. the only talk I have heard about nursing in the Netherlands is that men are much more common (we have one male nurse in the whole unit) and that nurses in emergency and intensive care units function very independently.

Best reply is to my e-mail [email protected] but post it here will work too!

To all others on this forum: maybe this information exchange can be of use for you too!

Thanks and greetings,

Gideon

If you have any more questions or can tell me about nursing in the Netherlands, I look forward to it.

fergus

Thanks a lot Fergus for taking the time to write your detailled reply, I surely learnt something here!

A male nurse is really normal here indeed, although women are still a majority, so much that even most of the books that I use for school refer to "the nurse" as "She" all the time (which I do not mind at all by the way :) But in my Hospital it does happen that you have a shift with mostly male collegues, I think you can safely say (for as far as my experience goes) that gender is not a real issue in Dutch health care, luckily!

The hospital where I am "learning the job" called Leyenburg in The Hague, being a student still, also offers a lot of places for trainees, student nurses and graduating Docters. It has 489 beds (which makes it among the bigger uin the Netherlands) and has recently added a coronic care unit. It has about 700 nurses, including a lot of students who, like me, work and get paid roughly 4 out of 5 days and attend classes on the fifth day. Right now I am back at school for no less then half a year but I can´t wait to be "back on the floor again!" I think you can imagine that!

Would be great to keep in touch through this forum, feel free to write again!

Yours,

Gideon

By the way:

I am going to share your answers with some fellow-students: can I use your name and city in my report?

yours,

Gideon