Thoughts from US nurses in New Zealand

uswoman · Aug 2, 2010

In the hospital where I worked, in Cincinnati, Ohio, and the last time there was about 1998, we had pyxis medstations. Basically, you accessed the machine by placing your index finger on an oval screen - you were identified by your fingerprint. You also had to use a code to log in and choose the patient you wanted a drug for. The system was programmed so you could only give the patient narcotics that were on his drug screen. The machine tracked whatever was taken out, so no need for another nurse to co-sign. The machine did it all. We also got stock meds that way, and everything was in unit dose - 30 ml of Mylanta or 2 Tylenol tabs packaged together. It saved a lot of money by being able to track what we used. Our machines were in an area not accressible by patients or visitors but were not locked as the medications in the machines were quite secure. I imagine bar coding is used now for some of the steps.

Medications for the patients came up in the middle of the night. We had med carts that had two cassettes with 8 drawers in each cassette. Pharmacy techs changed the cassettes every 24 hours. All medications were unit dose - in other words, if a pt was to get Digoxin .125 once a day, you got one dose of Digoxin .125 in the drawer. If they could have up to 6 doses of Tylenol per day, you got 6 little packages of two tabs each in the drawer. Anything that didn't come in unit dose, was labeled in a little ziplock plastic bag with the pts information and the drug. We didn't have boxes and bottles of medications in a room. The medication cart went to the patient room and the nurse took the drugs from the drawer with the patient's name directly to the patient. Since the carts were meant to be mobile, and they were lockable so once locked (and if left unattended, they locked automatically) no one could get to the medications without knowing the code to the lock. (No keys - touch pads) The pharmacy was in charge of reloading the medications carts every night. The whole system was one - Orders were sent to the pharmacy and entered there and meds sent up or set up in the drawers and all that information was compiled so that MARs (Medication Administration Records) were printed by each unit at night and placed on the charts. A new med record - updated - every day. If I remember correctly, there was also a medication history that could be printed. I'm sure things have changed since I last worked there.

We also used our badges to "log in" when we arrived at work, by swiping a magnetic stripe through a reader, and when we left. So, if you worked overtime, you didn't have to write it down - it was logged for you to the minute, and payroll had all that information. (And, if you showed up chronically late, that was also noted in the system.) You also had to log in at your designated unit. So, you could not log in on one unit, then catch the elevator to where ever you worked. You had to get to the proper place to log in. Most areas had key pad locks and if you needed to be in one of those areas, you needed to have the proper code to get in. We had magnetic key cards for the garage where we parked. Again, I bet things have changed since I worked there years ago.

And, I was in Cincinnati - the place where, Mark Twain once said, he wanted to be when the end of the world happened, "because everything happens 10 years later in Cincinnati."

I worked on a Cardiothoracic Stepdown unit and it was just routine to listen to every patient's lungs every shift and do a quick head to toe assessment. We even got pretty good at listening to heart sounds and picking up rubs. Every floor had a negative pressure room. There was air conditioning and heat and we had vents under the windows we could open - which were screened, too. Each patient bed had a television and a telephone. Nurses carried cell phones. The patient could press their call light and it lit up on a screen where the unit manager sat. She would answer via the bedside call system and see what the pt required. Then she would pick up the phone and call the nurse caring for that patient and tell her what they wanted, or if the nurse had a call from the lab, it could be transferred to her so she didn't have to constantly be running back to the nurses' station for every little thing. There were charting alcoves at every other room. Our patient rooms had a sink inside the door (for the nurses and doctors) as well as one in the bathroom. Rooms had no more than 2 patients and about half the rooms were private and each room had a full bath - toilet, sink, shower. I was in one of the hospitals in our system once, and in addition to my bed, I had a table and two chairs, a small couch that could be made into a bed, a TV in an armoire, and a small refrigerator below that. It was more like a very nice hotel room. I don't think I ever came across a manually operated hospital bed until I came to New Zealand. I just found it incredible that a major hospital - let alone an orthopedics ward - would have manually operated beds, but I found that to be true here.

Of course there are hospitals in the US that are way beyond - some have electronic charting so don't worry if you left your pen at home, you don't need it.

pedicurn, LPN, RN · Aug 2, 2010

Thanks USwoman for your post.

When I worked in NZ we had pyxis at one hospital. It had the narcotics in it but we still had to go and find another nurse to check it out. The machine would want her/his finger and logon as well. I didn't see the point of that ...after all the machine was doing the counting.

Good thing though, at this hospital....they also had stock on the shelf in the drug room.. So You didn't have to run to the pharmacy if something new was ordered. All the antibiotics are unmixed except Metronidazole. And only chemotherapy,Adrenaline,Noradrenanline and Dopamine infusions come premixed by pharmacy.

However i don't think pyxis are the norm there as the other hospital I worked at didn't have them, they still had the narcotic cupboard and keys.

I only worked in two places in NZ before going to Australia but in my workplaces they had electronic beds, one negative pressure room per unit, no individual phones or TV's, nearly all shared rooms, lack of bathrooms. I would see visitors use the patients bathroom !!! The only nurses who carry cellphones are managers and charge nurses.

We used our swipe card for entering everywhere and still had to fill out written timesheets.

Being late was frowned on ofcourse ....but the norm was to leave after handover ...didn't have to stay until 0730 or 1930

ANnot4me · Aug 3, 2010

My earlier posts were merely an attempt to highlight the differences in the standard of living due to the low wage economy. However, USWoman, your posts about practice and and the environment are completely valid. Nurses here are still seen as expensive gophers and I know I had a very hard time accepting the role of nursing in NZ. NZ nurses are among the lowest paid (if not the lowest) in the OECD and saving nurses time is just not a priority. While US nurses assess patients start and maintain IVs, foley catheters, perform phlebotomy and other things I can not think of at the moment, these are not routine nursing tasks here. Nurses may do them, but it is all part of special certifications. To me these are tasks I have performed for years, so it is no different to me than hunting down IV poles or making beds or looking all over for the controlled drug keys. But I sure invested a lot of time and effort acquiring my degree and the experience/skills I have acquired. The most important skill one can have here in NZ is to know how to keep your head down and do what you are told. The culture here is nothing like the US or even Australia.

Working in the ED was probably utilized my skills the best. Nothing like having six or more acutely unwell people to care for (oh, maybe twelve patients if your neighbor needs a break). My assessment skills came in real handy there when some bozo triage or charge nurse forgot to touch the patient or talk to them for just a minute before throwing them in a "stable" zone.

uswoman · Aug 4, 2010

Hi, pedicurn! Why am I not surprised a pyxis machine that is designed to increase safety and decrease time spent doing a task was overridden? Only in NZ - because that's not the way they are used to doing it. I've worked in places where change was not welcomed, but this country has them all beat. I've never seen a place so resistant to change! Also, we didn't have stock drugs (other than things normally found over the counter, generally given PRN.) The idea was that the pharmacy was responsible for processing the orders and getting the drug to the nurse, not the nurse running after the medication! Either a phamacy tech hand carried it up on the rounds twice each shift, or they sent it up in a pneumatic tube system. We didn't mix any drugs on the floor - all antibiotics were prepared under a hood in the IV department (part of the pharmacy). They had strict policies and procedures to make sure things were done right and the right drugs were mixed and checked. Also, a pharmacist was part of the code team, so if you had an arrest, the pharmacist showed up and prepared infusions and meds on the spot. (Chaplains also responded as part of the code team). The whole idea was that the patient is the center of care, and the nurses at the bedside were supposed to be at the bedside, not running all over creation, fetching this and that. We had an IV team (to start IVs) and and ECG team as well as phlebotomists so those tasks could be delegated, leaving the nurse free to do nursing care.

Chigap - loved the "expensive gophers" as that is absolutely right on! I see the nurses in NZ still stuck quite a bit in the role of "physician's handmaiden", especially in the larger hospital where I worked. You are correct, too, that certain tasks we did in the US were expected whereas here you have to have special certifications for this, that and the other thing and heaven forbid you move to another DHB because the next one would not accept the certifications from the previous one. You could be starting IVs for years but move elsewhere and you can't do it until you are properly signed off. I am still blown away by the NETP programs. I just can't understand how a nurse can graduate with a degree - yet need a year of training in order to function safely and competently as a nurse. In the US, at least where I came from, the only sort of internships we had were for new grads who wanted to work in highly specialized areas such as the ICUs. All that being said, I do want to say that I have worked (and presently work with) some excellent, very knowledgable nurses who know a lot and are quite good at what they do.

I would really love to know if there are any kiwi nurses that have immigrated to the US lately and how they perceive things in the US compared to NZ.

pedicurn, LPN, RN · Aug 5, 2010

Hi, pedicurn! Why am I not surprised a pyxis machine that is designed to increase safety and decrease time spent doing a task was overridden? Only in NZ - because that's not the way they are used to doing it. I've worked in places where change was not welcomed, but this country has them all beat. I've never seen a place so resistant to change! Also, we didn't have stock drugs (other than things normally found over the counter, generally given PRN.) The idea was that the pharmacy was responsible for processing the orders and getting the drug to the nurse, not the nurse running after the medication! Either a phamacy tech hand carried it up on the rounds twice each shift, or they sent it up in a pneumatic tube system. We didn't mix any drugs on the floor - all antibiotics were prepared under a hood in the IV department (part of the pharmacy). They had strict policies and procedures to make sure things were done right and the right drugs were mixed and checked. Also, a pharmacist was part of the code team, so if you had an arrest, the pharmacist showed up and prepared infusions and meds on the spot. (Chaplains also responded as part of the code team). The whole idea was that the patient is the center of care, and the nurses at the bedside were supposed to be at the bedside, not running all over creation, fetching this and that. We had an IV team (to start IVs) and and ECG team as well as phlebotomists so those tasks could be delegated, leaving the nurse free to do nursing care.
Chigap - loved the "expensive gophers" as that is absolutely right on! I see the nurses in NZ still stuck quite a bit in the role of "physician's handmaiden", especially in the larger hospital where I worked. You are correct, too, that certain tasks we did in the US were expected whereas here you have to have special certifications for this, that and the other thing and heaven forbid you move to another DHB because the next one would not accept the certifications from the previous one. You could be starting IVs for years but move elsewhere and you can't do it until you are properly signed off. I am still blown away by the NETP programs. I just can't understand how a nurse can graduate with a degree - yet need a year of training in order to function safely and competently as a nurse. In the US, at least where I came from, the only sort of internships we had were for new grads who wanted to work in highly specialized areas such as the ICUs. All that being said, I do want to say that I have worked (and presently work with) some excellent, very knowledgable nurses who know a lot and are quite good at what they do.
I would really love to know if there are any kiwi nurses that have immigrated to the US lately and how they perceive things in the US compared to NZ.

I guess smaller hospitals might be pretty resistant to change.

I have worked in the NZ in the past and am not sure I would agree with 'physicians handmaiden'. I found the NZ nurses quite assertive.

In Australia, I find the Australian doctors don't treat nurses quite so well.

Also, i have noted the tendancy of the US doctors working in Australia to order absolutely everything .... I mean they order nursing

care and some very obvious stuff. I am amazed with their orders...'turn the p't ...'feed the p't'....'inform the family'....'dress the wound'. Generally super authoritarian toward nurses

Do they do this to cover their own butts or do they dictate nursing care as well?

uswoman · Aug 5, 2010

It might be that they are US doctors working in another country, that they write orders for everything to cover themselves. I suppose they feel it's better to order it and err on the side of caution. In the states, working on a cardiovascular and thoracic stepdown unit, we had quite a few standing orders for treating arrythmias and so forth. We were trained, basically, to anticipate what the doctor was going to order or do, so one really had to be thinking ahead. We had a close working relationship with the cardiovascular surgeons and they had a lot of trust in us. I've found the doctors here to be more authoritarian, and somewhat condescending than in the states, (especially consultants and some registrars.)

iloveleeks · Aug 25, 2010

Rather poorly paid, little paid holiday, no pension contributions by hospital, somewhat high cost of living. I did it for 6 months, and it was good for that kind of contract length. Great for hiking. HOwever, I like to travel, and the NZ dollar isn't worth much once you take it overseas.

nz rn in oz · Sep 5, 2010

Hi everyone. I read this thread with interest, as although I have never worked in the US, I am a NZ RN currently working in Australia. I guess I would have to disagree with the comments made about NZ nurses still being Doctors handmaidens. As a nurse working in NZ in a large teaching hospital I felt I was well-respected by the majority of Doctors that I worked with and was responsible for all of my own clinical practice including Starting IV's, taking own bloods, complex wound dressings etc after only a few months of commencing practice as a new grad. This was the norm for all of the nurses that worked on our busy acute surgical unit. I have now worked in 3 hospitals in Australia and I guess have been very surprised at how many tasks here are still considered "Doctors jobs" or handed over to "more specialised nurses". Very few nurses in the unit where I work cannulate. On nights the busy junior doctor is called up from ED to insert an IV without any of the 3 or 4 nurses on duty even having an attempt. During one night shift where I was working agency the nurse team leader for the shift commented to me that she would have to delay the IV antibiotic that was due for her patient as the Doctor was busy in ED and couldn't come up to insert a cannula. When I offered to insert the IV for her she looked at me like I had 3 heads and even after inserting it for her I got the distinct impression the gesture was not well received! The unit where I currently work also has "wound nurses" who come and do the more "complex" wounds i.e the vast majority of them, and discharge planning nurses who take care of all referrals to allied health, home health nurses etc. I feel as though alot of what I consider core nursing tasks have been taken away from the humble ward nurse. I do acknowledge that many things are still a bit behind the times in NZ and of course we do have our fair share of scary bullying nurses but what country doesn't? Overall I would have to say that although I LOVE living in Autralia and the pay is much better & the lifestyle great I definitely prefer working in NZ hospitals.

Fiona59 · Sep 7, 2010

I'd love to have someone take away my wound vac dressing changes. Our wound nurse only shows up for the initial wound vac application.

neko2010 · Sep 13, 2010

I would love to ask questions to uswoman. How can I do that? I am interested in working in NZ. :nurse:

VentMaven · Dec 16, 2010

I thought Expat Exposed was a bunch of Debbie Downers too until I checked it out. Although I'm sure some posters' personal circumstances contribute to their unhappiness, you shouldn't discount what they have to say on that site completely.

My husband is a Kiwi and his whole family is in Auckland. I'm a respiratory therapist and I was looking at going to work in NZ once I'm done with nursing school. After brief shadowing experiences in Auckland I decided against it. The money isn't worth it, and the role is very different then in the US- very little autonomy. The pay scale is a joke. I have instead decided that once I have enough experience in critical care I will probably take travel contracts or go per diem and work a lot of overtime for a few months at a time stateside and then spend time off in between there as a visitor in NZ instead.

Don't get me wrong-New Zealand is great ... but much much better if you don't have to worry about making a living there.