Wanting to know different countries approach to health care and nursing

suzanne4, RN · Feb 14, 2006

Training in most SE Asian countries is now four years and equivalent to the US BSN. Significant difference is that the doctor is repsonsible for doing the assessment, not the nurse as we do here. Nurses from many overseas countries need to learn breath sounds and heart tones when they ome to the US............in some countries, they need to actually go to the pharmacy with money to get the patient's medications.

I am sure that others will come along and be more specific for you in what they do in their country.

ISM · Feb 23, 2006

hi there, i am from a small island in the caribbean. the R/N is the all rounder. she does everything for the client. In my country only the midwife sets up IV therapy and collect blood specimens. Other wise the physician does iv,blood specimen collection,and certain initial measures during assessment of the client.

what i realise is that nurses in the U.S do way more than that. Also delegation will be a first for me because like i stated earlier we do everything because the nurse may have 18 clients in icu working alone. Our average ratio is 12 clients to 1 R/N and 1 LPN.

our medical equipment etc is stone age in comparism to the U.S. i will have to learn so much to fit in.we improvise so much. but that is life.

there are times a midwife have 30+ clients including deliveries and sometimes patients are neglected as a result.I do not know if it is still that way but we were always short. my first experience as a graduate nurse in infectious unit with 12 clients; 2 AIDS clients, 1 critical and the rest TB.My critical client turned for the worse and the phone lines were down so i could not get assistance. it was horrible but i survived.We are definitely third world and i hope we will catch up someday.

elenova · Feb 23, 2006

Hi, there, I am from Bulgaria, East Europe, almost 8 mln. country. Our country has a different system too. I didnt see two nursing programs similar:nurse:

We have only RNs in my country.No LPN, but we have ladies, without medical background to clean and do the porter's job. We lose our license if we dont work for 5 years. After high school we study 3 years nursing College and as we r going to the EU in january 2007, the government have changed the system to an European few months ago. Well, the new students study the same basic material, but extra social medicine, hygiene, etc. Because most of the young population in my country is working overseas, to cover the workplaces, we do the nursing studies very intensively, so, we can graduate and start working. We have clinical practice in the morning and then lectures in the College in the afternoon.

Nurses do everything from vitals and injections to assessment and store requests. We do IV, the doctors do only the central veins. Of course, if we cant find a vein the doctor will help us. But we r expected to know how to do it.

I am happy I graduated in my country, coz when I started we were poor country and that gave me lots of courage, flexibility and creativity. I had to collect the medicine, needles, even the cotton for the injections from the patients... We had almost nothing and I was working in CCU. We had 2-3 nurses per 8 patients. No negligence, we look very good after our patients, at least in my department at that time. Imagine, we were doing smthg from nothing and we had some drugs in a store for very VIP or very ill patients. That was 8-9 years back. Now its much better and the hospitals have almost everything, though is not a state-of-art, but is in good condition and working :roll

Regards

goxy · Jun 30, 2007

I live in Serbia (8.5 million), in its capital Belgrade (2 million). And I worked 9 months after my internship in SICU of Institute for Digestive System Diseasies. It has 14 beds. And about 4 RNs come to 3-4 patients.

We also don't have CNAs or LPNs. RNs do all the work. And to become a general nurse you must have 8-years of Primary School, and later 4-years of Secondary Medical School. After Med. School, you go to 6-months internship, after which you go to State Nursing Exam that has 2 parts - one regarding laws in your country (mostly work and health legislation), and second exam about medicine and nursing. And when you pass it you get license to work. There is also High Medical School (3-years University Degree). If you have this Uni Degree in nursing, you have advantage to get a job. And you work the same things as Secondary Medical School nurse (the only difference is that you have about 30 euros bigger salary as Uni Degree nurse). And second difference comes about 10-20 years later, when Charge Nurse is selected. And when you can become Charge Nurse. But, mostly males (with Uni Degree) are preferred for Charge Nurses. Only when there isn't any RN with Uni Degree, than some Secondary Medical School RN may become Charge Nurse.

But it is interesting how in Serbian army nurse corps you have RNs and medics. I was trained army medical RN (8 months). In the army difference is that RNs are mostly trained from civillian nurses and medical doctors, while army medics may be even the one who weren't trained as nurses or doctors in civil life (for example one construction worker may be trained as army medic). And in practice difference is only in that, RNs mostly work in so called "Polish hospitals" behind the front line while medics are in the first line, and the biggest emphasizes in their education are bandages and analgetic medicaments. And, RNs do the same as civillian RNs and they are supervisors and in charge of army medics.

Regarding shifts. Very few hospitals outside Belgrade has 8-hours shifts. Majority of hospitals inside and outside Belgrade work in 12-hours shifts. And in all positions you work two days 12-hours shifts (24-hours total) and then you have two days of rest. Difference is only in intensive care units where you have 3 days of rest.

There is no big difference between male and female nurses in Serbia. Both genders do all the jobs. Females in fact dominate and I think that employers also like that. But they also like to employ and some male nurse, because they consider you stronger and big help for female nurses. And also in Urgent Medical Help - female nurses aren't allowed to work (but a few work but just for example in cardiovascular teams), because all Charge Nurses complained how they had a lot of problems with them, how they couldn't work in so stressful situations and how they weren't able to look to such a big mess of accidents in the streets...

In hospitals the only difference comes when you need to place urinary catheter. In theory both genders may place these catheters. And sometimes it is like that in the practice in some hospitals. But in majority cases, female place urinary catheters to females, and males to males (that was in the place I worked).

And when it comes to hygiene. Also, both genders take care of the hygiene for female and male genders. ONLY, when some female speaks how she wishes just female nurses to do it, then her wishes our fulfilled and only female nurses do it. And mostly, some younger shy girls request it. But, that is just in 15-20% of cases.

Also, there are some (mostly older) male patients (who are probably shy) here in Serbia, who prefer that male nurse takes care of them - their hygiene (and that happens in 10-15% of cases) and then their wishes are fulfilled.

There is advantage in Orthopedy for male nurses, especially when it comes to nurse that place gypsum. It is ALWAYS some GUY.

And what are nurses opinions about male nurses? In fact, they like us. They like that female still dominate, but they also like that there is one male nurse in the shift. Some, would like even 2 male nurses in the shift. :-) But, okay... I have never heard something against male nurses here in Serbia in general. Although, there are some female nurses who say how male nurses aren't that good in taking care of hygiene of the patients. But, some female nurses hold us better in all other medical interventions.

IMHO, there is no difference in the practice. I have seen female nurses who don't panic in reanimations. I have also seen male nurses who are quite good in taking care of patients hygiene. And I think that saying that some gender is better in nursing is just a prejudice.

In my hospital ICU it could be fulfiled only in 2 teams. We had 24 nurses (organised in 4 nurses teams), and only me and one guy were male nurses. In all other cases, they have to accept that female takes care of them.

And in operation rooms, instrument nurse (I think it is called like that?) is mainly a female as it is considered to be strictly female job. But there are also some male nurses. But very, very, very rare.

While anesthesist nurse is meant to be male nurse job, although there are still many female nurses working that.

The greatest thing in Serbia is that there is no any discrimination of women regarding salaries. Both genders in ALL fields of work (even non-medical occupations) have the same salaries. At first I thought that it is the same in all former communist countries. And then, I found out in the internet that in the former USSR also discrimination exist. In China, too. Chezcoslovakia...

So, that must be "invention" of Tito's communists. I think it is the same in all former Yugoslav countries (Slovenia, Croatia, Bosnia, Macedonia and Montenegro).

And it is very unfair and annoying to earn less money just because you are a female... :-(((

What is bad in Serbia regarding nurse salaries, is that all nurses have the same salaries regardless of position. So, mostly complained ICU nurses because they thought that they need to have much bigger salaries, because work in ICU can't be compared with some work for example in ordinary semi-intensive care unit or work in some internal medicine ward.

And also, till 2 years ago there was a (small) difference in salary between senior and junior nurses. And then, Ministry of Health revoked it, so that all nurses (regadless of work experience) started to work for the same salary. AND THAT IS VERY UNFAIR TO SENIOR NURSES...

Also, internship was paid till 2002. (even under Tito and dictatorship of Slobodan Milosevic) You could earn 65-80% of salary through internship. And it was also revoked. VERY UNFAIR... Today, all younger nurses find this internship as SLAVERY WORK...

As younger and senior nurses in Serbia have the same salaries. The only way for you as a senior nurse to have bigger salary is to become Chief of the shift. Chief of the shift is mostly selected from senior nurses (a nurse that has the biggest work experience) but that is not always in the practice. Sometimes, Chief of the shift is some younger nurse, but NOT some nurse beginner without much experience. And Chief of the shift has about 20 euros more in salary, and 2 free days more per year.

Charge nurse works only from Monday to Friday in early hours from 7-14 o'clock. After 14h Chief of the shift has the same authority as Charge Nurse.

Charge Nurse also has Deputy of Charge Nurse that also works only from Monday to Friday in early hours from 7-14 o'clock. In fact charge nurses really don't do anything at all. Just some papirology, and arrangements for patients to X-rays. All of their work do Deputy of Charge Nurse for them. And also, this Deputy of Charge Nurse was in my case the best nurse in the whole Clinical Center of Serbia (she won that prize :) ) And she is very nice woman. She likes to help other nurses, especially to train and help new nurses, and nursing students.

In Serbia nurses mostly work for 300-350 euros in state sector. And in private sector. In ambulances some work even for 200 euros, and majority work for the same money as in state sector - 300-350 euros. And there are some places where you can earn more 400-500 euros, but you can expect more work here than in state sector (in private sector bigger is ratio of patients to one nurse) And in private sector you need to have obligatory car drivers' license as you have a lot of travel / visiting work.

And this SICU is quite good in last 3-4 years. Before it was poorly equiped and all the things you did manually. Just manual measurement of blood pressure took you 1 hour to measure it on all patients. Today, it has monitors for all patients, infusion pumps, mechanical drop counters, and perfusors. But, we still don't use computers, and big papirology is really annoying. I hope that will change soon in the future.

But, I can't tell you what are other differences as I don't know what is your scope of practice. I also don't know the EU and the US nursing scope of practice. But I would like to know that. I only read something on this allnurses forums about the US nursing scope of practice, and it seems similar as in Serbia to me. And I don't know all the details. For example, why do they also wear sthetoscopes? In Serbia, you just take sthetoscopes ONLY when you go to manually measure blood pressure.

In fact, I would like that some the EU or the US RN contact me that we may see differences between our scope of practice and training. :-)

suzanne4, RN · Jul 1, 2007

thank you for posting about your country, and a big welcome to allnurses.com...............

hope that you will continue to post with us.:balloons:

safta24 · Jan 10, 2008

Goxy

What good insight into your nursing in Serbia. Thank you .

Hope someone does latch on to your invitationt to continue to compare

practives.

Safta24

crosstanya · Jan 29, 2008

I am a RN from South Africa. We have two programs to become a Registered nurse. Both are 4 year programs and include Midwifery.

The first is at a nursing college and you receive a Diploma in nursing science and midwifery. (This is the one I did.) The second option is a university program and you receive a Degree in nursing science and midwifery.

If you go to college, you are in a class with just nurses and the cost is a lot lower. If you go to University you might have other kinds of students in your class and it is more expensive.

College students have blocks of class and blocks of practical. We will work for 4 weeks and have class for 6-8 weeks and so on. When we do work, we work similar hours to what a RN is working. For example working 12 hours shifts in the medical ward for 4 weeks. 40 hour work week.

The university students are different. They follow the class schedule of the university and because their classes are not just for nurses they might have class in the morning and go to work from 1300 to 1900 and then 12 hours the next day and not work again till the next week. Just depends on the hours they need and the time they have available to work around their class schedule. Like I said, I took the other route so I am writing this as far as I remember it to be.

In the end we do about the same amount of practical hours. As far as I remember we both start of with the same salary (which is not good in my country). I believe that if you wanted to go further in nursing e.g. administration or education, you have to do your degree.

As far as working, Critical Care Nurses do things similar to the US. We take blood and starts IV fluid. It is difficult to really compare. Some things are the same and some are different. It even depends on where you are working. Again, I can’t really talk about flour nursing that much because I have been working in the ER since graduation. The only thing that does stand out is like Suzanne said. We are not primarily responsible for assessment and listening to heart sounds like they do in the states. That doesn’t mean we don’t asses the patients.

scrabblern, RN · Mar 12, 2009

Hi Goxy,

I was so glad that you took the time to write about nursing in Serbia. I grew up in Belgrade and left for US when I was 18, back in 95. I became an RN here. I had no idea really what nursing responsibilities were in Serbia.

I have spent some time researching the educational system in Serbia and it seems while RNs in Serbia have plenty of medical knowledge, their educational level doesn't quite match the knowledge.

Let me explain: In Serbia, a student's fate is decided right after primary school. After the first 8 years of education, the kids take tests in Serbian and Math, which is very similar to ACT and SAT in America. However, different high schools in Serbia accept different percentiles so one may not go where they want to go because their score is not good enough. Also after primary school, the student must decide if they are going to a technical school or nursing school!!

So, when a 14 year old enters the "Medical School" it's really a Nursing school. They attend classes in sciences, have labs, do clinicals, etcetera for four years! After that they may choose to attend more school ("Higher Medical School") for another three. STILL - even after all this education and practice they don't have a college degree, and from what I understand their scope of practice is far narrower than in the US nurse.

The highest educational level I saw in Serbia was called "Visoka Medicinska..." something close to "High Nursing School" which is actually equivalent to vo-tech education here.

I've recently read about Polish nurses who tried to get jobs in EU countries and their qualifications were not accepted, despite years of training and experience. !

Goxy, I hope you still read this website, I would love to compare the nursing professions in Serbia and USA.

Pozdrav

Jelena