What are Aussie hospital patients like?

[bukko]

I'm a registered nurse working on moving from the United States to Australia. (Filed my nursing licence appo with NSW in December and got a job offer this week from a hospital Canberra after a telephone interview.) I'm chuffed (is that slang term dated?) about the idea of going Down Under, and have learned a lot from the various threads in the ANZAC area.

What I want to know is, what are hospital patients like in Australia? By way of explanation, let me describe the typical patient I deal with in America. (I've worked at a dozen urban and rural hospitals in our states of Florida and California, so I've got a good base of experience.)

It's uncommon to have patients under the age of 65 (the age at which government-paid medical care kicks in.) Most of the people I take care of are in their 70s, 80s and older. Most are incontinent, demented, frequently combative and at risk of falling. The latter sentence is not meant to be pejorative -- the patients are what they are, and it is our duty to take care of them. Do hospital patients tend to be younger in Oz?

Do people in Australia follow the advice of doctors and nurses? Because of its revolutionary past, America has a cultural attitude of rebellion, especially since the 1960s. Very often that translates into deliberate disregard of the sensible health instructions medical staff give. Patients refuse to take meds, families violate fluid and food restrictions for CHFers and diabetics, people are contemptuous of health workers... Do you have a nicer lot there?

I currently live in San Francisco, an ethnic melting pot of a city, so more than a third of my patients on any night will speak a Chinese dialect, Russian or some other non-English language. In Florida, it was Spanish and Haitian Creole. I know Australia has a high proportion of immigrants, but are most of them from Anglophone origins?

In American hospitals, almost every patient is on intravenous fluids, antibiotics or other medications delivered via veins. I stink at starting IVs (unless it's a younger person with good arms.) I've read that cannulisation is primarily the responsibility of physicians in Australia. Is that true?

Lastly, and sorry if this seems creepy, but do Australian hospital patients get better? In America, it seems that the bulk of what hospital nurses do is extending existence, not curing people. Our typical admission is someone who's very old and seriously ill. We get them through the crisis, send them to their house or nursing home, and then get them in a month or three with a worsening of their ailment. I have many patients who I've seen on multiple hospital visits, to the point where I don't even have to look at their medical history to fill out the admitting paperwork -- I know it by heart. The stays get longer, and the outside intervals are shorter, until the person dies under our roof. I call it the "circling the drain syndrome." I don't begrudge these people the care -- again, it is our responsibility to tend to them. Their unfortunate condition is why I have a paycheque, after all. But often I feel like the U.S. medical system is only in the business of enabling superannuated people to take a few more breaths, at great expemnse to society, while the needs of younger, more cure-able people, are shunted aside. Is that how it is in Australia?

Sorry for the long post. No matter what the answers are, I'm still moving, and glad to do it. But I'd like to get a better idea of the medical zeitgeist under the Southern Cross.

[Grace Oz]

In a nutshell ..... it really all depends on where you work. Patients vary from one setting to another. Whether it be in a public hospital, a private hospital, aged care facility, mental health facility etc etc. Also depends on whether or not you work full-time, part-time, or casual.

In my own experience of recent times, most times, I was able to see the patient from admission through to discharge. I was permanent staff in that situation. Having said that though, it's also my experience to have admitted someone, perhaps nursed them for the early part of their admission, but not been there for the remainder of their stay or discharge. And vice versa. Sorry can't offer any more insights for you.

Cheers.....

Grace

[Tookie]

Bukko

it sounds as though you will be working in the acute section of care. I am in the aged care sector. I would like to think that we in this sector - well at least in the rural area where l am that we maintain people well and caringly for their final years of life.

From my recent visits to the acute sector. - Both my own and l recently stayed with my mother - (Night and day) whilst she was recovering from surgery (She also has a dementing disease as well as a numer of other problesm - so her recovery haas required a little more assistance from family than usual.)

Anyway ny experince was in the public sector - paid for by our mediacre system - I find that there are a number of aged people - but this is geneerally because they have an acute illness. Yes there are few who are wiating for a bed in aged care. Some small bush hospitals do have permanent aged people. I found that the staff who cared for me were very professional and knowledgable. - There is an expectation of a high standard of care.

The private hospital that my mother was at - (In Melbourne) whilst some of the care was excellent the 2 things that stood out to me was primarily the acue nurses have very little ability to care for confused people who require specific care whent ehy are confused and there was a large number of agency staff. - Some were excellent others were not.

The person you may care for in Canberra will vary - depnding upon where it is - I dont know Canberra Hospitals. The demographic of Canberra would have perdominately have a anglo saxon background orginally - however we have had a long histroy of multiculturilsm - So we do have a changing 'face' in our country. Canberra being our capital has a lot of government people and it is our place for diplomats as well.

Canberra in Spring is beautiful - the Floriade (Spring festival of flowers) is magnificant - A lot of people would not say it ia a 'happening place' Hoewever I think it has a lot of promise and should be a great place to base yourself in to be able to travel well.

You will be able to travel top both Melbourne and Sydney which are our 2 biggest cities.

Compliance - Most people will cooperate - some will question extensively some just go along.

I think that you will find people are people - we have great fresh foos anf lots of different cuisines - thanks to the immigrants and their multiculturalism

I am sure that you will find many diferet things. My very first job l had in London was at St Thomas's and l certainly came out after my first day with culture shock. But you will go with the flow. Welcome. I also apoligise about the spelling - cant find the spell check :rotfl:

Cheers

Tookie

[talaxandra]

First, congrats on your plan - Australia rocks, and I'm only marginally prejudiced! Oh, and 'chuffed' is fine :)

I agree with Grace - a lot of it depends where you're working, both sector (private or public), location (large city or rural/remote), hospital size and acuity, and specialty.

Generally speaking, large public hospitals have patients who are older, sicker and more complex than those in the private sector.

I can only speak from my own experience, of course. I work in a tertiary-level public hospital in Melbourne, one of the larger capital cities, or a mixed medical specialty ward. The average age of my patients is late sixties, which is higher than the hospital average, but we currently have patients aged 17, 22, and 98.

Because my ward's units include stroke service we have a fair number of patients at risk of falling, with dementia etc. Because our catchment area is highly multi-cultural, we also have a number of patients who speak little or no English. neither of these issues cause us significant, on-going problems, though there is naturally the odd drama here and there. Fortunately there are also good strategies in place to help minimise these issues. For example, we have a security protocol that minimises aggressive and combative behaviours, whether from patients or families.

Other units on my ward include renal medicine and neurology, so we have a lot of patients we get to know over a period of months or years who die. Combined with the stroke patients, this means that there aren't a majority of patients who get better, but I'm proud of our nursing care of the dying, and we do have wins on a regular basis.

I've worked at the same hospital for over 15 years, including my training. I've noticed, particularly in the last five or so years, an increase in acuity. Many patients have IV's and other invasive treatments. Policies vary from hospital to hospital, but where I work it's only in Cas that it's routine for nurses to cannulate. The hospital periodically runs nursing cannulation courses, but I think it's just yet another duty doctors are happy to pass on and nurses are eager to pick up, but which takes me away from providing patient care. There's certainly no expectation from doctors that we'll do it, and phlebotomy is still considered to be a medical task, though we'll take a stab if we have time and the patient's veins aren't too crappy.

I hope this helps a bit. Come on down!

[bukko]

Thank you for the primer on what to expect. I suppose that patients are patients no matter where in the world they are. There are only so many ways for the human body to malfunction, and that's going to happen more to old people than young ones. I was thinking that maybe Australian hospitals were filled with younger people injured in pub punch-ups, road train drivers who flew through the windscreen after plowing into mobs of kangaroos crossing the highways, victims of taipans, cassowaries and the other deadly wildlife that prowls your continent...; )

Interesting the distinction between public and private hospitals. Publics get the harder cases, eh? A similar distinction exists in America. Corporate and religious hospitals such as the one where I work tend to get medically ill patients. But in big cities, there's usually a government-owned hospital where the gunshot victims and other socially troubled types are sent. Oddly enough for a violent society such as my own, I've only taken care of one person who was recently shot, my very first patient as a nursing student in 1992, a middle-aged fellow who got popped in the abdomen during a bar fight. My countrymen are not skilled in the art of fisticuffs, so we resort to technology to resolve our disputes.

[jax]

I work in a large public hospital in an orthopaedic unit, so we have the elderly #NOFs and the young trauma patients. A bit of everything. Some of the patients follow instructions, use their brains and do their best to aid themselves in their recovery, and some are absolute dingbats....I suspect its the same the world over.

[Grace Oz]

I was thinking that maybe Australian hospitals were filled with younger people injured in pub punch-ups, road train drivers who flew through the windscreen after plowing into mobs of kangaroos crossing the highways, victims of taipans, cassowaries and the other deadly wildlife that prowls your continent...; )

Bukko......

With respect, I think perhaps a visit here to our wonderful, MODERN country, might be in order BEFORE you decide to come here to live!

Regards,

Grace

[bukko]

Bukko......

With respect, I think perhaps a visit here to our wonderful, MODERN country, might be in order BEFORE you decide to come here to live!

Regards,

Grace

No offence meant -- that was a joke (hence the winking emoticon.) I thought Australians were perversely proud of their dangerous wildlife like redbacks, cone shells and box jellies, not to mention better-known sorts such as your 10-metre-long crocs. I realize that no one has been killed by a cassowary since the early 1970s. I certainly have no room to talk about the natural dangers in a country, having lost a chunk of my left leg to gangrene resulting from a strike by one of our Florida rattlesnakes in 1972. That should give me some cred when I encounter some of your "Dundee" types from the NT, I hope.

And as for visiting, I booked one of those Quantas air pass deals last night for Sydney, the Gold Coast (my wife has a friend in Byron Bay), Adelaide and Melbourne. Skipping Canberra. Everyone tells me it's a nice place, but they wouldn't want to live there... Cheers!

[Grace Oz]

Bukko.... I've PM'd you.

Cheers,

Grace

[pmchap]

Hi Burko, congrats on the decision to move down under. I lived in Canada & the States for 10 years when I was younger and can tell you that living in a place that has less than a 40 degree change in temperature between summer and winter is wonderful. As for patients - every hospital in the world is trying to push patients out the doors faster and faster - hence the 45 year old with a AMI is sent home in 2-3 days because he is young and can recver quicker where the 75yr old with the same AMI will be taking up a bed for 7-10 days (because of potential other peoblems and the fact that the elderly are slower at recovering). I know it is put simply but I arthroscopes are done as day only procedures until you are above 65 then it becomes a stay over and keep an eye. Hence the average patient age is increasing - because you only see the really acute youngones.

I am an educator in Aged Care and Rehabilitation so I naturally only ever see patients over 65.... but I have worked in Acute medical, small rural hospitals, large tertiary hospitals, both public and private. A word about privates - if you need acute care - go public... if you just want to relax with a chronic or nonacute illness then private is great (hence patient age in privates is high - unless your in a maternity unit).

Well now that I've rambled on - my heading refering to humour was just to let you know that sometimes us Australians don't quite pick up on the fact that you yanks are taking the mickey. (we actually think that you don't know about Australia) So please forgive us when we presume that what you say is literal - (and if you can read between the lines you will see that I am saying that may Australians are quite gullable when it comes to what others say about Australia). A bit like Us Australians presuming that you have to deal with driveby shootings everyday....

Cheers & welcome

Peter

[Grace Oz]

you will see that I am saying that may Australians are quite gullable when it comes to what others say about Australia).

Peter old son,

Speak for yourself. Please don't assume of others. One of the golden rules in nursing.... Be OBJECTIVE, NOT subjective! As an educator, I'd have thought you would've known that.

Without prejudice...

Cheers...

Grace

[pmchap]

Peter old son,

Speak for yourself. Please don't assume of others. One of the golden rules in nursing.... Be OBJECTIVE, NOT subjective! As an educator, I'd have thought you would've known that.

Without prejudice...

Cheers...

Grace

:chuckle hi Grace - lovely to see that someone was willing to bite. Let's not forget that this whole thing starts when people categorise people based on one thing or another - and if you fit a category then, my dear, unfortunately some assuming and presuming is done.... :chuckle