Nurses, HCL International, Candidate,
Georgia Platman is one of two third year nursing degree students from King's College London on a semester-long exchange programme with the University of Pennsylvania, made possible by a scholarship from HCL International. Here, she sahes her experiences of nursing in the USA.
Differences, part 1
I have now been in the States for two and a half months and working in a highly esteemed Philadelphia hospital for almost two, but only now am I starting to compile my thoughts on the differences between the two systems in some coherent way. Assimilation takes a long time especially since student nurses here are only in the hospital two days a week, interspersed with university days, rather than a solid block of placement as we have in the UK where you are either in university or working full time in a hospital for a month or two. I hope to write a few blog entries for HCL International while I'm here to share some of these thoughts (whether they end up being coherent or not) with nurses around the world. My post today explores some of the differences between nursing in the USA and the UK.
I will write as a disclaimer to my blog that while I want to give some generalisations and specifics about nursing in the US, I have relatively little experience here. I am based on a women's health floor (incorporating gynaecology, oncology and obstetrics) at one of the best and most challenging hospitals in the country in terms of innovation and also acuity of patients and rare conditions seen, and I'm sure the nurses who are attracted to working in that kind of tertiary care setting are different to those who chose to work in the community, as they would be in the UK.
Nursing in the USA is definitely different from UK nursing, but it's a subtle difference; nurses here often ask me what distinguishes the two and I struggle to find an easy answer. The first thing that I usually say, perhaps just because it is a visible difference, is that nurses in the UK do not generally use stethoscopes. This has been met with a range of responses from nurses in the US, from 'well what do they use?' to 'but how do they listen to the patient's heart and lungs?' to 'what, do you mean stethoscopes don't exist in England?' I then explain that, yes, stethoscopes exist in my country, but that they are not usually the tool of the nurse, rather the doctor - after all, they are the ones doing the diagnostics. Here, even if a nurse hears something abnormal, they cannot actually do anything with that information other than share it with the doctor. On the other hand, arguably it does give the nurse the power to do a more holistic assessment of the patient, and I think this is why nurses here are incredulous that British nurses do not have that extra knowledge. The time with the stethoscope also gives the nurse authority to spend longer at the bedside, permitting them to perform a full assessment at the beginning of each shift, or when a patient's condition changes.
Another difference is that the nurses in my hospital here seem more antonomous than their UK counterparts. This is, in part due to the way the wards are set up - most people have individual rooms, or at most two to a room - the nurses do not physically see each others' patients so they keep to their own. There is also no double checking of controlled drugs (or narcotics, as they're called here) or IV medications, so there's less interaction with the other nurses. The Certified Nursing Assistants, or CNAs (like our Health Care Assistants) also do their jobs autonomously: changing bedding, doing observations or even washing patients is rare for nurses in my hospital. This can be good - clearly defined roles help both the nurses and CNAs do their jobs more efficiently. However, the sense of teamwork often apparent on wards I have worked on in Britain can be lacking as each goes about their own tasks.
There are a million more observations I could make about the two systems, but there isn't time and I have to study - as always at an Ivy League institution! Until my next entry, I will leave you with a taste of why assimilation can be so hard when you move countries as a nurse - even to an English-speaking one:
UK/US nursing terminology 101:
Obs = Vitals
BM = bowel movement, not blood sugar (I know a British nurse who, when asked by a doctor for the first time when a patient's last BM was, answered 'this morning, it was 120'. Confusion and embarrassment ensued!)
mobilise = ambulate
venflon/cannula = IV (e.g. 'I need to start an IV on a patient' instead of 'I need to cannulate a patient')
urinary catheter = foley
uriate = void
TWOC = DTV/TOV (due to void/trial of void)
med = drug
controlled drug = narcotic
the patient's notes = the chart
to do the paperwork = to chart something
HCA = CNA(certified nursing assistant)
Posted: Wednesday, 18 November 2009
