Nursing in New Zealand. Part 1.

Hi all!

I just went and made myself a large "cuppa", New Zealand speak for a cup of coffee or tea. Context: "Hey Deb, I'm running to the cafe, can I get you a cuppa?" At my work, this is usually followed up with a 5 minute conversation about how crappy the provided coffee is (their words, not mine), and "thank God there is a cafe with real coffee across the street". (A later post will be dedicated to Kiwis' version of "real coffee".) Anyways... I've got my cuppa (tea), and am ready to tackle the topic: Nursing in New Zealand. This will be a lengthy post, so I suggest you too go get yourself a cuppa.

"What is nursing in New Zealand like?" has to be the most common question I get, second to "Do the toilets really flush the other way around?" The latter has yet to be determined, as I need someone to confirm the direction of flush in the Northern Hemisphere first. Anyways...

I don't feel properly equipped to blog about nursing in New Zealand. First of all, I've only been here for 4 weeks (tomorrow), and at my job for 3 weeks. Secondly, I don't work in the hospital so I don't have side-by-side comparisons for my 3rd floor buddies.

So I've decided to give you a run down of what my work and typical workday are like, and hopefully within this, an idea of nursing in New Zealand. First, a picture.

From Scott's recent road ride to Diamond Harbour

I have an agreement with Pegasus 24 Hour Surgery to work .8 FTE. This translates 8 days per fortnight, or 4 8-hour days per week. Pretty sweet. In New Zealand, "24 Hour Surgery" does not correlate to a surgery center like in the United States. The name, misleading to expats, is commonly understood here: 24 Hour Surgery means 24 Hour Clinic. In nurse speak, it's basically a prompt care or urgent care center.

A bit more about Pegasus: the organization is actually owned, kind of like a co-op, by over 320 General Practitioners in the Canterbury area. (Canterbury is the county, if you will, that Christchurch is a part of.) So these 320 GPs use Pegasus as a sort of extension of their offices. When patients come in with infections, DVTs, fractures, etc. they can be sent to Pegasus for outpatient treatment that is much quicker and easier than going to hospital. (No, I did not forget the "the" before hospital. It's a British kind of thing I think, but they refer to the hospital as if it were a pronoun. Just, Hospital.)

A person does not have to be a patient of one of these GPs to use our services, they can also walk in off the street, be tourists, etc. These people will encounter a $50 charge (if its not a night/weekend/holiday- then its a few hundred) for our services. This $50 (or so) will cover all plastering of fractures, suturing of lacerations, visits by doctors, etc. Hello socialized medicine, call me a communist but I see your advantages. Moving on.

So Pegasus has a triage "ER" type facility and a fracture clinic downstairs, and upstairs they have an observation unit and the Community Care nursing team. I interviewed and was hired to be in triage, however, upon learning about my Public Health nursing degree and 6 months of experience as a student in the community, I was told that I would be "temporarily" placed in Community Care, as they are extremely short staffed.

More of Scott's road ride, I can't wait to retire from nursing and buy a farm.

Being that a) I can't exactly say "no" to the only employer I have in New Zealand and b) I had no idea how healthcare in New Zealand really operated, I took the opportunity in Community Care [Com Care] as a positive thing. Sure, I envisioned myself suturing up gnarly mountain bike lacerations on fellow adventurers, but how relaxing is it to kick back and shoot the breeze with one patient at a time!? No patient transfers, rare acute pain control, rare emergency situations. I recognize that I am at risk of losing my skills (outside of drug calculations and IV starts, which I do constantly), but for the moment, I am having a very relaxing introduction to nursing in New Zealand. It's quite refreshing, actually.

So here's my day: I arrive at work at either 7:30am or 3:00pm. There are no noc shifts in Com Care, just AMs or PMs, 8 hours either way. I get a list of my patients for the day, usually 4-6 names. We have handover (report). The patients either come into the clinic, or we go out to the home. We can go anywhere in Christchurch [Chch], as well as several surrounding communities. Up to about 50 minutes driving time one-way sometimes. This can make an 8 hour day go quickly, if you like beautiful scenery, ocean views, sheep, and inner-city post earthquake traffic. I'm in the honeymoon phase still, so I like it all. Anyhow...

The most common tasks of Com Care include:

IV antibiotic transfusions (90% Cephazolin, pronounced kef-zol-in in a charming accent)

SQ Clexane (Kiwi speak for Lovenox)

Lab draws 

ECGs

Wound dressing changes

Catheterizations

Patient Assessments (done at home only. After a patient has been discharged from hospital, the GP likes to follow up immediately. If it's a weekend or holiday, or the GP is on holiday, they contact Com Care to see the patient and make sure they are safe and happy at home. The patients are usually respiratory in nature.)

A photo from watching races at the Christchurch velodrome. Are you non-nurses bored yet?

So after I see patients in the clinic or at home, I write "notes" related to their care. We follow the SOAP (subjective, objective, action, plan) algorithm for your nurses out there. My notes range from 0.25-1.0 pages typed. That's it. That's all my charting. Wrap your brains around that.

There's a bit of written charting we keep in their file (calling it a chart would be laughable, it's 10-15 pages max) including vital signs, contact info, referral forms and usually a modest H&P. My responsibilities, besides typing my notes, also includes phoning GPs, hospital, clinics, etc. to arrange for my patient's appointments to ensure they have good continuing care. It's really quite a lovely service to be a part of. The nurses are (mostly) happy. The patients are happy. I have yet to be spoken to in an even slightly degrading manner by a patient. Or a doctor!

So as you Enloe readers can imagine, my job is so different from 3rd floor that it's barely comparable. I will be cross-training in triage at the end of summer (March), so perhaps that will lend itself to some more side-by-side analysis. Regardless, I'll try to summarize a few things that I find interesting about nursing in NZ. (But another picture beforehand, to keep everyone else awake...)

Public Seating in downtown Chch. A punting boat on the Avon river. A glimpse of earthquake rebuild behind the tree. 

Physicians

- Doctors are referred to by their first names, just like nurses. Can you imagine this in the states?

- Everyone shares the same staff room, from nurses' aides to doctors. And they all mingle.

- Docs frequently liaise with the nurse about how to improve the patient's care.

- At least at Pegasus, docs wear scrubs just like everyone else's. No fancy lab coats. No designer jeans.

Working Conditions

- Coffee, tea, milk, biscuits (cookies), crackers, and fruit are provided at all times for staff. Full meals are provided if you work weekends (sandwich/panini ingredients or frozen meals, usually.)

- If you must work a public holiday (NZ has 11 public holidays annually compared to 10 in the States), you receive 1.5x hourly pay and a "day in lieu" of PTO. This means you get a whole 8 hours of PTO to take whenever you want if you had to work a public holiday. Queens Birthday in June? Sign me up! This actually applies to all professions in New Zealand, but most places just close on public holidays.

- If you are sick, you may use your sick time. Why would you use your PTO???

- Weekend pay is time and a half. At hospital, it's double time. Weekends and holiday time (vacations) are precious to kiwis. A major catch phrase of the whole country is "the work-life balance".

General Nursing Comparisons

- Starting IVs (cannulation, if you astute readers remember) is a big deal here. You must take post-graduate classes and do continuing education to be certified to start IVs. Doctors frequently start IVs. (3rd floor: can you imagine it? Call CHG instead of VAD!)

- DVTs and asymptomatic PEs are managed in the community. Have a clot all the way from your ankle to your groin? No problem, we'll give you SC Clexane at home daily, and you'll be on warfarin. You'll come to clinic every 1-2 days for repeat INRs, and we'd prefer you don't go back to work. Bed rest shmedrest. Just take it easy please. 

- We send patients home with their peripheral IVs every single day. PICC lines are very rare. So is the incidence of patients using their peripheral line for IV drug abuse.

- I wear a funny uniform with a striped fitted button up blouse and black pants instead of scrubs. Apparently it's "more professional". New Zealand as a country is really into uniforms (bankers, cell phone retailers, cafe waitresses, etc. all wear matching uniforms, usually with blouses, skirts/slacks, and stripes involved.) I'll wear scrubs when I'm downstairs.

- Nurses in New Zealand are far more worldly. My colleagues have worked in hospitals and clinics in Saudi, Africa, Pakistan, Afghanistan, Australia, India, Germany, Finland, and the UK. It's inspiring, although to them I think my "big adventure" is pretty tame.

Healthcare in New Zealand

- People can pay or have additional insurance policies that pay for care in a private hospital. This hospital stay will include a better nurse:patient ratio, and (seriously) gourmet food services. As previously mentioned, a stay in the public hospital is free.

- New Zealand covers the cost of accidents for everyone. If you American readers come visit me (hint, hint) and break your leg parasailing or forget which side of the road to drive on and crash your rental, your visit to the hospital, treatment, medications, and follow up care are free. Completely.

I think that sums it up for now. If you've not fallen asleep, congratulations! In the time it's taken me to compose this, the weather has gone from calm and cloudy, to windy and stormy, to sprinkling rain, now to sunny and windy. This, I understand, is what Christchurch is known for. I'm going to get out and enjoy the sun while it lasts. 

A last photo, one of great importance:

Look what I got! Look what I got! Thank you, mom!!!