Recently I've really noticed the difference in the training that nurses get in America vs. New Zealand. I honestly don't know enough about the nursing schools here to even compare the inital training. But as far as "on the job" vs. "formal" training of certian procedures, there's some serious differences.
IV insertion or "cannulating"
In America, we were sent off as 4th semester nursing students to torture pregnant women admitted to the Labor and Delivery units. A woman in her 9th month of pregnancy will have 50% more blood in her body than the rest of us, so the idea was that the nursing students had big juicy veins to aim their shaking, wobbly, first-timer needles at. Since most of us only got to do this once or twice during the semester (oddly, women about to give birth don't like being practiced on), we all learned on the fly at our first jobs. Have you ever had a nurse just dig and dig and dig around, unable to find your vein? Yeah, she's probably new and practicing on you. Thank you for your participation.
In New Zealand, cannulating is a BIG DEAL. You are not taught how to cannulate in nursing school. After you've completed your nurse training and are hired somewhere, your new job will send you to a cannulation course, and only if your job requires it. I suppose to non-medical professionals this may seem prudent. But it's bizarre to meet 40 year vetran nurses who just learned how to put an IV in last week. It was even mandatory that I do the cannulation course with my 5 years of cannulation experience, because I was certified in a different country. Wild.
PICC (Peripherely Inserted Central Catheter) Lines
This is another thing that American nurses (at least where I trained) kind of learned on the fly. I mean sure, we learned all the rules and contraindications and things during our orientation, but it was fairly informal. There may have been a packet of information involved. I forget.
In New Zealand, you must attend advanced classes for PICC line certification, and this is to use and maintain a PICC, not to place one. Once again, the amount of excitement around venous access in this country seems a bit over the top, although I suppose I can get behind the PICC line education a bit more. As things stand right now, I'm not even allowed to flush 10ml NS through a PICC line, even though I've been using, maintaining, and removing them for years in America.
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| Kaikoura, NZ |
Suturing
To my knowledge, the only American nurses who can put stitches in are RNFAs and NPs. Someone correct me if Google has given me the wrong information on this. I've never known a nurse who was trained to suture.
In New Zealand, A&E (Accident and Emergency) nurses suture. No biggie. Theres a 2 hour course involved. You clean the wound, administer the anesthetic, and you put in the stitches. There are all types of stitch patterns. Who knew? You learn on pig flesh, and then if you're me, you get to "practice" on drunk guys who get punched in the face. After 10 supervised suturing sessions, I'll be on my own. Sweet as.
Casting or "Plastering"
Once again, I don't know any nurses in the States who put on casts. I'm pretty sure it is legally allowed, but most hospitals have a designated person or team who has had advanced training in this area. At my hospital, we had an orthotech who handled all of the casting, as well as most of the traction and a few other things.
In New Zealand, nurses put on plenty of casts. Orthopedic surgeons are still the ones managing compound fractures and anything that will need setting, bolting, plating, etc. But your run of the mill greenstick fracture is a nurse's job to cast. We can also order the X-ray. My cast or "plaster" traning was 3 hours long and included fingers, hands, arms, legs, ankles, and feet. It's definitely a learn-as-you-go mentality. (Don't let this put you off- a nurse will never plaster your broken arm without checking and rechecking the positioning, and likely having someone watch her the first several times as well!)
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| Marlborough Sounds, NZ |
Drug Double Checks
Every single IV medication has to be checked independently by two RNs. Antibiotics. IV fluids. Saline. I know. Pick yourself up off the floor and thank God that there's half as much documentation to do, because you'll be running after someone 24/7 for a signature. Im eternally grateful I'm not working on a busy surgical floor with this rule in place.
Where's That? What's This?
Where's the Dilaudid? The Phenergan? The Soma? Drugs that I used every single day (every hour of every day?) at work are nowhere to be found in New Zealand. Phenergan used to be around, but apparently they used it more freuquently, at my work anyways, for it's anti-histimine properties. Who knew it had those? Regardless, its been banned now because of it's extravasion tendencies.
What's entenox? Let me tell you, what they lack in the "hard stuff" pain killers, they make up with the brilliance of entenox. Laughing gas. It's used librally here for short term pain relief during suturing or painful dressing changes. While someone in the States is getting a shot of Morphine (and all of it's side effects), someone in New Zealand is happily puffing away on laughing gas, and is safe and sober to drive just a short while later. Fantastic.
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| Picton, NZ |
Lastly, and I've written about this before, I can't get over the relationship between the doctors and the nurses. Perhaps it's unique to where I'm working- but I'm told it's not. We're a team. Rarely do I feel like someone is talking down to me. They ask for nursing input and respect nursing opinion. They recognize that we're spending the time with the patient and are the eyes and ears. I just can't stress enough how this positively affects the outcome for our patients, and I wish some American docs would just get over it and step down (up?) to the nursing level. There's exceptions to the rule in both countries of course... but generally speaking here, it's a hugely noticable difference.
If you have any questions regarding nursing in NZ, leave a comment or send me an email. The Nursing Part 1 is still by far the most viewed post on my blog, so I figure there's nurses out there with inquiring minds!
Most importantly, I find that nurses in both countries follow the important life-rule that I've adopted since I began this line of work.
Work hard, play harder. Which I'll be doing this weekend on the northern east coast (see photos above)!
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