An Incomplete (and somewhat incoherent) Guide to: Healthcare in New Zealand

When we first got to New Zealand, I kept getting sick. Just little colds and other afflictions, but back to back viruses can really get to you. I don't know if it's actually a fact or not, but I've decided I was sick a lot because I didn't have the antibodies to fight any of the germs on this side of the world. It makes sense that you develop antibodies over time and can eventually resist circulating strains of illness in your community. But being on the other, bottom left corner side of the world, I apparently have the immune system of a newborn.

So I should have a few immunities 16 months later, right?  Well, it seems I'm collecting ALL the antibodies. Like a game of Monopoly, I'm collecting them all. I've got full sets of antibodies and I'm looking into how to put a hotel on them and charge rent. For the record, Scott's got none. He never gets sick. He's losing at Viral Monopoly.

(Read between the lines- I'm sick again.)

Anyways, that's my segue into another discussion (er, monologue) about healthcare in New Zealand. As I've mentioned before, according to my page views and stats, all you mystery readers really care about is a) How to move to New Zealand and b) Nursing/Healthcare in New Zealand. (Oddly, it's not baby ducks.) So lets talk again about the latter. And if you haven't caught up on Nursing in New Zealand Part 1 and Part 2, go do that. Otherwise don't pass go, and don't even think about collecting $200.

The Role of the GP in NZ Healthcare

Wow. I don't really know where to start and I obviously don't know everything about this topic. But here's what I do know. As a nurse and solid member of middle class America, I did not have a GP. If I had a medical problem I either saw a specialist (dermatologist, gynecologist) or I went to Prompt Care. I don't think this is the ideal method of healthcare for young Americans, but I know its what everyone my age did. I don't think a generally healthy 20-something female with no major medical issues could even get a GP. In fact, if I remember right, a lot of GPs were leaving the practice because of the rising rates of malpractice insurance, increased MediCare denial, etc.

So, uh, here's a contrast… nearly every person has a GP here. (Ok, Scott technically doesn't have one, but see above- he's collected no viruses, illnesses, or other medical problems.) I've got one and I've seen her several times, although each time she kind of pretends she doesn't remember me even though we also work together…

Anyways. Just about everyone has a GP. Also, you can usually get a same or next day appointment with your GP or another doctor at the practice. There is a charge for each visit to your GP, which you can avoid by going to Emergency and waiting 2-6 hours. (Hello downside of socialized medicine.) They will see you for free, and then bark at you for not going to your GP for a measly sore throat. (And then they will talk about you being a time waster behind your back, I promise.) The charge for seeing a GP is lower for enrolled patients. The government kicks in some money each time the GP sees an enrolled patient- promotion of continuity of care. Non-residents like us, and tourists, can't enroll. But we can still see the GP for a slightly higher cost.

An interesting thing about GPs here (to me anyways) is that everybody and their mother seems to be one. I know several in my personal life (as opposed to a grand total of zero back home). Also, they're not exactly up on any proverbial doctor pedestal. Not to say they aren't respected- they are- but as both a nurse and as a client I find GPs extremely easy to talk to. I've never felt rushed or ignored. I haven't really met any that consider themselves God's Gift to whatever.

Older Person's Health

At 65 years old, a person can be assessed by Older Person's Health (this organization may have a different name outside of Canterbury). This assessment comes via a recommendation by the GP. Once this assessment has been done, the GP can organize (at no cost):

- Rest Home level care
- Respite Care for a few days or weeks (both for patients who feel like they need extra help, but also just for family members who need a loved one looked after because they need a break!!)
- Rehabilitation
- Palliative Care (Hospice)
- Psychiatric evaluation and care
- Walkers, commodes, shower/wall handles, ramps, wheelchairs, etc.
- "Never Alone" alarms (like the commercial, I've fallen and I can't get up!…) to summon an ambulance. I think there is a yearly fee for this, but many people qualify for this to be waived.
- Meals on Wheels
- In-home help for just about everything:

• Medication management: Forgetful elderly people living alone need not be forced into care because they can't remember when/what meds to take. Someone can come in 1-3 times every day and administer medications.
• House cleaning 1-2 hours per week.
• Grocery shopping, pharmacy trips, etc, 1-2 hours per week.
• Dressing, showering, teeth cleaning, etc. (ADLs)
• Wound care, dressing changes, etc.

There is even a free 8 week cooking course called Senior Chef for people over 65 who want to improve their cooking skills and confidence in the kitchen. They are taught easy and healthy recipes and cooking techniques for 1-2 people. 

The elderly population is a bit more of my specialty, both here and in personal interest, however let's not minimize what socialized healthcare can do for other populations:

What else does your tax payer dollar get you in regards to healthcare? (as in… what's free?)

Maternity:

• All costs of required tests (ultrasounds, glucose tests, etc.)
• A midwife who organizes all appointments, meets with you several times, and is available for questions 24/7.
• All emergency visits and treatments while pregnant (visits to ED or the 24 Hour Surgery for things like PV bleeding, hyperemesis, lack of fetal movement, etc.)
• Giving birth, unless you book in a fancy shmancy private hospital.
• Follow up appointments including those for any complications.

Children:

• After the birth of your child, you will visit or be visited multiple times by a Plunket nurse. They are available by phone for advice 24/7. They make sure you are getting on with things like development, breastfeeding, sleeping, early childhood nutrition, etc. They have endless resources. They have FREE parenting classes, play groups, and can find you things like car seats at very little cost. 
• All visits to the GP, ED, 24 Hour Surgery, etc. are FREE to all children (NZ or other) under 6 years of age 24/7/365.

ACC (Accident Compensation Corporation):

The ACC is funded by "people’s earnings, businesses’ payrolls, petrol and fees from vehicle licensing, as well as Government funding". The ACC covers the cost to any person, NZ or tourist, who is injured and requires medical care in New Zealand. If you seek care in a private institution, the ACC will pay for a percentage of your care. If you are treated at the public hospital, or if they are too full to take you and you are instructed to go to a private institution, your full hospital bill is covered.

Broke your leg in 4 places while snowboarding for the first time? And actually it happened while you were walking to the bathroom and you weren't even snowboarding? And actually, come to think of it, you were walking backwards, showing off, because you were drunk, and you fell down the stairs and it was definitely your own fault?

No worries, ACC's got your back. (Although they'd probably prefer you sober up and take some pride in yourself, mate.)

The cost of follow ups with your GP, prescriptions, etc. are at a reduced cost, with ACC subsidizing a percentage of these bills.

The Cost of Prescription Medications:

• The cost of all subsidized prescription medication is $5. The catch: the medication you need must be subsidized by the government. Some medications are partially subsidized, and some not at all. One of my colleagues recently told me about their patient who was visiting from Europe. They had forgotten a medication at home which was pretty vital. This particular med is not subsidized in New Zealand, and was going to cost the patient $140/month. This was in no way because they were a tourist. They were angry.
• All subsidized medications for children under 6 are free.
• Over the counter (OTC) medications such as aspirin, Claritin, etc. are a lot more expensive than in the States. Ibuprofen 60 tablets is going to cost you about $20. But, if you go see your GP, they can write you a script for OTC medications. Viola! $5.

Made it this far? I commend you! Here's a photo of a recent sunrise…

BTW: No portion of this incoherent "guide" is actually a guide to you or anyone else.
Remember what they say about free advice: you get what you pay for!
And, I'm human. So there's probably some mistakes in here. Feel free to correct me.

Other Bits and Pieces that I find interesting:

• Gum, lozenges, and patches for smoking cessation can be attained for only $5. A pack of cigarettes costs $17.20. And the percentage of smokers is going down - currently at 15%, down from 21% in 2006. I feel like people in NZ understand that they are expected to take responsibility for themselves, and many of them do.
• The prevalence of Type II Diabetes is 11.0% of the population, right on par with America (10.9%). NZ is ranked 3rd in the world for adult obesity (behind the recently dethroned America at #2, and Mexico #1).
• Despite having a socialized system, NZ spends much less on healthcare per person than the US.
• Because of the ACC, there is no litigation surrounding accidents (your trampoline broke my back, now pay me $200,000; that fender-bender gave me whiplash, now I have PTSD and am suing you for $2 million in "pain and suffering"). Because there is no litigation, my car insurance costs $26/month. 

I feel like this may have gotten a bit ramble-y. Let's blame it on my non-subsidized intake of Benadryl and generic cough medicine. I think it's time for me to return to killing brain cells with Netflix. Now don't you wish I just posted about bikes and ducks? 

Halloween, and other news...

So thankfully Halloween isn't really a favorite holiday of mine, because it doesn't really exist in New Zealand. There's no pumpkins (it's springtime), no costumes, and definitely no ridiculously over-spiderwebbed porches. Actually, they don't have that fake spiderweb stuff here at all. One of the doctors I work with just returned from a conference in California, and was so amused by Halloween-mania that he bought himself some fake spiderwebs, a few severed fingers, and a big 'ol bag of mixed candy. And it was all only $22!!, he said. Ahhh…. New Zealand.

Halloween here looks like sunshine (but rain this afternoon apparently) and life as normal. Oh, and one minor little milestone I accomplished this morning…

Our applications for our 5-year work visas are submitted.

I just re-read my post from almost exactly this time last year (50 weeks ago, to be exact) when I submitted the paperwork for our one year work visas. The feeling is the same now as it was then: thank god that's done, it's out of my control now, and I deserve a drink!

The process of applying for our visas was complicated this time by the good 'ol USA and it's ridiculous shut down. My fingerprints should have been cleared by the FBI back in late September, and all of this should have been submitted with plenty of time to spare in the early days of October. Instead, my FBI clearance came in the mail yesterday (3 months after being initially submitted, pretty pathetic) and all of this got submitted today. Halloween.

In regards to the 5 year work visa- we are applying for a work visa and the NZ Immigration office will decide on the duration. This amount of time will be at least 2, and up to 5 years. Although we don't foresee living here through 2018, we are hoping for the maximum 5 year visa. Because really, we have no idea what we are doing.

We have 6 weeks until our one year visas expire, so in regards to the delayed submission, it should all be fine. But leaving it down to the wire like this is not my style, and I'm very unimpressed- can you tell?- by the reasons for the delay.

Once again we had to submit:

Four different meticulously filled out application forms (28 pages total)
Official job offers (we're both staying at our current positions)
Proof of prior experience in job field including hours worked
Proof of registration in job field
Letters of recommendation from current and past employers
FBI clearance
Proof of our relationship including:
  Letters from friends and family verifying the validity of our marriage (thank you again mom, dad, Ashley and Jade for printing and signing several copies!)
  Photos from throughout our relationship
  Proof of joint bank accounts
  Proof of owning property together
  Marriage Certificate

And this time around we each had to submit in addition:

Medical Certificates (at a cost of $600) including:
  Full physical
  Full set of blood work and urine samples
  Chest X-rays

Ahhhhh…. so when it's all done, this is what you have:

And what you should also have is a cold beer on a hot spring day. But for me, I'm off to work.

Nursing in New Zealand, Part 2

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.

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!)

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.

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)!

The Work Life Balance

The following is a blog post entered in Expats Blog's monthly blog contest. Please click here to visit the site, comment on this post, share this post, and check out the other entries!


Go Google the "Work Life Balance" and see what comes up. I'm too lazy to actually do it today... but here's what I know is out there: tons and tons of New Zealand Immigration websites and New Zealand employer websites claiming that New Zealand is the land of the Work Life Balance. Promises of more holiday time, less stress, and a slower way of life are offered like forbidden fruit on low hanging branches to expats on the other side of the world.

I read about the Work Life Balance again and again while planning my move to New Zealand.  In America I worked three grueling, merciless 12-hour shifts a week in the hospital. My days off were like a prize at the end of each week, rewarding me for not quitting or dying at work. So I learned about the Work Life Balance, I began to anticipate and expect it. We didn't know where in NZ we would end up, but by the time I finished my research, I was pretty sure we were going to get paid to lay on the beach and drink Marlborough Sauvignon Blanc while getting a tan and... wait, that's the Wine Life Balance. Very different... although very important.

Christchurch, Canterbury

Anyways, after all the research, I discerned that the theory is this: studies found that employees are happier when they feel like they get a reasonable amount of time away from work, with their families, and participating in the activities that they enjoy. Fair enough, right? While many people worldwide find themselves inundated with work and overtime, tied to cellphones 24/7, and taking their stress out on their friends and families, the Kiwis practically promise that this kind of stress doesn't exist in New Zealand. Or at least not much.

A recent survey revealed that Kiwis were the happiest workers in the world, with 74% reporting having a good work life balance. For comparison, America is at 66%, and the UK at 60%. Even more fascinating however, is this: 16,000 employers worldwide were polled about the efficiency of their employees. New Zealanders topped the productivity charts at 79%! (America 77%, China 73%). So maybe there is something to this Work Life Balance...

Lake Pukaki and Mount Cook

Now I have to say, when I showed up for my first day of work in New Zealand, I was a bit disappointed when I wasn't handed a beach towel and a Kindle and told "get to work". I mean, I think my home life would be a lot less stressful if I had finished the latest Dan Brown novel by now! Ah, but seriously, here's what I learned on my first day:

Work is still work. You are still expected to show up on time and do your 8 hours of work. You are not expected (at my job) to stay and work overtime. You are expected to help others out, and they will help you. You are expected to be efficient and professional. You are expected to dress appropriately. In my case (healthcare profession) there will be shift work. Everyone has to do it, and so do you. So much for my work life balance, right? Sounds just like good old work to me!

Craigieburn Forest, Canterbury

Now it has been nearly six months. I'm comfortable at my job, and taking on new roles. I'm lucky to work in a place where everyone is friendly and supportive. Sure, it's nice to have my days off, but I don't dread getting in to the car to go to work. Actually... I do. But that's because of the traffic in earthquake-ravaged Christchurch, not because of my destination. So what is different here? What tipped the scales into the precious balance between work and life? What is actually different than in America?

* I work four 8-hour shifts. I'm at work one more day per week, but for 33% less time each day, and a total of 4 hours less per week. It really is an unbeatable work schedule. Not every NZ employer can offer this, but it is very common.

* 4 weeks annual leave is the minimum an employer can offer. Coupled with the 11 national holidays, that's 31 paid days off work per year that every employee starts out with. My employer started me off with 5 weeks straight away. Talk about enjoying the balance!

* It's okay to be a minute or two late. Mobs of sheep happen on the state highway, and there's really nothing you can do about that. Also, surprise roadworks happen in Christchurch everyday, so no judgements in this city, ever.

* Post work socialization is common and encouraged. My husband's company just bought every single employee tickets to the Crusaders rugby game and paid for their food and beer.

* Many workplaces (including mine and my husband's) have a shower for employee use to promote exercise before work or on lunch break. This also encourages cycling to work, which is quite common in New Zealand.

Abel Tasman National Park

So do I, an American expat living in New Zealand, believe in this infamous Work Life Balance? Do I relish in my perfectly proportioned time allotments for work and for life? Do I feel less stress and therefore feel more inclined to work hard at work? (Of course I was always an exemplary employee, but hypothetically speaking...)

Yeah, I do. I don't think it actually is a strictly Kiwi thing, but I think New Zealand employers are really onto something with promoting the good ol' WLB. Expats come from all over the world to join that slower paced lifestyle, enjoy the stunning scenery, and provide a better life for their families. Work is still work, but in New Zealand, work is not life.

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!!!