Back on the Chain Gang

New job started 3 weeks ago. I had one looooong 5-day week of orientation to start it all off. And boy, was I glad to get onto "the floor" and back to 12h shifts where you don't miss out on the rest of your life all day, every day. I don't know how everyone else does the 9-5. But then, most people don't have a slightly anxious 3 year old waiting for them at home....

It's a big change, nursing in America. I guess there's a whole separate blog there, waiting to be written but I'm not sure if I can be bothered (as they're fond of saying in England) to do it. With all the changes to US health care waiting in the wings, and so much anxiety about it among members of the public, it is definitely a hot topic. In my first week of proper nursing (and I'm being preceptored, so am not carrying patients on my own yet) I've been quizzed about socialized medicine by patients, their families, and other nurses. Most are genuinely curious. Others are very critical. Here are some of my early observations of the differences between nursing in the UK and Texas:

• The social side of things feels wonderfully familiar: a sassy ward clerk who basically runs the whole unit;   the immediate bond with everyone else you encounter in uniform; the contempt for doctors who write illegible orders. Here, the television running all day in the break room is showing Oprah instead of Tricia, and the eccentric surgeon wears cowboy boots instead of a bow tie, but it feels the same. Weirdly, just like London, the pharmacy is run by incredibly elegant, aristocratic Indian women.
•  The unit is slightly better equipped than either of my London hospitals. So far, there are enough IV pumps, towels and, amazingly, nursing staff to go around. It is also extremely clean.
• Patient/nurse ratios are lower. RNs consider themselves very hard done by if they have to run 6 patients. Our minimum at Kingston was 8, and occasionally up to 12.
• The hospital offers room service for meals. This is new. Patients phone in orders from a menu, and their selections are limited if they are confined to a diabetic or "cardiac" diet. Food is served anytime between 7am and 7pm. Patients love it; nurses are not so sure. It does make pre-meal blood sugars a little hard to get if you're not watching...
• On the technical side, blood transfusions are always run concurrently with saline, and all IVs are on a pump, with no free hanging drips. Most medications are referred to by their brand name, which I find very annoying as I've had to relearn them (eg., Lasix = furosemide; Flagyl = metronidazole; Coumadin = warfarin). I'm trying not to see it as sinister brainwashing by the drug companies, but it rankles. Nurses can administer all controlled drugs, including morphine, with only one signature, but do have to double sign for insulin, which doesn't make much sense.
• The Patient Care Techs (or health care assistants as they are in the UK) are much better trained and I suspect, much better paid here in Texas. They work very independently and are permitted, with informal training, to do far more complicated tasks, including urinary catheterization. They are well respected too.

These are just a few of my observations from the first week or so. The main points are that I like the job very much. I have very clued-in, competent managers who are regularly on the floor, and the cafeteria makes excellent breakfast tacos. All good.