New Country, New Rules

Any nurse who has worked in various hospitals knows how greatly things can vary from one facility to the next. The first weeks of any new position are always a period of adjustment - a time to learn new protocols, paperwork, and policies. (Trying to find supplies is always fun, too.) So, of course I expected things to be different when I came here. Not only was I starting at a new hospital, I was essentially starting over. I was entering an entirely new healthcare system. But, as much as I anticipated differences, I expected there to be more similarities. After all, isn’t nursing is supposed to be universal?

To be fair, the basics are the same: general principles of patient care, the five rights of medication administration, etc… all of that stuff is universal. But I’m learning the actual nursing roles in here Australia vary greatly from what I was accustomed to in the United States. Nursing in the U.S. allowed me to be more autonomous. Here, I often feel like a nursing student again.

We double-check every IV, IM, or subcutaneous medication with another R.N. before administration, even saline flushes. All oral pain medications must be double-checked, too. (Oh – and there is no such thing as administering morphine IV. Apparently, that’s too dangerous. It must be given subcutaneous instead.) This double-checking may not seem like a big deal, but it can really slow you down, making your day much more difficult.

We’re not allowed to phlebotomize or start IVs, unless we’ve completed a special training course. (No matter I’ve been doing both since nursing school.) We are required to go through our charge nurse or another clinical nurse before paging a resident. We don’t even conduct head-to-toe assessments; we are neuro-specific nurses, so we focus on neurological exams. The physicians are responsible for the head-to-toe, as well as reviewing the labs. (Not knowing a patient’s electrolyte levels leaves me feeling quite panicky!)

After having much more responsibility and leeway in previous positions, I’m feeling slightly stifled. I’m afraid of losing my skills. I also worry I’m going to overstep my boundaries at any moment and do something outside my scope of practice. It’s a lot to learn. It’s difficult for me to let go of the level of control that I’m accustomed to possessing. Eventually, I will get the hang of it, though. I will get used to all of the rules and regulations that my American sensibilities deem silly. And when I return to the U.S., I will be able to tell my fellow nurses, “You will never believe how they do things in Australia…”