This is the first of a 2-part article and is a follow up to the CAN (Chinese American Nurses) Sisters I published on our blog on August 23, 2011. Click Here to Read the first article in this series.
The article is the collaborative work of a team of Chinese American Nurses (CAN) sisters. It speaks as “foreign” nurses who have worked in America for a number of years. Our group is very lucky to have CAN meetings twice a month. We have each other’s support. We share our setbacks and clarify our things that might confuse us. Together we provide opportunities to think things through; to have a better understanding of ourselves, to not let fear paralyze us; and to add strengths to face tomorrow with positive thoughts and energy. Go CAN!! Go!!!
Last month, a CAN nurse started to talk about the major differences that we are experiencing in the nursing functions and practices between China and the United States. Everyone joined in the discussion.
Assess and Reassess Our Patients
In USA:
Nurses are expected to know as much as possible about our patients. Nurses have a major responsibility in the assessment and re-assessment of our patients. Most nurses are doing a great job in assessing patients. Nurses are at patients’ bedside 24x7. Physicians are not. We may notice a change first, and take action as the law allows. We can initiate many nursing protocols, especially in an emergency, and then we report the changes to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.
In China:
The nurse-to-doctor ratio is nearly 1:1 in China. Doctors are just like nurses, at patients’ bedside 24x7. When new patients arrive, doctors perform the first assessments.
Report Abnormal Findings:
In USA:
Nurses report abnormal findings from our own assessments or from the results we receive from other departments or facilities. Most of our current practice is to report the results to nurses first. Nurses are expected and required to report abnormal findings to physicians. We can take actions that are legally allowed. Many nursing protocols are there for us to utilize, especially in an emergency, and then we turn around and report the results to physicians. Physicians come to assess, verify, confirm the changes, and take additional actions.
In China:
Doctors on the units get reports first. Nurses may not be aware of the results and reports. Therefore, nurses may not be aware of changes or actions needed.
Emergency Responsibilities:
In USA:
Nurses or anyone who witnesses the need can call a code. A nurse is usually the initial emergency responder, until an organized team comes. Teams, including physicians, take over the emergency situation. Organized teams, such as the Rapid Response Team, Code Blue Team, and Trauma Team, have additional training in things like Advanced Critical Life Support and Pediatric Advanced Life Support.
In China:
Doctors are at the patient’s bedside or nearby to respond and initiate emergency actions.
Administering Medications:
In USA:
Nurses are responsible to ensure medications which are taken by mouth (P.O. medications) are swallowed every time, with no exceptions. In the Medication Reconciliation process in some facilities, nurses verify medications on an on-going basis. Verbal and telephone orders are seen often in some facilities.
In China:
In past practice, P.O. medications might be left at the patient’s bedside or with their families, trusting that the patients would take their medications. This is not the right thing to do. It is very dangerous. What if a patient purposely hides his/her medications, and then overdoses on them? China’s nursing practice is changing; now nurses are watching patients take their medication more often. Doctors are there to verify medications in the Medication Reconciliation process. No verbal orders.
HIPAA Regulations:
In USA:
A patient’s health information is very private, personal property. It totally belongs to the patient. If we don’t have a patient’s written consent, or regulatory permissions, then we cannot give personal information to anyone except the patient. Self-imposed “kindness” such as initiating family or community support for a patient without the patient’s permission is no long allowed. For example, let’s say we go to work at the hospital and see our neighbor who is very sick. Our sick neighbor needs help, especially with child care. We cannot tell another neighbor who we think would be happy to help with the sick neighbor’s child. We have to plan ahead, talk about our intent, and ask the sick neighbor’s permission before we talk to the helpful neighbor. We would be violating the sick neighbor’s confidentiality if we talk to another neighbor without the sick neighbor’s permission.
In China:
Helpfulness and kindness are always welcome as long as it is a sincere act.
Sterile Technique
Performing and maintaining a sterile technique is a big deal in infection control to the nursing practice of both countries. Maintaining sterile technique saves lives, time and money.
In USA:
In some cases, CAN nurses had the perception that a few of their nurse co-workers’ practices were a bit sloppy. When you notice the lack of sterile technique, you must speak up. Express concern about contamination. This is a time to educate our co-workers in a kind way. Often the nurses who are doing the job may not be aware that contamination has occurred. Mentally, we know that it is difficult for us to point out any possible contaminations or any wrong doing. Culturally we were taught to pretend that we did not see; let others do whatever they want to do; we do what we are supposed to do to keep ourselves clean. “Mind our own business,” is what we learned. But in today’s world we need to prepare a simple and easy phrase or sentence that will help us to gently point out possible contamination. It will save lives. We have a lot to learn about how to be assertive and to be an advocate for our patients.
In China:
The fear of contamination and the strict self-monitoring of sterile techniques are emphasized more. CAN sisters feel that because of our past strict training, sterile technique is branded into our minds.
PIV Insertions:
In USA:
Many facilities prefer to have IV Teams for Peripheral IV insertions to save nursing time, promote patient satisfaction, and decrease line infections. Therefore, nurses’ experiences in starting PIVs are very different. Some nurses do not have to start an IV at all and they have no skill in PIV insertion. For some nurses who start PIVs occasionally, their skill is hit-and-miss. Very few nurses are good at PIV insertion.
In China:
CAN nurses discovered in the support group meeting that most of nurses are good at PIV insertions. We found out that CAN nurses are the “go-to person” for performing PIV insertions. Personally, I have never paid much attention to this as a big difference. It was delightful to find out that this is one of our common strengths.
Salaries & Bonuses:
In USA:
We make good salaries as nurses, even after about 40% is withheld in taxes, income taxes, and sale taxes. On the other hand, if we compare our salaries to physicians’ salaries, we find out a real gap. Physician pay is much higher. Of course, there are good reasons. Physician education and training are much longer and more in depth, and more physically and emotional demanding than nurses’ education. The demand for physicians is greater than the supply of physicians. We have many physician assistants and nurse practitioners who work under physicians and support some of our physician functions and responsibilities.
In China:
Nurses and physicians both have two types of incomes – regular salary and bonus. The nurses’ salaries are much closer to physicians’ salaries in China. Chinese doctors and nurses are equally compensated by the government. It is a perfect system for equal professionals. The differences in their earnings come from their bonuses, which are regulated and paid by the hospital. Currently, no nurse practitioners are working in a hospital or clinic in China.
Nurse to Physician Ratio:
In USA:
The variety of job choices for nurses is huge, including acute hospital care, clinics, nursing homes, home health, insurance, occupational health, schools, law firms, etc. The nursing functions and responsibilities are varied, and it is very different in different health-care and non-health care settings. The physician to nurse ratio ranges from 1:4 to 1:8 or more, depending on the type of facility and the time of day or night. Some nurses function independently.
In China:
Most of nurses are working in hospitals and clinics, the nurse to physician ratio is nearly 1:1. It is a perfect ratio for an equal professionalism. No nurses are function independently.
For us “foreign” nurses, especially those of us who have studied nursing or grown-up abroad, we often find that nursing functions and practices are very similar in some ways and quite different in other ways. This becomes apparent particularly on initial entry into the nursing profession in the USA. Adaptation will ease most barriers. The sooner we can identify the differences, analyze them, and find ways to adjust, the sooner we will adapt to the United States’ way of practice. As we open our hearts and minds to learn new things, we can expand our horizons. Every challenge forces us to learn and to bring out undiscovered talents within us, thereby making us stronger. There is no failure in trying to do the best we can do; the only failure is not trying to change and adapt to a different way of doing things. There are times we have to be brave enough, to have enough self confidence, and to excel on own strengths. We want to keep very strong, solid nursing skills, such as peripheral IV insertion skills. We want to keep the valuable nursing concepts, such as sterile techniques with us. Our skills will be lost if we do not practice constantly. In all, we are excited that we have opportunities to brand ourselves as the best we can be in United States.
Contributors:
Mai Tseng -- RN, BSN,MPA,EMBA, NE-BC,CRNI, LNC
Karen Cox -- RN, PHD, FAAN,
Laurie Ellison -- EMBA
Xu Hong Fang -- RN
Hong Guo -- RN
Sufan Sun -- RN
Please watch for the second half to this article to be published later in December.
