Beyond registration


(A view of pulpit rock, one of the main tourist attractions just outside of Stavanger. The views were incredible, 604m up tends to allow for that)

While the main focus of this blog has been undergraduate nurse education, I have found it interesting to look at the opportunities available to registered nurses here in Norway as well.

Often when choosing a career you consider what progression is available and what sort of opportunities and options are open to you within that career. One of the reasons I wanted to go in to nursing was the sheer amount of opportunity and learning continuum that the profession provided. I was not going to be constricted to one working environment (consider community, hospital, prison, military among others) and the clinical/leadership and management options provided you with the ability to mold your carer and aspirations with new experiences and interests. This variety also allows for a wide variety of personalities and characters within the profession itself, while still maintaining the underlying principles of care and compassion to create a dynamic and passionate workforce. So would this be the same here?

In Norway the band system of 5/6/7 and beyond does not exist as we have in the UK. In fact there isn’t a noticeable structure at all. There are ward managers and below them are assistant ward managers but nothing noticeable. The ward I work on at present has three assistant ward managers who take on similar duties and responsibilities that our own band 6 nurses back in the UK would hold. With this status comes an increase in pay and a absence of night shifts. It is a simple application process when a post becomes available. Everyone wears exactly the same uniform from newly qualified to ward manager. Even the non clinical staff will wear the same white scrubs. The doctors to distinguish themselves slightly will wear a white lab coat over their white scrubs. The does somewhat eliminate the hierarchical structure that is often, or has at least in history, dominated nursing within the UK. Personally though I like the alternative uniforms as it allows for staff, patients and visitors to distinguish from each other and it does give you a certain pride with identification.

I have already mentioned in a previous post that nurses here are trained generally and do not specialise in pediatrics/mental health/learning disability until 2 years after they qualify. After that they are able to take on a MSc in one of these specialties or in something like health and safety or management. These are full time courses run by the University of Stavanger, the fees are paid for but you lose income as you are unable to work so this may not be the most viable option for nurses, especially those with families.

There is another option however. After 2 years of practice experience nurses here are able to start undertaking a clinical specialist qualification. This is a part time qualification which is done in a nurses own time. It is run by the hospital and comes in three levels. A nurses pay will increase in small amounts with each level. This qualification was introduced to aid in nurse retention, allow for nurses to further their knowledge and skills which overall would help to provide a higher quality of nurse. There is no portfolio/or re validation requirement of nurses here. A few whom I have spoken to feel that this would be a good idea and wished it would be introduced to encourage skills to be kept up to date. The levels for the clinical specialist qualification are transferable within the hospital and to the community, but to move hospitals and still keep the same pay level and status is more at the discretion of the new ward manager and the human resources equivalent. Details  of each level are below:

Level 1 –  Available after 2 years of clinical experience. 1000 hours of reading around the topic of general advanced clinical nursing practice, computer based tests to assess knowledge on areas like nutrition, infection control and health and safety.

Level 2 – Available after 4 years of clinical experience. 1000 hours of reading more specific to your own specialty of advanced nursing practice e.g. cardiology, trauma and orthopedics, neurology. More computer based tests. Level 1+2 are evaluated by the hospital.

Level 3 – Available after 5-6 years clinical experience. The reading hours are increased and there are additional study groups put on by the University (this level is evaluated by the University as well as the hospital). Nurses are also required to write a paper on an area of their choice within their specialty. The salary for level 3 is the same as a specialist nurse, so one that has undertaken one of the 2 year full time MSc. There are not many of these Level 3 nurses as only a couple of applications each semester are allowed.

The title ‘clinical specialist’ is a general one rather than specific as we have in the UK such as a diabetes or tissue viability specialist nurse. All levels are moderated and marked. Level 2+3 also have mentoring requirement. This can be for peers or students.

With reference to mentoring, all nurses here mentor students. You can do a 2 day course held at the University but this is not compulsory and you can mentor a student without it. There is no yearly update as we have in the UK, certainly in Nottingham. Each student will have two mentors, one primary who will sign off any documentation, and the other if the primary mentor is unavailable for a shift. Students are assessed at a pass/fail and they have two attempts to pass. Students need to write evidence of what they have learned and reflected upon including a care plan about one patient. It is a lecturer and mentor who go through the paper work.

There are not any specific preceptorships available either for newly qualified nurses that I have found here, were as the UK is seeing a growing increase in the number of specific preceptiorships offered including rotational programs. So far I have established that newly qualified nurses could expect a few weeks of orientation and supernumerary status. This may change in different hospitals however.

To draw this post to a close, there was an attempt at introducing something similar to an advanced nurse practitioner (ANP) in A+E , but from talking to nurses who work there, this seems to have trickled out. One of the main reasons seemed to be that people just simply were not going for it. So far my research has not highlighted any areas of nurse consultants, though you will see alcohol consultants which can be a nurse or a social worker who has taken an additional course to train in that area. Not though to the level that we are beginning to see in the UK.

With all of this in mind, I do look at the two structures of the profession and working environment and wonder if I would have been as happy working here as I would in the UK. They certainly have their differences although the principles surrounding nursing are exactly the same. Though I am not initially sure  a grand total of 3 months allows me to make a well informed decision but first impressions would suggest that nurses in the UK have a certain degree of freedom and growth that suits me a great deal which is not translated quite as well here.






A nurse educational structure breakdown & and In other news I miss the price of bananas in the UK


(I Found these outside a toy shop, couldn’t help but find them entertaining)

Despite the expense, slight location isolation (still missing my four wheels) and that people just don’t seem to smile around here (going for  run, you nod acknowledge say good morning, etc…nothing, blank stare through..) this place is beautiful and I have never experienced cars stopping so far in advance for you to cross the road. We are talking you just have to be near a crossing or even look at it and they will stop. That never happens in the UK.

The week just gone did allow me to have a meeting with our academic link here at the University of Stavanger (UiS) and I was able to gain some enlightenment on the structure and general situation for nursing here in Stavanger.

Student nurses here at UiS (which I have discovered is a common thing in Norway generally) train as general nurses. They do not specialise unless they take on a masters. There are no specific adult, child, mental health or learning disability nurses training at an undergraduate level.

Their placement and theory time like ours is split 50/50 and they have placements in throughout their three years. They have one placement in there first year in which all students go to a nursing home. Students do not enter a hospital environment until there second year, where, continuing into there third year, they undertake placements in medical, surgical, community and mental health settings. Unlike our system they do not have anything that resembles a management placement. The end of their third year consists of them carrying out their thesis (dissertation) and then going on a six week elective. This I found a very interesting deviation, as up until this point we share many similarities in the structure of our training to Norway. This has brought me to think thus far, that, in this instance, student nurses in the UK are prepared and exposed to a far greater amount of leadership and management training and experience than our Norwegien counterparts. What will be very interesting to see is if this has any reflection in practice. I also hope to find out when I have a greater exposure in practice, to understand why that is.

I mentioned that we are similar in our training structure. This is the case, however one other element which does deviate slightly is that their theory and practice assessments are given the same weight as each other. In the UK, and in Nottingham I can only directly relate this, our placement grading makes up a far smaller proportion of our final grade. This also only came in in the year I started my training (2012), as until then, your performance in practice held no direct influence over your final grading. Personally, I prefer this over the current system we have. I feel that your ability and performance in practice should count for a far greater amount in your degree than it currently does. To give an example, each semester at UiS you get 20 ETC (European Transfer Credits though it goes up to 30 in the third year), and a practice block is weighted at 10 ECTs the same as a theory block.

The students here at UiS have a similar work load when it comes to assessment, however, what is most obvious from the offset is that exams are used more frequently. I tend to feel that we have death by written assignment, and that a more balanced way of assessing students would not go amiss.

Nurse education here in Norway is potentially undergoing a radical change. At present there is a national curriculum set, a bit like the NMC sets in the UK, which every institution has to follow. There is a greater North and South divide in Norway, with Northern areas and districts (those outside of a main city) not having the full range of services on offer. With Norway being a much larger and longer country than the UK, things here are very spread out and the current thinking is that the curriculum is to strict, and instead, to hand over control of the curriculum to individual universities and colleges. There would still be a minimum standard set, but it would be far more flexible. I can see the benefits of doing this, however, I can see that this might produce a much greater variance in the experiences and abilities of nurses on qualifying. How do you govern and ensure that patient care is going to be of a high standard from nurses no matter where they have trained, if the educational standards and training are not on an equal footing?

I could go into a list of the clinical skills students get taught/are expected to be able to perform, but I am currently still wading through the pack which details them. Trying to decipher the differences and understand the system may be something I get a greater understanding off in practice. Plus I would really like to get mentors and qualified nurses opinions here about where they think about the the diversity, amount and importance of those clinical skills taught. 

I will leave you with a nice little statistic which has become one of the most obvious things I have noticed since I have been here. People generally are of of a slim disposition. Despite the rates for men and women regarding being overweight or obese on the rise, they currently only sit at about 21% for women and 33% for men (Statistics Norway, 2013). Compare this to the UK where 57% of women and 67% of men are overweight or obese (Public Health England, 2o14). Now that is quite a contrast. To be honest, you can rarely go out anywhere without seeing people out walking/running/or pavement skiing (no I am not joking, think wheels on the bottom of skis and then just push yourself along). It will be interesting to see the rates of diabetes and cardiovascular conditions here compared to that of the UK. I really cannot wait to start in practice. I have a feeling there are going to be some massive contrasts (I have already been tipped off about the lack of paper work compared to the UK, this excites me). 

What I know so far, one week to go

This time next week I will have landed in Norway and the adventure begins! I will endeavor to update this more frequently while I am away however these last few weeks have been so hectic with planning, prep and generally living that this has fallen by the wayside a little.

So what do I know so far…. well other than the fact that I am going to need to budget to within inches of my life (Norway is one of the most expensive countries in the world….thought that one through didn’t I) and their nurses wear white (WHITE, of all the ridiculous colours for 1. a ginger to wear, bit washing out of the complexion, and 2. nursing…in white…really?) I have recently found something interesting out abut the ED department in Stavanger…..

They don’t have (or rarely have) walk ins. These are dealt with in the community. Now this is a definite contrast from the UK. Any one who has watched 24 hours in A+E or been in an A+E themselves will be only to used to the sight of people pitching up waiting to be seen. Without walk ins this leaves the A+E in Stavanger for pretty much full use of RTAs, cardiac arrests etc etc you get the idea… (what the title actually says its for……) All emergency admissions arrive at the A+E department having previously been seen by a GP and/or brought into hospital via ambulance, similar to A&E Resuscitation Area. The department has 28000 major emergencies annually (road traffic collisions, medical and surgical emergencies) and 17000 Minor Injuries.

I cannot wait to see how they run this. It is going to be a really interesting contrast to that of a UK A+E. I would also really like to gauge an understanding of how they structure their community based treatment that we would normally have as walk ins.

To add to my visit, today I found out I will be able to visit the SAFER – Stavanger Acute Medicine Foundation for Education and Research while I am out there. The main goal of this place is to enhance clinical competence and therefore improve patient safety. This is primarily done through simulations. I really hope I am allowed to take part….. as I have found frequently ‘what I hear I forget, what I see I remember, what I do I understand’ I believe that is some adaptation from a Chinese proverb…. I think.

This post should also be titled what I don’t know….Despite being allocated accommodation I have not the foggiest where I am actually staying. For some reason the international office at the University of Stavanger cannot tell us until the day we arrive. This in itself is not so much of a problem, I quite like surprises, but, when the price range of options goes from £300-£450 per month, and Norway being the expensive place it is, it makes budgeting plans and finance planning a little tricky. Not a fan.

The only real challenge I face now is packing. Never been good at travelling light. With a 23kg allowance I may need to start getting good at it pretty pronto.