But you have been taught the theory behind it right?

2014-03-13 11.13.02

(Wall mount within the Stavanger Acute Medicine Foundation for Education and Research aka SAFER)

One of the main things I wanted to look at when I came to Norway was the difference/similarities between the clinical education content/delivery to that of my own Univeristy. Since I started my nurse training I have been very interested in the comparison of skills needed for practice in the real word, and those taught within the program of study. I personally feel that they do not correspond to each other, and there is work and progress to be made in bringing undergraduate nurse education more into the 21st century.

While many may argue that nursing is an art not a science, I would beg to differ that it is in fact very much both these things. As once described and explained to me by a lecture that I very much admire at my University; with all the good graces of a nurse being kind, caring and compassionate (which I am not dismissing in the slightest they are essential in the profession), those things alone are not going to be able to settle a patient who is attached to a cardiac monitor which starts alarming and gets upset, alarmed or anxious without the nurse being able to interpret the monitor and explain why it may be doing what it is with the sound background of anatomy and physiology in that area. Or in pediatric nursing, how would a nurse explain to parents or the child themselves why they were receiving a certain medication or procedure. It is not always the doctors that are asked the questions and the nurses are often the most available source of information for patients/parents and next of kin. A nurse cannot always keep referring the questions to the doctors. Though of course nurses need to explain and work within the ream of our profession and sphere of competence, they cannot start offering out tip bits of information without the necessary qualifications. Our duty of care extends to ourselves having sufficient enough and up to date knowledge to care for our patients in the safest and most excellent manner.

In Norway one of the things I noticed first is that nursing students here are expected to learn and carry out cannulation in their second year. In the UK this is something most qualified nurses cannot do as it requires you to take an extra training package while you are working. This includes the need of supervision, which given the current climate mostly only doctors and phlebotomists can provide. The time they have to spare in not in great quantities. When I spent some time in the accident and emergency department here in Stavanger, the nursing and medical body were equally surprised that not only are we (as nursing students in the UK) not taught cannulation, we are not even taught the theory in our training either. One of the doctors was very quick to jump in and ask when we then did our cannulation training and I explained that it was not even mandatory on qualification. The puzzled and confused expression in their face more or less said it all. Here in Norway the majority of doctors do not cannulate (they have the option to learn but it is not mandatory), it is seen a nursing role. I have seen the benefit of nurses being able to undertake this skill on the wards as well, as when we are administrating antibiotics for example, and the cannula is not working, or has been removed. There is no time delay or hesitation in it being replaced and the antibiotics going through as the nursing staff can immediately put one back in. Treatments are not delayed, and from my experience in the UK, if a cannula is not working, it is often very difficult to find someone to replace it quickly. This means antibiotics and other medications are delayed and this may have an impact on the effectiveness of the prescribed treatment. I am by no means qualified to state that allowing and teaching nurses within their undergraduate training to cannulate would make the treatment for patients more effective and successful, but you can see the logic and the argument in the implementation. Nursing students here are also able to carry out male cathatrisation, another skill that nurses in the UK can only carry out on qualification with a specific training package.

Simulation training is used a lot more in undergraduate nurse training here than that of the UK. In the first month that I was in Norway I visited Stavanger Acute Medicine Foundation for Education and Research (SAFER) which provides simulation training to nursing students along with all emergency service personnel including the off shore workers on the oil rigs. There is nothing really of this size in the UK though Bristol is home to the Bristol Medical Simulation Center (BMSC), which offers a similar service. In Nottingham, simulation training is not used prominently in undergraduate nurse education, however there is talk that it may be introduced.

In my visit I joined a simulation lesson with other Norwegian nursing students and we carried out a basic refresher of CPR and the use of defibrillators. Afterwards we were split into two groups and put into a simulation room with one of the facilitators controlling the sound/movements/clinical condition of an electronic dummy that was laid out in a mock ward environment. We were fortunate enough that the educators and the majority of the other nursing students had good enough English to be able to attempt the simulation in English! There is a lot of research and studies being published at the moment which look at the use of simulation training and its benefits/suitability to nurse training. So far, much of the research would suggest that simulation in nurse education is beneficial in terms of increasing confidence, transitioning between theory and practice and clinical skills competence. Tough there are still questions which lie around simulations suitability to improving actual patient care. Its use however is on the increase and a number of reasons could be sited for things including a decreasing availability of placement areas and an increase in student numbers, the variations in competence in communication, administration of medicines and decision making among nursing students as found by the Nursing and Midwifery Council (NMC). Finally the increasing challenges nursing educators face in developing and  preparing students for the real world of nursing practice the variety of placement/clinical training opportunities available (which can impact on students exposure to certain environments and situations like acute and deteriorating patients), are other reasons that simulation training may become more prominent in future training.

It has been announced recently that there is going to be a review into undergraduate nurse education in the UK. Health Education England along with the NMC are to launch the `State of Caring Review´ in May this year lead by Lord Willis. It comes after the Francis Report highlighted concerns with nurse education and training. It will be interesting to see if the final report which is to be released early 2015, will consider or report on the clinical skills education and delivery along with any mention of need for increased simulation training.

 

 

 

 

 

 

 

 

Beyond registration

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(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


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(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.

4 weeks and counting

It is safe to say that anyone that knows me knows that I am not the most forth coming with writing (assignments bring me to a whole new level of procrastination). So please as a note, do not expect this to be beautifully written. I am far to dyslexic for that.

What this blog will hopefully do is bring into one place my time in Norway on the Erasmus program. For those of you reading this and thinking the what? The Erasmus in its most basic form is an exchange program for higher education students within Europe. 33 countries to be exact. My chosen destination is Norway which, as a quick geography pointer is nicely in Northern Europe on the western and northern part of the Scandinavian peninsula. That put in a more straight forward form; cold.

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I will be based at the University of Stavanger, a university in the south west home to around 9200 students. Which has most recently become the first and only Norwegian university to become a member of the European Consortium of Innovative Universities (ECIU). The current member base is 11 countries with the University of Strathclyde in Scotland the only UK representation.

My placements will be at the Stavanger University Hospital. It serves a population of around 300 000 being the local hospital for the municipality of Hjelmeland in the north to the municipality of Sokndal in the south, and it is the central hospital of Rogaland county.

The acute assessment ward (6 weeks) and the Accident and Emergency department (2 weeks) will be my specific areas for placement. Those of you any good at maths will realise that is only 8 weeks. I am away for 12. Fjords here I come.

That is the bare bones and basics for you. My flights are booked. I have umpteen numbers of thermals and counting and the lonely planet guide to Norway has just arrived on my doorstep. 4 weeks and counting.