(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.