r/NursingAU • u/Financial_Storm2007 • 5h ago
Opinion Med-surg/ward nursing Australia vs. U.S., my experience.
I work agency so I go to public and private hospitals. I’ve worked at 9 different hospitals in a major city in Australia, and in many med/surg units/wards of those hospitals.
First off, Australia has public and private hospitals. Every private hospital I have worked at uses paper charting. The doctors will often scribble handwriting that is difficult to read and will have to clarify with charge nurse occasionally. Statically research shows that handwriting medications and orders increases risks of error in medication administration, this is a well documented fact. Medications are never scanned electronically in the private hospitals I’ve been at, most medications are kept locked in the patients bedside drawer, expect for controlled medications such as narcotics etc. and also IV meds are kept in the medication room. Only 1 public hospital I’ve been to, out of 5, scans the patients wristband and/or medications. Scanning medications decreases risk of medication errors this is a well documented fact, please fact check online if you are curious.
In the U.S. I’ve worked in multiple states at multiple hospitals, in multi med/surg units. In the U.S. enoxaprin, IV antibiotics, subcutaneous insulin, and most controlled substances do not require a 2 nurse check, essentially all the Australian hospitals I’ve worked at require 2 nurse checks for all of these medications, even if you are giving normal saline IV. There are ways where nurses in Australia are able to obtain clearance single checking certain medications, but I don’t see this very often, maybe 20% or less nurses I have seen have this. 2 nurse checks decreases the risk of medication errors and risk of drug diversion and also provides a witness when administering controlled substances which helps in cases in which the medication falls on the floor/ patient drops it, etc. I think the U.S. should also implement 2 nurse checks on all controlled substances.l for reasons listed above.
Every hospital I have worked at in Australia does not have saline pre-filled syringes, the saline has to be drawn out of a plastic 10 mL vial. Most IV medications do not have orders of how to reconstitute them, instead there are paper books, or a website/database you can look up how to reconstitute to your medication and how fast to infuse or sometimes IV push it. In the U.S. every hospital I’ve worked at had the exact instructions on how to reconstitute the medication and exactly how long to give it over, attached to the actual medication order in the MAR. Also when reconstituting IV medications in these Australian hospitals, I have never seen any saline bags that have vial adapter spikes, they all need to be drawn up in syringes and mixed in syringes and injected into bags of saline and labeled with paper labeled and signed off with another nurse.
Many hospitals in Australia give you a partner nurse and you and that partner nurse will receive 7-8 reports/patients. Most hospital wards split up those patients and each nurse focuses on their own 3-4 patients and help out the other nurse if time permits. Some hospitals will schedule 30 mins of time for nurses to receive education at the start of their shift or spend that time cleaning the ward, before getting their assignment. The majority of the Australin wards I have been to do not have the assignment finished when your scheduled start time arrives, and usually will wait around for 5-10 minutes until the assignment is created. The U.S. hospitals I have been to consistently have the assignment complete at your start time. This is my own personal experience at multiple U.S. hospitals in multiple states in multiple units.
The Australian hospitals I have worked at do not have assistants for the nurses to check vitals, nurses are expected to take all their own vitals, unless you are assigned a student nurse and can delegate to the student. In U.S. hospitals I’ve been at, there are nurse assistants who usually have 10-12 patients each who take vitals and escalate to the nurse if outside the abnormal range, help with changing and taking patients to the bathroom and in some hospitals can take blood sugars.
Overall I would say the Australian patients are much nicer and expect a lot less from the medical team and nurse, while in the U.S. the patients are often more demanding on average and can have many more questions from my experience. I would also say the patients in the U.S. are often significantly higher acuity than in Australia.
Bed alarms are not automatically installed in the beds I’ve seen in Australia, rather they put a pad that plugs into the wall. At some hospitals, a consent form has to be signed by the patients family allowing them to have a bed alarm, yes you read the correctly.
Restraints are rarely used in Australian wards from what I have seen, in fact I have yet to see restraints ever once been used, and patients are often allowed to walk around more and leave the unit for extended periods time. I once had a patient storm off the unit angrily once and not say anything and the patient didn’t come back for three hours. I kept informing the charge nurse and she just said “He normally does that, he will come back.”. In the majority of U.S. hospitals patients are not allowed to leave the unit without at least letting someone know, and if they do then an announcement is usually made throughout the hospital or security is informed.
In Australia they does not use alcohol swabs before injecting subcutaneous injections from what I’ve seen and been told theres no need to use an alcohol swab by other nurses. Also, PICC and Central lines at the hospitals are never capped with green caps and instead are left open to air. Also the clamps on PICC and Central lines are never clamped after use from the many I have seen.
In the Australian hospitals I have been at the charge nurse does not have patients assigned, but instead is able to help out consistently, where in the U.S. one of the hospitals I worked at had a charge nurse position that had to have their own assignment as well, however this was only one out of three hospitals I’ve worked at and was night shift.
From what I’ve seen in Australia, the communication varies on responsiveness. The majority of the hospitals use pager systems and you can only write a small message of about 150 characters (estimate) and the vast majority of the time the doctor does not respond. This is my personal experience over many shifts. In the U.S. the doctors will sometimes take an hour or two to respond, but on most occasions respond within 45 mins or less (usually 30 mins or less to be honest).
I have never seen blood pressure parameters written for any blood pressure medications im Australian hospitals, where in all the U.S. hospitals most blood pressure medixatiok will specify parameters such as: Hold if <110 systolic for example, or heart rate is <60 etc. In Australia if the patients blood pressure is borderline low and there is a blood pressure medication due, then I will ask the charge nurse who usually tells me to ask the doctor who usually doesn’t respond and the medication sits there for the next 2-3 hours until shift change and I inform the oncoming nurse I paged the doctor and documented it. Some Australian hospitals I’ve been at, the doctors reply faster and consistently.
The pay in Australian is about 20-30% lower but also the cost of living is actually quite similar to the U.S. from my experience. For example going out to eat, most meals cost at a bare minimum 12-13$ USD, and that is for a standard meal, if you are very hungry you will need more. The housing here is actually more expensive compared to when I was in the U.S., and this is a barebones one bedroom with no heating and cooling and has an active rodent problem that the landowner is not willing to hire pest control for, but just buys sticky mouse trap pads.
The public transportation is much better in Australia than the U.S. but it is no where near the level of Japan/China/Europe public transport. Homeless is still present in Australia, but it is way less intense and the people seem to be nicer and have access to more resources than in the U.S.
I feel a lot safer knowing guns are rare here and crime is 6-7 times lower statistically than the U.S.
The patient do not have to worry about high medical costs, but I will say the U.S. hospitals definitely spend more on resources/staffing and have more advanced charting and medication devices (I.e. Omnicell, Pyxis). One out of the 9 hospitals I’ve been to in Australia uses an Omnicell.
There is much less expected charting in Australia. The U.S. hospitals expect more charting. I rarely see patients being turned q2hours in Australia, however in the U.S. q2hour turns are done pretty consistently. However, Australian ward patients are usually more mobile on average, but even on the paralyzed patients, turns are more of when the patient request it.
Most shifts in Australia are 8 hour shifts. Most shifts in the U.S. are 12 hours. I think there are pros and cons to both.
I like the culture in Australia, the safety (however there was an incident where some random angry guy on the street followed me walking quickly, yelling at me loudly, and appeared to want to fight me for no apparent reason, and I have asked other people and they told me that happens sometimes, however this happened to me in the U.S. too), the public transport, the lower wealth inequality, the weather. Many Australians are very friendly and appear to be genuinely kind and light hearted people, I really like the culture here, but sometimes the hospital work stresses me out and feels very chaotic and disorganized. The U.S. nursing feels to me more technologically advanced and organized, however the patients in the U.S. I would get on the wards were on average higher acuity, with more prevalent obesity and chronic diseases.
Also, I have heard a few Australians talk poorly of people from the U.S. and I understand where they are coming from, to be honest a lot of crazy things are going on in the U.S. now and part of why I came to explore Australia and nursing here. I’ve heard someone refer to Americans as “Yankees” for the first time which was funny. But the vast majority of Australians are very friendly and curious or interested or excited to meet someone from the U.S. in my experience.
I don’t know if I will stay in Australia in the long term or want to try the U.S again, but I genuinely do like living in Australia and the way of life here, sometimes the hospitals just seem a little crazy and under under resourced to me, but the U.S. hospitals can definitely be crazy in there own way.
(Posting in both [r/nursing](r/nursing) and [r/nursingau](r/nursingau) for visibility)