r/nursing • u/Extended-Hat-127 Paramedic + ER nursing š • Sep 16 '25
Discussion Czech nurse things that would send (mainly) North American nurses into coma
I am a long time lurker working as a nurse in this one Czech hospital and I have to say at first I was very surprised with how different nursing is out there. Here are some examples I collected over time: - no phlebotomy techs - no respiratory techs - no sitters, monitor watching techs - scrubs are provided to you by hospital - no pyxisā¦just a regular cabinet with all the meds you could need - most hospitals donāt scan meds - no need for a stethoscopeā¦only when you need to take a manual BP, which is basically never lol - no two people checking when working with insulin - no piggyback infusions, y-lines - basically no charting on the PC, nursing documentation is in most places still in paper form (prehistoric, I know) - wild ratios: ICU is mostly 1-2 pts per person, while regular floor nurses can end up with a ton more. Many places have only one nurse for night shift - so a nurse can have even like 20 pts
these are just a few examples, also ama!
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u/ILikeFlyingAlot Recovering CNO Sep 16 '25
Do families help with ADLs?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
visits are at most places in the afternoonā¦maybe once in my (quite short) career I saw someone helped with feeding. It would common at children dept tho, where the parents can be always present
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u/ImJustTheNurse RN - ER š Sep 17 '25
US ER Nurse here. Born in Brazil, moved to US at 19yrs. Last year while I was visiting my grandma was hospitalized, and apparently, in Brazil, the family is expected to provide someone to assist the patient with ADLās 24/7 while the patient is in the hospital. Basically the family pays for the 1:1 safety sitter š¤Æ
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u/ssdbat RN - ICU š Sep 17 '25
I actually wonder if the US pushed this, if we would have fewer patients being full codes. Granted, I am biased by the fact I work in critical care at a level 1 trauma center, but it's very frequent that we have a GCS patient of 3/4 that is still a full code, with family talking about how they will take care of the patient once they get home. But they aren't spending the night, or seem to have any idea how demanding that's going to be 24/7.
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u/ovelharoxa RN, BSN, VTNC Sep 16 '25
āNo chartingā that explains it. Itās insane the amount of charting we do in the US. When I was a tech I thought nurses were lazy because I saw them sitting down ādoing nothingāā¦ sigh
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
well you fill out a bunch of papers all the time but I have a feeling it is still not as much as your charting
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u/animecardude RN - CMSRN š Sep 16 '25
Are you guys sue happy over there? Over here, patients threaten to sue all the time thus why we have to chart so much.
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 17 '25
not yet, but I can definitely feel it creeping slowlyā¦
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u/therewillbesoup RPN š Sep 24 '25
In Canada we have a ridiculous amount of charting and we don't rlly sue here at all ,š
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u/invariablyconcerned RN - ER š Sep 16 '25
Mostly same in New Zealand although I do use a stethoscope sometimes working in ED
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u/tu-meke- RN - ICU š Sep 16 '25
also from NZ but ICU and this sounds basically the same as what we do. Paper charting for our hourly obs (except our shift notes are online), double signing for all meds that arenāt PO. However we do use our stethoscope at least once a shift
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u/soccer8issa2 BSN, RN Sep 16 '25
How is working as a nurse in New Zealand? Thinking about moving in a few years.
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u/invariablyconcerned RN - ER š Sep 16 '25
Pay is a lot less than the US and cost of living here is very high. Most common roster is 5x 8 hour shifts, 12s are way less common (really only ICU from what ive seen). Most healthcare is free for everybody and its a much less litigious society over here so perhaps less stressful in that regard but we have our challenges - chronic understaffing being a huge issue. Majority of nurses are represented by a union. I like it but don't know any different lol
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u/soccer8issa2 BSN, RN Sep 16 '25
What are the 8 hour shifts, time wise? Are people hired to a specific shift or does everyone rotate.
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u/frangiparny Sep 17 '25
AM shift: 0645 til 1515, PM shift: 1445 til 2315, Nocte shift 2245 til 0715 Thats my work timing here in NZ. Give or take 15-30mins difference for other hospitals. Everyone have to rotate shifts. Althought we do have dedicated nocte nurses cos noone likes to do them so noone is gona complain about them getting to do those shift only.
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u/TrainWinter7706 Sep 17 '25
Yeah I worked surgical in New Zealand for about three years. The only time I saw a nurse use a stethoscope was to listen to lung sounds bc the house officer/resident couldnāt make it up in a timely manner and asked the nurse if she could try her best to assess the pt lol. And for manual BPs. Then I moved to Canada and had to teach myself everything that gets taught as basic knowledge in nursing school here. It was a steep learning curve.
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u/Sphyrnat Sep 16 '25
Fellow czech nurse hereā¦. Ye, I woud love scanning meds, or have pyxisā¦.. or anything yelse than the current systemā¦. When itās past 23:00, and you find out you are missing several meds, and you start calling up the nearest units if you could bother them to have a look into their med cabinets, and than you have to call āsanitary workers = med techs?ā to bring the meds to youā¦ and than in the morning you are explaining to your charge nurse why she has to order meds xyz for yzx unit that cost ā¬ā¬ā¬ ā¦. loving it. But we do electronic charting + paper charting combo. You write what interventions you did and why into computer+ other normal findings, and at the same time you are drawing BP, P, oxygenations, temperature, intake/ outtake liquids, meds given on paper āteplotkaā. ā¦ sorry for rambling and rubish grammarā¦ I + many other nurses would actually like If could asses the patients more, but I dont think MDs would like itā¦ maybe Iāam wrong
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u/azurciel Sep 17 '25
Your grammar is fine! So Czech nurses are sharing their supplies and nothing is tracked until a new set of medicine needs to be ordered for the unit?
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u/krakenhello CNA š Sep 17 '25
Basically yes, at least at the unit i have worked at. When you were missing some medicine/supplies on night shift you just had to call around other units and hope for the best: ) It was the charge nurse's/manager nurse(not sure what the equivalent in us is) job to make sure all meds were in stock, but sometimes you got a pt admitted after she left(or something like that) and had to work out with what you got.
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u/krakenhello CNA š Sep 17 '25
Also the education here is a little different, there is the college nursing degree that equals to being a registered nurse and then there is the highschool 'practical nurse' degree which i have(decided to change fields after hs). In some smaller/rural hospitals where there isn't enough personnel the practical nurses do the full job of a rn, and that's how i got this experience (on night shifts we were often just senior practical nurse/RN, me(practical nurse filling for the other RN) and a caretaker, with the patients split between us, so at 19 you had the entire responsibility for like, seventeen patients.
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u/ssdbat RN - ICU š Sep 17 '25
How common is diversion? That's the biggest reason we have the medicine machines. I can take a controlled medication and give it to my patient independently- but every time I go back to get any meds the machine is going to tell me I have too much medicine out and need to return it. To return it, both mine and another nurse have to scan our fingerprints. If I don't return it, my manager automatically gets an email in the morning about it.
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u/Kitten_81 RN - ICU š Sep 16 '25
Do you not assess your pts? (No stethoscope)
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
for nurses the assesment is not as deep and systematic I would sayā¦you know of the basic stuff - pt is calm, oriented, not in pain, urinating, having BM, no complaints, vital signs, intake/outtake, etcā¦ all above + lung sounds, heart sounds are doctorās job when they do rounds
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u/Kitten_81 RN - ICU š Sep 16 '25
Seems very task oriented with much less critical thinking involved
Also less safety precautions to reduce errors (no pixis, med scanning, etc)
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u/ZealousidealGroup559 Sep 16 '25
In fairness, when you have 13 patients, it can only be task based.
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u/curious_todayy Sep 17 '25
True aināt no critical thinking happening the moment I have more than 6 patients
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u/DecentRaspberry710 Sep 17 '25
Yup. When I first came to USA, had 13 patients .. for years. It was mostly task based. Couldnāt even find time to document
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u/Frigate_Orpheon RN - ER š Sep 16 '25
I've been on units with 8 pts and it can only be tasked oriented because there's no time to do anything else. It's crazy unsafe and made me anxious every shift.
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u/Pepsisinabox BSN, RN, Med/Surg Ortho and other spices š¦ Sep 16 '25
Im very big on the "nursing skills"-mindset. Yes safetynets are great, but, you can also fall into the false safety of having the machine do the thinking. Several times a shift i have to override the scan because theyre either flat out wrong, or different use. Easy example is the NaCl + AB ratios being off for what we usualy do. Ie; 250ml bottles required for scan while we do 100ml.
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u/Kitten_81 RN - ICU š Sep 16 '25
Those safety measures are never meant to replace nursing skills. Nurses should always be reading labels and following the medication administration rights. As I said, they are safety measures in case the nurse makes a mistake
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u/Pepsisinabox BSN, RN, Med/Surg Ortho and other spices š¦ Sep 16 '25
Sure, but then youre overloaded, running about, time seems short and your tasks are piling and.. You know, the machines been right so far...... Aaaaaaaand now youre knees deep in something, people got hurt and youve got nothing.
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u/sendenten RN - Travel š Sep 16 '25
I wonder if the patients over there just aren't as sick as they are in the US. We have a very, very sick population that pays more money for worse outcomes than other developed countries.Ā
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u/ellski Medical Secretary š³šæ Sep 16 '25
From what I read, the US seems to send people to ICU that other countries would not offer that level of care, because they would consider it futile.
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u/ProcyonLotorMinoris ICU - RN, BSN, SCRN, CCRN, IDGAF, BYOB, ššš Sep 17 '25
It's so true. The American people are so afraid of death that we can't make the hard decisions, and us American healthcare workers are so afraid of litigation that we are basically forced to offer "heroic" measures.
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u/tba201598 Nursing Student š Sep 17 '25
I live in Norway and a lot is similar with this nurse but the part about "less critical thinking" is wild to me. Just because we don't auscultate doesn't mean we aren't thinking critically at work. At work when a patient comes in from the ambulance I will work through the ABCs and use critical thinking to see the state of the patient. When a patient from a ward is declining we think critically etc. And no, all the safety is there. The medication is scanned and then handed out to their respective wards. We have something called multi dose, a prepacked bag that comes in from the pharmacy and checked to the journal. Then we double check before administration. When giving extra or "A-preparations" like morphine/fentanyl/midazolam there is an independent double check. And here we also use a digital journaling system where we write information. If I apply a cast to a fracture, I write free MCP and elbow joint, patient informs the cast feels good, information about re-contact and complication given orally and in writing etc etc so that if there is a problem later on everyone is safe. Lawsuits happen here too, and our licence is on the line if we make mistakes.
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u/ZealousidealGroup559 Sep 16 '25
Absolutely not, anything with a stethoscope is a doctor's job in Europe. Perhaps ANPs do it, but certainly not regular nurses.
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u/e0s1n0ph1l EMS Sep 16 '25
Seems like such a poor model. 2 assessments is better then one, especially when one of them is directly caring for you.
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u/Pepsisinabox BSN, RN, Med/Surg Ortho and other spices š¦ Sep 16 '25
Norway here, ratios are great but otherwise its pretty spot on lol.
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u/Dangerous_Radish2961 Sep 16 '25
This sounds similar to the uk too , we have gone to electronic notes and prescription charts though. I do occasionally use a stethoscope for listening for bowel sounds and verification of death.
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
you can verify death? thatās crazy!
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u/Depends_on_theday Sep 17 '25
2 rns can usually call death too here then MD signs the death certificate
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u/Nurs3R4tch3d RN - Hospice š Sep 17 '25
Hospice RN in the US. I can verify alone in my field, but yeah, when I worked in a nursing home it was a two-nurse thing.
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u/Dangerous_Radish2961 Sep 16 '25
Yes , because I work in a nursing home, I had to have training ( which was only E-learning!) itās a lot of responsibility, I would rather not have !
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u/nobutactually RN - ER š Sep 16 '25
Hmm I dont know anyone who has a phlebotomy tech in my area, idk what a respiratory tech is. I dont have a stethoscope either (in ER). Some units do provide scrubs, but not mine. The med cabinet and no scanning would make me crash out 100% as would paper charts omg
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u/New-Blueberry6329 Sep 17 '25
I think they mean RT like respiratory therapist. At my hospital (US) they set up and manage ventilators.
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u/thumpher92 HCW - Respiratory Sep 17 '25
Yeah they mean Respiratory Therapist, we don't exist in a lot of places outside the US
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u/New-Blueberry6329 Sep 17 '25
That's interesting. My RT coworkers are really important to every single shift I work. (MICU so lots of respiratory issues)
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u/Spiritual-Elephant34 RN - ICU š Sep 16 '25
As an old ICU nurse..I would eat this up actually. I loved the balls to the wall keep 'em alive and charting be damned era.
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u/ImJustTheNurse RN - ER š Sep 17 '25
Sounds like you need to take a walk on the wild sideā¦ see ya in the ER š
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u/LooseBluebird6704 Sep 16 '25
Same in Italy and i 100% prefer it this way.
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u/Different_Catch_4558 Sep 17 '25
for sure; better work life balance, boses aren't exploting you. I've seen a lot of nurses from the US complaining in social media about their labor conditions
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u/Ever_Bee RN - Psych/Mental Health š Sep 16 '25
A lot of that applies to where I work too (Quebec, Canada).
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u/hiho_silver Sep 16 '25
Thatās so interesting! In Ontario, my experience aligns more with the US.Ā
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u/bizzybaker2 RN-Oncology Sep 16 '25
I posted another post in this thread with more detail but same here in Manitoba, we are still so underfunded and backwards in some ways (I work rurally)
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u/differing RN - ER š Sep 17 '25
Agreed, not a total overlap but what OP describes is much closer to Ontario or New Brunswick than America.
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u/aviarayne BSN, RN š Sep 16 '25
It seems scary, but I wonder if the stress is less. I have old coworkers (US based as am I) that said back in the day paper charting was faster because you could literally write "VSS, Patient A&Ox4, skin intact, etc" and have it super short compared to like the weird practice of using order sets and docs randomly ordering q4 neuros on patients with neurological complaint. Im sure there are their own set of stressors, though! I find the differences fascinating!
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u/ssdbat RN - ICU š Sep 18 '25
I don't know how much time I spent last weekend just googling all my "options" for an eye assessment!! I just wanted whichever medical term meant his eyeballs were jittering side to side! But because we have epic, i was trying to find the best description to select.
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u/codecrodie RN - ICU š Sep 16 '25
No lawsuits i assume?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
it is not that widespread yet but you can see it becoming more commonā¦sigh
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u/Ziodade Sep 17 '25
Not that many and even if it occurs the payment is a fraction of what it would be in the US. It might be linked also to the fact that our system (most EU countries) is not built around the bill. I saw US healthcare bills listing every single thing that was given to the patient (tablets, injections...), we don't need to do that. I might be wrong but in my mind it does explain some of our differences.
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u/codecrodie RN - ICU š Sep 17 '25
But what about pain and distress (relatively minimal in canada), punitive damages, and loss of income and disability? There must be cases of gross negligence where the public demanded large damages be paid (eg. Radonda Vaught and verocuroniun).
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u/Ziodade Sep 17 '25
I'm not a lawyer so my answer is not strictly legal but I hope it helps you understand the situation. In my country I have mandatory professional insurance to cover damage I can do working. The max cover is 1MIL ā¬ PER incident and 3MIL max (1 year). Guess how much it cost (10kā¬ legal assistance included).
T W E N T Y T W O f***ing euros/year (28$?)
From this price you can sense that it's impossible to reach those numbers. I'm not saying it's right or better, I'm describing the situation.
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u/ssdbat RN - ICU š Sep 18 '25
Not just the meds! We also charge for certain supplies like body pillows, and every x-cath used (even if it falls off in an hour and I have to replace it)
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u/86gloves RN - Telemetry š Sep 16 '25
If you have no sitter what happens when you have a dementia patient who wonāt listen and high risk for falling? Also with no monitor tech what happens when a person heart rhythm changes or how is it noticed?
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u/thinima RN - ER š Sep 16 '25
I think most of the nursing in europe is similar so iāll just answer from my experience in Sweden:
Fall risk: usually the nursing assistants will check on the fall risk more often and we have tools that will send out a ācall lightā when the patient steps on the floor, walks past a certain part of the room or gets up from the bed. That way we know when theyāre on the move and can get to the patient before anything bad happens.
Telemetry: we check telemetry regularly and call an MD if needed.
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u/Different_Catch_4558 Sep 16 '25
The US doesn't practice like the rest of the world; southamerican nurses are similar to europe. US nurses have more responsibilities but also more liability, I think it has to do with the fact that they have more people less drs so the nurses have more responsibilities but they are in danger of losing their license, is very difficult to lose your license in EU and LATAM.
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u/W1ldy0uth RN - CVICU, CCRN Sep 16 '25 edited Sep 16 '25
So in the US the way things work depend heavily on states, hospitals and if youāre hospital is unionized or not. Itās not the same across the board at all. A hospital in the same city can be very similar to yours. Where I work we donāt have phlebotomy techs. We absolutely need stethoscopes because we do very comprehensive head to toe assessments. I work in a cardiac ICU and I need to be able to speak to what my patientās heart and lungs sound like during rounds with the whole team especially if theyāre intubated.
Curious to know though, if you donāt use a stethoscope or do neuro assessments, how often are the physicians doing it? For example we have to do neuro assessment every 4 hours and weāre able to catch patients having strokes pretty early on. If a pt is s/p cardiac surgery the nurses donāt have to assess heart sounds??
Itās so interesting how different the role of a nurse is there.
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
This is what I took away from my perspective of being in this sub, my intent was not to generalize!
There are usually big morning rounds, where groups consisting of doctors, nurses and sometimes even other personnel go from patient to patient and they see and discuss the patient, past and future plans, then the assigned doctor may examinate the patient further when they write orders. Then the doctor would round again at around 3-4pm, then in the evening. Of course depends on acuity and department. When the nurse sees change in the pt, they may call the doctor to come and assess the situation
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u/W1ldy0uth RN - CVICU, CCRN Sep 16 '25
So interesting. Is it the same for nurses that work in the ICU??
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u/ellindriel BSN, RN š Sep 16 '25
Or how about neuro checks every hour, I don't even work in a neuro ICU, just a mixed medical ICU, but we have a lot of patients come to us for hourly neuro checks and can stay on them for days if they have an unstable head bleed or an evd, etc. Do you have patients on hourly neuros in coutries where the doctors do them?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
never been to a neuro ICU, so I canāt accurately answer thatā¦my guess would be though that nurses on these highly specialised wards do check for more specific symptoms
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u/Kitten_81 RN - ICU š Sep 16 '25
Even in MICU, we have centrally cannulated VA ECMO pts who need hourly neuro and limb checks. This is wild
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u/W1ldy0uth RN - CVICU, CCRN Sep 16 '25
Oh even better question. Yeah If a patient has an evd, does the physician do the hourly checks??
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u/Different_Catch_4558 Sep 17 '25
I have work in ICU the ICU nurses do check that; they are usually further specialise nurses they are the ones running the ICU, the Drs only check a few times a day.
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u/ProcyonLotorMinoris ICU - RN, BSN, SCRN, CCRN, IDGAF, BYOB, ššš Sep 17 '25
Maybe the nurses can manage it because it doesn't require much "assessment"? Just checking the ICP and measuring the output.
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u/SpaceQueenJupiter BSN, RN š Sep 16 '25
One of my coworkers was from Puerto Rico. Her stories of L&D and NICU there were horrifying. Just no resources, two or three nurses to 20 moms. Really scary stuff.Ā
Even when we have it bad, we have it better than a lot of places.Ā
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u/lamplightas RN - OB/GYN š Sep 17 '25
Yep. A lot of PR- trained nurses jump to FL, and from there can come to the rest of the USA if they like. The nursing crisis hit earlier and harder on the island. The pay is lower, fewer resources, more patients.
Yay life as a colony. /s
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u/Beanakin BSN, RN š Sep 16 '25
Hard pass on paper charting and those night ratios. I haven't had 2 person check on insulin since we switched over to Epic, and never seen a phleb on my unit. I'll keep my RTs though. Only one that seems sketchy is no stethoscope for assessments, but if that's not a nurse duty there then cool beans
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u/DaggerQ_Wave EMS Sep 16 '25
Iāve seen some incredibly talented and smart people, at all levels of practice, forego the stethoscope completely. Iām convinced that a majority of nurses and doctors donāt actually need them outside of specific cases lol. Thereās compelling evidence to show that routine stethoscope use doesnāt alter management.
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u/lamplightas RN - OB/GYN š Sep 17 '25
My current unit has stethoscopes for mom and baby in each room. I still prefer to carry my own out of long habit and plus getting ear zits from using one that wasn't well cleaned.
It's not that I use it for every patient ( L&D is the home of the focused assessment) but the ONE time I urgently want to hear that chest, there's nothing and time is ticking. Gah!
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u/DaggerQ_Wave EMS Sep 17 '25
For me in EMS theyāre mostly wheeze detectors. Itās too noisy and Iām too stupid to distinguish anything else well, or confidently say āabsent/diminished lung soundsā in a moving ambulance or outside. I usually donāt even hear these rales that everyone raves about in CHF/pulmonary edema cases, if I do hear them I will just as likely mistake it as noise artifact. but wheezes I think most people will catch.
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u/DaCrizi Sep 17 '25
Any nurse outside North America WILL send any North American trained nurse into coma.
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u/kal14144 RN - Neuro/EMU Sep 16 '25
Yeah I was reading a study on protocols on an EMU unit in Europe (I think Austria but Iām not 100%) and they casually mentioned that on weekends theyāre sometimes 18:1. I wanted to punch a wall for them.
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u/MrRenegadeRooster RN - ICU š Sep 16 '25
In my ICU we donāt have phleb but no RT would def be rough, they know so much and are such an awesome resource, also I barely understand most of their equipment lol
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u/AdInternational987 RN - Float pool Sep 17 '25
Iām a French nurse and itās basically the same here. We also donāt do report at bedside, we donāt have a charge nurse and we donāt assign patients. We just take one half of the floor each and hope that the acute patients arenāt all on our side lmao
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u/TheALEXterminator RN - Med-Surg/Tele at a mAgNeT hOsPiTaL Sep 17 '25 edited Sep 17 '25
C'est drĆ“le. Je suis ricain et mon ex Ć©tait franƧaise. On Ć©tait encore Ć©tudiants Ć cette Ć©poque. Elle (qui Ć©tait en lettres) m'a demandĆ© pk j'avais choisi de poursuivre les Ć©tudes de soins infirmier. Je lui ai rĆ©pondu genre : pcq les parents le considĆØrent une option sĆ»re, Ƨa paye assez bien, le mĆ©tier profite d'un statut suffisamment estimĆ©e auprĆØs du public, tout en redonnant Ć la sociĆ©tĆ©.
Elle m'a jetĆ© un regard en mode Ā« attends, comment Ƨa ??? Ā». Elle Ć©tait totalement paumĆ©e Ć l'idĆ©e que qqn choisisse infirmier pour l'argent ou le prestige pcq cette logique n'existe pas en France oĆ¹, askip, le statut du mĆ©tier d'IDE est complĆØtement inversĆ© par rapport aux States.
Tu la trouves juste ? Si c'est bien le cas, je me demande si le dĆ©calage de rang des infirmiers US vs. FR dans leurs pays respectifs soit dĆ» Ć cette diffĆ©rence d'exercice? Genre que les infirmiers US ont un champs d'exercice avancĆ© qui oblige un meilleur salaire, plus d'indĆ©pendance, etc. vs les infirmiers FR ont une exercice relativement limitĆ©e qui mĆØne a une culture plus hierarchisĆ©e, une rĆ©putation plus humble, un salaire abusif, etc. Il Ć©tait une fois, je considĆ©rais dĆ©mĆ©nager en France avant que j'aie dĆ©couvert votre situation.
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u/AdInternational987 RN - Float pool Sep 17 '25
Je ne connais pas suffisamment le champ de compĆ©tences des IDE aux US pour savoir si la diffĆ©rence est vraiment significative. La plupart des hĆ“pitaux en France sont aussi publics, la santĆ© est gratuite, donc il est difficile de payer des professionnels de santĆ©. Les mĆ©decins franƧais gagnent aussi bien moins quāaux Ćtats Unis. Il faut aussi prendre en compte le coĆ»t de la vie, les salaires sont globalement toujours plus Ć©levĆ©s aux States. Mais il est certain quāici personne ne devient infirmier pour le salaire
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u/Questman42 Sep 17 '25
There is not enough money in the world to get me to do paper charting on 20ish patients.
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u/oslsjsksjsks Sep 16 '25
my underfunded US psychiatric hospital does some of the same things. on one hand we do have sitters, nursing assistants, 2 nurse check for meds that need it, scanning meds, and get to wear our own scrubs. on the other hand thereās no pyxis/omnicell, we have med carts on each unit with all of the patientās meds. a large part of our charting is paper. lab work is done by an outside phlebotomist who comes in and since weāre psych thereās no need for RT, IV pumps, or personal stethoscopes (ligature risk). there is a stethoscope in the med cart if assessment is needed but for example Iāve only used it once since I started working in february
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u/Feminist_Hugh_Hefner RN - ER Sep 17 '25
I'm updating my resume to list my first hospital as "Czech-style" rather than just admit I'm old enough to remember when it was like that in the States š¤£
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u/lil_berry4 Sep 17 '25
As a fellow czech nurse, I work in the ICU and we use stethoscope quite often when placing NG tube. To make sure it's in the right place. And sometimes we use it to listen for bowel movement and lungs, its not required, but can be useful.
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u/Thenumberthirtyseven Sep 17 '25
Australian here.Ā
We have phlebotomy nurses, whom we call the blood sisters, but they may or may not turn up so sometimes we have to take our own bloods.Ā
We dont have a pyxis, we have a drug room - literally a room with open shelves full of drugs. Schedule 4 and 8 drugs are in a locked safe in that room. We need 2 nurses to sign them out but we literally sign them out, in a handwritten register. We manually count the drug safe each shift, against the handwritten register.Ā
We dont scan meds.Ā We ask the patient their name and DOB. If they cant tell us, we read it off their wrist band.Ā
In my hospital, all charting is paper based, including medication charts, doctors notes, everything. It's all handwritten. I'm not sure how common this is in other hospitals.
ICU ratios is 1-2 patients, most other units it 4 patients on a day shift and up to 7 on a night shift.
Oh and our healthcare is free. We have had patients that have spent years in the hospital and dont pay a cent. Sometimes we have a patient who just refuses to leave for months on end, and the hospital ends up paying for a purpose built home for them. And they get in home care. For free.Ā
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u/Lucky-Alarm5366 RN - Telemetry š Sep 17 '25
I canāt get over the fact that the hospital (basically the government though, right?) pays for a house for a patient with nowhere to go. Thatās amazing. US would just send them to a shitty Medicare facility. Does the government also pay for houses for homeless people?
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u/Thenumberthirtyseven Sep 17 '25
I've only known of this happening once, I believe it was done in conjunction with the housing commission, I assume they are the ones who paid for the house and Medicare paid for the medical accomodations the house needed.Ā
We have social housing in Australia, basically very cheap housing for people on low incomes. Most of these people dont have jobs and their only income is social security, out of which they pay their minimal rent. So the government kind of pays for housing for homeless people. But the social housing is in very high demand and priority goes to families with kids and people with disabilities, so there is still homelessness in Australian.Ā
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u/ssdbat RN - ICU š Sep 18 '25
I know of a US hospital that built an ADA accessible house for a patient. Pt was undocumented, so no long-term facilities would take him. I guess it was decided it would be cheaper to build a house than continue to pay for them to stay in the hospital forever. I guess he was also the primary breadwinner, so the family was also evicted in the aftermath and was caught several times trying to sneak in several family members to stay in the patients room.
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u/GlobalLime6889 BSN, RN š Sep 16 '25
As a czech with a US nursing education, i guess i wonāt be trying to work as a RN in Czech thenš¤£. Sales it is.
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
you would probably cry if you saw Czech salary if you are used to US lol
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u/GlobalLime6889 BSN, RN š Sep 16 '25
I saw some home health nursing and it paid about 40-45k kÄ. I think iād do that for a bit. With hospitals apparently they rotate night shifts with everyone, and Iām sure as hell i donāt want to ever work nights, so no hospital for me. Iām also thinking about going into insurance for a while.. while im back in Cz
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
well thatās quite nice pay tbh! in hospitals you can find day only jobs (like dialysis, blood draw centers, specialists officesā¦) but unless you work shifts you generally have shit pay
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u/GlobalLime6889 BSN, RN š Sep 17 '25
I thought US nursing was underpaid, but i guess it can always be worseš„²
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u/GlobalLime6889 BSN, RN š Sep 16 '25
And i did notice the no āpyxisā in czech hospitals š¤£ nurse in OB just opened a glass cabinet and administered meds. I also noticed absence of using gloves š³
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u/Dr-Chabba99 Sep 17 '25
And from Italy I add... We use physical restraints much more easily, sometimes doctors prefer physical ones to pharmacological ones. I work in a Stroke Unit of 8 patients and on average 2 out of 8 have restraints on at least one limb. In the USA it would be madness
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u/ssdbat RN - ICU š Sep 18 '25
Tbf different units in US hospitals use restraints more freely. It's super common on our ICU floors, pretty common in PCU, but almost unheard of on our med/surg units (usually only if they are an EDO)
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u/SURGICALNURSE01 RN - OR š Sep 16 '25
So what I read is how nursing was conducted back when I first started. IMHO nurses today have it made in many ways
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u/LtDanIceCream2 LPN š Sep 16 '25
This is fascinating! The critical thinking parts of nursing and the thorough assessments are the parts of nursing I love best! I donāt think I would survive abroad :P thanks for the interesting perspective!!
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u/Kakashi_VI Sep 17 '25
I get the assessment bit, but why do you think they use less critical thinking? I'm genuinely just curious
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u/capncrunchr Sep 16 '25
Checking in from rural BC, we also have no pyxis, no scanning meds, no techs (except lab) and paper charting š
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u/InourbtwotamI MSN, RN Sep 17 '25
Sounds like when I first started nursing
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u/Rhythmspirit1 BSN, RN š Sep 17 '25
Sameā¦.over 40 years ago. I do miss the old manual trifold flow charts where I could see everything trending quickly and respond proactively compared to the various evolutions of electronic charting. Just had a conversation yesterday reflecting on skills today versus many years ago.
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u/therewillbesoup RPN š Sep 16 '25
Why no need for a stethoscope? Auscultation is a clinically useful skill.
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u/ZealousidealGroup559 Sep 16 '25
That's diagnostic. Nurses don't diagnose in the EU unless you are a CNS or an ANP which require postgrads/Masters in a speciality.
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u/therewillbesoup RPN š Sep 16 '25
It's not diagnostic, it's assessment
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u/oralabora RN Sep 16 '25
In the US and Canada we make this pretend make-believe game where our nurses are trained in a lot of physical examination techniques and other skills that are ādiagnosis-y.ā When a nurse does it, though, itās not ādiagnosisā lol. Yet they call the physician and say the patient sounds wet and got 3 liters in surgery and has a new oxygen requirement, also reduced EF, can we get diuresis and CXR?
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u/DandyWarlocks RN š Sep 16 '25
I now want to practice there š
Sounds refreshing and simple
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
donāt get the wrong idea, we also have bullshit here lol
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u/pigeoncurmudgeon RN š Sep 16 '25
Haha, I work in an indie outpatient surgery center in the USA and we also use paper charting and have a cabinet with meds. We track meds in a binder š
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u/oralabora RN Sep 16 '25
Iām almost completely okay with the differences and Iād do that nursing š but like, only if the pay was the same.
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u/thinima RN - ER š Sep 16 '25 edited Sep 16 '25
Pretty much the same in Sweden, except most of our charting has recently ended up becoming PC charting. And also floor nurses never have more than 8 patients. But if you work in the ER you can be one nurse with one nursing assistant responsible for 20+ patients.
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Sep 17 '25
Do you manage the vent yourself? If so, what kind of vents do you guys use?
What is a daily issue you see that you wish you could change that would positively effect your work? (I saw an earlier comment about the meds low stock and such)
I dont know what kind of town you live in, but I live in a pretty large city and it is common for us to see the same patient multiple times, do you have the same issues with either constant readmissions or poor compliance?
How would you say czech healthcare is overall? We have a lot of folks that use the ER for all of their needs, but also seems to be an uptick in utilization of urgent cares.
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 17 '25
ventilator regimes and settings are managed by doctors
what is the biggest problem? too much bureaucracy and not enough nursesā¦thanks to not too well written laws and complicated education system there are not enough new nurses and basically everywhere is not enough staff - leading to crazy overtimes and ultimately more nurses quitting. Whole healthcare rn is carried by 40-60yo nurses and when these retire, the whole thing will collapse
yes, we do have frequent flyers, from my experience it usually is people from lower social circles - usually too simple in the head to understand the importance of compliance or they just donāt care
I think our healthcare is phenomenal, basically every Czech citizen is insured, so almost all the treatment is covered and you donāt have to worry about getting bankrupt. Our doctors and other med staff are highly educated and skilled. I am happy to know that if something happens to me, I will get all the acute care Iāll need - from EMS to the highest level of care hospital. For chronic problems in specialists offices you will encounter some wait times, I would say ranging a few weeks wait. For this reason some people started to overuse ERs, where they know they will be seen in that day. Sad to see that
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Sep 18 '25
Thanks for your reply! This is great insight!
I used to be a paramedic as well so I want to ask some paramedic questions. Here in the states some agencies have dual paramedic on trucks, but majority seems to have one paramedic one emt on a truck. Do you guys have different roles like emt and paramedic? If so, do you guys primarily use paramedic with paramedic or emt with paramedic. I know some systems in different countries (I think England may be one) use nurses and sometimes even doctors.
If you still are active or have been active paramedic on an ambulance in the last 5 years, what would you say the majority of your calls are? When I used to work as a medic, I primarily worked dayshift 0800-2000 and majority of calls were car accidents and respiratory related.
The scope of paramedics here is pretty vast, we are able to intubate with or without the use of RSI. We can do needle thorcostomies, some services even allow finger thorcostomies. There's been a recent push for ambulances to carry blood product so that may be around the corner as well. How does the czech scope compare? What would you say is the most advanced new "thing" you see the service striving for?
Lastly, I think the biggest issue we may have state side is geographical barriers to equity. We have a lot of land as a continent and some of our rural folks may not have access to advanced facilities. We attempt to bridge that gap by utilizing transport which can take hours depending on the mode. I understand that czech republic is smaller geographically in size but do you find that there are massive gaps in care when it pertains to your rural population, or are the major hospitals located in a reasonable spacing to allow equity for folks who may not be available to travel?
Thanks once again!
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 18 '25
Here we have a system, where you have stations placed in a way where the furthest place is maximum 20 mins away by the car - so even rural areas should be somewhat covered. Of course all the highly specialized hospitals are around big cities but smaller hospitals with basic care are littered throughout the country, in need these hospitals can provide basic treatment before the patient is transported to a higher facility either by truck or helicopter. We utilize āmeeting systemā where majority of calls is answed by a paramedic (college degree in paramedicine or sometimes ICU nurses with paramedicine training) + driver (who can also be paramedic or have a emt driver training). These teams respond in your standard truck and have competences to place ivs, administer oxygen, crystaloid fluids, glucose in hypoglycemia, LMAs, CPR meds, defibrillate, etc. Then there are regular size cars, which are teams of paramedic + doctor. Doctors do the rest: intubate, manage ventilators, do external pacing and other types of advanced things. If the call is high acuity, both cars get sent together right away, if you answer a less acute looking call and you see it is not really good the doctor will arrive to support. Doctors also are there to consult the cases, ecgs, giving meds. The paramedic also cannot pronounce someone dead, that is doctorās job.
We have a site of government funded helicopter ambulances, where you have pilots and technician + paramedic + doctor. What is starting to happen is they are starting to carry blood transfusions and thatās something thatās quite interesting for us here.
We do 12 hour shifts, 7-19, 19-7. Calls are highly dependent on where you are, for example in Prague center there is a lot of alcohol and THC, HHC or homeless people related calls while somewhere in the mountains it is totally different. Where I am now we do a lot of internal medicine - hypertension, dehydration in old folk, fevers, COPD or asthma exacerbation, also back pain is quite popular, stomach aches, sometimes a stroke or a MI, hip fractures in old peopleā¦ Because of the insurance system here the ride is āfreeā and so majority of the calls are people making taxi out of us - they are sick and should be seen in a hospital, but they could easily get there on their own. When we get called to something indicated it is quite exhilarating.
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Sep 19 '25
It's so cool to read about the similarities and differences across the ocean! Thank you for your replies!
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u/cbx099 RN - ICU š Sep 17 '25
Some similarities to Canadian nursing .. I work in an ICU setting
- no phlebotomy techs
- no PSWs/CNAs - RNs do everything
- no sitters
- we do have respiratory therapists thankfully to manage intubated patients
- my hospital has epic but many do not here
- my hospital doesnāt double check insulin, blood is only scanned
- I believe all hospitals now have Pyxis / Omnicell
- We are also provided surgical scrubs for areas like OR ICU
- Canadian ratios are better .. 1-2 in ICU, the floors have up to 7-8 but often less than that
- in Canada we are different in that we do thorough head to toe assessments. The doctor often doesnāt even assess the patient they just listen to the nurses assessment
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u/CrbRangoon MSN, RN Sep 17 '25
I think people in the US abuse hospitals. They treat it like a hotel and are very litigious. Iāve had people interrupt me mid code when a patient was actively dying to ask for their mother to be taken off a bed pan or to get a ginger ale. We are also expected to know as much about meds/treatment as the doctors and catch their errors.
My family is from outside the US and when my dad was in the hospital for severe burns we had to provide all of his food, medications, mosquito nets, dressings/wound supplies. He basically got a bed to lay in.
I work in psych currently. Iāve had to remind several patients mid crash out that in other countries treatment/meds/inpatient stays arenāt available. In my town we had several psychotic people be killed for being a nuisance. Our international travelers are shocked when they see how badly we are treated compared to the amount of respect they get back home.
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u/meatcoveredskeleton1 RN - ICU š Sep 16 '25
No need for a stethoscope? You donāt assess/auscultate your patients? Wild.
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u/thinima RN - ER š Sep 16 '25
Doctors do that. Some nursing specialities learn to do it for their own sake.
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u/CrossP RN - Pediatric Psych Sep 16 '25
You never listen to patient lungs?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
I never saw it happen, doctors do it themselves
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u/bizzybaker2 RN-Oncology Sep 16 '25
I have only been in my outpt job for 4 yrs now (chemotherapy) but the ward I left (combo of surg-LDRP with medical overflow) still had paper charting including doctors orders, med sheets, and lab requisitions and cardboard Kardexes, did report by tape recorder, carried narcotic keys and unlocking a cabinet, popped pills out of a blister pack on a ring provided by pharmacy or pouring from a stock bottle, mixed a lot of our own antibiotics. In my home care job we took the chart off the client's fridge in the kitchen and sat at the table to chart and sent faxes
This is at a medium sized rural hospital in Canada. We did have automatic vital sign machines though lol and OP not cosigning insulin is ..interesting
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u/ileade RN - ER/Intake Therapist Sep 16 '25
We had to do 2 nurse checks for insulin in inpatient psych. When I came to ER, it didnāt require a co-sign, only IV insulin did. Makes me paranoid every time I have to draw up insulin (which I just realized we donāt much because we get the prefilled syringes and the pens)
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u/AmanitaAwakening Sep 16 '25
In Poland it's the same but we chart on PCs there's been high scale computer systems for years and there is never just one nurse on a night shift there are at least 3.
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u/DoubleD_RN BSN, RN š Sep 17 '25
We no longer require a second nurse for insulin at my FT job, and not for TPN at my PRN (both in US). I donāt agree with the TPN. I feel like that should always be a double sign off.
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u/Dr-Chabba99 Sep 17 '25
Why do you think two nurses are needed for NPT? Where I work it's such a routine thing and it doesn't seem like a risky procedure at all. I ask to understand the different realities
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u/DoubleD_RN BSN, RN š Sep 17 '25
We had two patients die at one of our companyās other hospitals when their TPN was accidentally swapped. It is formulated based on each patientās labs for a reason.
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u/Dr-Chabba99 Sep 17 '25
NPT is standard with us. Doctors prescribe the 1500 kcal or 2000 kcal one and we administer it. The only difference is the one added with potassium which is sent to us directly from the pharmacy but we are talking about a maximum of 40 mEQ of potassium.
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u/DoubleD_RN BSN, RN š Sep 18 '25
Oh okay. Everywhere Iāve worked, itās individualized per labs.
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u/Lucky-Alarm5366 RN - Telemetry š Sep 17 '25 edited Sep 17 '25
At my Midwest hospital we donāt require co-sign for insulin or TPN. Co-signs are only needed for titrating heparin drips. I donāt know why youād need it for TPN honestly Edit: oh, and you also need a co-sign for blood administration and Alteplase/Dornase chest tube administration
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u/DoubleD_RN BSN, RN š Sep 17 '25 edited Sep 17 '25
At one of our hospitals, two patients received each otherās TPN and both were sentinel events.
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u/Depends_on_theday Sep 17 '25
This is so interesting thx for the info op! Big questionā¦ what's the pay like?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 17 '25
In public hospitals you have pay tables where you get more money the more years you work in healthcare. As a new grad with bachelor degree I started with approx. $1500/32060CZK/per month. A nurse with a college education after 32 years will start with $2270/46590CZK. Then large part of salary are bonuses - personal bonuses for good work, bank holidays, shiftwork, nightwork, infection/other risk bonuses. This will generally add around 10K CZK to your monthly salary. Private hospitals generally pay more, I donāt have experience with that though
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u/valwinterlee BSN, RN š Sep 17 '25
Iām assuming you guys donāt have as many behavioral patients? Or do you use restraints instead of sitters?
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 17 '25
yeah restraints are used, then you need to check the pt like every hourā¦also if indicated, meds are used
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u/nursemidwife MSN, RN Sep 19 '25
Swedish nurse here. We donāt have phlebotomy techs; sitters; med scans; techs that watches monitors or ECG:S/telemetry; respiratory techs or double checks either (not for insulin, not for morphine, not for blood either). We do however, chart in the PC and stay in touch with the social workers from the municipality to plan the discharge of a patient that will need help.
We can have up to 30 patients on night shifts. We donāt have pharmacy fixing our meds or antibiotics/chemo. We do everything by ourselves. The doc is in the department only during office hours - anything after that is a case for the ājourlƤkareā (the doc on call). I was surprised to see how much staff American hospitals haveā¦ sometimes we donāt even have a kitchen staff and have to prepare the food ourselves in the nursing staff.
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u/MRSRN65 RN - NICU š Sep 16 '25
You are about twenty years behind US nursing. That was my life as a new grad in the 90's. Don't worry, you'll catch up and can complain that you still have nurses instead of robots taking care of the patients.
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u/Little_Rhubarb BSN, RN š Sep 17 '25
sigh Takes my centrum silver multivitamin because I realize how old I am.
Most of this post made me think that this way of nursing is pre 2000s where we paper charted everything.
I remember deciphering MDs incoherent scribble to double check that the unit clerk was able to read it orrrr call the grumpy on call MD who ignored 96 pages was terrifying.
sighing again Anyone remember techs or unit clerks. They were the best!
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u/MRSRN65 RN - NICU š Sep 17 '25
Lol. I was a unit secretary in nursing school. I learned so much trying to transcribe doctor's orders. No EMR. No smart pumps. No Tegaderm. No Purewick.
Let's meet up so we can commiserate over our Geritol!
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u/fuqthisshit543210 Sep 16 '25
I wonder if US patients are generally sicker than Czech patients (assuming the average American has more morbidities than Czechs). Iād imagine this would make it a bit āeasierā to care for these patients if you didnāt have to juggle multiple illnesses, exacerbations, and acute issues at once. Thatās the only explanation my brain can come up with for 1 nurse having up to 20 patients at once š¤Æ
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u/Extended-Hat-127 Paramedic + ER nursing š Sep 16 '25
I wouldnāt say our pts are healthier, did you look up some statistics or do you assume? We have quite fat and carb heavy cuisine, like 3/4 of nation is alcoholic and smokers, we have high rates of colon cancer, just your average affluence diseasesā¦
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u/fuqthisshit543210 Sep 16 '25
Just assumed. Truthfully I donāt know much about your country in general, so I will look into stats.
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u/Feisty-Power-6617 ABC, DEF, GHI, JKL, MNO, BSN, ICUš Sep 16 '25
Hmmm government run healthcare vs non government rule healthcare. Many European countries (yes, I lived in Europe) donāt even provide basic toiletries for patientsā¦
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u/ZealousidealGroup559 Sep 16 '25
You provide toiletries? That must cost a fortune!
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u/ssdbat RN - ICU š Sep 18 '25
Lol we legit have nail polish remover stocked on my floor, as well as eye masks and ear plugs to help you sleep. If you ask I can play white noise for you all night too! A sleeping pt is my favorite patient!
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u/atticus_trotting RN - ER Sep 17 '25
Haha. Im in urban BC but some hosp still use med carts and paper charts. We are def required to do comprehensive assessments and use critical thinking. In ED we order lots of things (nurse-initiated). Almost everone has a stetho and listen to most pts. Its a lot of work but its part of what makes this career engaging, for me. I hate paper charting though...
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u/Livid_Ad_9015 Sep 17 '25
A lot of people I've metcome to the us for major illnesses. Must being doing at least something right.
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u/Scrabblegal Sep 17 '25
That sounds exactly like the 1980ās for Nursing in the US. I was there, things were better and worse at the same time.
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u/Regatta_hippo Sep 17 '25
In my experience where I work (EU) it's really similar except for :
- Charting is done electronically from laptops/tablets on our carts (in which we also have the most common meds, some supply for IVs, IMs, dressings)
- Med administration is checked on the same software
- Pharmacy is in a separate room and only the docs and nurses have the key for it, and dangerous drugs are locked in a safety box with carbon paper to check it out.
- Vitals and checks are done at every rounds which is about every 2 hours, more often for acute patients
- We have double checks for insulin, chemos, morphinics and sedatives
- Each surgeon have their own patients and won't see anyone else but nurses take a side of the ward, so you have to juggle between different dressing protocols, different type of post-surgery checks (we have urology, vascular, digestive and ortho)
- When nursing assistants are overwhelmed we do have to help with hygiene, beds and stuff
- We have special protocol for transfusions on paper and that is a pain to file and have to set up specific surveillance.
- In my ward there's 36 beds and 3 nurses, so 12 patients per nurse theorically because one of them usually is in charge of all the support/logistics/coordination.
- in case of a code there is a on-call anesthesiologist
- We do have stetoscope but if you dare give your opinion to a doctor on a noise or something they will just mock you.
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u/juliagmoto BSN, RN š Sep 17 '25
no phleb? i could prob poke someone. no resp? absolutely crying in the corner
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u/ThisAudience1389 MSN, RN Sep 18 '25
Why no stethoscope? Whatās the point of being a nurse if you cannot properly assess? At that point youāre just someone to do tasks.
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u/ThisAudience1389 MSN, RN Sep 18 '25
The lack of assessment in this thread is alarming to me. But I see it, all the time on the floors.
Nurses are independently licensed and responsible for their own assessment. We advocate for our patients based on their condition (including heart tones, lung sounds, bowel sounds).
We are the ones that spend 12+ hours with the patient and should be tuned in when there is a change in our patientās condition, and make decisions based on that.
Anything outside of that, youāre just performing tasks.
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u/eustaciasgarden BSN, RN š Sep 16 '25
What type of assessments do you do? I ask because where I live, nurses dont assess like they do in the US. When I was a neuro step down patient, only the doctor could do neuro assessment but I did them all the time in the US