Nursin' USA - Why I love nursing in the UK

25 April, 2010

In the spirit of positive thinking, our resident American nurse Sara Morgan explains why she loves being a nurse in the UK.

As spring seems to be (finally) arriving here in Britain, I thought that it was time for some unbridled optimism and good vibes all around. I have also noted the recurrent feedback from some of my readers that I spend more of my time mentioning areas where nursing in the UK is slightly frustrating to those of us from beyond Britain’s shores, than areas where British nursing truly excels. So, in the spirit of spring and positive thinking, I present my (American style) Top Five list of the best things about nursing in the UK:

1. Pins

Yeah, pins - as in those from your school of nursing. It is absolutely fantastic that nurses here take such pride in where they went to school. I’ve seen nurses who are total strangers and have clearly not been in nursing school for several decades strike up conversations as soon as they see each other’s pins and realise that they went to the same nursing school. When I graduated from nursing school, we were each given a pin and a lecture about how they represented the history of nursing, in much the same way that caps and capes had. Did any of us ever wear them? No. And when I moved here to the UK and finally had the opportunity to do so, I realised that my pin was lost. So I’ll send out my thanks (again) to the administrator back at my nursing school who was kind enough to send me a replacement.

2. Universal registration

There are not many things that I appreciate about the NMC, but the single register for all UK nurses is an organizational triumph. In the US, each state has its own Board of Nursing , so if a nurse moves from Texas to Florida, she has to get a new nursing license in Florida. And each state (all 50 of them) has different paperwork and different fees that need to be paid. Here in the UK, if I get tired of London and move to Cornwall, I don’t have to switch my NMC registration along with the address that my council tax is sent to.

3. Patients are more appreciative in the UK

Or maybe, because they don’t have to pay cash for their healthcare, they instead try to pay for it in chocolates and biscuits. I could live for days on the amount of food that is available on wards, although my uniform would cease to fit quite quickly. Gifts from patients are much less common in the US, although I am certain that they are no less appreciative of nurses’ efforts (even though I have no way to prove this by any average-sweets-per-patient calculation).

4. (Essentially) free nursing education

My pre-registration nursing education cost roughly $60,000. This did not include any living expenses and there are no bursaries in the US. I do not dare predict when these student loans will be paid off—an entirely too depressing exercise.

5. Universal healthcare

All of our patients in the UK have access to comprehensive care, ranging from preventative primary care to acute care to end of life care. Does that care differ slightly by postcode? Perhaps, but 99% of the care that we nurses provide is equally available to everyone. Patients may have to wait sometimes and they may not have the newest, shiniest facilities, but no one is denied the basic human right of health care. They may not always choose to use that care appropriately, but that is their decision to make, not ours. And the NHS, for all of its flaws, bureaucracies and inefficiencies, delivers a vital service to the UK that should be envied by Americans and all nationalities that have not yet developed their own national system for healthcare delivery. Although, based on the successful vote for healthcare reform in the US Congress on March 21, it seems as though the US has finally decided to follow the lead of the UK and provide care for all.

Readers' comments (23)

Catherine Rotte-Murray | 25-Apr-2010 11:00 am
I think we in Ireland could match 4 out of the 5 favourite things you like about UK nursing - all except the free universal healthcare. Ireland is unique in Europe in perpetrating a divisive two-tier health system whereby everyone pays health levies deducted at source as a tax and yet over half the population takes out private health insurance to enable them to queue jump for elective surgery. It is a disgraceful anomaly and I refuse to have it on principle even though the last time I was sick I spent 33 hours on a trolley in A&E and a side-ward. I am a public health nurse where the whole ethos is care based on need rather than ability to pay. (I am also a member of the Irish Labour Party who subscribe to universal health care, public not private, based on need.) As well as the divisive system I described, the free care is excellent for those who meet the criteria for a Medical Card - this gives free public care from GP to hospital to dental and optical. Sadly you can be excluded by working in a low -paid job as the ceiling is very low- below the minimum wage so it only suits social welfare recipients or part-timers. Opposition parties are full of ideas for change to universal care, only the right wing govt. believes in the market finding its level - our health minister famously said some years ago we were closer to Boston than Berlin - as if it was a proud boast! It might be in any other way than healthcare access! Glad that the US has seen sense at last - I cannot accept that healthcare is not a basic human right.
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mike | 25-Apr-2010 11:44 am
I'm sorry to bring down the spirit of optimism, but can I pull you on a few points?

Patients are more appreciative in the UK. Are they? Some are yes, and it is always nice to get a thankyou or a card, and boxes of roses are hoovered up in record time in the Nurses station, but not all patients are. But I think the culture of free for all healthcare (which I love and will always defend) and especially the patients 'rights' policies has created a culture were a large proportion of patients nit pick at the slightest thing and are not thankful at all. They are more concerned that their private side room doesn't have a big screen TV, or god forbid they have to go in a bay. They complain that Nurses aren't smiling, even though we may have finished a 12 hour shift and been run off our feet, they complain they complain they complain, never mind that we have just saved their lives. They put formal complaints in, they sue when things aren't 'perfect'. Although I suppose this last bit still isn't as bad as in America yet.

(Essentially) free nursing education. Again this is an annoying false assumption. Yes I did not have to pay tuition fees like I did with my first degree, but I did not get a bursary on the degree (incidentally noone else will either once diplomas are phased out). And I consider the full time hours that I had to work on placement and in uni WITHOUT PAY as payment for the degree. Students who gain their Nursing qualification WORK for that qualification, and put vastly more hours in than anyone working a normal 9 - 5, never mind the extra work we do just to earn money. I have never been so poor than I was as a student Nurse and considered leaving more than once because of it. Nursing quals are not 'free' by any stretch of the imagination and the government gets it's moneys worth out of us.

Universal Healthcare. Now this I agree with you on. It is not perfect by any stretch of the imagination but this is still perhaps one of the greatest things this country has ever done.
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Sue Bacon | 25-Apr-2010 1:10 pm
On the universal healthcare issue - don't forget that for every one operation in the private sector (apart from the expensive plastic surgery that is not entirely necessary for health) a space is freed up in the NHS and putting people up the list directly because we have a private health service as well.

I have worked in both sectors and believe me, the surgeons who do work in the private sector who also work in the NHS, only do so in their own time - hence w/es etc are busier than in the NHS.

Have you ever asked yourself how much money an NHS hospital makes by providing private appointments and beds ?- money that is welcome.

We will never be able to make everyone happy on this issue, but I firmly believe that we all have a right to spend our money as we wish.
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halfanurse1987 | 25-Apr-2010 2:15 pm
Mike you have highlighted the difference between Scotland and the rest of the UK.
I have a previous degree and am doing an nursing degree not a diploma and I get a full Bursary.
In Scotland, yes, to study nursing is essentially free. No tuition and a bursary for all provided your course is at pre-reg level. Of course if you chose to do the diploma initially and then go on to upgrade to the degree you will have to pay for that as you are already registered. If you do the degree first time round you dont have to pay and get the bursary because you are not on the register yet.
Makes me very glad that I am doing my degree up here.
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Anonymous | 25-Apr-2010 3:02 pm
I think it's wonderful that Sarah Morgan is having an overall positive experience working in England. I trained and have worked most of my career in Canada but had the greatest pleasure to work in England for 3 years, both in the private and public sectors. This summer I will have the opportunity to work in Virgina for 3 years. While each hospital setting that I have worked in has been a positive experience there are downsides to every work place but concentrating on the negative is unhealthy. Let's all take Sarah's viewpoint and only concentrate on the positive aspects of our jobs and maybe there would be less complaining in Nursing.
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Fiona Ramsay | 25-Apr-2010 8:10 pm
Sarah - even now you manage to say that the only reason that you are saying something positive is because the feedback you receive suggests you are negative.
One of the cornerstones of nursing is reflective practice - perhaps that would be a skill to role model in this forum. You are in a privileged and powerful position to have a public forum to air your views - perhaps there is a more positive way to use that power and privelege, something that brings people together for the greater benefit of health service recipients.
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fondmoton | 25-Apr-2010 11:26 pm
I'm an American (male) who would like to work as a nurse in the UK (LONDON). I enjoy this sight and would appreciate Sara or anyone who can give me the correct steps I need to follow to make this happen. I do know about the NHS, but not really what type of Visa is best to apply for, etc. In my early 40ies and don't what to waste years going down the wrong channels. I'm the UK and have many friends (some UK nationals and some Americans) and would like to experience working as a nurse there. I'm curious how nursing education compares to that in the US. Also, are male nurses pushed into psych and emergency nursing as seems to be the tendency in the US?
If you can provide the correct steps in the correct order, that would be so helpful.

The only aspect of complaining should be over compensation. It is nice if people thank you as that is the proper thing to do, but never should it be expected, nor gifts. If one is practicing for any there reason then working on their practice, I disagree. Nothing in life is free? Don't people pay tax in the UK? If any society charges a tax for any reason, that is for the welfare of all those people in the society. While some pay more then others by choice or not, should not be the issue. That is a real problem in the US, because we have our issues withimmigration and people working illegally, but those who are working must buy things and there is a tax on all most everything except essential food items. All taxes go to pay for all services. However, I don't think private should infringed on public.

If anyone can provide that direction I would greatly appreciate it? Thanks

P.S. What area of nursing are showing major shortages at the moment in the UK?
Just wondering. Huge deman for homecare in the US.

Thanks
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Anonymous | 26-Apr-2010 8:47 am
Fondmoton

Presuming you are a qualified nurse, you will find all the information you need about working in the UK on the NMC website.

Male nurses do gravitate to some areas but you can work where ever you like.

And yes, like the rest of us, you will pay tax, and national insurance which pays for your free at the point of contact health care.

Good Luck.
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Karen Alderson | 26-Apr-2010 9:59 am
As for patients being appreciative, I agree! I work in the community, where most of my patients can't afford to shower us with gifts, but they are 99.9% all so very grateful and pleased to see you - that's all the thanks we need!
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Anonymous | 26-Apr-2010 12:12 pm
We earn about half of what an American nurse gets to live in a more expensive society. But we get a few boxes of Quality Street. Great.

Nor do we have the minimum nurse:patient staffing legislation that some States have implemented.

As for pride in my school of nursing? You couldn't be further from the mark, it was a sham. I've already done a BSc at a proper Uni and the difference was remarkable.

The UK public think nurses are thick and one step up from a janitor. In the USA nurses are at least considered to be educated. Here, they do not know the difference between a domestic, healthcare assistant and nurse. If we try to inform them we are demonised.

I would rather be a nurse in the USA. Free nursing education? We come away unable to do IV meds, bloods, cannulation, tracheal suction. It's pathetic. Yet waste years on "the essence of care", and the latest initiative, to test compassion. Then suddenly, you're on your own on a ward and all of that pales into insignificance. USA nurses do the above things during their courses.

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jjjez@hotmail.com | 26-Apr-2010 8:23 pm
Wow. Even i haven't this much ire for this post.

This is a bit like 'Sicko' where Michael moore pointed out the inherent adavantages to not having the US healthcare system.

Who cares what the negatives are when so many positives have been pointed out.

She is admiring what we do and what we have to do it.

That said our education is atrocious. i'm glad i went to 40% of my lectures and learnt all the important stuff myself.

The training is in dire need of comparable standards with the rest of the world - that graduates its nurses as actualloy clinically able staff rather than the stepping stone nonsense the mummy bears insist on.
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Latterlife Midwife | 26-Apr-2010 8:25 pm
Fondmoton, go to the Nursing & Midwifery Council website and you will find what you need to have your qualifications assessed. They will tell you what you need to provide. If it is agreed you may attempt to be licensed here (you'll be lucky if you know anything in 3-6 months), you will need to take the Overseas Nurses Programme that might also require a placement work site of anywhere from 3-12 months.

At the same time, you will need to negotiate the extreme bureaucracy of the Home Office to apply for a visa to allow you to do the above. This will cost you a small fortune and you will have no access to a human being to answer questions; only a website. Paperwork is extremely tricky to fill out correctly, and you will find if anything is unclear/wrong, the fee you paid (hundreds of $$) will be kept and you will have to start again. Months will pass with you at the mercy of the Home Office. You will find it a tad easier if you qualify to be hired at Band 7 or higher (senior supervisory level nurses), because 'regular strength' nurses, and midwives (Band 5 & 6), are not on the immigration shortage lists any more excepting a few, i.e. theatre nurses seem to always be there.

If the Home Office should make an error which is then verified as such, you will find a year passing before it is corrected. And all this for, as Anonymous | 26-Apr-2010 12:12 pm says, "...about half of what an American nurse gets to live in a more expensive society." It is very expensive to live in the UK. Even after 3 years here, I am still stunned at times when I realise what I've just paid in equivalent $$'s. Half the pay, often twice the expenses. The huge saving grace, of course, is the NHS itself, with the access to health care you will enjoy.

I'm not going to badmouth nursing or midwifery here because there are many great things about both. But the struggle is real and must not be ignored. I came over with a great sense of adventure after retiring from many years of nursing in the US and having raised a family. I do not regret it one bit but it was 10 times harder than I expected, and continues to be. I love Britain but will probably have to give up after a few more years, or I'll have nothing left in my bank account. Unless you come over with a hefty surplus, expect to run through your savings trying to live frugally.

Finally, be sure to look at the recent Nursing Times article in which Dr. Pena calls for a safe nurse:patient ratio. The letters section of that article will open your eyes, chill your blood, and curl your hair all at the same time. Good luck with whatever you do - you're going to need it.
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Laura Canna | 27-Apr-2010 4:03 pm
Mike: "Patients are more appreciative in the UK. Are they?...I think the culture of free for all healthcare (which I love and will always defend) and especially the patients 'rights' policies has created a culture were a large proportion of patients nit pick at the slightest thing and are not thankful at all. They are more concerned that their private side room doesn't have a big screen TV, or god forbid they have to go in a bay. They complain that Nurses aren't smiling, even though we may have finished a 12 hour shift and been run off our feet, they complain they complain they complain, never mind that we have just saved their lives."

I'm an italian nurse and we have the same problem. Everywhere people speak about patients' rights, best care for everybody, high standars of quality, and people (or clients or patients) because of these rights are becoming more and more impolite, especially with nurses.. what about Nurses' rights in the UK? Are they better of Italy?
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Anonymous | 27-Apr-2010 7:10 pm
I am sorry but as a foreigner your English moaning got to me.

In most of Europe we are priviliged to have a national health system. We have mostly first class care at no cost to ourselves. Sure, we wait a long time for non urgent referals, but in an emergency the care is there and we do not have to worry about the finances. Different countries have slightly different systems and maybe if we learn to pick the best bits from each we can make it each one even better, but the fact that it is FREE, should make us all very grateful.

Imagine if someone from your family was diagnosed with cancer, or had a heart attack. How many of us would have the finances to pay for treatment? Please lets not slam the system because it has kinks that need ironing or because we are overworked and stressed. As workers in that system we are its first line of defence. We are also in a position to innovate and make it better for all.

As regards to training, in England you are far too spoiled. I studied full time for a Diploma in Nursing. Back home degrees are only a recent introduction which has only just started. I (or rather my parents) paid for my university training (like 98% of parents of uni students back home). For the first year I was at uni AM and PM. During the second and third year we alternated; hospital in AM (0800-1300), class in PM (1400-1700), viceversa the following week (class 0900-1300, hospital 1400-1800). I worked like an ass and never got paid. You could argue my parents paid for me to work (and get trained). And when I got home I still had assignements.

Yes, that makes a 40h hour week, unpaid, for the best part of two years. It was real work too. The idea being that after you finished, if you were let loose in a hospital or community you kenw how to handle yourself.

Better system? Worse system? I like some things, prefer others in the UK. But having the privilige of going to university and getting paid for it? Completely new concept until I got to this country. Just because it is changing dont be ungrateful for it.

Another new concept. Further training (completing my BSc) is paid for by my Trust. And I get time off work for some of it too! Some may complain that it is not enough, I am just grateful for the opportunity. Could it be better? Sure. But dont be unappreciative of what you have simply because you have it.

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jjjez@hotmail.com | 28-Apr-2010 11:57 am
Well you aren'tpaid to go to university at all.
they have to conribute to your living expenses because nurses don't get the glorious 3 monthsof holiday to earn money.
and besides £7000 ayear is nothing. once my rent had gone out i had £25 a week to live on

don't comparethe paid wage status of previous years to the situation today. they aren't comparable
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Anonymous | 29-Apr-2010 1:20 am
There are loads of really great thing's about the U.K.'s healthcare system. When I've travelled around the world and experienced some of the inferior system's my thoughts are always glad we've got the NHS - but it could be so much better. There is far too much waste and poor way's of working.

However I should point out that it's not free and a good amount is sub standard.

Michael Moore's film is a crock. 40 million people without healthcare in a country with a population of 300 million? Between the 18-40 indestructibles who are never going to buy insurance and the people at the bottom of the pile who would never wipe their own arse if the government didn't pay for it that's not a lot of people falling through the cracks. Free healthcare in Cuba? Give me a break Michael. You got the top flight tourist stuff, I'm sure you wouldn't want to live and work there. Socialist party nepotism at it's best.

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Steve Williams | 29-Apr-2010 3:35 am
Hey Guys and Gals.... (c) Jimmy Saville OBE

Stop nit-picking Sara Morgan's musings. She's a Yank in Britland - I'm a Brit in North America. I find her articles fascinating (from a reverse viewpoint) and I wish I had the testicular courage to write a similar series of columns.

What I find deeply disappointing is the parochial and proprietorial views expressed by the totally-passable but prolific poster known only as "ANONYMOUS" on these pages. He's a great poster but definitely NOT a nurse of any standing - just an NT-paid wind-up merchant or troll - please ignore him!

Good grief, get a life!

Modern nursing, per se. , may have begun in the Middle Eastern theatre of the Crimea War - Turkey - courtesy of a statistician who recruited dedicated Nuns to follow her radical and controversial teachings... but, seriously, that was nearly 150 years ago...

Have we, as qualified nurses, not moved a little further on now? I think not!

When Flo started gathering her stats there was no concept of cross-infection... she asked female nurses to wear their headgear in order to prevent their live nits dropping into patients open wounds. Dohhhh....

150 years later and UK nurses are still whining - like little girls and postulating pre-pubescent prima-donnas - about trivia like uniforms, pay, parochial and proprietorial aspects.

"As you sow, so shall ye reap"

I only ask that UK nurses understand that the Registered Nursing qualification does actually exist beyond the EU borders - it is acknowledged in the Northern Hemisphere (apart from frigging Ontario) but what we need to do is establish collaborative and positive dialogue between ALL of our professional colleagues (in whichever country they are currently practising) to bring about "universal" good-practice.

Dohhhh... It's a no-brainer.. Keep on going on about going on Sara... I love it!

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Anonymous | 30-Apr-2010 1:31 pm
Steve, I work in "frigging Ontario". I am interested to understand what you mean by your above comment.
Thanks
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Steve Williams | 1-May-2010 3:17 am
One word... REPROCITY

Look it up. It's in WEBSTER's and OXFORD's.

Alas... The College of Nurses of Ontario does not recognise the word.

Yup, if you qualify in the UK your RN status will be recognised by every country in the world – and all nine Provinces and three Territories of Canada. Only 'frigging Ontario' demands that you go back and take a 'frigging' RN entrance exam. Trust me, I had to go and do it!!!!

Bitter? You bet your sweet bippy I am – especially since I know that that Ontario-trained Registered Nurses get a free-pass into the NHS.

My personal opinion... the current nursing legislative body should not recognise the Ontario RN qualification until they recognise ours.
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Anonymous | 1-May-2010 11:53 pm
Do you mean RECIPROCITY? Mr Williams
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