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Nursin' USA - Lessons from across the pond


In the first of a new series looking at the differences between nursing in the UK and the US, Sara Morgan talks about tricky hospital corners.

When I first moved to the UK and began practicing as a nurse here, I knew that adjustments would have to be made. 

First, I had to relearn my mother tongue because, as George Bernard Shaw noted, “England and America are two countries separated by a common language”. Every drug had a different name on this side of the Atlantic, abbreviations were changed (why is nitroglycerin GTN in the UK and NTG in the US?) and my spelling, which had always been stellar, was suddenly terrible. Recognize these: pediatrics, esophagus and hemaglobin? 

While my left brain was struggling with getting my words and pronunciation right, my left brain was coming to grips with all of the different numbers I was encountering. I was surprised that the UK still weighed people in stones as I was quite sure that both pounds and kilograms were readily available.  Most lab values had radically changed as well.  A normal blood glucose in the US is between 80 and 120 mg/dL. Change the units, though, and all of a sudden, normal becomes 4 to 7 mmol/L here in the UK. 

But my biggest hurdle in adjusting to work here came from a surprising source: hospital corners.

You are probably reading this thinking ”What’s the problem? Hospital corners are easy to do and if you weren’t taught how to do them at home, weren’t you taught during your very first hospital placement in nursing school?And that’s where you would have identified a key difference between American and British healthcare: the fitted sheet. 

In my American hospital, we had fitted sheets to go on mattresses and flat sheets to be tucked over patients with their blankets. When I realized that my new English hospital didn’t have any fitted sheets, I suggested that purchasing some might save a lot of time for nurses when they make beds. Additionally, since fitted sheets don’t slide loose, nurses aren’t constantly trying to pull out wrinkles that have formed underneath patients who do a lot of tossing and turning. The explanation I received was this: all sheets were pressed after laundering and fitted sheets would not pass through the rollers of the press.  Since I had no suggestions for how to get around this requirement, I was left wondering why sheets needed to be pressed in the first place. I admit that Americans are known for being casual in both dress and attitudes, but in this case, our “casual” and therefore unpressed hospital sheets seemed to be a benefit to both nurses and patients. 

Fitted sheets were not unique to my hospital, either. Back in nursing school, in between learning to measure blood pressures and how to put on sterile gloves, we were shown how to make hospital corners. Once. And the professor even prefaced the lesson by saying “We will be showing you how to make hospital corners today, but only for historical reasons. You’ll never have to do them in practice.”  We all watched attentively, laughed at how old-fashioned it seemed (right up there with wearing nursing caps) and then promptly forgot all about it.

“We will be showing you how to make hospital corners today, but only for historical reasons. You’ll never have to do them in practice.” 

This lesson came back to haunt me. I was fine asking my fellow English nurses to show me how to use an unfamiliar type of ECG machine, or having to look up drug names in the BNF, but my pride was at stake when it came to bed making. I simply couldn’t ask anyone how to make hospital corners. It was too basic a skill, almost as bad as asking someone to show me how to feel a pulse. So I slyly watched the other nurses around me, and tried to pick up their techniques. If I was helping someone to make a bed, I made sure I was ready with the blankets and top sheet, while the other person tightly tucked in the corners. But for all of my observing, copying and practice, I still can’t make a proper hospital corner. The edges are loose, the creases saggy and the sheet pulls free at the slightest hint of tension. 

So, to any of my British patients who have woken in bed to find bunches of fabric gathered under their shoulders, or the bottom of their sheet wrapped around an ankle, I offer my apologies.  This American can convert her weight into stone and spell colour with an extra ‘u’, but she simply cannot master the art of the hospital corner.


About Sara Morgan

Sara Morgan trained and practiced as a nurse in the United States before coming to work in the UK.  She has worked as both a nurse practitioner and as a lead nurse on the Productive Ward initiative.



Readers' comments (27)

  • Nice. I am British but I trained in the United States. I lived over there for a total of 20 years before I came back to the UK. Old fashioned and backward are understatements. The backwardness really makes things hard for the nurses here.

    I was taken by surprise by the hospital gowns here in the UK. They have no snaps on the shoulders and staff have to take IV tubing out of pumps and weed the entire set up through the sleeves when changing a gown. Or they have to disconnect the IV. This leads to care assistants pulling IV lines out of pumps without clamping the line, even after being told that they shouldn't be touching the things. Why don't we just have snaps on the sleeves?

    The enitre 30 bed ward has two phones in bad locations away from the patients. Over there each nurse had hospital issued mobile phones strapped to their uniforms so that the ward clerk could just transfer a call straight to the individual. If I was with a poorly patient and needed to call a medic, I didn't actually have to leave the patient's side to go and que up by the far away phone as I do here. If I was with a patient and needed help I rang another nurse rather than leave the patient to look for another member of staff.

    We had computers that we entered obs and intake and output values into and it totaled things and gave a nice updated print out. Our handovers were updated daily by computers and ward clerks who were trained to make sure all the information was needed was there. The information that you needed to do your job and no about your patients was so much clearer and organised.

    Over here I have to short hand jot all the information I am getting for 20 patients in report. IF my hand cannot keep up with the speaker, I miss crucial information. Pharmacy immediately recieved orders for any new IV drugs that were ordered via computer by the doctor and mixed the IV meds and tubed them up to us ready to go over there.

    It takes me two hours to order from pharmacy, chase IV drugs and mix them myself just for the IV's on one drug round in the NHS. No wonder the patients here don't see their nurse.

    And this was in the US 15 years ago.

    I am heading back over there so I guess it is time for reverse culture shock to rear it's ugly head.

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  • Wow. I never would have thought that any thing so ridiculous, time wasting and screwed up as productive ward would come from an American.

    The problems on these wards are lack of staff and poor design of the wards themselves. No amount of cupboard tidying and fall charts to colour in are going to solve those problems. It just makes it worse.

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  • I am a Canadian trained nurse (Graduated in 1982, who had the opportunity to work 3 years recently in England: both in the private and public hospitals. At first it was challenging with the drug names and the terminology, as there were differences in the spelling the pronunciation of words, At first it was difficult to even understand what you were saying but now I am proficient in understanding and even chuckle when I hear the language on TV or see a British play at the theater. All in all I managed quite well working as a nurse in the UK and I had a wonderful experience and made a lot of friends.
    This year I am embarking on a new adventure and will be working in the USA. I look forward to the differences and the similarities that I will encounter and am up for a new and exciting experience to live in another country. I will let you know how I made out when I get back to Canada in 3 years. As for making beds, I know how to miter a corner and I know how to use fitted sheets so I should be OK!!
    After all. the principles of nursing is the same no matter where you work.

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  • I nursed in Germany for a while, they had fitted sheets and duvets - easy peasy!

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  • Sara, If I were you I would still try to get fitted sheets as they are much more practical and comfortable for patients. If your administration say that all sheets need to be pressed then I would say that fitted sheets don't need to be pressed and would save a lot of time and money in not pressing them. Fitted sheets certainly aren't pressed where I work in Canada and they are soft and comfy for the patient. I think the problem is that England is too stuck in the past and is not open to change. Am I right or wrong?

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  • I really do feel you guys, i mean being in a school that still wears a hat and wears a dress and stockings what can i say. despite the fact that all our textbooks are american textbooks and a good number of our tutors are american trained, we are still stuck in the archaic form of nursing. nothing is computerised asides the clerk's notes, we still have to jot down during hand overs and hunt the pharmacy down for meds then mix them. infact it's hilarious but not only do we still make beds like the british, we still mix our hep flush ourselves with an 100ml NS bag and heparin, if the nurses choose to do so... it's ridiculous in this time and day but some nursing schools and teaching hospitals are still in the then days and al the evidence of technoloy we have is in our textbooks. Oh did i mention am a BSN student.... u can imagine how it was for my associate colleagues or the diploma nurses.... well the good thing is we're learning the hard way, bet it will help us to manage situations when technology fails....

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  • "I think the problem is that England is too stuck in the past and is not open to change. Am I right or wrong?"

    100% right.

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  • Having nursed for 20 years in UK,
    then 20 years in the US,I recently visited my 94 year old Mum(Mom) in a UK hospital.
    It really was like stepping back in time,with the archaic unappealing nurses uniforms which must have been designed by Florence Nightingale herself...(OK the silly hats have finally been consigned to oblivion).
    As for corners on sheets,I trained in RAMC and still make hospital (army) corners on top sheets AND blankets much to the amazement of my US counterparts.
    I'm sure fitted sheets are better for our patients, and running round the bed lifting the mattress stretching them to the corners is healthy exercise for those of us with an unhealthy lifestyle.
    The jury is still out on cost savings.
    Nonetheless,despite my criticisms,
    my Mum received exceptional and expensive medical.nursing and discharge planning care from a well organised treatment team ,which cannot be surpassed
    in the best of US hospitals.
    My thanks to Doncaster Royal Infirmary and the NHS.

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  • I am a UK trained nurse, currently working in Vancouver, Canada. I worked in the NHS for 17 years before coming to Canada, and am all too familiar with the outdated uniforms, caps, capes, hospital corners etc. But I have to say that working in scrubs (any cartoon character will do) just doesn't have the same professional appearance. Doctors, nurses, ward aides, care aides, porters - they all look the same!! There is no distinguishing whi is who. Also, the hospital where i work is so pleased we have finally gotten a vernacare bedpan macerator!!! they don't believe me when I tell them we had these 15 years ago in the NHS. We still have to hand wash plastic bedpans however and this is normal practice!!! Seems behind the times. And for those people not lucky enough to have an employer who pays for their health benefits, the cost of being ill/having a long term condition in Canada is astronomical. I know one thing for sure, in the UK we don't kow how lucky we are to have the NHS!!

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  • Aonymous at 4:58. I am not sure I understand your post. I thought that they had socialised medicine in Canada? Why do people there need employer provided health insurance? Is it so they can go to the USA for treatment because the socialised medicine is so horrific?

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