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Nursin' USA - Why I love nursing in the UK


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 (24)

  • 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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  • 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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  • 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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  • 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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  • 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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  • 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

    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.


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  • 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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  • 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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  • 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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