Sports in Australia
Australia has major professional leagues in Australian Rules football (Australian Football League) and rugby league or league football (National Rugby League). However, league football is predominantly only played in Queensland and New South Wales. Rugby union also exists, but I have heard very little about this sport. There are state and national cricket teams. There is a professional soccer league, but I heard nothing about it until after the season was already over. I think there is also a professional netball league. Netball is much like basketball, except there is no backboard, and dribbling and running with the ball is not permitted. As far as I know, the professional league is women only, and while there are co-ed recreational teams, the sport is predominantly played by women. Recreational tennis is fairly common, but public and school tennis courts are locked and are allowed to be played on only for a fee. University sports are played only in a recreational sense.
Sports in the U.S.
The U.S. has major professional leagues in football, baseball, basketball, ice hockey, and soccer. Public and school (high school and university) tennis courts are unlocked and open to the public free of charge. College (university) sports require a high degree of talent and skill, are highly competetive, and carry a following similar to that of professional teams.
Clothing in Australia
Pants, shorts, and skirts are worn much tighter in Australia than in the U.S. by both men and women (No, the guys don't wear skirts). Dresses and skirts are also worn a lot shorter. Skinny jeans are not necessarily an indicator of a guy's sexual orientation. Guys wear their shorts, especially athletic shorts, much shorter than American guys do. Shorts are fairly commonly worn to work. Weekend evening going out attire for girls is most often a dressy minidress and very high heels. Tights or pantyhose are almost always black or navy blue. People commonly ride the bus, walk down the street, and go into stores barefoot.
Clothing in the U.S.
Pants, shorts, and skirts are worn much looser in the U.S. than Australia by both men and women. Skinny jeans worn by men are usually only worn by gay men. Mens' shorts, including athletic shorts, are almost always long enough to touch the top of the guy's knees. Shorts are never worn to work and would be considered completely unprofessional. Weekend evening going out attire for girls would most often be jeans and a nice shirt. Pantyhose are almost always skin-colored. Going barefoot in a public place other than the pool or the beach is considered low class. Most businesses (stores, restaurants, etc.) have signs bearing the slogan "No shoes, no shirt, no service", meaning that if you are barefoot or shirtless, they will not serve you.
Monday, June 14, 2010
Sunday, May 23, 2010
Free Refills & Fast Food Restaurants
Drink Refills in the U.S.
Anytime you go to a restaurant in the U.S., every person will be given a water glass that will be refilled by the waiter anytime it gets low. In the same way, if you order a soda, the waiter will also continually refill your soda glass. There is no limit to the amount of refills you get, and the vast majority of restaurants will only charge you for one drink.
Drink Refills in Australia
Water glasses are provided at some restaurants in Australia along with a carafe filled with water. Waiters do not routinely check on their customers, so if you drink all the water in your carafe, your waiter may not be around to notice. If you order a soda, the glass is about 2/3 the size of a soda glass in the U.S. Free refills in restaurants do not exist. If you want a refill on your soda, you have to pay for another drink.
Fast Food Restaurants in Australia
Fast food restaurant chains in Australia are McDonald's (called Macca's), Burger King (called Hungry Jack's), KFC, Subway, and Red Rooster. If you order a regular size combo meal, the drink and French fries (called hot chips) are about the size of those in a Happy Meal. If you upsize your meal once, the drink and French fries are about the size of those in an All-American Meal. If you upsize your meal twice, you will receive a drink and French fries the size of a regular combo in the U.S. The only fast food chain that has its drink machine in the dining area and not behind the counter is Hungry Jack's, so that's the only place you can get free refills. I think the food at McDonald's, Hungry Jack's, KFC, and Subway tastes about the same as it does in the U.S., however KFC does not sell biscuits or strawberry shortcakes in Australia.
Fast Food Restaurants in the U.S.
There are no Red Roosters in the U.S., but with that exception, the U.S. has the same fast food chains as Australia and quite a few more.The vast majority of fast food restaurants have their drink machines in the dining area, not behind the counter, so you can always get free refills.
Anytime you go to a restaurant in the U.S., every person will be given a water glass that will be refilled by the waiter anytime it gets low. In the same way, if you order a soda, the waiter will also continually refill your soda glass. There is no limit to the amount of refills you get, and the vast majority of restaurants will only charge you for one drink.
Drink Refills in Australia
Water glasses are provided at some restaurants in Australia along with a carafe filled with water. Waiters do not routinely check on their customers, so if you drink all the water in your carafe, your waiter may not be around to notice. If you order a soda, the glass is about 2/3 the size of a soda glass in the U.S. Free refills in restaurants do not exist. If you want a refill on your soda, you have to pay for another drink.
Fast Food Restaurants in Australia
Fast food restaurant chains in Australia are McDonald's (called Macca's), Burger King (called Hungry Jack's), KFC, Subway, and Red Rooster. If you order a regular size combo meal, the drink and French fries (called hot chips) are about the size of those in a Happy Meal. If you upsize your meal once, the drink and French fries are about the size of those in an All-American Meal. If you upsize your meal twice, you will receive a drink and French fries the size of a regular combo in the U.S. The only fast food chain that has its drink machine in the dining area and not behind the counter is Hungry Jack's, so that's the only place you can get free refills. I think the food at McDonald's, Hungry Jack's, KFC, and Subway tastes about the same as it does in the U.S., however KFC does not sell biscuits or strawberry shortcakes in Australia.
Fast Food Restaurants in the U.S.
There are no Red Roosters in the U.S., but with that exception, the U.S. has the same fast food chains as Australia and quite a few more.The vast majority of fast food restaurants have their drink machines in the dining area, not behind the counter, so you can always get free refills.
Saturday, May 1, 2010
Housing & Driving
Housing in Australia.
The vast majority of single adults live in shared housing, meaning they share a house or apartment with at least one other person. Rent is charged on a weekly basis, and bond (deposit) is usually 4 weeks rent. Some houses and apartments have air conditioning, but definitely not all. Even those with air conditioning often only have a wall air conditioner in the living room, but nowhere else. Housing is very expensive. A furnished 1 bedroom or studio apartment at the lowest end of the scale would be at least $400-$450/week not including utilities.
Housing in the U.S.
Most single adults have their own apartments. Shared housing after graduating from college (uni) is fairly uncommon. Rent is charged on a monthly basis. Deposit varies, but I think my deposit when I lived in Houston was $250. My friend's apartment in Boston did not have air conditioning, but I think that's the only house or apartment I've ever been in that didn't have AC. Every apartment I've lived in has had central (ducted) air conditioning except one, which was very old and had a window unit. Housing costs vary by region. An unfurnished one bedroom or studio apartment in Houston would cost from just under $600/month to around $900/month. Furnished one bedroom or studio apartments in Washington, DC and Chicago would be $1100-$1500/month, New York City $2600/month, and San Francisco and Boston $1850/month. An unfurnished lower end one bedroom or studio apartment in New York City would be $1600-$1750/month.
Driving in Australia.
Cars drive on the left side of the road (People also walk on the left hand side of the sidewalk (footpath), store aisle, hallway, etc.). The driver's side of the car is the right hand side. Drivers shift gears with their left hands. I have not seen any intersections with stop signs. All intersections without stoplights have roundabouts. Speeds are measured in kilometers/hour and distances are measured in kilometers. The fastest speed limit is 110km/h (68mph). Petrol (gasoline) is measured in liters. The average price of petrol in Brisbane is $1.303/L AUD ($4.82/gallon USD). I don't think I've seen any gas stations with pay-at-the-pump. Gas stations are called servos. Street lines are painted in white. Chevys, GMC's, Pontiacs, and Saturns are not sold in Australia. Even for the brands that are the same as in the U.S., the vast majority of the models are different. I can count the number of luxury cars I've seen on one hand. Most cars are compact cars or small sedans. There really aren't trucks like the ones in the U.S. Utes and sport utes are probably the closest thing to a truck. I think vehicle registration is around $700 AUD($642.34 USD)/year.
Driving in the U.S.
Cars drive on the right side of the road (People also walk on the right hand side of the sidewalk (footpath), store aisle, hallway, etc.). The driver's side of the car is the left hand side. Drivers shift gears with their right hands. Intersections with stop signs are common. The only place I can think of that has roundabouts is Washington, DC. Speeds are measured in miles/hour and distances are measured in miles. Speed limits vary state to state. The fastest speed in New York is 55mph (86km/h), 65mph (105km/h) in most of the east, 70mph (113km/h) in most of the midwest and California, 75mph (121km/h) in the west, and 80mph (129km/h) in west Texas. Gasoline (petrol) is measured in gallons. The average price of gas in Texas is $2.745/gallon USD (74 cents/L AUD). Servos are called gas stations. The vast majority of gas stations have pay-at-the-pump, where you can pay by swiping your credit or debit card at the pump, and never have to go inside the store. Street lines are painted yellow to separate oncoming traffic and white to separate same direction traffic. Holdens and Peugeots are not sold in the U.S. Luxury cars are commonplace. There are a few compact cars, but most cars are medium sized sedans, SUV's (sport utility vehicles), or trucks. Vehicle registration in Texas is around $70 USD ($76.31 AUD)/year.
The vast majority of single adults live in shared housing, meaning they share a house or apartment with at least one other person. Rent is charged on a weekly basis, and bond (deposit) is usually 4 weeks rent. Some houses and apartments have air conditioning, but definitely not all. Even those with air conditioning often only have a wall air conditioner in the living room, but nowhere else. Housing is very expensive. A furnished 1 bedroom or studio apartment at the lowest end of the scale would be at least $400-$450/week not including utilities.
Housing in the U.S.
Most single adults have their own apartments. Shared housing after graduating from college (uni) is fairly uncommon. Rent is charged on a monthly basis. Deposit varies, but I think my deposit when I lived in Houston was $250. My friend's apartment in Boston did not have air conditioning, but I think that's the only house or apartment I've ever been in that didn't have AC. Every apartment I've lived in has had central (ducted) air conditioning except one, which was very old and had a window unit. Housing costs vary by region. An unfurnished one bedroom or studio apartment in Houston would cost from just under $600/month to around $900/month. Furnished one bedroom or studio apartments in Washington, DC and Chicago would be $1100-$1500/month, New York City $2600/month, and San Francisco and Boston $1850/month. An unfurnished lower end one bedroom or studio apartment in New York City would be $1600-$1750/month.
Driving in Australia.
Cars drive on the left side of the road (People also walk on the left hand side of the sidewalk (footpath), store aisle, hallway, etc.). The driver's side of the car is the right hand side. Drivers shift gears with their left hands. I have not seen any intersections with stop signs. All intersections without stoplights have roundabouts. Speeds are measured in kilometers/hour and distances are measured in kilometers. The fastest speed limit is 110km/h (68mph). Petrol (gasoline) is measured in liters. The average price of petrol in Brisbane is $1.303/L AUD ($4.82/gallon USD). I don't think I've seen any gas stations with pay-at-the-pump. Gas stations are called servos. Street lines are painted in white. Chevys, GMC's, Pontiacs, and Saturns are not sold in Australia. Even for the brands that are the same as in the U.S., the vast majority of the models are different. I can count the number of luxury cars I've seen on one hand. Most cars are compact cars or small sedans. There really aren't trucks like the ones in the U.S. Utes and sport utes are probably the closest thing to a truck. I think vehicle registration is around $700 AUD($642.34 USD)/year.
Driving in the U.S.
Cars drive on the right side of the road (People also walk on the right hand side of the sidewalk (footpath), store aisle, hallway, etc.). The driver's side of the car is the left hand side. Drivers shift gears with their right hands. Intersections with stop signs are common. The only place I can think of that has roundabouts is Washington, DC. Speeds are measured in miles/hour and distances are measured in miles. Speed limits vary state to state. The fastest speed in New York is 55mph (86km/h), 65mph (105km/h) in most of the east, 70mph (113km/h) in most of the midwest and California, 75mph (121km/h) in the west, and 80mph (129km/h) in west Texas. Gasoline (petrol) is measured in gallons. The average price of gas in Texas is $2.745/gallon USD (74 cents/L AUD). Servos are called gas stations. The vast majority of gas stations have pay-at-the-pump, where you can pay by swiping your credit or debit card at the pump, and never have to go inside the store. Street lines are painted yellow to separate oncoming traffic and white to separate same direction traffic. Holdens and Peugeots are not sold in the U.S. Luxury cars are commonplace. There are a few compact cars, but most cars are medium sized sedans, SUV's (sport utility vehicles), or trucks. Vehicle registration in Texas is around $70 USD ($76.31 AUD)/year.
Sunday, April 25, 2010
Units of Measurement, Dates, Tax & Tip
The metric system (Australia).
Distances are measured in meters and kilometers. Speeds are measured in kilometers/hour. Temperatures are measured in celsius or centigrade. Height and length are measured in centimeters. Weight is measured in grams and kilograms. Volumes are measured in milliliters and liters. Nutrition information is measured in kilojoules.
The English or customary system (U.S.).
Distances are measured in feet, yards, and miles. Speeds are measured in miles/hour. Temperatures are measured in Fahrenheit. Height and length are measured in feet and inches. Weight is measured in ounces and pounds. Volumes are measured in fluid ounces, cups, pints, quarts, and gallons. Nutrition information is measured in calories.
Dates in Australia.
The day of the month always comes first, followed by the month, then the year. The 26th of October, 1982 would be written 26 October 1982 or 26/10/1982. The latter would be read and spoken as 26th of the 10th, 1982.
Dates in the U.S.
The month always comes first, followed by the day of the month, then the year. The 26th of October, 1982 would be written as October 26, 1982 or 10/26/1982. The latter would be read and spoken as ten, twenty-six, 1982.
Tax and tip in Australia.
Tax is always included in advertised prices. If something is advertised as $20, whether it is food, clothing, or petrol (gasoline), $20 is how much will be charged. Tipping is not expected for pretty much anything. Waiters make around $20/hour. There are public holiday surcharges for eating at a restaurant on a public holiday, usually about 15%.
Tax and tip in the U.S.
Tax is rarely ever included in advertised prices. I think the reason for this is that merchants feel they are more likely to make a sale if the customer perceives a lower price. Sales tax varies from state to state with the lowest being 5.5 or 6%. Sales tax in Texas is 8.25% and in Northern California is around 11.5%. Tipping is expected by waiters, bartenders, bellhops, taxi drivers, hairdressers, and shuttle drivers if they handle your luggage. It is considered tacky to not tip. Tips for waiters are usually 15-20% and bartenders can expect about $1 per drink. Tips for other professions vary. I think waiters make less than $3/hour, but waiters and bartenders can make a lot of money in tips. Tipping is an incentive for the service person to give good service. The amount of tip is expected to correspond with how good the service is. There are no public holiday surcharges.
Distances are measured in meters and kilometers. Speeds are measured in kilometers/hour. Temperatures are measured in celsius or centigrade. Height and length are measured in centimeters. Weight is measured in grams and kilograms. Volumes are measured in milliliters and liters. Nutrition information is measured in kilojoules.
The English or customary system (U.S.).
Distances are measured in feet, yards, and miles. Speeds are measured in miles/hour. Temperatures are measured in Fahrenheit. Height and length are measured in feet and inches. Weight is measured in ounces and pounds. Volumes are measured in fluid ounces, cups, pints, quarts, and gallons. Nutrition information is measured in calories.
Dates in Australia.
The day of the month always comes first, followed by the month, then the year. The 26th of October, 1982 would be written 26 October 1982 or 26/10/1982. The latter would be read and spoken as 26th of the 10th, 1982.
Dates in the U.S.
The month always comes first, followed by the day of the month, then the year. The 26th of October, 1982 would be written as October 26, 1982 or 10/26/1982. The latter would be read and spoken as ten, twenty-six, 1982.
Tax and tip in Australia.
Tax is always included in advertised prices. If something is advertised as $20, whether it is food, clothing, or petrol (gasoline), $20 is how much will be charged. Tipping is not expected for pretty much anything. Waiters make around $20/hour. There are public holiday surcharges for eating at a restaurant on a public holiday, usually about 15%.
Tax and tip in the U.S.
Tax is rarely ever included in advertised prices. I think the reason for this is that merchants feel they are more likely to make a sale if the customer perceives a lower price. Sales tax varies from state to state with the lowest being 5.5 or 6%. Sales tax in Texas is 8.25% and in Northern California is around 11.5%. Tipping is expected by waiters, bartenders, bellhops, taxi drivers, hairdressers, and shuttle drivers if they handle your luggage. It is considered tacky to not tip. Tips for waiters are usually 15-20% and bartenders can expect about $1 per drink. Tips for other professions vary. I think waiters make less than $3/hour, but waiters and bartenders can make a lot of money in tips. Tipping is an incentive for the service person to give good service. The amount of tip is expected to correspond with how good the service is. There are no public holiday surcharges.
Wednesday, April 21, 2010
Postal Service
The U.S. Postal Service
The U.S. Postal Service is owned and operated by the U.S. government. Post offices have individual listed phone numbers at which they can be contacted. The U.S. Postal Service picks up mail from and delivers mail to private residential mailboxes. Mail is picked up and delivered Monday-Saturday. Post office hours vary, but most open between 7:30 & 9AM Monday-Friday and close between 5 & 6:30PM. Saturdays, they open between 7:30 and 10AM and close between 12noon & 4PM. Some post offices are open Sundays for several hours. The post office is closed for 10 holidays each year. The price of a domestic stamp is 44 cents USD (47 cents AUD). The cost to mail a letter to Australia is 98 cents USD ($1.05 AUD). Mail forwarding is a free service.
Australia Post
Australia Post is a private company. Post offices do not have listed phone numbers. If you want to contact a post office, you have to call the national line. Australia post only delivers mail to private residential mailboxes; it does not pick it up. If you want to mail something, you have to take it to a street mailbox. Mail is picked up and delivered Monday-Friday. Post offices are open 9AM-5PM Monday-Friday and 9AM-12noon on Saturdays. The post office is closed for 11-13 holidays a year, including Good Friday, Easter Saturday, and Easter Monday. The price of a domestic stamp is 55 cents AUD (51 cents USD). The cost to mail a letter to the U.S. is $2.10 AUD ($1.95 USD). The cost of having your mail forwarded is $13.50 for 1 month, $25.50 for 3 months, $37 for 6 months, and $68 AUD for a year ($11.26, $21.27, $30.86, and $56.73 USD).
The U.S. Postal Service is owned and operated by the U.S. government. Post offices have individual listed phone numbers at which they can be contacted. The U.S. Postal Service picks up mail from and delivers mail to private residential mailboxes. Mail is picked up and delivered Monday-Saturday. Post office hours vary, but most open between 7:30 & 9AM Monday-Friday and close between 5 & 6:30PM. Saturdays, they open between 7:30 and 10AM and close between 12noon & 4PM. Some post offices are open Sundays for several hours. The post office is closed for 10 holidays each year. The price of a domestic stamp is 44 cents USD (47 cents AUD). The cost to mail a letter to Australia is 98 cents USD ($1.05 AUD). Mail forwarding is a free service.
Australia Post
Australia Post is a private company. Post offices do not have listed phone numbers. If you want to contact a post office, you have to call the national line. Australia post only delivers mail to private residential mailboxes; it does not pick it up. If you want to mail something, you have to take it to a street mailbox. Mail is picked up and delivered Monday-Friday. Post offices are open 9AM-5PM Monday-Friday and 9AM-12noon on Saturdays. The post office is closed for 11-13 holidays a year, including Good Friday, Easter Saturday, and Easter Monday. The price of a domestic stamp is 55 cents AUD (51 cents USD). The cost to mail a letter to the U.S. is $2.10 AUD ($1.95 USD). The cost of having your mail forwarded is $13.50 for 1 month, $25.50 for 3 months, $37 for 6 months, and $68 AUD for a year ($11.26, $21.27, $30.86, and $56.73 USD).
Saturday, April 17, 2010
Air conditioning, laundry, and store hours
Air conditioning in the U.S.
The vast majority of buildings in the U.S. are air conditioned. This includes houses, apartments, restaurants, stores, churches, businesses, hospitals, trains, etc. The only places I can think of that aren't air conditioned are some of the dorms at my sister's university in Virginia, the camp I worked at in Maine, my friend's apartment in Boston, and all school buses. That's it. The vast majority of air conditioning is central (ducted) air conditioning. The only places you'll find wall air conditioners are in some hotel rooms. Window units can be found in some old buildings that were built before AC was invented. However, even in old buildings, many have had central AC installed.
Air conditioning in Australia
Air conditioning is standard in hospitals, trains, and grocery stores. That's about it. Some houses, apartments, stores, and restaurants have it, but definitely not all. I have only been in 1 house that had central AC. Most air conditioners in houses and apartments are wall air conditioners.
Laundry in the U.S.
Washing machines and dryers are bigger in the U.S. than in Australia. Clothes are always put in the dryer, which has a lint removing function and a wrinkle guard cycle. Clothes come out of the dryer soft and virtually lint and wrinkle free in about 45 minutes. Clotheslines are very rare and come from the first half of the 20th century. Other than my dad, I don't think I've ever met anyone living in the U.S. who hung their clothes on a clothesline to dry. Occasionally in the country, you might see a clothesline, but it's probably being used only because the owner cannot afford a dryer.
Laundry in Australia
Washing machines and dryers are smaller in Australia than in the U.S. Most Australians have dryers, but they rarely ever use them. Clothes are always hung on a clothesline and left to dry. The reason for not using the dryer is to save energy. If the weather is very sunny, clothes might be dry in several hours. If the weather is not very sunny, clothes might still not be dry more than 24 hours after being hung on the line. If the weather is rainy, clothes must be hung on a clothesline under an awning. I've also had to rush out into the sudden rain to frantically take my clothes off the outside line to keep them from getting soaked. Clothes, sheets, and towels are sort of stiff when dried on the line. They must be lint rolled and ironed, and some clothes will still be wrinkled even after they have been ironed.
Store hours in the U.S.
Most grocery stores in the U.S. open at 6 or 7 AM and close at 11PM or midnight 7 days a week. HEB is open until 1AM, and Wal-Mart is open 24 hours a day. Target is open 8AM-10PM everyday except Sunday on which it closes at 9PM. Most stores are open later on Saturdays than any other day of the week. The only days stores are closed completely are Christmas and maybe Thanksgiving, and even then, some stores will still be open.
Store hours in Australia
Woolworth's, one of the 2 major grocery store chains, is open from 8AM -9PM on weekdays, 8AM-5PM on Saturdays, and 9AM-6PM on Sundays. Target opens everday at 9AM except Sundays, on which it opens at 10AM. It closes on Sundays at 4PM, Saturdays at 5PM, Mondays, Tuesdays, Wednesdays, and Fridays at 7PM, and Thursdays at 9PM. I have seen only two 24 hour establishments since I have been in Australia, and both were convenience store type places. On some holidays, like Labor Day, stores are closed completely.
The vast majority of buildings in the U.S. are air conditioned. This includes houses, apartments, restaurants, stores, churches, businesses, hospitals, trains, etc. The only places I can think of that aren't air conditioned are some of the dorms at my sister's university in Virginia, the camp I worked at in Maine, my friend's apartment in Boston, and all school buses. That's it. The vast majority of air conditioning is central (ducted) air conditioning. The only places you'll find wall air conditioners are in some hotel rooms. Window units can be found in some old buildings that were built before AC was invented. However, even in old buildings, many have had central AC installed.
Air conditioning in Australia
Air conditioning is standard in hospitals, trains, and grocery stores. That's about it. Some houses, apartments, stores, and restaurants have it, but definitely not all. I have only been in 1 house that had central AC. Most air conditioners in houses and apartments are wall air conditioners.
Laundry in the U.S.
Washing machines and dryers are bigger in the U.S. than in Australia. Clothes are always put in the dryer, which has a lint removing function and a wrinkle guard cycle. Clothes come out of the dryer soft and virtually lint and wrinkle free in about 45 minutes. Clotheslines are very rare and come from the first half of the 20th century. Other than my dad, I don't think I've ever met anyone living in the U.S. who hung their clothes on a clothesline to dry. Occasionally in the country, you might see a clothesline, but it's probably being used only because the owner cannot afford a dryer.
Laundry in Australia
Washing machines and dryers are smaller in Australia than in the U.S. Most Australians have dryers, but they rarely ever use them. Clothes are always hung on a clothesline and left to dry. The reason for not using the dryer is to save energy. If the weather is very sunny, clothes might be dry in several hours. If the weather is not very sunny, clothes might still not be dry more than 24 hours after being hung on the line. If the weather is rainy, clothes must be hung on a clothesline under an awning. I've also had to rush out into the sudden rain to frantically take my clothes off the outside line to keep them from getting soaked. Clothes, sheets, and towels are sort of stiff when dried on the line. They must be lint rolled and ironed, and some clothes will still be wrinkled even after they have been ironed.
Store hours in the U.S.
Most grocery stores in the U.S. open at 6 or 7 AM and close at 11PM or midnight 7 days a week. HEB is open until 1AM, and Wal-Mart is open 24 hours a day. Target is open 8AM-10PM everyday except Sunday on which it closes at 9PM. Most stores are open later on Saturdays than any other day of the week. The only days stores are closed completely are Christmas and maybe Thanksgiving, and even then, some stores will still be open.
Store hours in Australia
Woolworth's, one of the 2 major grocery store chains, is open from 8AM -9PM on weekdays, 8AM-5PM on Saturdays, and 9AM-6PM on Sundays. Target opens everday at 9AM except Sundays, on which it opens at 10AM. It closes on Sundays at 4PM, Saturdays at 5PM, Mondays, Tuesdays, Wednesdays, and Fridays at 7PM, and Thursdays at 9PM. I have seen only two 24 hour establishments since I have been in Australia, and both were convenience store type places. On some holidays, like Labor Day, stores are closed completely.
Saturday, April 3, 2010
Nursing in the U.S.
Qualifications.
RN. There are 3 courses of study that can lead up to becoming an RN. The first is a diploma in nursing. This is a 3 year hospital based course. This is the way all RN's were originally trained, however there are very few diploma programs still in existance. The second path to becoming an RN is an associate degree in nursing. This is a 2 year course taught at a community college or junior college. More RN's have this degree than any other. The 3rd way to become an RN is a Bachelor of Science in Nursing (BSN). This is a 4 year university degree. Individual courses in physical assessment, nursing research, and community health nursing are part of a BSN program, while I don't think these are included in an associate program. Regardless of course of study, all RN candidates take the same exam. Some nursing positions and hospitals require a BSN. At Scott & White Hospital, BSN's were paid $0.18 more per hour than ADN's, but I don't think there is a pay difference at most hospitals.
LPN or LVN (Licensed Practical or Vocational Nurse). This is a 12 month program. Scope of practice for LVN's varies from state to state and hospital to hospital. In the Texas Nurse Practice Act, there is nothing specifically prohibiting LVN's from performing certain skills; that is left up to the individual hospital. At St. Joseph Medical Center, LVN's could not perform the admission assessment, start a blood transfusion (though they could monitor it once it was started by an RN), or give IV push medications. The same rules applied at Scott & White Hospital, but LVN's were not able to do discharge teaching either. At Washington Hospital Center in Washington, DC, the LPN's performed exactly the same functions as the RN's. Some hospitals do not hire LPN's. LPN's commonly work in clinics and doctors' offices.
CNA (Certified Nursing Assistant). I think this is a 6 week course, though I could be wrong about that. CNA's take all the vital signs (obs), check blood sugars, collect lab specimens, take weights, record intake & output (fluid balance), bathe & clean patients, make beds, feed patients, bring water & snacks, empty bedpans, urinals, & urinary catheters, etc. At the 2 hospitals I worked that did not have phlebotamy teams, the CNA's also drew all the peripheral blood tests.
Competancies. As a new grad, there are certain competancies on which nurses must be checked off. This is fairly informal. The new grad would be checked off by their preceptor. Hospitals do not have policies and procedures for performing basic clinical skills. As an experienced RN, it would be expected that you would know how to perform clinical skills appropriately. There are no competancy check offs for experienced RN's. Chemotherapy certification and Advanced Cardiovascular Life Support are national certifications and are recognized by all hospitals.
Medication checks. Chemotherapy, heparin drips, TPN, and PPN (total and peripheral parenteral nutriton) must be double checked and signed off with another nurse. At some facilities insulin and subcutaneous heparin must be double checked and signed off with another nurse. For narcotics and some sedatives, a second nurse is required to check and sign only if a partial dose is to be given (i.e., 1mg of a 2mg vial is to be given). If the full dose is to be given, a 2nd nurse is not required. Those are the only medications that are required to be double checked with another nurse, at least in the nursing specialties in which I've worked.
Documentation. This varies from hospital to hospital. There is the intake & output (fluid balance chart), physical assessment, nurse's note, care plan, acuity chart, and admission assessment. I probably spend at least 2 hours of each shift in documentation.
Physical assessment. It is the responsibility of the nurse to perform a head to toe physical assessment of the patient every shift. This usually involves the neuro, respiratory, cardiovascular, gastrointestinal, urinary, & integumentary (skin) systems. The nurse is expected to listen to lung, heart, & bowel sounds with a stethoscope. If there is any question of neuro deficiency, the nurse is expected to check the patient's pupils for size & reactivity, test strength in all extremities, & determine level of consciousness.
Supplies. Plastic aprons and safety goggles are not required to be worn for any procedures or skills. The only exception to that might be goggles when dealing with chemotherapy. Isolation gowns are worn when a patient is on contact precautions for MRSA, VRE, c.diff, or pseudomonas. There is both primary & secondary (piggyback) IV tubing. A primary IV fluid will be attached to the primary IV tubing. All other medications (chemo, antibiotics, potassium, antiemetics, etc.) are attached to the piggyback tubing, which is connected to a port (bung) in the primary IV tubing above the point where the primary tubing is in the pump. Both primary & piggyback rates and volumes can be set on the IV pump. Once the piggyback medication is complete, the IV pump automatically switches to run the primary IV fluid. There are no IV flushes to be given and no disconnecting done unless multiple secondary medications are to be given. IV tubing may be disconnected then reconnected to a patient so long as a sterile cap is placed on the end of the IV tubing. Patients are disconnected from IV lines to shower, unless the IV fluid running is something that cannot be interrupted such as chemo, a blood transfusion, or TPN. To access an IV port (bung), it must be swabbed with 1 alcohol wipe. Emesis (kidney) basins are not used for holding supplies. Medications that need to be drawn up are done so on the counter (bench) in the medication room. General waste is not double bagged. Chemo waste might be different. Urinals and bedpans are not reused for multiple patients but are thrown away once the patient is discharged.
Sterile procedures. A central line dressing change is a sterile procedure. All needed supplies come in a prepackaged pack. The entire process takes about 5-10 minutes to do. Accessing port-a-caths and removing PICC lines are not sterile procedures. The handwash prior to doing a central line dressing change is no different than a regular handwash.
Vacation time. The usual amount of PTO (paid time off) is 4 weeks/year. PTO is based on number of hours worked, so the more hours you work, the more PTO you get. There are no monthly rostered days off, and no extra PTO is awarded for shift work or working Sundays.
Sick time. Employees accrue sick time, but at St. Joseph Medical Center, you could not use your sick time until you had already used 3 days of PTO. You also had to have a note from a doctor in order to collect on your sick time. Any sick time remaining when you left the facility was lost. This might be different at other hospitals.
Shifts. Most of the hospitals I have worked at operated on 8 and 12 hour shifts. One hospital offered only 12 hour shifts. Some hospitals have certain floors (wards) that operate on 12 hour shifts only or 8 hour shifts only. Most of the floors (wards) I've worked on are a combination of both. 12 hour day shift is 7A-7:30P, 12 hour night shift is 7P-7:30A, 8 hour day shift is 7A-3:30P, 8 hour evening shift is 3-11:30P, & 8 hour night shift is 11p-7:30A. At St. Joseph Medical Center shifts were 6:30A-7P, 6:30P-7A, 6:30A-3P, 2:30P-11P, & 10:30P-7A. Employees are hired to work a specific shift (i.e., nights only).
Uniforms. Nurses do not wear a uniform as such. All clinical (dealing with patients) nurses wear scrubs. Shorts are not allowed to be worn by hospital employees and would be considered very unprofessional. St. Joseph Medical Center and Scott & White Hospital had color coded scrubs, i.e., all nurses wore royal blue scrubs, all nurse aides wore ceil blue scrubs, all secretaries (administrative officers) wore maroon scrubs, etc. At all the other hospitals I worked, nurses could wear whatever color of scrubs they chose. Most nurses wear tennis shoes (sneakers) or a type of clog made specifically for medical personnel. Shoes can be any color. Most of the places I have worked did not have jewelry restrictions. At St. Joseph Medical Center, earrings were supposed to be no longer than chin level. Wristwatches are the norm. I have seen only 2 nurses besides myself with fob watches.
Unions. There were state nurses unions in New York, Illinois, California, and Massachusetts. I'm sure there are other states with unions too. There was not a district union for DC, but Washington Hospital Center had its own union. There is no nurses union in Texas. At some hospitals, nurses are required to be a member of the union. I know in New York and Boston, some hospitals were union and others were not. Unions do not provide indemnity (malpractice) insurance. I think the union dues for the Massachusetts nurses union were $700-$800/year, but I'm not sure of that.
Licensure. State-by-state. There is something called the Nurse Licensure Compact, of which 23 states are a part. A nurse who received their first nursing license in a compact state may legally practice nursing in any other compact state without having to obtain a license there. However, for nurses who received their first license in a non-compact state, if they want to work in compact states, they have to obtain a license in each compact state in which they want to work. I find this defeats the purpose of the compact. Luckily, my first license was in a compact state. Requirements for licensure vary state to state. I think the least expensive license fee I paid was $50 for Illinois, and the most expensive was $250-$300 for DC. The shortest wait time was 2 weeks for Hawaii, and the longest was 8 months for Illinois. Some of the requirements for licensure are fingerprinting, nursing school transcripts, verification from nursing school, and license verification from every other state of licensure. Licenses must be renewed every 3 years in New York and every 2 years in other states. Nurses must obtain a certain number of hours of continuing education for licensure renewal.
Beds and baths. Nurses rarely make beds or give baths, and when they do, it is usually helping the CNA. CNA's make the beds and give the baths.
OB nurses. Obstetrical nursing is a semester long course taught in each nursing school. Nurses can specialize in labor & delivery, postpartum (mother/baby), and antepartum. Midwives are fairly rare and have a very similar role to that of an OB doctor.
Washington Hospital Center, Washington, DC. Traveling nurse pay rate =$33/h + housing. There were no shift diffs or weekend diffs for traveling nurses. I received holiday pay for working Thanksgiving. Full time for traveling nurses was three 12h shifts/week. Full time for regular staff was two 12 & two 8 hour shifts/week. At least half of your shifts had to be evenings or nights. There was a weekend crew who worked two 12 hour shifts every Sat./Sun. & were paid for 36 hours. I had to work about 2 weekend shifts every 3 weeks. Max patient:nurse ratio was 4:1 for the resource (charge) nurse & 6:1 for everyone else. For a 34 bed unit, there were usually no more than 2 CNA's, and quite often only 1 or none. Other than taking vital signs, bathing patients, and making beds, most usual CNA responsibilites fell on the nurse. IV & phlebotamy team.
Mount Sinai Medical Center, New York, NY. Traveling nurse pay rate = $32/h + housing. There were no shift diffs or weekend diffs for traveling nurses. Full time was three 12h shifts each week with a fourth 12h shift every 4th week. I had to work about 1 weekend shift every 3 weeks. Nurses were responsible for checking all blood sugars. There was no IV or phlebotamy team or respiratory therapists. No max patient:nurse ratio. Usually 5 or 6:1 on days and 6 or 7:1 on nights. The most I ever had was 7 on days and 9 very briefly on nights.
University of Chicago Hospitals, Chicago, IL. Traveling nurse pay rate = $26.75/h (2008) & $25/h (2009). Evening, nite, & weekend day diff = $2/h (2008) & $1/h (2009). Evening & nite weekend diff = $4/h (2008) & $2/h (2009). I received holiday pay for working Thanksgiving. Full time = three 12h or five 8h shifts/week. Every other Sat./Sun. mandatory. Phlebotamy team. Max patient:nurse ratio was 5:1.
Mills-Peninsula Hospital, Burlingame, CA. Traveling nurse pay rate = $26/h + housing + $273/week for meals. No weekend diff for traveling nurses. New grad staff nurse pay rate = $44/h. Full time = five 8 hour shifts/week. Every other Sat./Sun. mandatory. Nurses check all blood sugars & do all dressing changes including wound vac dressings. Phlebotamy team. Max patient:nurse ratio was 5:1.
Brigham & Women's Hospital, Boston, MA. Traveling nurse pay rate = $19.25/h + housing + $245/week for meals. No shift diff or weekend diff for traveling nurses. For regular staff, Columbus Day & Veteran's Day received holiday pay. For regular staff, any hours worked after a 12 hour shift were paid double time. Full time = three 12h or five 8h shifts/week. Max patient: nurse ratio from 7A-11P 3:1 & from 11P-7A 4:1. IV team & phlebotamy team.
RN. There are 3 courses of study that can lead up to becoming an RN. The first is a diploma in nursing. This is a 3 year hospital based course. This is the way all RN's were originally trained, however there are very few diploma programs still in existance. The second path to becoming an RN is an associate degree in nursing. This is a 2 year course taught at a community college or junior college. More RN's have this degree than any other. The 3rd way to become an RN is a Bachelor of Science in Nursing (BSN). This is a 4 year university degree. Individual courses in physical assessment, nursing research, and community health nursing are part of a BSN program, while I don't think these are included in an associate program. Regardless of course of study, all RN candidates take the same exam. Some nursing positions and hospitals require a BSN. At Scott & White Hospital, BSN's were paid $0.18 more per hour than ADN's, but I don't think there is a pay difference at most hospitals.
LPN or LVN (Licensed Practical or Vocational Nurse). This is a 12 month program. Scope of practice for LVN's varies from state to state and hospital to hospital. In the Texas Nurse Practice Act, there is nothing specifically prohibiting LVN's from performing certain skills; that is left up to the individual hospital. At St. Joseph Medical Center, LVN's could not perform the admission assessment, start a blood transfusion (though they could monitor it once it was started by an RN), or give IV push medications. The same rules applied at Scott & White Hospital, but LVN's were not able to do discharge teaching either. At Washington Hospital Center in Washington, DC, the LPN's performed exactly the same functions as the RN's. Some hospitals do not hire LPN's. LPN's commonly work in clinics and doctors' offices.
CNA (Certified Nursing Assistant). I think this is a 6 week course, though I could be wrong about that. CNA's take all the vital signs (obs), check blood sugars, collect lab specimens, take weights, record intake & output (fluid balance), bathe & clean patients, make beds, feed patients, bring water & snacks, empty bedpans, urinals, & urinary catheters, etc. At the 2 hospitals I worked that did not have phlebotamy teams, the CNA's also drew all the peripheral blood tests.
Competancies. As a new grad, there are certain competancies on which nurses must be checked off. This is fairly informal. The new grad would be checked off by their preceptor. Hospitals do not have policies and procedures for performing basic clinical skills. As an experienced RN, it would be expected that you would know how to perform clinical skills appropriately. There are no competancy check offs for experienced RN's. Chemotherapy certification and Advanced Cardiovascular Life Support are national certifications and are recognized by all hospitals.
Medication checks. Chemotherapy, heparin drips, TPN, and PPN (total and peripheral parenteral nutriton) must be double checked and signed off with another nurse. At some facilities insulin and subcutaneous heparin must be double checked and signed off with another nurse. For narcotics and some sedatives, a second nurse is required to check and sign only if a partial dose is to be given (i.e., 1mg of a 2mg vial is to be given). If the full dose is to be given, a 2nd nurse is not required. Those are the only medications that are required to be double checked with another nurse, at least in the nursing specialties in which I've worked.
Documentation. This varies from hospital to hospital. There is the intake & output (fluid balance chart), physical assessment, nurse's note, care plan, acuity chart, and admission assessment. I probably spend at least 2 hours of each shift in documentation.
Physical assessment. It is the responsibility of the nurse to perform a head to toe physical assessment of the patient every shift. This usually involves the neuro, respiratory, cardiovascular, gastrointestinal, urinary, & integumentary (skin) systems. The nurse is expected to listen to lung, heart, & bowel sounds with a stethoscope. If there is any question of neuro deficiency, the nurse is expected to check the patient's pupils for size & reactivity, test strength in all extremities, & determine level of consciousness.
Technology. Most medications are kept in a medication machine called Pyxis, Accudose, or Omnicell. The machine is operated by a touch screen computer. The nurse enters the patient's name then chooses from the list of that patient's medications. A drawer containing the medication opens. Most hospitals are at least partially if not completely computerized when it comes to documentation. Vital signs (obs), nursing assessments, intake & output (fluid balance), medication administration, progress notes, doctors' orders, etc. are computerized. All patient armbands and blood labels are printed from a computer.
Supplies. Plastic aprons and safety goggles are not required to be worn for any procedures or skills. The only exception to that might be goggles when dealing with chemotherapy. Isolation gowns are worn when a patient is on contact precautions for MRSA, VRE, c.diff, or pseudomonas. There is both primary & secondary (piggyback) IV tubing. A primary IV fluid will be attached to the primary IV tubing. All other medications (chemo, antibiotics, potassium, antiemetics, etc.) are attached to the piggyback tubing, which is connected to a port (bung) in the primary IV tubing above the point where the primary tubing is in the pump. Both primary & piggyback rates and volumes can be set on the IV pump. Once the piggyback medication is complete, the IV pump automatically switches to run the primary IV fluid. There are no IV flushes to be given and no disconnecting done unless multiple secondary medications are to be given. IV tubing may be disconnected then reconnected to a patient so long as a sterile cap is placed on the end of the IV tubing. Patients are disconnected from IV lines to shower, unless the IV fluid running is something that cannot be interrupted such as chemo, a blood transfusion, or TPN. To access an IV port (bung), it must be swabbed with 1 alcohol wipe. Emesis (kidney) basins are not used for holding supplies. Medications that need to be drawn up are done so on the counter (bench) in the medication room. General waste is not double bagged. Chemo waste might be different. Urinals and bedpans are not reused for multiple patients but are thrown away once the patient is discharged.
Sterile procedures. A central line dressing change is a sterile procedure. All needed supplies come in a prepackaged pack. The entire process takes about 5-10 minutes to do. Accessing port-a-caths and removing PICC lines are not sterile procedures. The handwash prior to doing a central line dressing change is no different than a regular handwash.
Vacation time. The usual amount of PTO (paid time off) is 4 weeks/year. PTO is based on number of hours worked, so the more hours you work, the more PTO you get. There are no monthly rostered days off, and no extra PTO is awarded for shift work or working Sundays.
Sick time. Employees accrue sick time, but at St. Joseph Medical Center, you could not use your sick time until you had already used 3 days of PTO. You also had to have a note from a doctor in order to collect on your sick time. Any sick time remaining when you left the facility was lost. This might be different at other hospitals.
Shifts. Most of the hospitals I have worked at operated on 8 and 12 hour shifts. One hospital offered only 12 hour shifts. Some hospitals have certain floors (wards) that operate on 12 hour shifts only or 8 hour shifts only. Most of the floors (wards) I've worked on are a combination of both. 12 hour day shift is 7A-7:30P, 12 hour night shift is 7P-7:30A, 8 hour day shift is 7A-3:30P, 8 hour evening shift is 3-11:30P, & 8 hour night shift is 11p-7:30A. At St. Joseph Medical Center shifts were 6:30A-7P, 6:30P-7A, 6:30A-3P, 2:30P-11P, & 10:30P-7A. Employees are hired to work a specific shift (i.e., nights only).
Uniforms. Nurses do not wear a uniform as such. All clinical (dealing with patients) nurses wear scrubs. Shorts are not allowed to be worn by hospital employees and would be considered very unprofessional. St. Joseph Medical Center and Scott & White Hospital had color coded scrubs, i.e., all nurses wore royal blue scrubs, all nurse aides wore ceil blue scrubs, all secretaries (administrative officers) wore maroon scrubs, etc. At all the other hospitals I worked, nurses could wear whatever color of scrubs they chose. Most nurses wear tennis shoes (sneakers) or a type of clog made specifically for medical personnel. Shoes can be any color. Most of the places I have worked did not have jewelry restrictions. At St. Joseph Medical Center, earrings were supposed to be no longer than chin level. Wristwatches are the norm. I have seen only 2 nurses besides myself with fob watches.
Unions. There were state nurses unions in New York, Illinois, California, and Massachusetts. I'm sure there are other states with unions too. There was not a district union for DC, but Washington Hospital Center had its own union. There is no nurses union in Texas. At some hospitals, nurses are required to be a member of the union. I know in New York and Boston, some hospitals were union and others were not. Unions do not provide indemnity (malpractice) insurance. I think the union dues for the Massachusetts nurses union were $700-$800/year, but I'm not sure of that.
Licensure. State-by-state. There is something called the Nurse Licensure Compact, of which 23 states are a part. A nurse who received their first nursing license in a compact state may legally practice nursing in any other compact state without having to obtain a license there. However, for nurses who received their first license in a non-compact state, if they want to work in compact states, they have to obtain a license in each compact state in which they want to work. I find this defeats the purpose of the compact. Luckily, my first license was in a compact state. Requirements for licensure vary state to state. I think the least expensive license fee I paid was $50 for Illinois, and the most expensive was $250-$300 for DC. The shortest wait time was 2 weeks for Hawaii, and the longest was 8 months for Illinois. Some of the requirements for licensure are fingerprinting, nursing school transcripts, verification from nursing school, and license verification from every other state of licensure. Licenses must be renewed every 3 years in New York and every 2 years in other states. Nurses must obtain a certain number of hours of continuing education for licensure renewal.
Beds and baths. Nurses rarely make beds or give baths, and when they do, it is usually helping the CNA. CNA's make the beds and give the baths.
OB nurses. Obstetrical nursing is a semester long course taught in each nursing school. Nurses can specialize in labor & delivery, postpartum (mother/baby), and antepartum. Midwives are fairly rare and have a very similar role to that of an OB doctor.
Holiday pay. Time & a half for all holidays.
Patient to nurse ratios, pay rates, hours, etc. vary from hospital to hospital even in the U.S. These are the hospitals I've worked at in a nutshell.
Washington Hospital Center, Washington, DC. Traveling nurse pay rate =$33/h + housing. There were no shift diffs or weekend diffs for traveling nurses. I received holiday pay for working Thanksgiving. Full time for traveling nurses was three 12h shifts/week. Full time for regular staff was two 12 & two 8 hour shifts/week. At least half of your shifts had to be evenings or nights. There was a weekend crew who worked two 12 hour shifts every Sat./Sun. & were paid for 36 hours. I had to work about 2 weekend shifts every 3 weeks. Max patient:nurse ratio was 4:1 for the resource (charge) nurse & 6:1 for everyone else. For a 34 bed unit, there were usually no more than 2 CNA's, and quite often only 1 or none. Other than taking vital signs, bathing patients, and making beds, most usual CNA responsibilites fell on the nurse. IV & phlebotamy team.
Mount Sinai Medical Center, New York, NY. Traveling nurse pay rate = $32/h + housing. There were no shift diffs or weekend diffs for traveling nurses. Full time was three 12h shifts each week with a fourth 12h shift every 4th week. I had to work about 1 weekend shift every 3 weeks. Nurses were responsible for checking all blood sugars. There was no IV or phlebotamy team or respiratory therapists. No max patient:nurse ratio. Usually 5 or 6:1 on days and 6 or 7:1 on nights. The most I ever had was 7 on days and 9 very briefly on nights.
University of Chicago Hospitals, Chicago, IL. Traveling nurse pay rate = $26.75/h (2008) & $25/h (2009). Evening, nite, & weekend day diff = $2/h (2008) & $1/h (2009). Evening & nite weekend diff = $4/h (2008) & $2/h (2009). I received holiday pay for working Thanksgiving. Full time = three 12h or five 8h shifts/week. Every other Sat./Sun. mandatory. Phlebotamy team. Max patient:nurse ratio was 5:1.
Mills-Peninsula Hospital, Burlingame, CA. Traveling nurse pay rate = $26/h + housing + $273/week for meals. No weekend diff for traveling nurses. New grad staff nurse pay rate = $44/h. Full time = five 8 hour shifts/week. Every other Sat./Sun. mandatory. Nurses check all blood sugars & do all dressing changes including wound vac dressings. Phlebotamy team. Max patient:nurse ratio was 5:1.
Brigham & Women's Hospital, Boston, MA. Traveling nurse pay rate = $19.25/h + housing + $245/week for meals. No shift diff or weekend diff for traveling nurses. For regular staff, Columbus Day & Veteran's Day received holiday pay. For regular staff, any hours worked after a 12 hour shift were paid double time. Full time = three 12h or five 8h shifts/week. Max patient: nurse ratio from 7A-11P 3:1 & from 11P-7A 4:1. IV team & phlebotamy team.
Friday, March 19, 2010
Nursing in Australia
Some things about nursing in Australia are the same as the U.S. Others are different.
Qualifications.
RN. I think all RN's here have a 3 year university degree. Classroom and clinical are not concurrent. Students will have classroom education only for the first part of the semester, then clinical only for the remaining part of the semester. Clinical rotations are done under a preceptor. The student will work the same shifts as their preceptor including evenings, nights, and weekends. The clinical rotation is not necessarily the same area of nursing as the course the student just studied in class.
EN (Enrolled Nurse). 18 month course. Not licensed to give medications. I heard from one RN that the primary functions of an EN were to take vital signs (obs) and give baths. However, I've got to think that they can do more than that after an 18 month course.
EEN (Endorsed Enrolled Nurse). Has taken an extra course and is licensed to administer PO meds.
AIN (Assistant in Nursing). Not licensed to take vital signs. May perform patient care only under the direct supervision of an RN.
Clinical Nurse (CN). A clinical nurse is an RN usually with more experience than a regular RN. The clinical nurse position has to be applied for at the individual hospital.
Public and private hospitals. I think pay is roughly the same at public and private hospitals. Pay at all public hospitals is the same regardless of which hospital you work at. I've heard that work conditions for nurses are much worse at private hospitals than public hospitals. An RN I know used to work at a private hospital, and the usual patient assignment was an RN, an EN, and an AIN assigned to 15 patients. At the hospital where I work now (public), on the oncology ward, the patient:RN ratio is 3:1 on days and 6:1 on nights. Also, there are no residents in private hospitals.
Pay. The easiest way to determine pay is to go to health.qld.gov.au/hrpolicies/wage_rates/nursing.asp. Shift diffs are outlined at health.qld.gov.au/nursing/salary.asp. Keep in mind that all these values are in AUD. In order to be paid according to your experience, you have to provide the payroll department with official documents from each prior place of employment with dates and total hours worked. I've actually had a lot of trouble getting paid according to my experience. When I first started work, the payroll department automatically classified me at the new grad rate, and never told me I had to provide any previous employment documentation. I assumed that my pay rate would be based on my nursing school graduation date and experience listed on my resume. I kind of found out about the previous employment documentation requirement by accident. One of my previous employers did not keep a record of my total hours worked, so I had to write up a statutory declaration attesting that I had worked so many hours for that employer. I had to get the statutory declaration signed and stamped by a Justice of the Peace. I've been working here for 10 weeks, and the paycheck that I received last week is the first one that I've been paid more than the new grad rate. They will back pay you though. Right now payroll has classified me as a nurse with 3 years experience, even though I've been licensed for more than 5 years and practicing for more than 4-1/2. I've been given several different definitions as to how they classify experience. I'm still working on getting bumped up another pay grade.
Competencies. When starting work at a new hospital, regardless of nursing experience, nurses are required to be supervised doing certain skills until they can be officially checked off by a clinical facilitator as doing that skill the "right" way according to the hospital's policies and procedures. For the hematology/oncology daycare unit at my hospital, those skills were drawing blood both peripherally and from a central line, starting IV's (cannulating), accessing port-a-caths, central line dressing changes, removing PICC lines, doing venesections, and assisting with bone marrow aspirations. There are not nationwide or statewide certifications for chemo administration or advanced cardiac life support. They are hospital specific. Even though all public hospitals in Queensland are owned and operated by Queensland Health, competencies do not transfer from one hospital to another and must be redone at each new hospital.
Medication checks. All non-PO meds and contolled (narcotics, sedatives, etc.) PO meds must be double checked and signed off with another nurse. Yes, this even includes stuff like a bag of normal saline.
Documentation. I work in an outpatient setting, which is obviously going to be different than working on the floor (ward), but documentation is minimal. Nurses have to write a progress note on each patient, but this is usually only a few sentences. For patients who come in 3 times a week to have their blood drawn and see the doctor and patients who are receving chemotherapy, there is a 1 page front and back assessment sheet. It is not a physical assessment. It covers stuff like N/V, cough, shortness of breath, elimination problems, fatigue, etc. That's it.
Physical assessment. As far as I know, nurses do not perform physical assessments. That is the responsibility of the doctors. I have yet to see a nurse anywhere in the hospital with a stethoscope.
Technology. At the hospital where I work, only lab results and chemotherapy orders are computerized. All patient armbands and blood tubes have to be hand labeled. There is nothing resembling Pyxis, Omnicell, or Accudose. All controlled medications (sedatives, narcotics, etc.) are kept in a locked cabinet and have to be signed out by 2 nurses. All other medications are kept in an unlocked cabinet, on shelves, or in cubbyholes.
Medications. Some medications are the same as in the U.S.; some are different. Many IV medications are packaged in ampules. Few IV medications are premixed by the pharmacy. Nurses are required to add antinausea, potassium, magnesium, antibiotics, etc. to a bag of IV fluid. Hospital pharmacies are only open regular business hours.
Supplies. Nurses are required to wear safety goggles and a disposable plastic apron for most procedures/skills. There is only primary IV tubing, no secondary or piggyback tubing. Any time one IV medication or chemotherapy is complete, a 100mL bag of normal saline is hung and flushed through the IV line. We go through a lot of 100 mL normal saline bags. IV tubing is not allowed to be disconnected from a patient, then reconnected. If IV tubing is disconnected from a patient, it must be thrown away and new tubing used. Patients are not disconnected from IV lines when showering. Every time an IV hub (bung) is accessed/used it must be swabbed with 3 alcohol wipes. Most nurses put all their various equipment for giving a medication (ampules, syringes, needles, etc.) into an emesis (kidney) basin and throw the basin away afterwards. All clinical waste and chemo waste is double bagged. Urinals and bedpans are put in a sterilizer and reused.
Sterile procedures. Central line dressing changes, accessing port-a-caths, and removing PICC lines are all sterile procedures. A central line dressing change involves setting up a sterile field and opening numerous packages onto it. The entire process takes 30-45 minutes. A 1 minute handwash done a specific way must be done prior to all sterile procedures.
Qualifications.
RN. I think all RN's here have a 3 year university degree. Classroom and clinical are not concurrent. Students will have classroom education only for the first part of the semester, then clinical only for the remaining part of the semester. Clinical rotations are done under a preceptor. The student will work the same shifts as their preceptor including evenings, nights, and weekends. The clinical rotation is not necessarily the same area of nursing as the course the student just studied in class.
EN (Enrolled Nurse). 18 month course. Not licensed to give medications. I heard from one RN that the primary functions of an EN were to take vital signs (obs) and give baths. However, I've got to think that they can do more than that after an 18 month course.
EEN (Endorsed Enrolled Nurse). Has taken an extra course and is licensed to administer PO meds.
AIN (Assistant in Nursing). Not licensed to take vital signs. May perform patient care only under the direct supervision of an RN.
Clinical Nurse (CN). A clinical nurse is an RN usually with more experience than a regular RN. The clinical nurse position has to be applied for at the individual hospital.
Public and private hospitals. I think pay is roughly the same at public and private hospitals. Pay at all public hospitals is the same regardless of which hospital you work at. I've heard that work conditions for nurses are much worse at private hospitals than public hospitals. An RN I know used to work at a private hospital, and the usual patient assignment was an RN, an EN, and an AIN assigned to 15 patients. At the hospital where I work now (public), on the oncology ward, the patient:RN ratio is 3:1 on days and 6:1 on nights. Also, there are no residents in private hospitals.
Pay. The easiest way to determine pay is to go to health.qld.gov.au/hrpolicies/wage_rates/nursing.asp. Shift diffs are outlined at health.qld.gov.au/nursing/salary.asp. Keep in mind that all these values are in AUD. In order to be paid according to your experience, you have to provide the payroll department with official documents from each prior place of employment with dates and total hours worked. I've actually had a lot of trouble getting paid according to my experience. When I first started work, the payroll department automatically classified me at the new grad rate, and never told me I had to provide any previous employment documentation. I assumed that my pay rate would be based on my nursing school graduation date and experience listed on my resume. I kind of found out about the previous employment documentation requirement by accident. One of my previous employers did not keep a record of my total hours worked, so I had to write up a statutory declaration attesting that I had worked so many hours for that employer. I had to get the statutory declaration signed and stamped by a Justice of the Peace. I've been working here for 10 weeks, and the paycheck that I received last week is the first one that I've been paid more than the new grad rate. They will back pay you though. Right now payroll has classified me as a nurse with 3 years experience, even though I've been licensed for more than 5 years and practicing for more than 4-1/2. I've been given several different definitions as to how they classify experience. I'm still working on getting bumped up another pay grade.
Competencies. When starting work at a new hospital, regardless of nursing experience, nurses are required to be supervised doing certain skills until they can be officially checked off by a clinical facilitator as doing that skill the "right" way according to the hospital's policies and procedures. For the hematology/oncology daycare unit at my hospital, those skills were drawing blood both peripherally and from a central line, starting IV's (cannulating), accessing port-a-caths, central line dressing changes, removing PICC lines, doing venesections, and assisting with bone marrow aspirations. There are not nationwide or statewide certifications for chemo administration or advanced cardiac life support. They are hospital specific. Even though all public hospitals in Queensland are owned and operated by Queensland Health, competencies do not transfer from one hospital to another and must be redone at each new hospital.
Medication checks. All non-PO meds and contolled (narcotics, sedatives, etc.) PO meds must be double checked and signed off with another nurse. Yes, this even includes stuff like a bag of normal saline.
Documentation. I work in an outpatient setting, which is obviously going to be different than working on the floor (ward), but documentation is minimal. Nurses have to write a progress note on each patient, but this is usually only a few sentences. For patients who come in 3 times a week to have their blood drawn and see the doctor and patients who are receving chemotherapy, there is a 1 page front and back assessment sheet. It is not a physical assessment. It covers stuff like N/V, cough, shortness of breath, elimination problems, fatigue, etc. That's it.
Physical assessment. As far as I know, nurses do not perform physical assessments. That is the responsibility of the doctors. I have yet to see a nurse anywhere in the hospital with a stethoscope.
Technology. At the hospital where I work, only lab results and chemotherapy orders are computerized. All patient armbands and blood tubes have to be hand labeled. There is nothing resembling Pyxis, Omnicell, or Accudose. All controlled medications (sedatives, narcotics, etc.) are kept in a locked cabinet and have to be signed out by 2 nurses. All other medications are kept in an unlocked cabinet, on shelves, or in cubbyholes.
Medications. Some medications are the same as in the U.S.; some are different. Many IV medications are packaged in ampules. Few IV medications are premixed by the pharmacy. Nurses are required to add antinausea, potassium, magnesium, antibiotics, etc. to a bag of IV fluid. Hospital pharmacies are only open regular business hours.
Supplies. Nurses are required to wear safety goggles and a disposable plastic apron for most procedures/skills. There is only primary IV tubing, no secondary or piggyback tubing. Any time one IV medication or chemotherapy is complete, a 100mL bag of normal saline is hung and flushed through the IV line. We go through a lot of 100 mL normal saline bags. IV tubing is not allowed to be disconnected from a patient, then reconnected. If IV tubing is disconnected from a patient, it must be thrown away and new tubing used. Patients are not disconnected from IV lines when showering. Every time an IV hub (bung) is accessed/used it must be swabbed with 3 alcohol wipes. Most nurses put all their various equipment for giving a medication (ampules, syringes, needles, etc.) into an emesis (kidney) basin and throw the basin away afterwards. All clinical waste and chemo waste is double bagged. Urinals and bedpans are put in a sterilizer and reused.
Sterile procedures. Central line dressing changes, accessing port-a-caths, and removing PICC lines are all sterile procedures. A central line dressing change involves setting up a sterile field and opening numerous packages onto it. The entire process takes 30-45 minutes. A 1 minute handwash done a specific way must be done prior to all sterile procedures.
Vacation time. I think the usual amount of vacation time is 25 eight hour days. If you work shifts, I think you get an extra week off. If you work so many Sundays, I think you get an extra week off. A full-time work week is 38 hours/week, so nurses who work 40 hours/week get one rostered day off per 4 weeks.
Shifts. I think most hospitals operate largely on 2 eight hour shifts: 7AM-3:30PM (earlies) and 1PM-9:30PM (afternoons), and 10 hour "lates" (9PM-7:30AM). Some places do offer 12 hour shifts. Shifts are rotated so that no one gets stuck working all nights or evenings.
Uniforms. Nurses are required to wear uniforms, which are provided by the hospital. All Queensland Health facilities have the same uniforms. One of the uniform choices is shorts. The only people who wear scrubs are some ER nurses and people who work in the oncology pharmacy and OR (They call it theatre here.). Most nurses wear a sort of casual Mary Jane type of shoe. Shoes must be black or navy and are provided by the nurse. Tennis shoes are not allowed. Studs are the only earrings that are allowed to be worn. Wedding bands without raised stones are the only rings allowed. Wristwatches are not allowed. Nurses wear fob watches which are pinned to the shirt.
Unions. Most nurses are a member of the state nurses' union. Union members are automatically provided with malpractice (indemnity) insurance. The union has also been successful in negotiating something like a 12.5% increase in wages over the past 3 years. Union dues for a full-time RN are $19.20 AUD/fortnight (2 weeks) or $17.58 USD.
Licensure. State by state, just like the U.S. It took about 2 months for me to get licensed in Queensland and cost about $195 USD. I did not have to take a test in order to be licensed. Licenses must be renewed every year.
Baths and beds. It is the usual responsibilty of a ward (floor) nurse to make beds and give baths.
OB nurses. As far as I know, OB nurses do not exist. All OB patients are taken care of by midwives. I don't think OB is even taught in nursing school.
I've only been nursing here for 10 weeks, so to my Australian nursing colleagues, feel free to correct any points I have gotten wrong. Any questions about other facets of life, just let me know.
Saturday, March 13, 2010
The Australian healthcare system
Now for the Australian healthcare system. I've only been working in the Australian healthcare system for 9 weeks, so I don't know everything about it, but I'll try to represent it as accurately as I can.
Who is eligible? Medicare is the name of the government health program in Australia. All Australian citizens and permanent residents, New Zealand citizens, and those who are in the process of obtaining permanent Australian residency are eligible for Medicare. Australia also has reciprocal agreements with Finland, Italy, Malta, New Zealand, Norway, Ireland, Sweden, Belgium, the Netherlands, and the U.K. One of the nurses I work with is from the U.K., and she is covered by Medicare. Since I'm only a temporary Australian resident, I do not qualify for Medicare.
Hospitals. There are public and private hospitals. All the public hospitals are owned by the government. For example, the hospital I work at is public and is owned and operated by Queensland Health, a division of the state government of Queensland. I think that all care received at a public hospital is free. Public patients are not able to choose to have a private room. Most of the rooms I have seen on the ward (floor, nursing unit) have 4 patients per room. One of my male patients told me he was once placed in a room with 3 women patients. I don't know that the patients are able to choose which doctor they see either. I think it's just the one that's assigned to their case.
Prescriptions. For prescriptions, some are free; some are not. I work with oncology patients, and I think that any home medications that are to be taken in conjunction with chemotherapy are free. After receiving their treatment, the patients pick up those precriptions from the hospital pharmacy before going home. A medication for a long-standing heart condition, however, would be paid for by the patient.
Doctors' visits. The GP (general practitioner), equivalent to an American family practice or internal medicine doctor, is the gatekeeper in the health system. In order to see any type of specialist, patients must obtain a referral from a GP. Patients are required to pay for doctors' visits, but can submit a reimbursement request to Medicare to be reimbursed for about 75% of the cost. In some doctors' offices, patients can swipe their Medicare card, the same way you would swipe a credit card, and this submits an automatic reimbursement request to Medicare. There are some doctors who bulk bill, and care from those doctors would be free, but I don't think the majority of doctors bulk bill. When the Australian national health system first began, all doctors' visits were free, but when that was occurring, doctors were not making enough money to cover their expenses.
Wait times. One of my friends cancelled her dermatologist appointment and was told she could not get another one for 8 months. Her aunt was found to have a melanoma (the most deadly form of skin cancer) and was told she had to wait either 5 weeks or 5 months to have the surgery to remove it. A person would have to wait about 5 years for a joint replacement.
Dental. Dental care is not covered by Medicare.
Optical. Optical care is free. I'm not sure if this includes the cost of glasses or contacts or not.
Health insurance. Employers do not provide employees with health insurance. Residents are encouraged to purchase private health insurance. Residents are taxed at a higher rate if they do not hold private health insurance. People who have private health insurance can choose their own doctor. They can choose to go to a private hospital instead of a public hospital. They can choose to have a private room while in the hospital. A person having a colonoscopy at a public hospital might have to wait all day, while a person with insurance at a private hospital would probably be taken in with little or no wait time. Health insurance also covers a portion of health costs not covered by Medicare, which the patient would otherwise be responsible for paying out of pocket. Because I'm not eligible for Medicare, I took out my own health insurance policy, for which I pay $115/month AUD ($105 USD). There are wait times with Australian health insurance. I couldn't use my health insurance for the first 2 months I had it, and certain services are not covered until the plan has been in effect for 6 months or a year.
Where does the money come from to fund Medicare? All working Australians pay 1% of their wages in taxes that go to the Medicare system.
How did national healthcare in Australia come about? I think it was around 1971, that workers unions cut a deal with the government. Workers unions agreed to not ask for pay increases for a certain amount of time (I think maybe 5-10 years) if the government would implement a national healthcare system.
For my Australian friends and relatives, feel free to correct me on any points I didn't get right. I'm happy to be educated. Any questions or other stuff you want to know about, just say so.
Who is eligible? Medicare is the name of the government health program in Australia. All Australian citizens and permanent residents, New Zealand citizens, and those who are in the process of obtaining permanent Australian residency are eligible for Medicare. Australia also has reciprocal agreements with Finland, Italy, Malta, New Zealand, Norway, Ireland, Sweden, Belgium, the Netherlands, and the U.K. One of the nurses I work with is from the U.K., and she is covered by Medicare. Since I'm only a temporary Australian resident, I do not qualify for Medicare.
Hospitals. There are public and private hospitals. All the public hospitals are owned by the government. For example, the hospital I work at is public and is owned and operated by Queensland Health, a division of the state government of Queensland. I think that all care received at a public hospital is free. Public patients are not able to choose to have a private room. Most of the rooms I have seen on the ward (floor, nursing unit) have 4 patients per room. One of my male patients told me he was once placed in a room with 3 women patients. I don't know that the patients are able to choose which doctor they see either. I think it's just the one that's assigned to their case.
Prescriptions. For prescriptions, some are free; some are not. I work with oncology patients, and I think that any home medications that are to be taken in conjunction with chemotherapy are free. After receiving their treatment, the patients pick up those precriptions from the hospital pharmacy before going home. A medication for a long-standing heart condition, however, would be paid for by the patient.
Doctors' visits. The GP (general practitioner), equivalent to an American family practice or internal medicine doctor, is the gatekeeper in the health system. In order to see any type of specialist, patients must obtain a referral from a GP. Patients are required to pay for doctors' visits, but can submit a reimbursement request to Medicare to be reimbursed for about 75% of the cost. In some doctors' offices, patients can swipe their Medicare card, the same way you would swipe a credit card, and this submits an automatic reimbursement request to Medicare. There are some doctors who bulk bill, and care from those doctors would be free, but I don't think the majority of doctors bulk bill. When the Australian national health system first began, all doctors' visits were free, but when that was occurring, doctors were not making enough money to cover their expenses.
Wait times. One of my friends cancelled her dermatologist appointment and was told she could not get another one for 8 months. Her aunt was found to have a melanoma (the most deadly form of skin cancer) and was told she had to wait either 5 weeks or 5 months to have the surgery to remove it. A person would have to wait about 5 years for a joint replacement.
Dental. Dental care is not covered by Medicare.
Optical. Optical care is free. I'm not sure if this includes the cost of glasses or contacts or not.
Health insurance. Employers do not provide employees with health insurance. Residents are encouraged to purchase private health insurance. Residents are taxed at a higher rate if they do not hold private health insurance. People who have private health insurance can choose their own doctor. They can choose to go to a private hospital instead of a public hospital. They can choose to have a private room while in the hospital. A person having a colonoscopy at a public hospital might have to wait all day, while a person with insurance at a private hospital would probably be taken in with little or no wait time. Health insurance also covers a portion of health costs not covered by Medicare, which the patient would otherwise be responsible for paying out of pocket. Because I'm not eligible for Medicare, I took out my own health insurance policy, for which I pay $115/month AUD ($105 USD). There are wait times with Australian health insurance. I couldn't use my health insurance for the first 2 months I had it, and certain services are not covered until the plan has been in effect for 6 months or a year.
Where does the money come from to fund Medicare? All working Australians pay 1% of their wages in taxes that go to the Medicare system.
How did national healthcare in Australia come about? I think it was around 1971, that workers unions cut a deal with the government. Workers unions agreed to not ask for pay increases for a certain amount of time (I think maybe 5-10 years) if the government would implement a national healthcare system.
For my Australian friends and relatives, feel free to correct me on any points I didn't get right. I'm happy to be educated. Any questions or other stuff you want to know about, just say so.
Sunday, March 7, 2010
The U.S. healthcare system
Hey everyone. I've been in Australia 2 months now, and things are sure a lot different here than in the U.S. For my Aussie friends and relatives as well as my non-Aussie counterparts, I thought I'd do a little comparing and contrasting of life in Australia versus life in the U.S.
First of all, the U.S. healthcare system. Most Australians I've talked to have the impression that healthcare in the U.S. is so expensive that only wealthy people can afford it. They have the impression that if you don't have health insurance, you will not receive medical treatment. I've even heard the slogan, if you're visiting the U.S., "If you get a pain, take a plane", meaning if you develop a medical issue while in the U.S., you should seek medical treatment in another country.
It's a shame Australians have gotten this impression, because it's totally inaccurate.
The U.S. is a mostly private healthcare system. The vast majority of hospitals are private. The only ones I can think of that are public are Ben Taub in Houston, Cook County Hospital in Chicago, and I think Washington Hospital Center in Washington, DC and Massachusetts General Hospital in Boston are semi-private. Because hospitals are private and independent, policies and employee wages vary from hospital to hospital.
Health insurance: I think all employers are required to provide health insurance for full-time employees. The basic coverage is free for the employee. The employee can choose to add their spouse and children to the plan, but the employee will be responsible for the extra cost. Some health insurance plans include dental; some do not. Employees can choose to pay a little extra to have dental and/or optical coverage included in their health plans. For the unemployed, part-time employees, and the self-employed, if they want health insurance, they must pay for their own plan. Co-pays are common with health insurance plans for routine dentist or doctor's visits. $15-$30 per visit would be the amount the insured patient would be responsible to pay.
Medicare and Medicaid: Medicaid is a government health program for poor people. I don't think people covered by Medicaid pay any health costs. Medicare is a government health program for the elderly. Medicare covers most health costs, but the covered individual might be responsible for a very small portion of costs.
The uninsured: Not everyone in the U.S. has insurance, Medicare, or Medicaid. For those without coverage, they must pay the full fee for medical treatment. For example, an uninsured person may have to pay $150 for a doctor's visit, while someone with insurance may only have to pay $30, as the insurance company will pay the rest of the cost. If an uninsured person were admitted to the hospital for surgery or any other medical issue, the cost of their stay would be higher than a person with insurance. Once the person was discharged from the hospital, they would receive bills from the hospital and doctors. They would most likely be on a monthly payment plan until the balance was completed. For a lengthy or expensive hospital stay, an uninsured person might be making monthly medical payments for years.
What about people without any money? What about, for example, homeless people? All hospitals in the U.S. are required by law to treat everyone in need of emergency medical treatment, regardless of ability to pay. If a homeless person were to come to an ER with pneumonia, the hospital would admit him, treat him until he was well enough for discharge, then discharge him. The hospital would have to eat the cost of his stay. They would not, however, have given him what would be considered optional treatments, such as chemotherapy or a joint replacement.
At the hospital where my mom works, 30% of the patients do not pay anything.
How payment from an insurance company, Medicare, or Medicaid works. Insurance, Medicaid, and Medicare payment for services is usually based on DRG's (diagnosis related groups). Medicaid, Medicare, and insurance companies have a set max amount they will pay for a particular medical treatment or condition. For example, Medicare may have a $7000 set cost for a hip replacement. Regardless of whether the person receiving the hip replacement stays in the hospital for 2 days or 2 weeks, Medicare will not pay more than the $7000 set amount. If the person's hospital stay cost more than the $7000 cap, the hospital would have to eat the rest of the cost of the patient's hospital stay. Because of this, doctors, nurses, social workers, etc. are encouraged to discharge patients in a timely fashion. Patients who develop secondary conditions or infections while in the hospital and thus end up staying longer cause the hospital to lose money. Medicare and Medicaid will not pay the cost of expenses incurred if a patient develops a bed sore while in the hospital. For this reason, recognition of preexisting bed sores upon admission and prevention of future bedsores is highly harped upon. In my last job, a patient was admitted to the hospital with a preexisting bedsore, but the nurse admitting the patient failed to notice it. Because the bedsore was not documented upon admission, Medicare/Medicaid considers it to have developed while the patient was in the hospital, therefore Medicare/Medicaid will not pay any of the costs realated to the bedsore. The hospital has to eat those costs. Insurance companies also operate on DRG's. If the costs of a hospital stay exceed the insurance cap, the patient will be billed by the hospital for those costs.
A few Australians have also expressed concern that a hospital would discharge a patient before the patient was well enough to go home. Doctors, nurses, and hospitals all have liability and could be sued if a patient was discharged and developed a worsened condition after discharge. ER doctors are especially leary of this, and because of it, I have seen so many patients admitted, who, in my opinion could have been safely discharged home.
Wait times. For a visit to an internal medicine or family practice doctor (the equivalent of an Australian GP), in a non-urgent situation, the wait time might be a couple of days. For a dermatologist, the wait time would likely be 3-6 weeks. For a gynecologist, the wait time would be anywhere from a few days to 6 weeks. For a dentist, the wait time would be 1-6 weeks. For a non-emergent surgery, the wait time would probably be anywhere from a few days to less than a month.
Having worked in the U.S. healthcare system for 4-1/2 years, I can say that it is by no means a perfect system, but it actually works pretty well. Athletes from Europe will come to the U.S. for sports-related repairative surgery. If the U.S. healthcare system were truly inadequate, stuff like that wouldn't happen.
I'm sure I've probably left out a lot of stuff, but this is a start. If you have any questions, about the U.S. healthcare system or any other comparison of Australia and the U.S., let me know.
First of all, the U.S. healthcare system. Most Australians I've talked to have the impression that healthcare in the U.S. is so expensive that only wealthy people can afford it. They have the impression that if you don't have health insurance, you will not receive medical treatment. I've even heard the slogan, if you're visiting the U.S., "If you get a pain, take a plane", meaning if you develop a medical issue while in the U.S., you should seek medical treatment in another country.
It's a shame Australians have gotten this impression, because it's totally inaccurate.
The U.S. is a mostly private healthcare system. The vast majority of hospitals are private. The only ones I can think of that are public are Ben Taub in Houston, Cook County Hospital in Chicago, and I think Washington Hospital Center in Washington, DC and Massachusetts General Hospital in Boston are semi-private. Because hospitals are private and independent, policies and employee wages vary from hospital to hospital.
Health insurance: I think all employers are required to provide health insurance for full-time employees. The basic coverage is free for the employee. The employee can choose to add their spouse and children to the plan, but the employee will be responsible for the extra cost. Some health insurance plans include dental; some do not. Employees can choose to pay a little extra to have dental and/or optical coverage included in their health plans. For the unemployed, part-time employees, and the self-employed, if they want health insurance, they must pay for their own plan. Co-pays are common with health insurance plans for routine dentist or doctor's visits. $15-$30 per visit would be the amount the insured patient would be responsible to pay.
Medicare and Medicaid: Medicaid is a government health program for poor people. I don't think people covered by Medicaid pay any health costs. Medicare is a government health program for the elderly. Medicare covers most health costs, but the covered individual might be responsible for a very small portion of costs.
The uninsured: Not everyone in the U.S. has insurance, Medicare, or Medicaid. For those without coverage, they must pay the full fee for medical treatment. For example, an uninsured person may have to pay $150 for a doctor's visit, while someone with insurance may only have to pay $30, as the insurance company will pay the rest of the cost. If an uninsured person were admitted to the hospital for surgery or any other medical issue, the cost of their stay would be higher than a person with insurance. Once the person was discharged from the hospital, they would receive bills from the hospital and doctors. They would most likely be on a monthly payment plan until the balance was completed. For a lengthy or expensive hospital stay, an uninsured person might be making monthly medical payments for years.
What about people without any money? What about, for example, homeless people? All hospitals in the U.S. are required by law to treat everyone in need of emergency medical treatment, regardless of ability to pay. If a homeless person were to come to an ER with pneumonia, the hospital would admit him, treat him until he was well enough for discharge, then discharge him. The hospital would have to eat the cost of his stay. They would not, however, have given him what would be considered optional treatments, such as chemotherapy or a joint replacement.
At the hospital where my mom works, 30% of the patients do not pay anything.
How payment from an insurance company, Medicare, or Medicaid works. Insurance, Medicaid, and Medicare payment for services is usually based on DRG's (diagnosis related groups). Medicaid, Medicare, and insurance companies have a set max amount they will pay for a particular medical treatment or condition. For example, Medicare may have a $7000 set cost for a hip replacement. Regardless of whether the person receiving the hip replacement stays in the hospital for 2 days or 2 weeks, Medicare will not pay more than the $7000 set amount. If the person's hospital stay cost more than the $7000 cap, the hospital would have to eat the rest of the cost of the patient's hospital stay. Because of this, doctors, nurses, social workers, etc. are encouraged to discharge patients in a timely fashion. Patients who develop secondary conditions or infections while in the hospital and thus end up staying longer cause the hospital to lose money. Medicare and Medicaid will not pay the cost of expenses incurred if a patient develops a bed sore while in the hospital. For this reason, recognition of preexisting bed sores upon admission and prevention of future bedsores is highly harped upon. In my last job, a patient was admitted to the hospital with a preexisting bedsore, but the nurse admitting the patient failed to notice it. Because the bedsore was not documented upon admission, Medicare/Medicaid considers it to have developed while the patient was in the hospital, therefore Medicare/Medicaid will not pay any of the costs realated to the bedsore. The hospital has to eat those costs. Insurance companies also operate on DRG's. If the costs of a hospital stay exceed the insurance cap, the patient will be billed by the hospital for those costs.
A few Australians have also expressed concern that a hospital would discharge a patient before the patient was well enough to go home. Doctors, nurses, and hospitals all have liability and could be sued if a patient was discharged and developed a worsened condition after discharge. ER doctors are especially leary of this, and because of it, I have seen so many patients admitted, who, in my opinion could have been safely discharged home.
Wait times. For a visit to an internal medicine or family practice doctor (the equivalent of an Australian GP), in a non-urgent situation, the wait time might be a couple of days. For a dermatologist, the wait time would likely be 3-6 weeks. For a gynecologist, the wait time would be anywhere from a few days to 6 weeks. For a dentist, the wait time would be 1-6 weeks. For a non-emergent surgery, the wait time would probably be anywhere from a few days to less than a month.
Having worked in the U.S. healthcare system for 4-1/2 years, I can say that it is by no means a perfect system, but it actually works pretty well. Athletes from Europe will come to the U.S. for sports-related repairative surgery. If the U.S. healthcare system were truly inadequate, stuff like that wouldn't happen.
I'm sure I've probably left out a lot of stuff, but this is a start. If you have any questions, about the U.S. healthcare system or any other comparison of Australia and the U.S., let me know.
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