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.

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.

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.

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.