Travel Nursing - UK vs USA
"It took me 30 seconds to pull my jaw off the floor. I had never seen this before."
Since moving to the UK in May to be a NICU nurse, I have received a ton of questions from old and new colleagues, friends, and family about the differences between nursing in America versus nursing in England. I think any time you change hospital, there’s a learning curve. Every unit has their own policies and methods for doing things. I expected this when I started my new job in England and from my first day onwards I’ve been busy learning the ins and outs of my new unit. This hasn’t phased me, but I have been very surprised at the different roles nurses play in the UK compared to the States.
I have only been working here for four months, so it hasn’t been a long time, but I’ve made a list of some of the key differences I’ve noticed in nursing during my initial time here. I thought this would be useful for anyone curious about nursing on either side of the Atlantic before they take the plunge.
1. The Pay
Okay, so this wasn’t news to me. I knew what my new salary would be before I signed my contract, and I had heard before I applied that American nurses are paid better. It really hit me though when I received my first pay check in England. “Not bad,” I said to my new travel nurse friend from Spain, who looked at me incredulously. She later explained to me that what I had received was not a twice monthly pay check like my previous job had paid me, but the pay check for the entire month. Ah... Not great! Because nurses are paid a fairly low starting salary in England, you can’t help but feel nurses here are a bit unappreciated. Not by the people; in my experience so far the patients’ families have been very lovely and gracious as a whole, but by the country. The downside to universal health care I suppose.
It is possible to earn more as a nurse in England, but this requires moving up the nursing ladder into more managerial roles and less clinical ones. This isn’t a bad option, but frustrating when you think about how much more work and time you have to put in here to be paid the same as a starting nurse in the States. While the pay may not necessarily be my ideal for the long-term, I knew what I was going into and, for me personally, I feel like what I’m losing in salary I am gaining in worldly experience. It was worth it for me for this phase of my life, but it is something I would definitely want to inform others about before they sign up to come over.
2. The Nursing Hierarchy
It wasn’t until a few months into my application process that I heard of England’s “band” system for nurses. Nurses are placed into their band, most commonly ranging from a band 3 to band 8. A band 3 is equivalent to a health care assistant, moving to a staff nurse, then junior/senior sister, to matron. While we don’t have this system in America, I can understand the pros and cons to implementing it. On the one hand, the roles are clearly labelled in English hospitals. You know which band hold which roles and can very clearly seek out who you need help from. I also think this provides incentive to move up the nursing ladder, which may include additional courses to undertake and usually includes a pay raise.
On the other hand, I’ve noticed nurses are very obviously labelled which band they are in. I understand the purpose of this because it makes it easy to find who you are looking for, but sometimes inconveniently, I also have seen parents request only nurses of a certain band level to look after their baby (when a lower band nurse is perfectly sufficient). I also have felt a sense of an grouping culture between the nurses in different bands. Nurses in the States have different roles as well, but while I worked there I definitely felt more of a sense of being equals and shared respect.
3. Nurse Roles
Honestly, I was a bit shocked when I came to England to discover that the nurses here are more limited in what they are allowed to do. I was caring for a baby whose IV (a tube into the vein) came out and needed to be replaced. I gathered the equipment to restart the IV when the nurse I was working with stopped me to call the doctor. I was confused why we needed the doctor when she explained to me that we don’t insert the IV’s, but instead the doctors do. It took me probably 30 seconds to pull my jaw off the floor. I had never seen a doctor insert an IV. I even had a doctor I worked with in America tell me that IV’s are “really a nurse’s job.”
This has caused some frustration for me because there have been times when I needed an IV ASAP and I had to wait on a doctor to make time to come do it because I’m not allowed. I could have saved everyone time by doing it myself. I should mention that this isn’t the case for all nurses in England, but they do implement it where I work. This isn’t the only skill that nurses aren’t allowed to do here. There are many tasks that require someone else to come in and do instead of us. In America, I feel that there is a higher level of expectation nurses are given after they’ve completed nursing school. We are expected to utilize our critical thinking and judgement skills. We are expected to carry out tasks and skills and practice them until we are confident. We are trusted at the bedside to intervene and advocate for our patients.
This culture does still exist in England, but I find that it is scaled back. If something needs doing or decisions need to be made, everyone goes to the doctor. There are absolutely instances where this is necessary in both England and America, but more commonly in America nurses are trusted to make their own judgement to an extent, whereas in England the nurse's role feels a bit more hands-off.
Read more about the roles of a NICU nurse here.
4. Holidays and Shift Work
I think every hospital varies when it comes to their scheduling and time off system, but something I thought was worth mentioning that I get asked about is annual leave in one versus the other. In England, you are allowed six weeks of leave per year, which I do find generous. In America, you use your Paid Time Off that you accumulate through working hours. I never felt this was an issue when I worked in America, however now that I have this allowance I am very grateful for it! Another difference I’ve found is that American nurses usually work a set schedule of all day shifts or all night shifts, whereas in England it is very common to be asked to rotate between the two. After a little adaptation period this has never been a problem for me though.
5. Should You Do It?
I just wanted to close by saying that I really only have been in England for 4 months, and this has just been my personal experience, opinion, and observations so far! Not everything I have written applies to all hospitals or units.
If I were to give advice to someone who is thinking about coming to England from America, I would advise you to think about what's important to you and why you want to be a travel nurse overseas. If the money is what you are looking for, I would recommend staying in the States. If you want to have the opportunity to live abroad, travel to different countries in different continents and see the world while still working as a nurse, I think its a great opportunity and learning experience! Both hospitals are filled with caring and compassionate nurses - they just sound a bit different over here! Cheers y'all, Kirsten x