Tuesday, November 12, 2013

Australia Nursing from the USA

Working as a nurse is very different here from the states but so far I enjoy it. For one thing there are no RT's. And I'd say that is my weakest area, but I'm getting more comfortable. I've found the nurses here to be much more helpful than any hospital I worked back home.  Another difference is no orthoglass so that means using plaster which also isn't as bad as I thought it would be. Here's a good video on backslaps (http://www.youtube.com/watch?v=iGPDeHgyDVw (Preview) ) Also blood glucose is in mmol/L not mg/dL so a normal value is 5.5 mmol/L or 100 mg/dL. Other differences a roster= schedule, nurse/patient ratio = load, 
I like Sydney because I don't need a car, its fairly easy to get around on public transport, and there's plenty to do. However, anywhere outside the city you will need a car. Australia is a huge country. 
Starting work as an agency nurse you won't get the vented patients until you're comfortable. You will get some on highflow nasal prong and bipap but those are not too hard. Review a respiratory book and you should be good. I'd rather take two non-vent right now until I'm more confident. The nurse patient load in ICU is 1:2 for non-vent and 1:1 for vent patients. If you're working ICU when you have a vent patient I'd just start kinda playing with the vent and looking at the settings. Try to do everything as if there was no RT. Its not as hard as I thought. Understanding the ABG's is more difficult for me. I have very limited ICU experience and I'm still able to do it pretty well. Most of the nurses are much for helpful and in the bigger hospitals there's also more staff who just walk around helping.

The work load is about as busy as the US hospitals. 
I took contract travel nursing it for 2 months. I'm went to a very rural town called Cloncurry in Queensland. The hospital has apartments right behind the hospital which travel nurses live.  In Cloncurry the hospital consists of a 3 bed ED, medical, and aged care facility. When I left a two weeks ago there were 12 patients. 4 acute adults, 1 peds, and 7 aged care. It was an adjustment working in Cloncurry but I was paid so stinking much I can't complain (All of that extra money is being saved for my visa). I learned that Queensland pays the most for nurses and rural nursing pays very well. Rural nursing you almost take the role of a nurse practitioner. Nurses do just about everything. From suturing to diagnosing ear infections and giving antibiotics. Many of the rural nurses are what's called RIPRN trained and it opens up the scope of practice even more. In Cloncurry the doctors only come to the hospital for real emergencies (but you can consult with them over the phone) or on rounds for the inpatients twice a day. I've not had any major issues in rural nursing. Its pretty neat doing medicine without the luxuries, it was an interesting challenge. Its been such a good experience and I highly recommend at least doing it once. 
Back to Sydney I'm normally an ER nurse but because I was worried at first about not getting shifts I signed up for HDU (similar to stepdown unit), ICU, and the general medical floor. I work mainly ICU and HDU but I've worked just about everywhere. Its been a neat experience. I was so nervous! I had my training in a box and thought I could not survive anywhere but ER. I'm glad I took the leap. Don't expect to work ER right away. All nurses start out on the medical ward or if you have ER experience you can also do ICU. The reason is the drugs are different and the scope of practice is different and one can be supervised a little more. My ER shifts were not bad but again it is pretty different.

Rural nursing and urban nursing are so extremely different. In the city you pretty much have unlimited resources and backup. Its almost sad because nurses have such a limited scope in the city (one example you can't start an IV without taking a course first).  There are physio's who do the backslab (plaster splints for broken bones) in the city but in rural you will do it all and then some!

If I were preparing on such a big move I'd start by doing assessments as if you were a doctor. Including looking in the ears, nose, mouth. When you have a limb injury try to pinpoint exactly what area is likely injured (because x-rays are not always available) look at ways to diagnosis with limited resources. 

I use two nursing agencies one Nightingale is wonderful. I love them.  They explained things very well and I highly recommend them. The only downside is they only do Sydney region. But when starting I think that would be the best place to start. http://www.nightingalenursing.com.au The second one is Healthcare Australia (HCA). They are one of the largest and can offer positions in all states. The pay is good. And I'm just finished a contract with them in rural Queensland. http://www.healthcareaustralia.com.au/

There are many agencies to work with (I've spoken with almost all of them) and these two are the most friendly and helpful. I would avoid an agency called Koala Nursing they were flat out rude and not helpful at all (and I was just trying to as a few simple questions).

I'm on a working holiday visa (allows me to work for 1 year) and I'm working on getting my long term visa. I don't want a sponsorship I want to do it myself so I'm  not limited to one area of Australia. 

I hope this isn't too long. This is a work in progress for me. And I encourage you to do your own research and figure out the best path for you.


Friday, November 8, 2013

The First Steps to Working as a Nurse in Australia from America



So I've been asked by a few people what the process of becoming a nurse in Australia. I figured I go ahead and make a few blog posts on my experience and hopefully it will help. So enjoy! This is the way I did it. I encourage you to do your own research and figure out the best path. I've included links that took me hours to figure out what-went-where and will definitely assist in educating you on the process.

The first thing you need is apply to AHPRA . Applying is mainly just a lot of paperwork you will need letters from your former employers, transcripts, proof of identity, your state board of nursing to send in a verification letter, a resume' (CV) and patience.  Follow the directions on the application exactly and you should do fine. With my application AHPRA requested another letter from my nursing school with a breakdown of the clinical and theory hours. I do not recall that being on the list of required documents but they might ask for it.  It does take a month or so to get an answer.

Once you are approved for a license you will get a letter that states you're eligible to be a registered nurse. After you will need to physically arrive at the AHPRA office and provide: 1.  proof of identity (passport and printed copy of your visa) and 2. evidence of Australian residential address or an original letter with an offer for employment. 

I worked with an agency and had a letter. And opened a bank account with Commonwealth Bank online before I arrived. Its also important to note this is probably the only time you will need an actual print out of your visa. When I arrived they specifically asked for a printout of my visa.

If you are under 30 you can do a working holiday visa (this is what I did) and this allows you to stay for 1 year. Its a good way to take a look and make sure moving overseas is right for you. Since the USA does not have a working holiday visa many countries won't offer it to USA citizens. Australia is one of the few that does. Since your working in healthcare for the visa you will need a physical, chest x-ray and blood work. Once you apply for the visa make sure you schedule the appointment with a doctor ASAP in the event there's a delay in appointments. You will need a few forms to take to the doctor from the visa application so its a good idea to have the printer handy or make sure you can save it to thumb drive.

If you're over 30 you will need either sponsorship Healthcare Australia  can give your more information on that (let them know I sent you I might get a little bonus). The application for agency nursing is almost as long as the application for AHPRA! And you will need two referrals from supervisors.

The other option is the 189 Independent skilled visa. I'm currently working on the 189 visa and will keep you updated on how it goes. You will need to be assessed my ANMAC and then invited to apply for the visa. You will need many of the same documents used for AHPRA.

Did I mention its a LONG application and a lot of paperwork?!?! It will get frustrating. Take one step at a time and it will work out. Keep copies of everything. You will need them later. I made the mistake of sending an original document and it's been frustration trying to get my former employer to write a new letter.

I hope this helps! Later I will share more on life in Australia and the adventures of being a nurse Down Under.