My international journey as a nurse began in April 1999 when I left the UK to work in the USA and it has continued for the past 20 years. Last year, I had the privilege of going on a teaching trip to Oulu in the remote north of Finland. This April, I continued my international nursing journey by making a return trip to Oulu 20 years to the day I left for the USA.
I started my career as a nursing student in London, working at the Royal London Hospital in Whitechapel as an emergency department nurse. At the time, many of my colleagues were looking at working abroad.
Many were heading off to Saudi Arabia or Australia and, while the draw of tax-free salaries or more money may have been a lure for some, for me it was a desire to explore a new way of living and working.
My journey began in the USA. On arrival in Phoenix, Arizona, in April 1999, I was met with a temperature more akin to a heatwave in the UK at around 30°C. By contrast, Oulu at the same time of year hit a high of just 4°C.
The contrasts continued. While anticipated, it was a shock to the system to see how American insurance-based health care differed from that in the UK; however, the Finnish healthcare system is, as in the UK, a publicly funded entity.
I worked as clinical nurse in a large level 1 trauma centre at the renowned Barrow Neurological Institute in Phoenix. My experience in London had prepared me for the management of trauma cases. At the time, the Royal London Hospital had the first helicopter emergency service in the UK. In Phoenix, the institute had access to at least four helicopter companies. To be in charge in the unit felt like being an air traffic controller at times.
My salary was good compared with the UK, and the 24-hour approach was a revelation, a necessity and enhanced the richness of the experience. Added to this was the weather. Winters were similar to a nice summer in the UK; however, the summers in Arizona were a mere 27°C at their coolest, rising to the low 40°Cs. This meant the best thing to do in the summer was simply to ‘get out of Dodge’. With access to cooler temperatures a few hours north of Phoenix, I enjoyed bike riding in the scenic area of Sedona, or venturing further north to the Grand Canyon for hiking and sightseeing. Further afield I visited Las Vegas for weekends and ventured through to Colorado, Utah, and to the beach in southern California.
Very soon I found that I worked to live—I ventured out and explored while I could—but my work as a registered nurse in a big US hospital remains a highlight of my career. People may criticise the US healthcare system, but working in it did teach me the value of clinical resources and that they are finite. It wasn't that we ‘nickel and dimed’ everything, we were careful about what resources we used and when we used them. We sought ways to improve the way the service was operated and always, despite the insurance-based system, put the patient first.
The sometimes much-maligned ‘have a nice day’ attitude was important in US health care. I soon came to learn that this wasn't because you hoped they would return or because you expected a nice tip as you would in a restaurant—it was genuinely because nurses felt a need to keep the patient and their family at the centre of their care and that they were to be treated as if they would return. We strove to provide the best quality care for the best value.
I came to realise that the staff were just as important to the hospital as the patients. I had the misfortune to be diagnosed with a rare lung condition and had to undergo a series of operations. As a member of staff, the chief nurse took it upon herself to ensure that I was looked after well and that those who did not need to be present for my operations were ushered away. I experienced the best that the US healthcare system can offer. But I did note that there are disparities within the US system. I was examined and treated by a specialist in pulmonary sarcoid in Los Angeles. This was because of the insurance that I was fortunate to hold. Sadly, this is not the case for all, and there are many who do not have access to such care.
However, in my next job I was privileged to work at St Joseph's Hospital in Phoenix, which, at the time, was part of a corporation called Catholic Healthcare West. Its one abiding mantra was to look after the poor and disenfranchised, which, as a nurse, I was able to do.
I look back on my time in the trauma centre at ‘St Joe's’ with fond memories; I started in 1999 as a staff RN, and I took a charge nurse post followed by a clinical educator post. I was fortunate to have my master's degree funded by the organisation, which allowed me to explore the intricate world of healthcare quality management, an area that is very different from subsequent experiences in similar areas in the NHS.
My final experience as a nurse in Phoenix was as Assistant Professor of Nursing at Grand Canyon University. I enjoyed my last year in Phoenix, teaching and guiding a new generation on their nursing journey. It was this experience that has led me to pursue a career in education—work I love.
Twenty years on from starting my international journey, I have recently returned from my second teaching visit to northern Finland. This trip allowed me to enjoy the things I love about my career: first, the opportunity to travel and, second, to teach a new group of students.
Last year, I was invited to Oulu to teach a group of students using simulation, to tour facilities and network with staff across Europe. The one abiding memory of these opportunities is the realisation that all nurses are in this job for the betterment of patient care through teaching and supporting our newest members of the profession.
The similarities between the nursing professions in different countries do not end there. I taught a simulated session on systematic A to E assessment. This method of assessment is universally accepted and practised, and it was exciting to see that I could deliver a session to an international audience.
Despite these similarities, there were some challenging differences. For example, I attended a session by a Belgian colleague about end-of-life care. This is an important aspect of health care; however, it is only when one is exposed to the international nuances that you realise how perceptions about end-of-life care differ.
From a Belgian/Dutch perspective, end-of-life care includes euthanasia, something that we do not experience in the UK or Finland. However, I was surprised that the Finnish students did not seem to share my sense of unease at hearing this talk. I asked whether healthcare workers can conscientiously object to participating in this and was told that staff can do so if they wish. However, it was during the discussion around conscientious objection that a point made by a Finnish student challenged me, and could go some way to explain why the students did not share my unease.
Simply put, the idea that any healthcare worker could conscientiously object to assisting or supporting a person in need, and putting their own morals ahead of this, seemed alien to them. Indeed, they felt that if they came into health care, they cared for all, did not discriminate and that it simply was not their place to object. Their role was to put the patient first.
My reason for discussing this in an article on international nursing is that, while we may have differing views and processes in each country, and different approaches to training our nurses and healthcare workers, one resounding theme has always been evident to me in the USA and Finland and from international colleagues. It is simply that the patient and his or her family is our first priority and providing high-quality care is the most important thing we do—it is the reason I and many others came into nursing in the first place.