First month

Today it is exactly one month since we’ve left Norway and live in NZ. A lot has happened in this short period of time as I’ve worked three weeks on the ED, Mireille finished her first week on the Neurosurgical and ENT ward and Eva has already been to school for two weeks. We bought two cars and are on the hunt for something temporary to live as we hope to be able to buy a house after a few years from now. Because with a small deposit (5%) it’s possible to buy a house in NZ.

Me in uniform

Orientation

The first three weeks on the ED in Dunedin were meant for orientation and to familiarise myself with the health care system and logistics within the hospital. During these weeks I’ve worked together with two preceptors who were very friendly and patient with me. When I came home after my first shift I wondered what I had done to myself and my family by moving to NZ. I was overwhelmed by the overload of information, mainly because the hospital has not been digitized yet. There are many pathways and everything has to be written down on paper like the anamnesis, vital signs, medication, screening lists etc. I had to calm myself down, drink a Speights (NZ beer) and talk with my colleagues the next day about these differences. The second day at work was much better. I regained confidence, focused and realized I didn’t need to know everything from day one. The impression I have so far is that my colleagues have a good set of nursing skills and are used to work in an environment with a high level of clinical reasoning. I can learn from them and they can learn from me. I work within a multidisciplinary and multicultural team with a horizontal hierarchy in which every discipline is very approachable. Professionally it is a positive challenging workplace. As an ED nurse my work is quite similar to the ED in the Netherlands, but different in some aspects from Norway. In the Netherlands, I remember that 15 years ago, it was the ED nurse that assisted when a patient needed to be intubated while nowadays this is done by the (nurse) anaesthetist and in Norway it is the operating room nurse that assists when a chest tube is inserted, here in Dunedin these skills are part of my function.

Differences

The main dissimilarity in NZ versus The Netherlands and Norway is that all patients have free and unlimited access to the ED. All patients, if not referred, have to be assessed by an Emergency Physician first. The Emergency Physicians function is to differentiate and allocate patients to the specialty that is best for the patient's problem. In The Netherlands or Norway would many of these patients be directly referred back to their General Practitioner if not potentially critically ill or injured. Some patients present themselves with problems that have existed for weeks. This means that many patients have to be assessed on the ED which I believe causes overcrowding and extra pressure on staff, especially in combination with not having enough beds in the wards. The ED can be like a patient decompensating when having heart or renal failure. If you give to much fluids without urinating her or she will decompensate and drown. The same problem also occurs in Emergency Departments in The Netherlands and Norway.

Another difference but not so very different is the triage system. In NZ we use the Australasian Triage Scale Category which is quite similar to the RETTS system being used in Norway and the Manchester Triage System being used in The Netherlands. In short, the differences are mainly colors and numbers. If a patient gets an ATS 1 score in NZ will a patient in The Netherlands or Norway be triaged red. In both cases the patient requires immediate treatment.

Sometimes other medications are used like Metaraminol as a Vasopressor instead of Noradrenaline. These are solutions prepared by the pharmacy. Very helpful in acute situations which reduces stress and contributes to the prevention of errors.

Metaraminol