Four months ago I decided to take a big leap of faith and move across the border to work as nurse in a state that I have never visited. I am Canadian (proud one at that!) and I have been working as an RN for five years and the last three years have been dedicated to emergency nursing. I’ve always wanted to be a travel nurse since graduating nursing school so I seized the opportunity I had to travel to make my dream happen. I choose my first assignment to be in Houston, Texas – partly because it is home of the largest medical hub in the world. I have never been to Houston, or Texas. Nor do I have family or friends here. But I decided to surrender myself to the unknown and start a new chapter.
Although I miss my friends and family back home, working within the American health care system has taught me a lot in a short amount of time. Don’t get me wrong, I love Canada and I think Canada has an amazing health care system with great access to many people around the country. But, I wanted to challenge myself and grow in my nursing career. I wanted to experience the similarities and differences of working in a busy urban Canadian ER department vs an busy urban American ER department.
So far I can say that the transition has been a challenging one. Coming from the Canadian health care system and trying to navigate the American health care system takes time. Nursing is nursing wherever you go but the way in which things are done here are just different. I had to learn computer documentation for all of my documentation (in my old job we would use electronic documentation for medication, physician and admission orders only and not for nursing assessment documentation). I had to wrap my head around the fact that hospitals specifically get money for seeing, treating and discharging a patient in a specific timeframe. That being said, the turnover in the ER here is much faster. Patient’s are seen very quickly once they enter a room within the department. In contrast back home here I worked a patient would arrive to a room by EMS or the triage RN and be seen first by the assigned RN for that room. As nurse I would carry out specific medical directives if my patient met the specific criteria. The patient would then wait in the room up to an hour until being seen by one of our ER physicians and it was based on patient acuity (however it the patient was unstable – I would ask an ER physician to see them STAT).
Press Ganey is an important term that management will talk about very frequently here. There is a strong emphasis on customer service and patient satisfaction scores as it relates to hospital and departmental funding. The better the survey scores patients fill out the more money the department can get.
One of the hardest things I learn’t was that taking a 30 minute break for lunch during a 12 hour shift was the standard here – even on nights. I was so accustomed to taking 3 separate 30-45 minute breaks at my other job back in Canada. Oh how I miss that!
One of the humblest things I have learnt is that (at least in my experience) people who I have come in contact with here in Houston, generally have a very positive image of Canadians. I have been told that Canadians are such nice people and that we are so polite! I think it’s true, Canadians on a whole tend to get a good rep, but, I must also say that people I have encountered with here in Houston are really nice too! That southern charm/hospitality is very true and I love Houston for that.
Regardless of what the differences are, we as nurses have the incredible opportunity to impact people wherever we go. Yes policies, departments and management may change, but your ability to directly change a person’s life stays the same regardless of where you go.