TO FURTHER global awareness, nursing students from Birmingham City University in the U.K. and the University of Pittsburgh in Pennsylvania visited each other for 2 weeks. The exchange stemmed from an international partnership between the two universities initiated in 2005 to share information about simulation technology.
First the students from the U.K. came to Pittsburgh, attended nursing classes, observed staff nurses, and met with U.S. nursing students. The following summer, the U.S. students traveled to the U.K., observed in hospitals, participated in simulations, attended lectures, and met with U.K. students.
The trips gave students in both groups the opportunity to learn about and experience nursing and healthcare delivery in another country. Afterward, we reflected on the experience to identify the positive and negative aspects of healthcare delivery and education in each country, compare the educational and healthcare delivery systems, and note the cultural differences. This article presents the U.K. students' observations first, then the U.S. students' observations.
U.K. students in the U.S.
By Abbie Moseley, RN, and Becky Clifford, RN
During the summer before the third year at our university, we had the opportunity to visit the University of Pittsburgh's School of Nursing and some University of Pittsburgh Medical Center hospitals over a 2-week period. Our visit gave us a basic knowledge and understanding of genetics and transplant nursing, two specialties of this medical center. We attended lectures on genetics and observed nurses working on transplant units at the hospitals.
During our stay, we became aware of some interesting differences affecting nursing students in our two countries. Because nursing education in the U.K. is funded by the National Health Service (NHS), students gaining a qualification in health specialties are exempt from paying tuition fees. Many students also qualify for a bursary or a stipend, a monthly payment to assist with general living costs. They get these funds if they pursue the diploma program instead of the degree program, the two routes of entry into the nursing profession.
The route of entry for undergraduates is being reviewed, and the government is considering an all-degree profession. This has already taken place for midwifery, and we're regulated by the same professional body, the Nursing and Midwifery Council. The bursary may explain the high proportion of mature students with families and domestic responsibilities.
This wasn't evident in the U.S.; most nursing students appeared to be recent high school graduates. We found that in the U.S., many students applied for scholarships. Students rarely move out of their home state to study because tuition is high and limited financial assistance is available.
Before applying for a nursing course after high school or college, the U.K. applicant must choose a specialty or branch of nursing because we don't have generic programs as in the U.S. We feel the U.S. system gives the students more insight into all aspects of nursing and provides wider knowledge and more choices after graduation. The drive for academic success in the U.S. appears to be very much encouraged, with a higher emphasis on returning to postgraduate education than in the U.K.
We were lucky enough to experience the simulation centers in Pittsburgh, which we find an exceptional format for nurse education, above and beyond the level of simulated education we experienced in the U.K. We've shared this aspect of our trip with the faculty of the health department at Birmingham City University to improve our simulation opportunities, an area of potential collaboration between the universities and practice staff.1
The cost of healthcare in the U.S. appears to affect the ability of staff to meet patients' essential needs. In the U.K., basic essential care, such as hygiene needs, is emphasized. In the U.S., we found the nurse's role to be more advanced, focusing less on basics. If a U.S. patient can't afford all aspects of healthcare, they may not get any.
We found that U.S. patients with chronic conditions were refusing life-changing treatment due to cost and concern about the financial impact on their loved ones. This was the main difference we encountered because in the U.K., taxes fund the NHS, ensuring that every citizen has access to healthcare.
U.S. students in the U.K.
By Colleen Vogelman, SN; Molly Boyce, SN; Caren Seltz, SN; and Brittany Genday, SN
Four of us were offered an opportunity to study abroad after our sophomore year. We discovered that Birmingham, a very ethnically diverse city, is becoming the first city in the U.K. where whites aren't the majority. This diversity has proven to be a challenge for nurses because they must competently care for many non-English-speaking patients and also respect myriad cultural practices. This diversity isn't as apparent in Pittsburgh.
At the undergraduate level, nurses in the U.K. specialize in one of five areas: adult, pediatric, mental health, learning disability, and midwifery. We believe the U.S. nursing schools prepare students with a broader knowledge base.
We found it interesting that students in the U.K. had blocks of theory followed by blocks of clinical placement. The hours they spent on theory and clinicals were equal, while in the United States, more hours are devoted to theory.
Another major difference in clinical education is that U.K. students are assigned a one-on-one RN preceptor throughout the program instead of being assigned to clinical groups of about eight students. All U.K. staff nurses are considered qualified to precept.
The realm of U.K. healthcare was automatically vastly different because it provides universal healthcare. All citizens have access to the system, regardless of their contribution. We learned that a minimum of 11% of citizens' salary is deducted to fund this, but all citizens are entitled to healthcare even if they don't work or pay taxes. Elective procedures, such as cosmetic and gastric bypass surgery, aren't covered by the NHS, have lengthy wait times, and rarely occur. Some choose to purchase additional private insurance to obtain this coverage.
We also found major differences in the practice of obstetrics. Midwifery, the standard for deliveries in the U.K., is very efficient, saves money, and provides women with continuity of care from the prenatal through postpartum periods.
We also noticed some structural differences in the hospitals themselves. In the U.S., private or semiprivate rooms are most common, but in the U.K., bays or wards with multiple patients in one room are the norm. We believe this makes it difficult to implement effective isolation practices commonly used in the United States. We found privacy to be an issue in this more open patient-care setting. For instance, in the U.K. hospital, patient names were written on a board in the center of the ward.
We also saw a significant difference in uniforms and the nursing hierarchy. U.K. nurses wear color-coded uniforms based on their position: staff nurse, senior staff nurse, sister, senior sister, and matron. As in the U.S., nursing is a predominantly female field, but U.K. men in nursing use these titles as well. The matron is comparable to the nurse manager of an entire department, a senior sister is similar to a unit director, and a sister is equivalent to a charge nurse. Many U.S. hospitals are slowly starting to return to a color-coded system, which differs from the U.K. system because the color indicates a specific role but not the rank or position of a nurse.
Benefits of studying abroad
So why study abroad? We were fortunate enough to gain a new perspective about another country's healthcare system as undergraduate students. We not only learned about another culture, but we were also able to reflect more upon our own culture, healthcare system, and education. We saw the flaws and benefits of each system. We've made amazing friendships that endure, despite the ocean and thousands of miles between us. Altogether, the trips provided us with a memorable educational experience that we highly recommend to any students considering a study abroad opportunity.