For all of my nurse friends in the United States of America......

WOW!  What a culture shock!!  At first I didn't think there would be much difference in my nursing practice but as I went farther into my orientation I found out how wrong I was!!!

First off..there are no pre-mixed drips here.  We have to mix our own inotropes!  There are formulae to be used depending on the patients weight.  There are no standard concentrations and everything is based on .01 mcg/ml.  If you are using a 50 cc bag it is .03xthe patient's weight in kilograms to get the amount of milligrams to add to the bag,  for 100 cc bag it is .06 and for a 250 cc bag it is  1.5.  Then you multiply the milligrams by 1000 to get the micrograms...then divide by the volume, divide by the patient's weight and divide by 60 and that gives you the micrograms/kg/min.  Two nurses have to do the calculations separately till both agree.

There is no unit dosing here.  Everything is in multidose vials.   Also there are no pre-filled syringes only vials.  The clinical educator and a nurse came to me yesterday with an insulin pen...no one knew how to use it but they figured I did.  They had the pen but no needle caps to put on it and they did not know at the time these pens are for single patient use.  They had been drawing the insulin out of the top with a needle (I could just imagine Carey's and Becky's looks if they saw this).

We draw ALL of our own blood sampling.  I don't consider this a problem.  All of the patients in all of the ICU's have either a PICC line or a central line.  We also do our own blood cultures and there is quite the protocol for doing them.  A couple of years back there was a huge infection control problem which is why they are so compulsive now about how we draw blood cultures, do trach care, do wound care etc.  All of the rooms in my unit are positive pressure rooms.  We have had several patients with H1N1 flu and the reason it is so serious here is because many of the patients have serious genetic diseases that make them high risk for morbid complications.  I'm telling you every night I come home and have to look up a half a dozen things I have never heard of!!

I have to do conversions all day long!  I'm sure over time it will come to me more naturally.  The hospital is run based on the American system of practice but temperatures and lab tests use the European system of measurement.  For example. a good blood glucose here is 4-5.  Multiply that number by 18 to get our equilivant.  A low hemoglobin here would be 78.  Thank goodness they put the normal range by the labs or I would never remember all that stuff!!  PT, INR and PTT is the same but the chemistrys are very different!!

I like not having to charge my patients for every little thing.  I can use as much gauze and wound care stuff as I want.  I can use all the chux in the world and not have to scan a single charge.  Communication is a problem but I am learning more Arabic and can instruct in one word requests (though they think I speak with a funny accent :) and I STILL have a lot of trouble with the gutteral click)  A lot can be communicated by gentle handling and a soft touch.  My preceptor was kind of rough with a mother who just wanted to rub her daughter's back (her daughter is 16, has leukemia and probably will not see her 17th birthday).  After the preceptor left I took some lotion and started massaging the girl's feet.  The mother saw what I was doing and was so happy there was one thing she could do to give her daughter some comfort.  So I gave her the lotion and she went at it!  I have discovered when it comes to caring for people body, mind and spirit are very much universal!

My first day on my own was yesterday and it was a great day!  There is a lot to experience here and I am embracing that!!!!

Chris Young, SN1 xx