a glimpse into A&E – Tamara

Stories of American nurses in the UK

The path I took to become an American nurse in the UK is just one of many which is why I’ve invited others like me to share their stories. The first in this series explored Kelley’s journey to becoming a cardiac critical care nurse in London. In this post Tamara, a fellow nurse and blogger, talks about her move all the way from Washington State to Winchester and working as an A&E nurse.

Read more on her blog The Nurse’s Eye

A little bit about me

At least the weather is the same.

I am Tamara Glasgow from Tacoma Washington which is thirty minutes south of Seattle. My family and I, including the dog, moved to Winchester England in late October 2020. Winchester is about 60 minutes west of London. We finished isolation 4 days prior to going into the first lock down. My motivation to be in the UK was to live abroad and to experience the NHS system first hand.  I go into depth decision to move in my post Why England.

Working in the UK

In the USA I was a critical care transport nurse and picked up shifts in the ED at a trauma center and at a Pediatric hospital. In the UK I could not find a position as a critical care transport nurse therefore I applied to the ED (A&E). Even though I did not have to switch specialty it has still been a steep learning curve.

As in any emergency department there is not an average day but to sum one up it would consist of shuffling patients in and out of the department. One of the biggest differences is you do not need a medical diagnosis to be admitted to a hospital in the UK. For example a patient with abdominal tenderness and an elevated white blood count has possible (query) appendicitis. They will get moved/admitted to the ward for further work up. Then said patient might be discharged a couple of hours later from the ward. In the USA the patient requires a medical diagnosis to be admitted onto the ward.  

The A&E in the UK offers many opportunities for growth ranging from becoming a preceptor to an Emergency Nurse Practitioner. Though this is different from the USA version of a nurse practitioner, you are able to treat minor complaints independently.

The good and the bad

The biggest benefit of being a nurse in the UK is the work life balance. On you first day you are granted 7 weeks off for the year and at our trust you are encouraged to take two weeks off every quarter.

My favorite titbits about an English A&E are:

• there are no discharge instructions to hand out or to wait for
• You can grab the discharge medications you need out of a cupboard
• We rarely administer narcotics since IV paracetamol normally does the trick
• You come across many different accents

Just this past week I had an older gentleman tell me in a perfect English accent “may I have another spot of tea.” Oh and of course tea will alleviate most ailments.  

As a seasoned nurse the main challenge has been getting to know the different medications and having to mix them up myself. This includes high alert medications such as norepinephrine or insulin. Another drawback is, that patient I mentioned above with query appendicitis that needs a CT abdomen or an ultrasound if they come in at night they will be moved to the ward and wait until morning to have the diagnostic study completed. And the last difference for me is that nurses here are specifically trained to be adult, child, mental health or a midwife. Therefore as an American trained nurse it can be a shock for them to see you do fetal heart tones or that you are comfortable starting an IV in an infant. 

Advice

My number one piece of advice that was given to me by another American nurse who moved to the UK was to bring all your certificates. The fancier the better. It will clear your path to be able to do things the moment you arrive. For example I brought an actual certificate from my days as a PICC line nurse that stated I had trained in vascular access which cleared the way for me to put IVs (cannulas) in on my second day.

In addition, I recommend you take the OSCE and get your NMC pin prior to getting a job. This allows you to negotiate your wages based on years of experience which will make a difference in your wages in the long run. If you get hired prior to getting your registration (NMC pin) you will start at a band 4 level and then move on to the lowest level of a band 5. Versus having your pin in hand and starting on the upper end of a band 5.

And final word of advice, if you are thinking about if it is worth it, do it! It will not be easy but those big dreams never are…I did a post The Mountains We Climbed to get to England that captures the challenges my family and I have encountered.

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