On August 17th, 2019, a great adventure began for the six of us. We arrived in Bergen, and of course, it was raining. Although the weather could have dampened our mood, it felt as though this new place was just saying; “Welcome home”.
Right away we started in classes with various lecturers. They kindly introduced us to Norway’s culture, healthcare system, and language. Two weeks later we began our clinical practice at Fyllingsdalen Sykehjem (nursing home). Here we spent the following four weeks.
At the end of our time at the nursing home we were asked to share what we had learned.
Where to begin? We experienced and learned so much during this time, not only about nursing, but also about culture, language, and the art of caring. After reflecting on those four weeks, we put our takeaways into five different points.
The Five Greatest Takeaways from American Nursing Students in Norway
In the US, it is emphasized and strictly enforced that nurses perform hand hygiene when they enter the room. They immediately put on gloves, and they also perform hand hygiene as they exit the room. In Norway we have noticed that hand hygiene is less of a priority than it is in the US. In general, wearing gloves was an exception, not a rule. From this we learned to appreciate the importance of physical, skin-to-skin contact between the nurse and patient.
We noticed that nurses share responsibilities and collaborate well. Also, we noticed less of a hierarchy between different healthcare professionals. Everyone worked together and respected each other in their respective roles. Nurses valued and took time to form meaningful relationships with their patients. They often sat down when speaking with patients. In the US, nurses are each assigned 4-7 patients, for whom they are solely responsible. Nurses do not “share” patients with other nurses. But of course, we collaborate and help each other often.
In the US, medication administration is a strict and highly secured process performed only by registered nurses. The steps for administering medication are extremely rigid and often nurses must use their thumb print to access medication. We were surprised to see the amount of trust given to nurses during medication administration here in Norway.
Role of the Nurse
In the US, a nurse’s time is spent administering medications, monitoring for complications, documenting, and communicating with other members of the health care team. All other types of patient care are delegated to the nurse assistants. At the Fyllingsdalen Sykehjem, nurses were involved in all parts of caring for patients. We appreciated the intimate way that nurses were able to get to know their patients by helping with daily tasks. Also nurses were able to spend much more time with patients because of the shared responsibilities.
Security and Documentation
In the US, nurses must document absolutely everything. We take vital signs three times a day, and document any time a patient uses the bathroom or takes a shower. Nurses spend a large portion of their shift documenting because we are taught that “if it is not documented, it did not happen”. In Norway, we noticed that nurses documented their tasks, however it was more focused on abnormalities, rather than normal occurrences.
How these experiences will change our nursing practice
Studying in a foreign country has made us more confident and creative as nurses.
This experience has grown our cultural awareness, and will make us provide better care to patients from cultures that differ from our own.
We will remember to make our patients feel like humans by making skin-to-skin contact whenever possible.
We will take time to sit at eye-level with our patients.
We will make time to perform daily tasks for our patients, such as bathing and feeding, instead of delegating these tasks to assistants, so that we can develop a deeper relationship with our patients.
Experiences from home care nursing in the community
After our time in the nursing home we spent five weeks in home care nursing in the community.
Homecare nursing is used in the United States, however it is not used in the same way that it is here in Norway. That difference is mostly due to the great expense it is to have homecare nurses in the US. In fact, this is such an underused service in our country, that nursing students are not required to ever experience this field in our schooling. So this is our first time in home care nursing ever, not just in Norway.
There are many things that struck us about home nursing, from managing a full schedule, to learning about the personal lifestyle of each of our patients.
Here are some of our reflections
We reflected together with our instructor about our impressions of homecare nursing.
“You have to be ready for anything in homecare. You never know what will lie behind the door.”
“When I come into a patient’s home, I feel that I must be an unwanted guest.”
“I think that the patients must feel very anxious, because they do not know who will be walking through their door to care for them.”
“In the hospital, it is nurses who host patients, but in homecare it is the patient who hosts the nurses.”
“It is difficult to know what to do when a home feels unlivable to us. What is a nurse supposed to do if a patient’s home is dirty or smelly? Do we say something, or respect the way the patient wants to live?”
“You learn so much about a patient by walking into their home. The pictures on the walls and the things they keep reveal more than words ever could. This makes language barrier much easier to overcome.”
Strengthening our nursing skills
It has been a great privilege to be able to step into Norwegian homes. From this we have strengthened our nursing skills. Through this unique field of nursing we have also learned so much about the Norwegian culture and healthcare system. As foreigners, every part of this new culture is exciting and interesting to us. We feel as though we are gaining “the inside scoop” to the authentic Norwegian culture by stepping into our patients’ homes.