We speak with Marie about her nurse training in the UK as an Enrolled Nurse and later Student Nurse, her career throughout Europe and her current job as a Senior Community Staff Nurse in France. About Matt Farrah - follow me on Google+

You have a great deal of experience as a staff nurse. Can you tell us how you started your career in nursing

I had not planned a career in nursing. In fact I was studying Graphic Design at a London School of Art and though I was extremely happy with life as an art-student, doubts as to whether I would 'make it' in this fiercely competitive world eventually prompted me to write to The Hospital For Sick Children, Gt. Ormond St. seeking advice and guidance into possible careers with children. After all, I had hoped to become an illustrator of childrens' books so my passion for small children took me there.

So I found myself just 2 months later in June 1978, arriving with a small suitcase at the Nurses Home as a Pupil Nurse on a 2 year Enrolled Course. It was only in the early weeks of my training that I learnt of the different trainings available and realised that I was on an Enrolled Course due to my lack of qualifications. I had left school with a modest 5 'O' levels and 2 'A's , one of which was Art and the other, French!

I enjoyed every minute of my life as a Pupil Nurse and on passing the exams in 1980, I applied to further my training and began a shortened 2 year course as a Student nurse in January 1981 qualifying as a State Registered Nurse in 1983. I have many fond and treasured memories of those early years and recall so clearly the day I held the Registration Certificate in my hand. I felt proud to be a Nurse!

How does the training you undertook to become a registered nurse differ from the training available today in the UK?

I think that when I undertook my training, things were much more 'personal' and there were smaller intakes of student nurses. Hence one felt more supported both by other students as well as by the School of Nursing. Today, theoretical studies are followed at a University and practical placements in the hospital setting, sometimes in several teaching hospitals so as to acquire the clinical practice experience required to pass each assessment.

I also had a salary when I began in 1978, a whole �30 a week! This enabled me to travel home by train on days off, buy the few personal things I needed at the age of 19 and even save a little. In 1981, I passed my driving test and bought a lovely old car for �350 and all this from my salary as a trainee-nurse. Of course, I lived 'in' and ate (rather badly!) at the Hospital canteen.

I do remember well just how strict the training was compared to today. Apart from the very fussy uniforms with starched caps and aprons, (though I would be lying if I said I hadn't felt proud to wear them !)..a nurse was not allowed to wear any jewellery or have her hair touching the collar. At all times on or off-duty , a nurse had to behave in a manner in accordance with the code of practice set down by the Royal College of Nursing. Junior nurses held respect, fear or both for trained nurses and there were never first names used, not even in the School of Nursing on study days.

I think that today, trainee nurses are more at ease in the learning environment but they have to deal with different pressures that were not present in my early days. Camaraderie was an essential part as life as a junior nurse and I'm not sure that today this is felt quite so much.

I'm beginning to feel far too old so hopefully I have answered this question enough !

You�ve worked a great deal in mainland Europe, including in Brussels and France. How did you find adapting to working as a staff nurse in a new country?

I had left England due to my husband's work in 1990. My children were still very small and I was fortunate to be able to care for them full-time especially as their father travelled extensively and was away from home often on business. In 1992, we moved to Brussels following 2 years in France, and as both children were now in school, I took the plunge and offered to work on a voluntary basis at the local Hospice.

My rusty school French was enough to grasp essential information to assist as an untrained nurse in the care of terminally ill patients. As well as brushing up my French , I was able to observe how nurses work in Europe. I think the main difference at that time was that UK trained nurses remained involved in total patient care whereas in France and Belgium, the basic nursing roles for the most part, were carried out by auxiliary nurses.

I spent 10 months 'working' on a ward in this Hospice and was offered a position there but once more, my husband's work moved the family back to France. I had enjoyed the learning experience in palliative care as well as gaining confidence with the language, especially in medical terminology, so important� and without which, I could not have embarked on a career in France.

Can you explain to anyone interested in working in mainland Europe how you have maintained your NMC pin number?

This is simple. I took advice directly from the Nursing Midwifery Council. One maintains 'Status' by way of annual subscription and informing the NMC of any change regarding professional situation or address. I received a great deal of support and advice particularly when I felt ready to re-insert as a State Registered nurse in France following a break in my career when my children were young. I was advised to contact the equivalent body of the NMC in France and apply to take a 'Return to Practice Course' .

You already speak French, so I imagine you were able to communicate well with the patients you were treating. Did you find you needed to re-fresh your medical vocabulary as well?

This question has been covered for the most part previously. However despite more than 20 years speaking French, I still find myself asking for help or clarification now and then. Nursing, especially on the Community where one works alone, requires absolute certainty and leaves no room for doubt or error in Clinical practice. I am always aware of the risks should I misunderstand something and I am never too proud to ask for clarification whether it be to do with the language or a procedure I am not familiar with. The Nursing profession is always advancing and it is our responsibility to inform ourselves and seek new knowledge wherever we are.

I must add on a lighter note that my skills in French still amuse patients and colleagues alike and I can never hide my accent ! But I get by safely and that is the main thing.

Is there a similar funding crisis going on in France as there is within the NHS here in the UK? Are you finding that budgets have been cut or resources restricted?

In order to answer this question fairly, I would have to explain how the French health system works. Quite different to that of the NHS...

In the year 2000, the World Health Organisation declared that the French Healthcare System to be the best in the world. Its structure, though it has evolved, has been in place for over 100 years. Like everywhere in developing countries, increasing rises in drug costs and the rising number of elderly patients needing medical and nursing care results in the constant need to review the budget and its resources.

Cutbacks such as minimising staff and closing down clinics or reducing hospital bed intakes are not an option in France. Healthcare is considered to be the right of every citizen in France equally available to all no matter where they live or their income. Because the French are unwilling to reform their highly acclaimed Healthcare System, it is the Tax System they consider reforming in order to meet the needs of the on-going economical crisis.

The French Healthcare System is funded through Payroll taxes, taken at source from every worker. This accounts for some 60% of its funding. The rest is sourced from indirect taxes such as alcohol and tobacco taxes. Payroll taxes are paid directly to the Social Security and goes towards Unemployment, Retirement and Healthcare. Revenue Tax is paid independently. French taxes are very high though are proportionate to income. The poorest in society have free Universal healthcare (financed by taxes) and those suffering with long term illness, are also provided with free healthcare.

At present, there are talks in French Government to discuss further raising of taxes for the French citizens in order to maintain the healthcare system as it is. I can comment from personal experience that while it is evident that healthcare in France works well and to a high standard, staff are working long hours with minimal cover and patients are waiting longer for out-patient appointments and long queues in A&E (except for acute conditions requiring emergency treatment and Cancer diagnosis follow-up).

My healthcare cover, like every working citizen, is taken at source from my salary. Should I need to see a GP, this is paid by reimbursed within days into my bank account. The Social Security issue cards (like a credit card format) and each time a Doctor, Specialist, Dentist or Chemist is used, the card is swiped and any payment made is reimbursed to about 70%.� Should I become un-employed, be in serious financial difficulty or diagnosed with a long term illness, then no payment is made following consultations.

I have the option to take out a 'supplement' healthcare cover. There are many to choose from and various levels / options to choose from. For some 40 euros each month, I am fully covered, including dental/crown work and Opticians/glasses. I have chosen this level and benefit as need extensive crown work and wear glasses for reading. I am also covered 100% for any eventual hospital admission as whilst the medical / surgical care is covered the bed, room, food is not and can amount to a surprising amount on discharge. Age is a factor and of course, it costs much more once you reach 50 (my case!).

The French Healthcare System cannot really be compared to that of the NHS in the UK but I am sure both systems have something to learn from each other !

What are the main differences you�ve noticed in your current role as Community Staff Nurse in France to community nursing in the UK?

I am not able to compare never having worked as a Community Nurse in the UK. I have only faint memories when in the last month before my Finals, I tagged along with a Community Midwife and also a Health Visitor (not the same role as a District nurse!) which gave me a taste for a possible choice of career to follow later on. Little did I know it would be in France and quite some time later!

My day begins at 07.15 when I arrive at the Community Nurses office to organise the morning visits and check for additional cases or changes overnight. I work within a large team and on any one shift, there are 5 Community staff nurses and 14 untrained nurses known in France as nursing assistants. The team covers about 120sq miles and this is divided into 4 sectors. Each one being covered by a Community staff nurse and 3 or 4 nursing assistants. Work cars and all equipment is supplied.

I report to the Nursing Manager for all updates, changes, new referrals, and any relevant information relating to patient care in the Community. The team arrive for 07.30 and relate to one another within the sector regarding patient care and specific needs for that shift. By 07.45, the team has set off and will return to base for 12.30.

A typical morning, yesterday for example, I began with venepuncture calls to patients where the prescription specifies 'fasting bloods'. On occasions, there can be as many as 4 or 5 to do before the first scheduled regular visit to a patient so it can be quite stressful trying to get round and successfully fill and label the tiny test tubes at each visit. I always feel a sense of relief when the bloods are done!

Between 08.15 and 09.00, visits are taken up with insulin management or medication administration to patients who are unable to do so themselves either because of poor eye-sight, physical incapacity or dementia.

Following these visits which amount to 4 at the moment, I go to a patient where an overnight IV is running via an implantable catheter device. The infusion runs via a Gemstar Pump, recently very popular here in France and seems to have replaced the syringe driver where small amounts are given either IV or S/C. My visit involves disconnecting the infusion and rinsing the implantable catheter. I also ascertain the patients well being, level of pain or discomfort and observe urinary output. All such information is documented on site so that the nursing assistant, the patient's visiting doctor and other visiting staff nurses may consult or leave relevant information. As I am about to leave the patient, there is a knock at the door to announce the arrival of a colleague, a nursing assistant to help the patient with daily hygiene care.

The visits which follow involve dressings. Firstly to attend to a chronic leg ulcer where it was noted that the wound was beginning to discharge a thick yellow serum indicating a possible infection. So I made a call to the patient's GP who would pass by early afternoon, possibly to prescribe an antibiotic therapy. Dressings can involve post-operative care as was the case yesterday where I had to change a dressing to the scalp on a patient who needed skin grafting following removal of cancerous tissue on the top of their head. I made note that the dressing had to be changed daily and the metal clips were to be removed in 10 days. I also changed the dressing to his chest where the graft was taken and noted that there were nylon sutures to be removed in 6 days. As this patient intended to return to work the next day (self employed), I needed to stress to him the importance of keeping the dressings clean and dry and also re-scheduled the visits for the evening rounds which allowed him to work during the day. As a Community Nurse, strict measures to avoid cross-infection are vital though not always easy in community work.

Mid morning brings me to a palliative care visit where a patient requires total nursing care and is in the terminal stages of cancer involving their tongue, throat and inner ear. My visit here can take from 45 minutes to 1h30 and involves assessing the patient's pain and discomfort and though the patient is conscious, he has a tracheostomy and is too weak to use the vocal inner tube. He is assisted day and night to manage the suction machine, which relieves collecting secretions both from the lungs and from the mouth where saliva can no longer be swallowed. Pain is relieved with Morphine Sulphate infusing S/C via the Gemstar Pump. Once I have seen to his pain management, tracheostomy care, urinary catheter care, and administered prescribed fluids and medication via a jejunostomy tube, I carry out hygiene care relieving pressure areas with gentle massage.

Towards the end of my morning shift, I use the time to take blood from a patient on anti-coagulant therapy in order to check that the levels are both safe and effective. A vast number of patients are on anti-coagulant medication requiring blood monitoring and I wonder if this is the case in the UK?

Before I know it, it's midday and I have 2 visits back to patients needing insulin management before their lunch. On returning to base, any necessary notes are made and I finish the morning at 12.30pm.

Evening rounds begin again at 5pm so I get into the office at 4.30pm to allow time to pick up lab reports and call GP's where necessary with dosage levels for A.C.T. I may also need to speak with a doctor regarding a patient's condition where it was not appropriate to call from the patient's home. It is also the time to meet with my Nursing Manager who may wish to speak to me regarding implementation possibilities of a new patient needing visits.

My evening round involves insulin / medication administration during the first hour. Any overnight infusion therapies are set up and patients on pain relief either IV or S/C are visited and assessed. Last night, a visit involved disconnecting an IV chemotherapy diffuser on a patient who attends an out-patients chemotherapy clinic. This is diffused over a 48h period and enables the patient to return home wearing a small portable diffuser attached to his implantable catheter device. I tend to see patients who may need time to talk towards the end of the evening shift so that I feel I have the time if they need it and they don't sense the need for me to rush to another waiting patient. This particular visit necessitated such time as the patient is in terminal stages of liver cancer and chemotherapy is being administered to relieve symptoms and slow progress.

I generally get back in time to complete written handover notes, chat with colleagues either to do with work or personal chit-chat and leave at 8pm.

My work as a Senior Community Staff Nurse involves not only the patients and their families, but a wide team made up of nursing care staff, doctors, specialists, physiotherapists, and pharmacists. Two days are never the same. The work is very varied. Being well organised and punctual together with effective communicational skills, are essential for this role. But for me personally, to realise that to enter into the home of a patient is to enter into their world as a guest. I recognise that I am in a position of trust and that it is I who should adapt to them and their needs (as opposed to the hospital environment). And if I can help to make the world in their homes a little easier at each visit, then I have achieved my objective and am satisfied with my work as a community nurse.

I am fortunate to be part of a very good team who support each other and who seek to work to a very high standard. I am particularly touched to have been so easily accepted seeing as I am not French. I think that despite my french accent and frequent mistakes in the use of the French language, which continue to amuse both patients and colleagues alike, I have found working in France to be a very worthwhile experience and I am glad I took the challenge to practise here in France all those years ago.

I am planning to return to the UK because my 2 children, now grown, have settled there and I miss them too much. I have also begun to sense a longing for England and realise that as I am getting older, I don't belong here and never will. There are certainly many benefits and advantages for me if I remained in France but as the saying goes 'Home is where the heart is' or so I believe!

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