Becoming a nurse

Participating in an international clinical placement

The beginning
On 27th October 2018, my international clinical placement adventure began. My trip leads me to Turnhout, a town in Northern Belgium, with about 45'000 inhabitants. Antwerp is about an hour away and the Dutch border almost next door.
Luckily, I arrived some days before my first day at work. This had the advantage to set up my room at a student residence.

For seven weeks I worked at the "wit-gele kruis Antwerpen" (white-yellow cross of Antwerp), a home nursing care institution. It offers a variety of nursing care services 24/7.

My personal motivation to participate in an international clinical placement is, because I'm a curious and open-minded person, who wants to know about how people from all over the world are doing nursing. I'm a person, who not only likes to make friends at school, work or my sport club, but also over the borders of countries. I'm a good listener and in the situation of a problem-solving process, I try my best to work out a solution with the other team members. It's okay to have different views. Normally I'm interested in the reasons why people think different than me about a subject. To understand their point of view and the reasons underlining it, widens my own horizon. Finally, I don't have to agree with them, but everyone deserves the respect to listen to them.

To deal with nursing as an international subject already during my Bachelor studies helps me for a better understanding of nursing in a bigger context. I think that intercultural competences will be sooner or later core competences of a nurse and contribute to a better healing process and more efficiency. That's why I set the goal to develop my intercultural competences during this clinical placement. Additionally, I wanted to have a deeper insight into the Belgian health care system, while I was gaining work experience.

Clinical Placement
I worked Monday to Friday from 7.30 am to 11.30 am. Lucky me, my boss gave me all the weekends free, which – for a nurse- is quite unusual. Furthermore, I worked in turns of a week from 1.00 pm to 5.00 pm. The other week I worked from 5.00 pm to 9.00 pm and so on. Overall, my workload was 36 hours per week which corresponds to a full-time nursing job in Belgium.

The tour of the nurse, I worked with, was set on a tablet. At the beginning of every visit at a patient's home, we needed to scan his identity card. Afterwards, the interventions we've done, needed to be documented on the tablet for the electronic nursing dossier.

The morning tour contained visits of 10 to 15 patients. Helping them with personal hygiene, measuring blood sugar and giving insulin injections counted to my morning activities. Putting on compression stockings, preparing and administering medication were other tasks. One of our patients also needed help with caring for his colostomy.

We always started the evening tour with the patients needing insulin injections. Those visits were quite short, but not less important. We were responsible for about 20 to 25 patients. Next to insulin injections, we also did anticoagulation injections, put off the compression stockings and help with changing to pyjama for the night and administer medication.

The afternoon tour contained shorter and longer visits of around 15 patients. Some of those patients needed at least three times a day nursing care. Others needed dressing chances, wound cleansing or injections. But also a bit more difficult tasks were done as flushing a port or stopping a chemotherapy, administering a magnesium infusion etc. Also people, who are getting home care for the first time were set on this tour.

As morning and evening tours only covered 1-2 villages, the range of the afternoon tour was bigger. It is to be explained with the fact that in the afternoon, less people needed nursing care and therefore less tours are "ongoing". I really enjoyed the afternoon tour, because usually we had a lot of interesting wound dressings. But especially those dressings needed patience from my side in the beginning. Watching and observing first, before I could do them by myself. Even though, in a lot of cases creativity and improvisation were needed, we usually could keep to the hygiene guidelines.

***

It's Monday. My second week at the "wit-gele kruis Antwerpen" just had started and I had to overcome my first big challenge. The nurse, whom I worked with was sick. She didn't feel that bad to stay at home, but she wasn't as healthy to work with the patients. So we decided together, that she's going to do the paper work and I'm going to do all tasks, that include to get in contact with the patients. When I was unsure, I always could ask her for advice. Even though, this morning was quite tiring, at the same time I was very proud on me and it strengthened my self-confidence.

From the third week on, I was allowed to care for patients on my own. In the mean time, the nurse I worked with, would  go to another patient an do there the necessary care. This confidence meant a lot for me and was a motivator all the time.
The period between the end of November and the beginning of December was intense. I had to do extra hours. But I always said to myself, as it is only good for my patients then it's fine. Heading for Christmas, luckily, the workload decreased and I had again the chance to speak a little bit longer to my patients.
As the clinical placement progressed I took over more and more responsibility. I got also an insight into the administrative tasks of a community nurse.
I got a lot of constructive feedback. All in all it was very positive and with every new day I felt the intimacy between me and the patients growing a little bit. I'm very happy that my Dutch language skills helped me to come to this point and I could feel that I got more and more self-confident. That motivated me and it was just a lot of fun doing my work.

Similarities and differences between Belgian and Swiss health care
After those two very intense months at the "wit-gele kruis Antwerpen" I got the impression that there are a lot of similarities to the health care system and the community care I know from Switzerland. They have so called „service flats" for older people. Those apartments can be part of a nursing home. The elderly living in those flats are still in a quite good health estate and more or less independent. Nursing care needs services are taken over by the community nurses and not by the nurses from the nursing home. In Switzerland I know quite similar projects.

But I noticed some differences as well. Belgian identity cards have an integrated chip, which allows access to the electronic patient dossier.
Blood sugar levels are documented in mg/dl. I was used to document them in mmol/l, but in the end it doesn't matter. You just need to be aware of the two different documenting methods.
What I really admired and quite impressed me was the realisation of reference care on the morning tour. The concept of reference care was very well implemented. Every nurse has a fixed tour with usually the same patients. When she's on holiday usually the same representative will take her tour over. For the patients it's a huge advantage to have "their" community nurse and not every day somebody different. This guarantees for an intimate but professional patient-care-relationship.

Conclusion
A clinical placement abroad enables on the one hand an insight in another health care system. On the other hand, it inevitably brings a change of perspective and it's a school for live. What I take with me from this placement is the joy of nursing and the knowledge and the confirmation to do it at any place for anybody in this world. In return I got endless gratitude.

Has somebody else already experiences of their own with beeing on an international clinical placement?

What were your biggest challenges?

What did you enjoy most?

What helped you back in your home country?