Nursing in China

Though study abroad programs typically are aimed at students, two critical care nurses – and lifelong learners – recently took advantage of an opportunity to learn about healthcare in China.

Tanya Huff, MSN, RN, CCRN, CCNS, CNE, clinical assistant professor at Virginia Commonwealth University (VCU) School of Nursing and Cheryl Herrmann, APN, RN, CCRN, CCNS-CSC-CMC, described their experience to rapt audiences at the 2011 AACN NTI show in Chicago.

The two were part of a 12-person critical care delegation in 2005 with People to People Ambassador Programs.

Though they were impressed with the comparative sophistication of the equipment, some fundamental differences between the U.S. and Chinese healthcare systems were surprising, as was the lack of introspection surrounding nursing job satisfaction.

Both encouraged attendees to seize an opportunity to participate in a similar professional ambassadorship program if given the chance.


East Meets West

Critical care nurses reflect on Chinese ambassadorship.

Equipped for Millions


Though hospitals in urban Beijing treat many more patients, their equipment was no more sophisticated than their counterparts in the U.S.

“Some of the group thought the hospitals were more modern than others,” offered Herrmann. “I’ve done medical missions in locations where there are no monitors and thought they are very modern.”

Still, paper charting, not electronic, was the norm. Nurses access medications by simply retrieving them from an open area, instead of via an automated dispensing system.

Although handwashing is encouraged, some of the nurse visitors were concerned the sink area wasn’t very big. Any evidence-based research is conducted by doctors, not RNs.

“I found it interesting that the equipment is reused,” Huff noted. “In China, they use chest tubes again, and we’d never do that.”

Philosophical Differences

For Huff, one of the biggest shocks wasn’t the massive, 1,500-bed hospitals to accommodate Beijing’s population of more than 14 million at the time, but rather the different attitude about patient care, especially when the diagnosis is terminal.

“In the U.S., we try to keep everybody alive forever,” she said. “They don’t do that over there. The U.S. population has pushed healthcare to where we try and save everybody. In China, the population is so huge. If they can’t turn a patient around right away, that’s it.”

Illustrating this mentality is the equipment in the ICU. Though the ventilators are the same, the Chinese don’t buy special mattresses to prevent pressure ulcers. According to the counterparts Huff and Herrmann met, patients in China don’t stay in the ICU long enough to develop pressure ulcers.

(Story continues below this gallery of photos by critical care nurses Tanya Huff and Cheryl Herrmann.)

Satisfied Nurses

Chinese nurses stand a statistically better chance of finding a good job than doctors in their country but the time constraints are the same as in the U.S. Without any assistive personnel like LPNs or CNAs, Chinese nurses rely on families to help feed and bathe patients.

In stark contrast, family members aren’t permitted in Chinese ICUs and nurses will update one family member once a day on the patient’s progress.

Huff asked about the dichotomy between relying heavily on families in primary care and shunning them in critical care, but was told that families trust nurses’ knowledge on the job.

Staffing ratios on non-ICU floors mirror the U.S., but the ratios in the ICUs average at 2:1 or 1:1, said Huff. Yet the family assistance equation seems to work, evidenced by the fact that turnover is non-existent after the initial 2-year rotation.


Nurse Exchange

Chinese nurses visit and learn at St. David’s North Austin Medical Center in Texas.

Furthermore, nurse retention remains high without any kind of self-scheduling, weekend work hours plan, or flex time.

“We told them that, 15 years ago, we didn’t have self-scheduling,” said Herrmann. “We talked to them about strategies to decrease stress and the need to care of themselves and support one another.”

That’s not to say Chinese hospitals don’t value their nurses. According to Huff, many show their appreciation by providing technology to make the job easier.

“The theory seemed to be ‘you’re a nurse and you should be happy you’re caring for patients and in the profession you chose,'” she said.

Sociological Factors

Both Huff and Herrmann were surprised that job satisfaction was so high, given that the mostly BSN-prepared nursing workforce starts on the job around age 20. The average age in the profession is 35.

“Over here, it’s all about drama,” said Huff. “In China, they’re more about getting the job done. Even the younger nurses are more like my parents’ generation in that they don’t talk back.”


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Despite respectful silence, working in “silos” is a habit ingrained in the Chinese nurses since early childhood. It’s only natural. After some digging, the nurse ambassadors learned that many young nurses were themselves only children, born during a period when the government limited reproduction.

“Most of them grew up with two parents and never worked in team,” Huff said. “In the U.S., everybody learns teamwork in school and most families have at least two children. They didn’t have that concept at all.

“In ICU, we talked about how we just work together for each patient,” she said. “Your patient might be busy at this time, someone else’s at a different time. They’d heard about ICU teamwork but never really saw it in action.”

Global Workforce

Given China’s increasing dominance on the world stage, it’s a given that some Eastern nursing practices will find their way to the U.S. and vice versa.

Especially with healthcare reform on the horizon, Huff thinks Eastern attitudes about end-of-life care may re-surface in the U.S.

“A trip like this showed me a lot of different perspectives,” she said. “The way we do things in the U.S. isn’t the only way and this trip opened my eyes.”

Robin Hocevar is senior regional editor at ADVANCE.

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