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Under socialized medicine, career advancement and pay structure may seem rigidly defined and less rewarding to individuals in the United Kingdom, but British nurses have strong job security, subsidized education and —depending on training—the right to perform minor surgeries.

The first difference that Bethann Siviter, RN, noticed when she left the United States to pursue a nursing career in England was the uniforms.

"Being from the States, I associated blue uniforms with physical therapy," said the former LPN. "Here, nurses wear blue. The darker the blue, the higher the level of nurse. It was the weirdest thing."

So, Siviter donned her light blue uniform and requisite black shoes and started training as a nurse in the United Kingdom. Five years later, she is entering the profession with a degree she said she could not have afforded in the United States and a starting vacation allowance of five weeks a year.

Nurses may capture the public's imagination the same way in both countries-patients on both sides of the Atlantic look to their nurses for clear advice and detailed explanations-but socialized medicine in the United Kingdom means significant differences for the nurses themselves. Career advancement and pay structure may seem rigidly defined and less rewarding to individuals in the United Kingdom, but British nurses have strong job security, subsidized education and-depending on training-the right to perform minor surgeries.

Between two-thirds and three-quarters of Britain's estimated 450,000 active registered nurses work in the hospitals and clinics of the National Health System, the government-financed health care program available to every citizen of the United Kingdom.

State-sponsored medicine extends to nurse training in England, Scotland, Wales and Northern Ireland-the four countries that make up the United Kingdom.

Educational assistance

"Here, they don't get paid a lot of money, but they get supported by the government while they get their degree," Siviter said. The British government paid Siviter's course fees, her uniform costs, plus the equivalent of a $720 monthly stipend during her three-year education to get a diploma. Her training included classes plus a dozen six- to eight-week placements in clinical environments. As with all British nursing students, she studied nursing basics her first year, then chose to continue in one of four specialty areas: adult health, mental health, learning disabilities or children's health.

Siviter opted to continue for a fourth year, which will end in a specialized degree. She is sponsored by her employer, who has paid her a year's salary of about $30,000 while the government paid her tuition.

With her degree and certifications, Siviter will be a "community specialist district nurse," the equivalent of a visiting nurse in the United States. In the compartmentalized world of British medicine, she must have a special license to work in this field, but she also has more clinical authority than her American counterparts. She can write prescriptions related to care outside the hospital for blood glucose monitoring machines or for medicines to treat lice and constipation.

The downside of a state-directed health care system, Siviter said, is the rigidity with which jobs are defined. Nurses enter the profession at a given "grade," depending on their education and experience. Career advancement between grades is not automatic. Nurses must apply for a job at the next grade if they wish to move forward.

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