Playing around

Well, I just finished my clinical hours at the health center. I was suppposed to go in this evening (uhh...my last Friday evening in Savonlinna). I had a meeting with my clinical instructor though to go to beforehand, and the first thing she said to me right when I walked in was,

Her: "I've been looking at your schedule."
Me: "Yeah I wanted to talk to you about that."
Her: "You don't have to go today."
Me: "...uh."
Her: "Really."
Me: "Thanks!!!!" Big Smile on my face

I didn't want to spend my last weekend at the Health Center ward, and it was a beautiful day!

No, my days at the Health Center ward were actually pretty good. It was a rehab unit, and it gave me a good picture of what nurses do here in Finland.

There are lots of similarities but also lots of big differences. Like I've already mentioned, there aren't any CNAs so the nurses not only give medications, do wound care, ect, they also do all vital signs, bathing, turning, lifting, ect. So these nurses have 8-10 patients during the day, but can have about 20 at night. The nurses also don't do physical assessments. In the United States, nurses carry and use stethoscopes very, very often. It is a critical and expected part of our work skills to assess a patient's condition very quickly. I was surprised that Finnish nurses don't do this.

The Day Room

The nurse preceptor I had these two weeks was absolutely fabulous! I loved being around her and we had a great time. Even though I wasn't able to communicate in Finnish, she did a great job translating rounds, nursing report, and conversations in general to me.

We also never could pose for a serious picture....

 Unfortunately, this was the first time I really got that in my entire time here. So I feel like I learned a lot more from that. She also let me do things right away, which I appreciated. Like, "do you want to give this shot?" Or on my first day, "Ok, you change this (very big, very bad) wound." No problem. She also was just so much fun to be around. I think that nightshift bonding really helped, but we laughed and had so many great times comparing nursing and cultural differences between Finland, US, and Germany (where she was born.)

Just having a fun time!

The "serious" picture! We cracked up right after this was taken

The work at this ward was very difficult, and I think that it would be hard for me to want to do it long term. It's physically demanding on your body, lots of lifting and moving patients who may not have or be able to use limbs. It also takes a lot of mental strength to take care of that many patients on your own.

Part of the day room

Rehab room

We saw patients with everything from dementia, to strokes, joint replacements, heart failure, amputations, and infections. Some patients had IVs, but not all. Some also had catheters.

There was a doctor on hand during the days. Apparently, there used to be one always there, but they've had to make money cuts somewhere, and that was one way to do it. Also, there is a shortage of doctors around here, too. Because of those two things, they are closing wards at health centers and hospitals. For example, the labor and delivery unit at the hospital here is closing, and people will have to travel to Kuopio (100km away) in order to have their baby! I think that is so far away.

The health center ward is part of the same hospital/healthcare system. After they are discharged from the hospital, if they need more rehab they come here. Afterwards, they might go to a nursing home or assisted living. People might stay anywhere from 2 weeks to a few months, but no longer. It's not intended to be a long term care facility.

And for all my nursing friends out there, I know you're interested in their different medicines and IV equipment :) haha, maybe not.

Med Room

SO much easier to use...

Ok, so it wasn't the location that I really wanted to be at for clinical. Let's be honest, I wanted to be at the hospital. But it turned out ok. I had a great time with the nurses there, the patients were very kind and patient with my lack of Finnish. One sweet old man knew no English except for "Good Morning, Darling." THAT was funny :) and sweet. Another lady laid her head on my shoulder when I was sitting next to her on the bed, and another lady whose legs had to be amputated was always so so happy to see us enter the room, and gave such big smiles, it made ME happy. I found that these elderly patients were very sweet and accepting of me!

And clearly I have no self-preservation....

Racing down the hall

Oh look!

In spite of the awful white uniforms, I learned a lot and enjoyed overall my time at the Health Center Ward 1!

The Walking Dead

Twice this week I'd say this was a pretty accurate description of me...

The First
My clinical place last week and this one was at an inpatient ward at the Health Center. This is a rehab ward, so we have lots of patients that are recovering from surgeries, might have infections, or something acute, not severe enough for the hospital. The doctor is there during the week, but on the weekends, if anything happens, they have to send patients to the ER. I think this is almost between a skilled nursing facility and an in-hospital rehab unit. We have patients with IVs and give injections a lot. There are others that have pretty severe wounds, some of the worst I've seen. We take of quite a few patients with amputations. We have dealt with catheters, blood draws, taking out stitches, and those normal nursing jobs. The one big difference is that nurses here don't use stethoscopes at all, even in the hospital. In our hospitals, nurses do a physical assessment at least once a shift, listening to lungs and hearts, feeling for pulses, edema, checking mental status, ect. These nurses here do a basic assessment, not a formal one, but for the most part, don't learn about listening to lungs and hearts, which is important for telling if the patient is breathing ok. My preceptor told me that she learned on her own, and will sometimes take a stethoscope if she is seriously worried, but when no one else is on hand to help. The RN's also do a lot of CNA work, liking showering and taking people to the bathroom, ect. There aren't CNAs actually (lots of LPNs though), but two nurses take care of 8-10 patients and do everything.

In case you're interested...all the rooms are shared. 

Anyway, at this ward, I have to work the shifts that my nurse preceptor works because there are few that speak English well enough to feel comfortable taking a foreign student. They do 8 hour shifts, 5 times a week. But on Sunday night she was scheduled to do a double shift, from 4pm-7am. Let's just say it was a long night. There wasn't really that much going on (besides lots of lifting and turning patients), but somewhere around 4 am, I just really felt the exhaustion creep in, like when you are at a sleepover and then things get crazy. That is what it felt like! My nurse preceptor is hilarious and ended up putting medicine cups on her eyes, saying they were the "wake up cups." We thought it was hysterical. And then we were wheeling ourselves in these wheelchairs and that lay straight back. Around 6am we went into a patient's room, where we were told, "you both look exhausted." We were.

Am I tired??

Yes of course!

At the end of the night, it was the weirdest thing to say good morning to patients that we had said goodnight to only hours before. I started falling into walls, and the long long 45 minute walk home was torturous. I'm pretty sure I was walking all zig-zag like. As I stumbled out of the health center back aching, feet sore, tired eyes, I felt like the walking dead. 15 hours is too long. The normal 8 hours they do makes you feel like you always have to be at work. However, our 12 hours is just perfect. I will never never grumble about them again!

The Second
Today I took a day off from the ward to see how home care nursing works over here. There are several offices around the town, and I had to go to the one that's about 2 miles west of the city center. Because I had to be there at 7, Leena was so nice and dropped me off in the morning, but I had to go back on my own. It was supposed to be a straight shot...more on that later.

We never did any kind of home health clinical at BYU, and I really enjoyed this. Remember, they have a public system, not private agencies that contract out home care like ours. So when the patient leaves the hospital, the doctor writes what the patient needs (such as medicines, lab draws, ect), the home nurse does them and writes in the the chart, which the hospital specialist (whose office is called the polyclinic) can then see the results. There is a doctor that works just for the home health once a week, but because everything is connected to each other, the healthcare really flows well. It also is growning quickly. They don't have enough facilities or nursing homes, so there is more need for nurses to work in this way.

The LPNs might come several times a day to make sure medicines are taken, that they eat, can shower, go to the bathroom. The RN comes maybe once a week to do a more complete assessment, do wound dressing changes, give injections, do lab tests, fill medicine boxes, ect.

I liked this because the nurse can work pretty independently. They have a schedule that the computer program makes for them, based off the patiens' orders in the computer, so she takes the list and her car for about five hours in the morning, and in the afternoon she charts. She is independent and can make decisions on her own. She always has resources if needed, but does a lot of really cool things. These patients tend to be lonely and crave company, and the nurse I was with said that bringing them that company and helping them feel another's touch is why she loves her job. I think the day shifts 7-3 is really nice and especially the driving and not being in an office.

After the day was over, I had the make the trek home. I knew it was going to take about 45 minutes, so I started out jamming to my music. 45 minutes later I start noticing that there are fewer and fewer houses, cars, and people. I'm the only one on the road. That can't be right...I should be getting close. Then I pass the sign that shows I'm leaving the city boundaries....oops. I pulled out my phone which thankfully google maps shows me my direction and location. I just kept going west instead of east!! So then there was another 45 minute walk to get back to my starting point, and then the real 45 minutes to get home. I can't believe I was so stupid! I should have looked at the map earlier, but I was content just walking and singing that I didn't even think I was going in the wrong direction!

Yep. WAY off course!

By the time I got home, my upper and lower back was hurting, my muscles were all tight, and my hands were getting swollen. It took me over 2 hours to get home, and I don't think I have ever been so happy to see the Blue House!! Again, I felt like the Walking Dead, because I walked so far I felt dead! I just collapsed onto my bed and starting writing this rant. I will be grateful again for the only 40 minute walk to the Health Center ward tomorrow! Ah, it's those little things in life!

Like a familiar lake and knowing where I am again!

"Alright, you've seen it once, next it's your turn."

That one little sentence seemed to be the phrase of the week during my time at the Savonlinna Central Hospital. Although that didn't actually happen, it didn't stop all the anesthesiologists, surgeons, and nurses from teasing me that next I'd be doing their job.

My time in the Operating and Anesthesia Wards was a little different that I expected, and a lot better! I will admit that I wasn't entirely sure I was going to like it--after all, my two days in the OR during my Medical-Surgical Rotation was more than enough for me. It seemed too repetitive, not very interactive, and something where you spend a lot of time just waiting. I'm so pleased to say that I had no idea what the OR is like in Finland, but I was happily surprised by it. Here are a few reasons why.

1. The nurses

Ok, so in the OR, there are several different types of nurses. There's the scrub nurse who assists in the surgery and there is the circulator, who runs and maintains the flow of the OR. She also prepares the patient for surgery. Here in Finland, there is another type of nurse, the Anesthesia Nurse. Basically, she maintains all the anesthesia during the procedure and ensures that the patient remains stable. She can give medications to maintain the blood pressure or heart rate, and can turn up or down the gas depending on the patient's carbon dioxide and brain wave levels.

I was so happy when they assigned me to an anesthesia nurse for the two weeks. I don't particularly find the other two areas on the OR interesting (sorry!), but I loved the anesthesia side. I really loved our critical care/ICU rotation last semester, and this was the closest I got to something like that. I learned about the ventilators, and helped ventilate patients manually before and after intubation. I got to look and assess the stability of the patient and determine if they needed any type of medication (diazepam, heart rate, blood pressure, pain med, ect). I learned a lot about the anesthesia medications and side effects, got to practice those IVs, and was asked lots of critical thinking questions like, "what next." I loved it.

All of these nurses were very welcoming to me, even if they didn't speak to me in English. I found them to be a little shy at first, but then soon warmed up to me as I spoke with them. They were very knowledgeable and so used to having students that I found I got lots of practice. Two nurses even let me stick them with IVs multiple times so I could practice. After that I nailed every IV I tried (and I got to try a lot!)

Shameless selfie...not in a warehouse, just the locker rooms!

2. The surgeons

The surgeons were very welcoming as well. I noticed that once I was introduced as an exchange student, almost all of them opened up conversation with me, invited me to watch closer, ask questions, ect. The nurse commented that she was impressed, because many students have a fear of interacting with doctors and surgeons, feeling intimidated, so they don't. I can be, but they were all so easy to talk to and when I showed interest in what they were doing, they were eager to show me what they did. I even got to cut into a gallbladder to look for stones after they removed it! It was very exciting. I saw a c-section, hip/knee replacements, the gallbladder surgery, breast removals, cancer ablations, spinal surgery, ear/nose/throat stuff, plastic surgery, ect. So many different things. It was from a surgeon who first told me "Now you've seen it once, next it's your turn." Yeah. Definitely. NOT.

On a personal soapbox and going back to what I said earlier, I don't believe that nurses should fear doctors. My nurse said that she has noticed that many Finnish nurses still feel that way towards them and that they don't feel like they can approach them, challenge them, or make suggestions. This is something I feel like is even among us in the States, a little bit. I feel very strongly that there should be open communication and mutual respect for the different professions, because they are very different and have different focuses.

Day Surgery...

The windows from the OR look out to the beautiful lakes!

3. The anesthesiologists

Here the anesthesiologists start the anesthesia (intubation, gas, medications), monitor that the patient is stable and then move on to the next patient, leaving the nurse in charge. These anesthesiologists also were very nice to me and let me do a lot. One of them let me intubate several times! He was standing over my shoulder telling me exactly what to do and helping me do it right, but still, it was very exciting! He also taught me about the post-op orders for medications that he gives, and asked me lots of questions to help me see what might be needed. I assisted with spinal anesthesia as well, and with epidurals and ventilating patients again. After each anesthesia (spinal or general), every single anesthesiologist said, "You've seen me do it, next I won't need to come, it's your turn." Every single one!

The challenges: 
Now, I did really enjoy this rotation, I learned a lot and saw some really cool stuff. There were, of course, some challenges though.

1. Medications.
Ok, did you all realize that we use different medication names? Most of the time, the generic name is the same, like diazepam or propofol or fentanyl. But of course all the trade names that people use in daily life are very different. I was lost the first day trying to remember all those trade names for Finnish meds. Thank goodness the BYU College of Nursing made also made us learn generic names! I didn't realize it would come in handy. But also, for example the generic name for Acetaminophen (Tylenol) is different every where else except America. We call it acetaminophen; everywhere else calls it paracetamol. It's the most basic medication you learn in nursing school, and they all looked at me funny when I said I didn't know what it was. It's hard to remember that you actually are knowledgeable and skilled when basic things like medications are different.

These are also how most of the US medications come...

And these are how Finland's come...there's a slight difference in preparing them. 

2. Method/Measurements.
Of course they use Celsius and the metric system. We also actually use those in medicine as well, so I'm sort of comfortable doing calculations and stuff and knowing what the normal weight/temp would be. But then, they have different scales for levels of hemoglobin or blood sugar. Those are also very basic things we learn in nursing school, but here I felt like I didn't know anything because they asked me if it was normal, and I had to say I didn't know.... Equipment is very different, all supplied by European companies for the most part, so the IV sets were different, the monitors in different languages, the pumps very different. In a way it's like relearning everything. I just had to remind myself to be patient and humble and willing to learn. THAT is hard. NaCl (Sodium Chloride) is actually called Natrium Chloride...easy to see why, but it's those little differences that make you stop and think again.

3. Language
Once again, the language barrier is difficult. I have to admit I didn't think it would be that much of a problem before coming. I think my clinical instructors here were wise when they put me in anesthesia, because you don't really talk to the patients except before and after. Do you know how awkward it is when you know people are talking about you (I can follow conversations that much) or around you, but not be able to add in? It's hard to feel part of the group too when you are sitting there. I do try to make conversation, but many times when I try to talk, they are shy and uncomfortable and start looking for my nurse to translate everything they want to say. Many people have told me that they were taught so much about grammar in school and less about conversation, so they are afraid of making mistakes when they talk. I honestly don't care about that. I just want to feel like I can be apart of the conversation, greet patients, make small talk, help the patients not feel awkward when the nurse talks to me and directs me in English. That has been the most difficult thing. Especially since I'm a very social person and want to talk to everyone!

I think I will not take for granted those situations where I understand and can follow the conversation. I think I will think and feel differently when I have a patient that doesn't speak my language. I think I will be more understanding, empathetic, and more willing to find alternate methods of communicating because I do understand what it is like to be talked around or not talked to. And as a healthcare provider, I don't feel like we should ever let our patients feel that way. They have a hard enough time as it is being sick, dependent, and many times helpless. I don't want to add that other feeling as well.

Whew. What a soapbox. If you actually made it to the end of this post, congrats! I really only expect my fam bam to stick it through :) But I'm always happy when others are interested haha. I didn't get to take many pictures while there, so sorry about that! Just know, most of the hospital looked just like ours do. Stay tuned for latest updates this week about my new clinical rotation!

In the meantime, enjoy this beautiful view of the lake!

Wrapping up Public Health

In my last week of Public Health Rotations here, I spent my time at the Pediatric Clinic at the Savonlinna Health Center. I have explained that all preventative services are provided at these clinics. It's one big building that has many separate offices.

The Pediatric Clinic takes care of babies from the time they are born until they are 6 years old, getting ready to start pre-school. (Here their kindergarten is what we call pre-school and vice versa). Here is the break down of visists, if you are interested

2-3 weeks old
6 weeks (doctor)
2 months
4 months (doctor)
6 months
8 months (doctor)
10 months
12 months
1.5 years (doctor)
2 years
3 years
4 years (see the doctor and public health nurse)
5 years
6 years

This week I helped the nurse during these appointments. Mostly it was checking development, like rolling over, hearing, losing baby reflexes, ect. It is difficult when the parents feel uncomfortable speaking English, so then I end up spending the hour not understanding...sometimes it took all my concentration to stay awake!! But the nurse again was so wonderful and very passionate about her work. She told me at the end that before I came she was very nervous to have an international student, because she wasn't sure what I'd be like and she thought she would struggle with English. It's very humbling to be told something like that, and then hear that she really enjoyed her week, couldn't have asked for a better student (yay!), and to come back and visit her!

Another thing I was interested in is the differences in vaccination recommendations. In the US the routine is to give Hep B at birth before leaving the hospital, unless parents decide not to have it. They only give it here if there is a high risk factor for the baby getting the disease. They also don't immunize against Chicken Pox at all. The government pays for all the childhood vaccinations and decided that the HPV vaccine was more of a priority than the Chicken Pox. Of course if the parents want it they can pay to have it. They also have to pay to get Hep A/B. So that's one big downside of this kind of healthcare. The government has to prioritize the importance of immunizations. But I have noticed that there is excellent continuity in healthcare. They have good interdisciplinary teams and the pediatric nurse works closely with the school nurse so as the child transitions in life, there is an easy transition to those changes in healthcare. They don't have to fill out so many forms every time they go somewhere. It is all in the system :)

The pediatric clinic was probably my favorite place to be. There is no language barrier with babies and children. :) I loved making faces and playing with them in my broken Finnish. I did notice that in cultural and language boundaries one of the most important things is nonverbal communication: how you sit, how you pay attention to how they are speaking, your facial expressions, ect. I made a point to introduce myself and greet in Finnish. I could understand the nurse introducing me, so I was able to talk to them at that point a little in Finnish and English. I noticed that playing with their kids and seeming at the same time like I was listening is what warmed the parents up to me and to speaking English to me. They were able to see that I was interested in them and their child's healthcare, and because I had to make the extra effort to go out of my way to talk to them and interact with them, they were very willing to let me be an active part of the appointment. I really appreciated that! I know that sometimes I can be an introvert and it would have been easy just to sit there the whole time. But nursing school has put me in very uncomfortable situations before where I have had to be an active voice and make myself a participant. That has served me well and prepared me for being here. I had to make an extra effort here to learn and participate, and in a way that makes me feel like it is that much harder and probably that much more rewarding for me, too.

So all in all my three weeks of public health nursing have been very eye-opening. I've learned that people like their healthcare here (they hate the huge taxes and cost of it), but enjoy the benefits and services that they see as the government taking care of them. I've met really fantastic nurses who have a passion for teaching and sharing their knowledge. I've improved my Finnish :) This week is a wrapup final group presentation and exam at the university. Then I'm off to my Winter Ski Holiday!

We were good buddies :)

(Rural) Women's Health Nursing

This week I did my clinicals about 30km out of Savonlinna, in the area of Kerimäki. I thought Savonlinna was small, but this town makes Savonlinna look like a major city! There are about 30,000 people living in and around Savonlinna. Kerimäki has about 6,000 and that includes towns about 10km around it. It's pretty rural. (They are proud of their 40 new babies each year haha). Even so, it was really interesting to see the differences and similarities. Because it's all part of the public healthcare, things ran pretty much the same as in Savonlinna. This health center basically is a branch of the main one in Savonlinna.

But I'm getting ahead of myself. The day started every morning at 6:30 (or 6:35 if I felt like running late). I had to leave the house at 7 to walk to the bus stop to catch the 7:15 bus. I sat on the bus until about 7:50ish and then made it to the health center just in time for it to open at 8. Oh and it cost me 6 euros one way. I loved the bus ride actually because it took me through woods and small villages in the area. It was so beautiful.

The very tiny bench only bus station. 

I'm getting really good at taking selfies :)

I've explained a little about the healthcare, but basically, any preventative services are provided at one office: the health center. So, there you can find the pediatric clinic, the maternity clinic, the clinic for older adults, the diabetic nurse, the mental health nurse, the social worker, the dentist, ect. These clinics are all run by nurses, but several days a week, there is a doctor on hand. Since Kerimäki is very small, there is only one women's health nurse that meets with all the women in the area for prenatal, family planning, vaccinations, and things like pap smears. One nurse takes care of all the women! They see the doctor only if they need to start a new contraceptive or to put in an IUD or something that the nurse can't resolve on her own or if the patient requests it. Again, public health nurses here have a lot of responsibility and do so much in taking care of the day to day things. I've noticed they seem to be between a Registered Nurse and a Nurse Practitioner, like we would like of it.

The Public Health Nurse sets and runs her own appointments and works very independently

The public health nurse in the women's health side takes care of all the prenatal appointments for women, about 9 times. They also visit the doctor at the clinic once, and the doctor at unit at the hospital twice. They are never sure which doctor is going to be there, but since Savonlinna Hospital and healthcenters are small, usually they are the same ones. At their regular appointments, the nurse measures basic weight, hemoglobin, tests urine, measures fundal height of the baby, finds the heartbeat, can do the 10 week ultrasound, ect. She is the one to notice rising glucose levels or high blood pressure, after which she can make recommendations and refer the patient to the specialists, who work at the hospital.

I thought this poster was so cute!

In Finland, women get maternity leave for 9 months and men can get it for 3 weeks. After the mom goes back to work (if she has to), the father can get another 1 month leave. After the 156th day of the pregnancy, women can apply to get a maternity package. Basically, it has outfits and supplies for the baby for the first several months. You can opt out and get money instead (140euros), but it sounds like most people get the package. This is free for them from their national health insurance called Kela, it comes out of all the taxes that they pay. Expecting parents also get a free dental visit, basically a chance to learn more about taking care of their teeth and how to do that for their kids. I don't think dental is included in their free healthcare. After the baby is born, the Public Health Nurse makes a home visit within 10 days to check on the mom and the baby.

Maternity Package (if you're interested in seeing what comes in the package)

This week I spent a lot of time with the nurse doing these prenatal visits. It was really hard not speaking the language, but most understood English if it was spoken, so I was able to say some things. They all let me feel the baby and find the heartbeat, and do that fun stuff. I just loved seeing how happy these women were! It felt like we were doing something good. We also did preventative care, such a pap smears and health checks for older women, updating vaccinations (such as TDAP or HPV), counseling for contraceptives, and today we did a home visit for an new baby.

Feeling very official :)

As a side note, I really like the idea of at least one home visit for new babies. We spent about an hour and a half there, taking care of the mom, making sure she wasn't bleeding as much, checking her hemoglobin and BP, counseling with her about changes in her life and how she's adjusting and coping. We also talked about diet and contraceptives. Then we measured the baby's weight, did an assessment of growing and reflexes, and watched how he was breastfeeding. It was a comprehensive visit to make sure mom and baby (and the dad!) were recovering well. It was so personalized, and the family really welcomed us and respected the nurse's input. I really prefer this to our system. I know that there is a "class" often given at the hospital that talks about these same things and then the baby goes for his first appointment a week or so later. I think having the nurse come to the house is a really good idea. The mom is still recovering, but you get a better glimpse of family life and the way things look. The mom is more comfortable opening up. You can observe, is the house a mess? Is the mom put together? Are there other kids preventing mom from recovering? It is a good holistic way to help mom and baby.

The public health nurse has so much information around her office that she can share. She has info about contraceptives, agencies for social services, products to use for different complaints, where to get extra help, classes on how to eat right and feed the baby well, info for new dads so they don't feel left out of the pregnancy process ect. ect.

This cabinet was only hiding the massive amount of pamphlets she had on hand!

It was another good week with a great nurse to work with. She and I laughed so hard so often, we got very distracted from work! When she found out that I love the Finnish piirakkas (rice pudding pie/pastry), she brought one in for me, just because. I have found so far that the Finnish nurses are very compassionate, caring and passionate about what they do and eager to share it with others!

School Health Nursing

Disclaimer: long post ahead!

As I've mentioned, I spent my first clinical week following a public health nurse at two different elementary schools, Normaalikoulu and Kellarpellon koulu.

See this unassuming field?
They teach the kids how to ski and ice skate starting in 1st grade!

Public health nurses have additional education beyond a nurse and work somewhat independently in this healthcare system. They make their own appointments and manage the health of school age children, looking out for diseases such as diabetes type 1, eyesight problems, hearing, or vaccination needs.

In this public system, nobody falls through cracks. From the time the child is born, they are part of the child clinic that follows up until school age, then the school health care, then student university healthcare, then occupational care, and if needed, maternity care. As the people move up in age, their "primary care" is offered at these clinics. For the school age children, this clinic is at school.  Some of those primary healthcare services that are provided include yearly health checks by nurses, and physical exams by physicians every few years. Public health nurses manage these clinics and perform a lot of services for families. When the family goes to the doctor for a physical, they see their nurse, who remains the same, but they cannot pick their physician. The nurse may spend 40-60minutes doing a health check and interview, the doctor usually only gets 20 if it's a healthy child. In these elementary schools, the doctor visits once a week, and that's when the school nurse can discuss any concerns about specific children needing appointments or referrals to a specialist.

In this system, public health nurses are very well respected and needed. Parents call them first for child illnesses, and in school health, she is the most visible healthcare provider. If they feel ill at home (and it's non emergent) they call the school health nurse. She then assesses and advises them on what to do, and if needed, makes an appointment with the school physician. Those appointments take place usually at school. Basically, the healthcare for the school age child is provided at the elementary school level.

The office...

This week at school, I helped the nurse perform health checks. In grades 1,5, and 9, they have a physical with the doctor as well. Our health checks included interviewing them about their stage in life, their hobbies, interests, family life, and stressors. We took height, weight, hearing, vision, BP, and hemoglobin levels. We talked about alcohol and tobacco use and eating healthy. For these kids, I was able to talk to them on a basic level in english. The nurse translated for me for other times. We also gave vaccinations as needed (many of those are free to students through their healthcare) and washed out many ears :) A useful skill. Of course, there were kids that got hurt at gym or felt ill. We assessed them as needed. We also checked blood sugars and were watching out for symptoms of diabetes. We had meetings to attend with the interdisciplinary team: principal, teachers, social worker, special education teacher, and school psychologist if needed. The school health nurse provides teaching as needed for these members about different illnesses and is the person responsible for catching changes in health and promoting it.


I think that having health care in the schools makes the public health nurse visible to students. I noticed that the kids all knew her by name and came to her with their concerns. Because anytime they are sick or for their yearly health checks they come to her, they know her and trust her. When I think back to the school nurses I had, I don't remember them. Because they weren't really visible. Yes, they performed eye or ear checks. They check for scoliosis.  But these school nurses are part of the primary health care system, and do the work we would think of in our doctor's offices.

Sirkku, the nurse I worked with was so kind and compassionate to these kids. She has a gentle voice and a calm demeanor that puts the kids to ease at once. I was nervous, too, haha but she made me feel so welcome! She answered my millions of questions so patiently. She is a gem :)

I'm also a giant when you compare height!