Differences between practicing nursing in Romania and Portugal

8/22/2019 Differences between practicing nursing in Romania and Portugal

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Escola Superior de Enfermagem do Porto

Unidade Curricular: Ensinho Clinico em meio Hospitalar

Differences between practicing nursing in

Romania and Portugal


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Porto, 2013

Escola Superior de Enfermagem do Porto

Unidade Curricular: Ensinho Clinico em meio Hospitalar

Differences between practicing nursing in

Romania and Portugal

Written by: Mariana Postolache

Coordinator: Alda Mendes

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Table of contents

Introduction.........................................................................................................................3

CHAPTER I......................................................................................41.1. The healthcare system in Romania..............................................................................4

1.2 The duties of nurses in Romania.................................................................................101.3 The healthcare system in Portugal..............................................................................111.4. The duties of nurses in Portugal.................................................................................14

CHAPTER II..................................................................................182.1. My experience in Porto..............................................................................................182.2. My experience in Hospital.........................................................................................222.3. My perspective for the future as a nurse....................................................................23

Conclusion.......................................................................................24

References.......................................................................................25

Introduction

I have chosen this theme because of the experience that I m living now. I am

a nursing student, and I m doing now practice at the Hospital Sao Joao, Porto,

Portugal. I got here with Erasmus program but actually I study nursing in Romania

at the Universitatea Transilvania from Brasov. I am in the 4 year student. This

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theme will reflect my view about this two countries and their health system seen

from my experience.

In my opinion, I can do this comparison because I had experienced the both

educational and health system from Romania and Portugal. In Romania I had

studied for 4 years at the Universitatea Transilvania, in these 4 years I had many

courses and practice in the hospital. Here in Porto I studied for two months in the

school and two months practice in the hospital. I will make a comparison between

this two countries that is subjective, it s from my point of view.

Since I arrived in Porto I started to make comparisons, because everything is

very different, starting with language, people, attitude, the way of living. These

writing will give me the opportunity to show the differences and impressions about

my experience

Also, an important role of this writing is to show differences between nurses

from these two countries. Even if nursing is a specialty that is common in every

country and has the most important goal caring about the patients, the duties of the

nurses and the way they see this specialty is different. I will try to show in this study

these differences.

In my opinion it is very important to know other educational and health

system in order to evolve and became a specialist. Observing other systems givesyou the opportunity to see the good parts and the bad parts of things, it s in your

power to choose the right way.

CHAPTER I

1.1. The healthcare system in Romania

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About Romanian healthcare system I will use below some general informations,

taken from several sources, mixed with my own experience, studying and doing practice

inside of it.

As all around the world, healthcare system mission resides in evaluating, promoting,

preserving and ameliorating the health status for individuals and groups, these improving

their quality of life.

The Romanian health system is a functional system which is mandatory by law for

all Romanian citizens and assures the financing of the services provided to the patients,

whether in outpatient practice, inpatient or drug reimbursement. Citizens of other EU

countries visiting Romania can access the system if they hold a European Health Insurance

Card from their home country.

The unified national social health insurance fund is administered by the National

Health Insurance Agency (CNAS) and its regional centers. The following categories are

insured without having to pay any contribution:

Children of 18 years and under

Individuals of 26 years and under if in higher education

War veterans/widows and invalids

Disabled people without income

Pregnant women and those who have recently given birth, if they do not earn

income or their income is lower than the national gross minimum wage

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Everyone else pays contributions out of their salary.

Under the above-mentioned law, all those insured are entitled to free medical

services such as medical consultations, prescriptions, and basic hospital care. Primary

medical assistance is provided by family doctors or General Practitioners (GPs).

The organizational structure in the Romanian healthcare system

Source: Health Systems in Transition; vol. 10; no. 3; 2008. ROMANIA. Health

System Review

The percentage in income that constitutes the individual contribution to the fund is

quite big, but it was never enough, since the beginning of the found to the present. This lack

of founds can be seen in most of the Romanian hospitals.

Firstly, there is a lack of medical staff (doctors and nurses), the remaining personal

need to compensate and have more patients to care. Also they have low salaries, that is the

reason why they are not motivated to remain in Romanian health system

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Secondly, in hospitals is a lack of drugs, medical equipments and devices. This

makes the work of the personal more difficult and patients prefer to go to private hospitals

for a better care even if they need to pay more there.

According to a recent study from Expert Forum (EFOR) and Local American

Working Group (LAWG), quoting data from 2012.Romania has the lowest percentage of

Gross Domestic Product (GDP) spent on health in the EU, with only 5.8 percent of its GDP

going on health.

Health financing is only two thirds of the minimum needed in the country. For

comparison, according to the same sources in Portugal the government spends 10.4 percent

of its GDP in this important sector.

From a primary analysis, several negative facts can be identified: a small number of

contributors in comparison with the beneficiaries (some population groups such as children

do not contribute to this fund, but they benefits), the contribution of each insured loses his

individuality, the money is collected by the Ministry of Finance, the reimbursement is

provided by the National Health Insurance, in circumstances where the money come from

the same Ministry of Finance.

In this context, the state budget provides small financial additions for the national

programs (preventive and curative, emergencies etc.) through the Ministry of Health.

( DRUGUS, L. - Managementul Sanataii Ed. Sedcom Libris, Iasi, 2002 )The Romanian health sector went through a process of reform began in 2000 which

entered into a final adjustment phase in 2010 when the economic crisis, the health

professionals accelerated trend of labor migration, the precarious health of the population

brought new challenges to the unsolved existing problems.

Romania has lost around 10,000 doctors in the last five years, as better pay has

tempted medical professionals to emigrate, according to Vasile Astarastoae, president of

the Doctors College in Romania. Only 7,000 doctors graduated from the local education

system during this period. Romania has a total of 56,000 doctors, out of which 13,000 are

residents, 2,000 are retired but still in the Colleges records and the rest are free

practitioners. (2012 Romania - Insider)

According with WHO data (2008), Romania, with 1,9 doctors per 1000 inhabitants,

is ranking 31 out of 33 countries from Europe, only Albania and Bosnia-Herzegovina

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having lower ratios. The same is true for nurses (3,89 per 1000), dentists (0,22 per 1000) or

pharmacists (0,06 per 1000). There is also an important imbalance between the different

regions, there are 98 communities (villages) without any doctor or nurse. In one third of the

territory more than 30% of the medical specialties are not covered at all (cardiology,

emergency care, intensive therapy care, diabetes, etc.) and the same for nurses, quoting data

from Report of the Presidential Commission for Romanian Public Health Policies Analysis

and Development, Bucharest, 2008, available at http://www.presidency.ro/?lang=ro)

The countrys healthcare system has been under spotlight in recent years, when it

has become clear that more and more young doctors are choosing to work abroad, for a

higher salary. A residents monthly salary in Romania is of around RON 800 (the

equivalent of some EUR 185), while in Western Europe, doctors can earn at least ten times

as much.

The social status of nurses can be described as modest compared to less qualified

workers. Nurses are still regarded as doctors assistants and not as independent and

autonomous health workers. Changes in their professional training system may have future

benefits, as an increasing number of nurses and midwives with university training will enter

the labor market, and training at college level will disappear.

The healthcare system in Romania is likely to change following planned healthcare

reforms. The Health Ministry is currently working on creating the new legislativeframework for the system.

Although Romania is continuing to recover from the Global downturn, the Euro

crisis continues to impact this recovery. Romania has a persistent healthcare budgetary

shortfall but there have been some recent and on-going reforms aimed at addressing this

shortfall and these include:

Revising the reference price of some expensive drugs in September 2011

Reducing the governments package of benefits

A claw-back tax mechanism whereby manufacturers will bear the cost of drug

overconsumption

Introduction of a co-payment law for medical services.

(International Monetary Fund. Romania: Third Review Under the Stand-By Arrangement

Staff Report; Staff. Published January 2012.)

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Unlike other segments of the economy, the Romanian private medical system has

not been too badly sickened by the crisis. Proof is the large number of hospitals and clinics

opening and the massive investment, with the new trend being the construction of

specialized hospitals. The private practices, private investigations facilities, private clinics

and hospitals have two main funding sources: the contract with the health insurance and

direct payment from patients for services provided.

Private hospitals displayed a significant evolution over the recent years. According

to data released by the Ministry of Health, in 2009, more than 40 private hospitals

concluded contracts for health insurance; a number that increased to 52 in 2010.

The current system of financing allows payments for medical services at higher rates for the

private system than for the public system. Within the context of the current financial crisis

the under financing of the health system is worsened by the unlawful competition of private

hospitals that access funds from the system of public health insurance. Fair norms of

financing must be set out and implemented in order to prevent throwing the system out of

balance because while private hospitals can turn down medical assistance to patients with

high risk of complications (because the pre-set limit of expenditure can be exceeded), this

is not allowed for the public health care units, which have to respond to all demands while

brushing aside financing aspects. (Report of the Government of Romania on Healthcare

System, 2011)Most market players say that the private medical services market will continue to

grow, especially in the context of health reform that creates market opportunities for both

multidisciplinary medical centers, as well as specialized clinics. This diversification is good

primarily for patients. "I think the market of private clinics will develop. New private

hospitals will appear, private healthcare will become more accessible and consumers will

perceive these services better and start to use them more. I think we will have a growing

market offering customers high quality services," predicted Andrei Gagea, executive

director at Academica Medical Center Bucharest.

Emergency care is available free for everyone including those without state health

insurance. However, once your condition is stabilized you will need the proof of your

insurance status. Emergency treatment is provided at the emergency room of all hospitals,

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which is open non-stop all year. You may use their services if you need immediate

attention, or if youre GP refers you to them, or if there is no GP service available.

SMURD (the Romanian acronym for "Serviciul Mobil de Urgen, Reanimare i

Descarcerare", that meansMobile Emergency Service for Resuscitation and Extrication) is

an emergency rescue service based in Romania. SMURD is a complementary service, with

a lot of bases in the whole Romania, still expanding, that services the worst emergency

cases in a good collaboration with the traditional Ambulance (Serviciul de Ambulan).

Also HEMS (helicopter emergency medical system) has been implemented in six cities

(Trgu Mure, Bucharest, Iai, Craiova, Arad, Constanta) while in other cities the system is

only ambulance based or in exceptional cases police and army helicopters are used.

(Wikipedia)

Before the development of SMURD, Romanian nurses and doctors worked on

ambulances but lacked formal training in the principles of emergency care.

1.2 The duties of nurses in Romania

According to the Ordinul Asistentilor Medicali Generalisti, Moaselor si

Asistentilor Medicali din Romania, NR. 560 din 12 august 2009, a nurse from

Romania need to have a set of principles that represent the fundamental values for

practicing their profession.

In my opinion being a nurse in Romania is a challenge, firstly, it s hard to find a job

after finishing the University. In Hospitals are a lack of nurses and doctors. Secondly,

even if you find a job as a nurse, its very low paid. Even though there are all this

problems in the medical system, nurses are well trained and have skills that nurses

from other countries don t have.

For example, they can succeed working with a lack of materials sometimes can

miss the essential things in Hospitals like: gloves and disinfectants. It s very hard also for

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them to take care of too much patients in a shift, more than 7 patients, this is the reason

why they are careless.

I really hope that things will change in the future and nurses from Romania will

have the same conditions of work as the European ones.

1.3 The healthcare system in Portugal

The healthcare system in Portugal consists of three coexisting systems: the National

Health Service (NHS), special social health insurance schemes (health subsystems) and

voluntary private health insurance. The Portuguese Ministry of Health (Ministrio de

Sade) is in charge of managing the NHS, which is financed through general taxation.

Any legal resident registered at a local medical centre has the right to receive

healthcare insurance, which covers basic health issues such as sickness or accidents. Extra

health insurance coverage is also available to meet your individual needs. Anyone

registered for social security coverage also receives healthcare coverage. The Social

Security Institute (Instituto da Solidariedade e da Segurana Social) is responsible for

administering social security benefits such as pensions and maternity benefits. Private

insurance is available for hospital visits and specialist treatment.

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Hospital services are provided with a discount, and sometimes even without charge,

for people that are registered at a local medical centre. If you are on a holiday in Portugal,

you are also entitled to medical care. However, you are expected to have acquired an E111

document from your birth country. The expenses will be covered by your insurance

company in your home country. (wikipedia.org/wiki/Health_in_Portugal)

Portugal began the 1980s with some of the lowest results among the EU15 countries

for indicators of population health, but improvement over the following 2530 years was

continuous and, although some results are still among the lowest of the E15, the gap has

closed significantly. In 1980, life expectancy at birth was 71 years, a difference of 3 years

compared to the EU15 average; by 2008, the gap had closed to just under 1 years.

Potential years of life lost before the age of 65 years (a measure of premature death) was

40% greater than the median for the EU15 countries in 1980, whereas by 2003 it was only

20% greater. In the case of infant and perinatal mortality (deaths in the first year and first 7

days of life, respectively), the rates for Portugal are now better than the EU15 averages,

with infant mortality falling from a rate that was twice the EU15 average in 1980. (Health

systems in transition: Portugal health system review 2011)

Source: OECD

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Source: OECD

As we can see above, the progress that Portugal made in the last 30-40 years it s

quite big and after my experience in a Portuguese hospital I can understand why in

Romania these negative indicators are still so high. Portugal has made rapid progress in

providing a comprehensive range of health services to the whole population.

Lifestyle choices made by individuals, such as smoking or nutrition habits, level of

physical activity, alcohol consumption and driving habits are predictors of future health

status and future health system performance. Health promotion, disease prevention and

public health policies attempt to promote healthier types of behavior. These policies

interact with social factors and social policies related to areas such as education, transport

and the regulation of illegal or prohibited substances.

In these four months of living here I have observed that Portuguese people have a

different education regarding bad habits. They tend to eat more healthy food, rich in natural

products such as fruits, vegetables and a big amount of sea food. It is fair to say thou, that

this difference is more or less related to different economic levels on which these two

countries are situated. Anyway, there are many initiatives coming from RomanianGovernment or different NGS s that are trying to show to the people how to live their lives

in a healthy way.

Unfortunately, the actual economic crisis affected the Portuguese health system like

in any other country across the world. There are also imbalances between the number of

nurses and doctors. Many healthcare professionals who retire are not being replaced due to

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restricted admissions to medical schools in recent years, according to the 2007 publication

Health systems in transition: Portugal health system review. Also, many patients still go

to the emergency department of a hospital for treatment rather than to the local health

centre. Portugal has already cut public sector wages and raised taxes to reduce its budget

deficit and deal with its economic crisis and thousands of doctors and nurses have gone on

strike in Portugal to protest against cuts in the health budget.

Overall the Portuguese population enjoys good health, increasing life expectancy

and universal access to care through the National Health Service. There have been

considerable health improvements in the recent two decades, partly explained by better

access to an expanding health care network of public and private providers. Yet, there is

also evidence that avoidable mortality is high compared to other European countries and

that inequalities in health and access to care have increased among regions and social

groups. One of the key concerns for the future is furthermore how to sustain the quality of

health services and to keep investing in health and disease prevention in the context of a

shrinking national economy and severe fiscal constraints as a result of both a global

economic slowdown and the European sovereign debt crisis. Sustaining good and equitable

population health and services coverage in the long run is challenging in particular in view

of the progressive ageing of the Portuguese population which means an increasing

economic dependency rate, a diminishing taxable income for health, a diminishingprofessional pool to care for health, and potentially an increasing demand on health services

posed by patients with multiple diseases and disabilities.

1.4. The duties of nurses in Portugal

According to the Ordem dos enfermeiros, Competencias do enfermeiro de

cuidados , Conselho de Enfermagem Outubro de 2003, the professional exercise of a

nurse is focused on the interpersonal relationship between a nurse and a person, or between

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a nurse and a group of persons. The most important skills that nurse from Portugal posses

are divided into three categories.

1. Professional, legal and ethical practice

2. Provide and manage care

3. Professional development

Firstly, I noticed that Portuguese nurses are very competent and responsible. They

are always concerned about their patients. When I started the practice in Hospital Sao

Joao I knew that I will have a lot of things to learn from them. My first contact with a

Portuguese nurse was with my tutor. Even if we spooked for a short period of time first

day, I noticed that he was interested in giving me as much informations as possible and

that he is having a lot of experience in this field.

I started to observe the activity of the nurses from the Orthopedic Service, during

the three shifts. First shift begins at 8 AM. Usually in the morning there are three nurses.

Each nurse has five patients to care. It is very different from Romanian Hospital where a

nurse can have sometimes more that seven patients to care, this can be difficult and the

patients can suffer from that.

It all starts with the pass of the shift. The nurses who worked during the night are

telling all the events that happened during their shift, if there are changes in the patientscare and health status. They take seriously each patient and their needs. After this, nurses

are starting to plan all the intervention and make them carefully.

Morning shift

-Preparation of the medicine, checking the medical prescription and the last

administration

- Collect blood, urine and other sampling for analyses

- Researches of capillary glycemia and insulin correction if it s needed

- To assist the patients during the feeding, especially those who are having

difficulties in alimentation

- Perform the hygiene of the patients

- Lift the patients for going to the bathroom and shower

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- Perform the dressing (remove the aspiration drain, epidural catheters, chirurgical

wounds, remove the suture)

- Collaboration with nurse from Rehabilitation

- Going after patients that have been recently operated to Post Anesthesia Unit

(assessment of Vital Function: temperature, blood pressure; checking the drains and

epidural catheters, observing the level of pain).

- Observing the Diet

- Making the discharges

- Complete SAPE register

- Print new therapeutic sheets.

Afternoon Shift

- Passing the shift, knowing information about every patients

- Planning the cares

- Preparation of the medicine, checking the medical prescription and the last

administration

- To evaluate the Vital Function (temperature, blood pressure, heart rate)

- Going after patients that have been recently operated to Post Anesthesia Unit

(assessment of Vital Function: temperature, blood pressure; checking the drains andepidural catheters, observing the level of pain).

- Observing the status of the patients that have been recent operated

- Researches of capillary glycemia and insulin correction if it s needed

- To assist the patients during the feeding, especially those who are having

difficulties in alimentation

- Shaving the patients that needs this and need to be operated the next day

- Insert catheters

- Change the position of the patients

- To complete SAPE register

Night Shift

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- Passing the shift, knowing information about every patients

- Planning the cares

- Preparation of the medicine, checking the medical prescription and the last

administration

- Checking the Temperature of the patients

- Change the position of the patients, apply cream

- Preparing the patients that need to be operated next day in the morning

- Insert catheters, when it s needed

- To complete SAPE register.

From my point of view nurses from here are doing their job very good. They are

concerned about patients care and do everything it s possible for them to feel better. In

these three shifts the most important objective for nurses is to maintain integrity of the

patients.

I noticed that they are doing their job with joy and really like their profession. For

this they are continuously improving their knowledge about cares.

Secondly, I liked to be part of this team, where professionalism is a virtue. I started

to think from other point of view nursing, to plan my activity and think overall in order to

understand the needs of a patient. There is a big difference between nurses from Romaniaand Portugal. Nurses from here are very well trained and treating the patients with the best

care. Nurses in Romania are disappointed about their job. The reasons are mainly the low

salaries and the poor work conditions in Hospitals.

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CHAPTER II

2.1. My experience in Porto

My experience in Porto started in March. I arrived in a rainy day and was very

impressed about the new country and city. First month was for accommodation, to

accommodate with the language, people, school. I need to admit that it was not easy, and

the cold and the rain made this process more difficult

The hardest thing about going in other country to study is passing from your

comfort zone to unknown, which happed to me also. In Romania everything was usual,

knowing the language, going to University, having your family and friends near. Here it s

different, you get on your own, you are starting a new chapter with new places, new

language and people. This is very helpful for your personal development.

I never understood properly the quote: Travel makes you richer till I arrived

here, traveling makes you richer in thinking and the way you see the world.

People

My personal opinion about the Portuguese people is that they are very kind and

always trying to help, it s a good characteristic for a person. I took this conclusion from my

experience and from the people that I met. Of course, there are also exceptions, but the

most of the people are good here.

I started to make an opinion about people in the first day I arrived here. I was very

well received by a family, which hosted us in their house even if they didnt know us.

The first day at the school was also successful. I was so excited about meeting new

people, also, my colleagues and teachers were ready to help me and give me all the

information that I need. Even if the language barrier was between us, we made a

connection. People in Romania are more restrictive about helping and understanding your

needs. They are also friendly people, but the hard life from Romania made them caring

more about them self. I was pleased to meet here quality people.

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School

It was very interesting to know about my new courses. I found out that I will have a

course named Health in Community and after Practice in hospital. It was surprising

to know that it will be only these 2 courses because in Romania usually we have more

courses in a short period of time. For example, my colleagues from Romania have this

semester 7 courses, also practice in Hospital. In my opinion having the schedule so

crowded it s worse, because you don t have sufficient time to understand properly all things

related to this discipline. This is the reason why Romanian students are treating superficial

the courses and the practice.

Here at the school, I learned how to work in a team, it was new for me. In Romania,

usually we have courses with all year students and only a few laboratories where we are in

small groups. Our job at this courses and laboratories is to listen to the professor who is

teaching a lesson. Here is very different, this small groups that I also been part of it, are

very efficient. Every student here has his own role in the process of education. I noticed

that they are concerned about finding new information, learning, understanding, working as

a team, making projects. They are doing these things without supervision of a teacher. This

is a big difference, students from Romania are related to their teachers and here the students

are more independent.

In my first course I met the nurses from community. It was interesting to see whatthey are doing. I noticed that nurses are informers. Their role is to promote health and

prevent diseases. Also, they have communication skills and a good practical training. In my

opinion it is essential for a nurse that works in community to have that kind of skills

because they work with different types of people.

I learned that Community Health Nursing practice has an important role for society.

The goal is to maintain, preserve and promote health by providing information, education,

lessons and health care service for the community.

My group was researching about actual issues in community (hygiene, sexuality,

contraceptive methods). The information about these issues was transmitted to groups of

young people that were in high school.

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Important was, finding information, structure them in order to communicate a clear

and simple message. I liked very much the way my colleagues talk and explain the issues to

the teenagers. I think that it was simple to understand, interesting and very useful.

In Romania, I never did this kind of work, it was new for me. I learned that is

important to work as a team, to collaborate with the teacher and the nurses in order to do a

good job.

Porto

Also known as Oporto in English is the second-largest city in Portugal, after Lisbon.

Its administrative limits (an area of 41.66 km) include a population of 237,584. Located

along the Douro river estuary in northern Portugal, Porto is one of the oldest European

centers, and registered as a World Heritage Site by UNESCO in 1996.

One of Portugal's internationally famous exports is Port wine, is named after Porto,

since the metropolitan area, and in particular the adegas of Vila Nova de Gaia, were

responsible for the production and export of the wine.

It s a beautiful town, that have a lot of historical places and attractions. I liked

especially the mixture between old buildings and nature with colored flowers. I was excited

about the ocean and beaches because it was the first time I saw this.

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Brasov

Is a city in Romania, located in the central part of the country, about 166 km north

of Bucharest and 380km from the Black Sea. It is surrounded by the Southern Carpathians

and is part of the Transylvania region.

According to the last Romanian census, from 2011, there were 227,961 people

living within the city of Brasov.

The city is notable for being the birthplace of the national anthem of Romania and

for hosting the Golden Stag International Music Festival.

Brasov during the winter in breathtaking when the mountains, snow and nature gives you

the feeling that you are in an wonderland.

These two beautiful cities are quite similar. The biggest difference is that Porto have

river and ocean and Brasov have mountains and heals. But they both are touristic towns

with historical places, they are cozy and comfortable.

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2.2. My experience in Hospital

In my opinion attitude is an important thing. This attitude reflects the way you are

seeing an experience and how the observers see you. It s important to take seriously

everything you do and do it well.

I started the practice in Hospital Sao Joao, Orthopedic Service with a lot of

expectations. Expectations that I will learn new things, gain practical skills, meet the nurses

and observe their work with patients. I can say that it was a unique experience for me.

In the first day at the Hospital I meet my tutor, meet the other nurses, the patients. I

started to discover the service and the procedures that need to be done during a shift, I can t

say it was easy. I had difficulties in understanding the patients and talking with other

nurses. It was very helpful that my tutor was speaking English but still was a lot of new

words to learn for me, words from the service that are more used. I can say that the fact that

I did t knew the language was a problem for me at the beginning and made me feel worried

about my evolution as a nurse. It is very important to talk with the patients and to know

what their needs are.

In Romania I had a lack of practice in the Hospital, because of the system and

because we don t have a tutor in Hospital that could teach us things and be responsible for

us. This lack of practice was seen here, there was a difference between me and the othernursing students. The Portuguese nursing students were very confident about them and had

a lot of experience in accomplishing all the tasks that are needed in the service. I was a

beginner and needed to start everything from scratch. Even the basic things like doing

injections, inserting catheters, change the dressing was quite difficult for me because of this

lack of practice.

Theoretically I learn at the University about this things, how to perform them well

but I did t had the necessary practice. I felt like I m disappointing my tutor that had a lot of

expectation from me. I always kept my positive attitude and determination to succeed.

I learned that you need to be patient and serious in order to succeed, also a few basic

thing s that I think are important:

Dont put too much pressure on yourself, but try youre hardest and be

proud of your achievements.

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Always look for new informations and be attentive of everything is

happening near you

Take advantage of every opportunity to learn new things

Use your tutor in order to perform things properly Never try and do something if you are unclear about what youve been asked

to do. It is always better to ask - 10 times if needs be - so you understand

100%.

Learn to perform everything with professionalism.

Dont refer to patients by their condition or bed number it s important to

learn their names.

At the end of this practice I can say that I have developed myself, as a person

and a nurse, it s a big difference between me at the beginning of the practice and now. I can

say that now I am ready to think about my future career as a nurse and I have the right skills

for succeed. I will never forget this experience and I m grateful for this extraordinary

opportunity.

2.3. My perspective for the future as a nurse

After the experience from Orthopedic Service I feel more confident about my

future. I gained here a set of skills that will help me caring the patients more professionally.

I can say that I m ready now to work in a Hospital and have in my care patients. Even if I

have things to improve, I will continue practicing nursing at the highest level.

This year in Romania I will take my degree and I can start practice nursing. I think

now I have an advantage over my colleagues from Romania and I m confident that I will

find a good job.

Porto, 2013 23


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Conclusion

At the end of this study I can say that I succeeded to complete all my objectives. In

the first chapters I emphasized more the differences between health systems in Romania

and Portugal and practicing nursing because this is my field of studying and working. You

can find here all the informations needed about both Health systems and nurses skills in

order to make a comparison.

The other chapters were more personal and are showing my point of view about

Erasmus experience. The objective is to inform about my practice in Hospital, skills that I

gained, my thoughts about future, my impressions about the city, people and the way of

living.

I think that this study could be very helpful for a future Erasmus student that will do

practice in Hospital but also for the nurses from Romania and Portugal that are curious to

know about other Health systems and nurses.

Porto, 2013 24


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The Impact of the Health Care System Reform on the Romanian Nurses

Professionalization Process (English version) - Silvia POPOVICI, 2012

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DRUGUS, L. - Managementul Sanataii Ed. Sedcom Libris, Iasi, 2002

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Differences between practicing nursing in Romania and Portugal

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