Critical care nursing in Europe varies from one country to another. The EfCCNa Exchange Programme enables critical care nurses to spend some time on a ICU in another European country.
Aims and Objectives of the programme
- to widen the professional horizon of critical care nurses in Europe
- to promote international collaboration and to share expertise
- to stimulate the personal professional development of critical care nurses in Europe
Who can participate?
All critical care nurses or nurses working in intensive care who own a membership in their national professional organisation which is member of EfCCNa. Additionally, it is anticipated that participants have got a sound experience in intensive care nursing (5 y)
For more information on the programme see links below
From May 12 to 16, I had the opportunity to take part in a short-term exchange stay as a nurse at Karolinska University Hospital in Stockholm – one of the most advanced medical facilities in Europe. This experience has significantly enriched both my professional and personal life.
During the stay, I observed the functioning of several intensive care units – including central, neurosurgical, and thoracic ICUs – as well as modern operating rooms. Each unit was identically equipped, contributing to greater efficiency and consistency for staff. One nurse was responsible for one patient, assisted by a healthcare aide caring for two patients. I was impressed by the calm, respectful environment and the high level of organization and teamwork. One aspect that stood out was the Swedish approach to equality and communication. Nurses enjoyed a high level of autonomy, and patients were involved in decisions about their treatment. There was no strict hierarchy, and everyone communicated openly and with mutual respect. Family members could visit patients without time restrictions, which reflected a truly patient-centered approach. Technology played a major role in everyday work. Digital records, electronic documentation, and modern equipment made workflows more effective. Security and order were also remarkable – access to any part of the hospital was only possible with a personal access card.
The staff was extremely welcoming, open, and willing to explain their system and share their experiences. I gained not only valuable knowledge but also new perspectives and inspiration. This exchange stay gave me more than I had hoped – it strengthened my professional identity and broadened my view as a nurse and as a person. I would wholeheartedly recommend it to anyone considering a similar opportunity.
In August, I visited the Anesthesiology Department and the Emergency Department of Landspitalli University Hospital. When I arrived at the Hringbraut ICU, one of the two ICUs in Reykjavík, I couldn't hide my enthusiasm. Working organization, the hospitality of colleagues, the number of support staff with certain tasks, as well as the equipment and space, left me speechless.
Undergraduate program in Iceland lasts 4 years. In the first two years, students learn the basics of natural and social sciences, as well as humanities. The remaining 2 years are focused on higher education, depending on the student's priority. All nurses employed in the ICU previously attended a one- or two-year course to work in a specialized unit. As everywhere in Europe, Icelanders are also looking for additional staff as the number of qualified nurses decreases significantly every year.
An impressive difference compared to our ICU is the involvement of a clinical pharmacist who is responsible for preparing medications for each patient. Also, I was delighted by the spaciousness of the rooms, the patients moving crane, the therapy preparation room as well as the meaningfully organized resuscitation cart, something that I'll try to apply in my work as well.
I was also very surprised by the fact that the nurses in the operating theatre administer anesthesia by themselves, while the doctor is present in the monitoring room and comes at the nurses call. After bachelor's degree, these nurses completed a two-year course to work in the anesthesiology department and are very capable and skilled in their work.
Colleague Dora, who met me at the Emergency Care Unit, showed me the concept of department and how the dispatch service works, which, unlike our hospital, is located at the same hospital, nearby. She also showed me the triage procedure, day care hospital, resuscitation, acute and subacute rooms.
Due to the arrangement of the space itself, the number of patients and staff, at one point I felt like I was in the American series ER.
In a conversation with my colleagues, I learned that their working week lasts 36 hours, but if they want, they can apply for additional work. The salaries of nurses in Iceland are far higher than the salaries of nurses in Croatia. Iceland is expensive for everyone, but the prices follow a standard that is very high and I think it is justified. Iceland is an ordered country that takes care of its children, its people and its workers.The time spent in Iceland and the exchange program itself is an experience that I wish for anyone who, despite all the obstacles, does this job with the same enthusiasm and love as the first day.
In April 2024 we had the opportunity to visit the Amsterdam UMC in Amsterdam, Netherlands. Our visit was fulfilled through the Erasmus+ program, which was the main financial contributor to our experience. We feel the need to express our gratitude to EfCCNa for being the interface between us and our colleagues in Amsterdam. Special thanks to Mrs. Willemke S. and Mrs Frederique P. for their hospitality and guidance in this unique experience. Through our short visit, we had noticed that nurses employed in the ICU, have a prerequisite education of 1.5 year course in intensive care, so they are paid more than the rest of the nursing staff. In Cyprus, no additional qualifications are required to work in intensive care, even though several educational programs such as postgraduate degrees, intensive care specializations are provided by many university institutions. Many of them working in intensive care have these qualifications! During our visit, we followed a day-by-day routine of our ICU colleges in Amsterdam, became familiar with procedures, protocols, new equipment, and the organization of the ICU department overall. An impressive difference with our ICU department in Cyprus is the involvement of a Clinical Pharmacist in the daily routine of the ICU department in the Netherlands, who is responsible for ordering, preparing, and administrating the medication each patient drawer. This is important in infection prevention and it is very helpful for the ICU nurse to preserve time for other duties regarding the ICU patient. Finally, we would like to state that the whole experience is going to be unforgettable.
Our suggestion is that this kind of exchange should be continuous, so more of our colleagues get the opportunity to familiarize themselves with new data, new cultures, new procedures, and new opportunities for knowledge.
I am a nurse in the polytrauma ICU of the Hospital 12 de Octubre in Madrid. My visit to Cyprus was scheduled before the pandemic, so when I was contacted again, I was overjoyed.
I feel very fortunate to have had the opportunity to see a healthcare system from the inside. Jelena facilitated all the conversations with the coordinator in Cyprus (Maria Foka) to whom I am eternally grateful. My experience at the Nicosia General Hospital starts from the 22nd to the 28th of May. From the very first minute I was given a tour of the different ICUs so that my colleagues could get to know me and get to know me.
It is a 400-bed hospital in which the intensive care units are divided into three, with ICU 1 and ICU 2 for medical and surgical pathology and a third ICU for coronary intensive care. I rotated through all of them and even had the opportunity to see the layout of the emergency department. Unlike my hospital, they treat severe trauma there, while we treat it directly in the ICU, in an initial care box, without going through the emergency department. I had the opportunity to speak with the nurse trainer of the trauma team and talk about the incidence of their admissions, the importance of staff training and ATLS follow-up and knowledge in order to become high performing teams.
She was pleasantly surprised by the extensive training the nurses receive, there is no perfusionist, so they are the ones who handle the ECMO. They are skilled in imaging techniques such as peripheral artery cannulation with ultrasound. They are highly independent, use nursing protocols for ion replacement as well as connection to mechanical ventilation in cases of weaning. I found the nursing staff to be highly motivated and team players.
The working hours are more attractive, with 6 hours in the morning and afternoon and 12 hours at night; unlike in my country where the working hours are 7-7-10 hours.
I appreciate the effort of my colleagues to speak English to communicate with me and the interest aroused by the health system in my country.
On the other hand, as there is no nursing assistant or orderly with the functions that are recognised in my hospital, the nursing load is very high.
I invite all colleagues to try the experience and enjoy the luxury of seeing with your own eyes how our work is carried out in other countries.
‘’So much of who we are is where we have been’’ once said by William Langewiesche. With this quote, I would like to start this brief report on how my experience at the Karolinska University Hospital affected my mindset, emotional intelligence, and knowledge. Through the Erasmus learning program and the valuable help of EfCCNa, I was able to travel to Stockholm at the Karolinska University Hospital from 15.-19.05.23.
To begin with, as an ICU nurse, I wanted to gain as much knowledge in intensive care as possible. During my short visit in Karolinska, I could visit their Central ICU, Neuro ICU, Thoracic ICU, Trauma Center, and the ECMO unit. Little did I know about Sweden’s healthcare care system and how ICU nurses are educated there. As I was informed, nurses working in ICU departments are obligated to follow an extra one-year course in addition to their basic degree. Cyprus’ educational system offers a four- years bachelor’s degree in nursing, MSc and Ph.D. in Intensive Care Nursing, and a one-year Diploma in Intensive Care Nursing. Nevertheless, an entry into ICU for a nurse in Cyprus does not imply further qualifications as a prerequisite except the BSc degree. Knowledge is mainly gained through experience, shadowing experienced nurses, in-house ICU education, and some ongoing educational courses.
To continue, what surprised me in a positive way was that Sweden, according to the CDC’s latest stats, is in the green zone regarding hospital infection rates and the use of antibiotics. So, seeing in person what they do differently and better compared to Cyprus, inspired me to talk to the right people about changes in my country. I can come up with a lot of suggestions that could reduce the ICU infection rates at the hospital where I work. Unfortunately, the infection rates put Cyprus in the red zone according to the statistics. An example that could be implemented in Cyprus is the closed systems of central and arterial lines, which make infection of those systems by retrieving blood samples highly unlikely.
Another thing that left me astonished was the ECMO Unit, which felt like going deep into «NASA’s laboratories» for me. As I have read, Sweden placed their first ECMO in 1987, while Cyprus was placed in 2020 and in reality, we have done only baby steps in this domain. I was really fascinated by the advanced equipment, and the high level of knowledge, skills, and innovation.
Furthermore, I was surprised but also disappointed, by the fact that the ratio of nurses to patients is mostly 1:1 in Sweden. This is not applied in Cyprus simply because we are always short of staff. Also, the role of nurse assistant is well established in Sweden’s healthcare system. The nurse assistant role is highly valuable and appreciated not only in Sweden but globally, and it should be applied in every healthcare system. Due to their demanding duty list, they discharge nurses from a lot of workload, in order for them to mainly focus on monitoring assessment and medication, all for the patient’s benefit.
To sum up, my whole experience in Karolinska Hospital was memorable, making me feel nostalgic for coming back to Cyprus. My wish for the future is for all healthcare systems, to work for the benefit of the critically ill and for the role of nurse to never be underestimated.
In the end it finally happened, after long waiting due to the pandemic I’ve been able to attend my exchange program appointed by EfCCNa. I spent a wonderful week at Karolinska University hospital in Stockholm, Sweden from May 20 to 27. As a critical care nurse I can now confirm this experience can be considered a cornerstone of our profession. Thanks to this exchange, a motivated and open minded nurse can achieve its goals about confrontation with other cultures, self empowerment and skills improvement and, why not, spend some beautiful time in a stunning European capital. I had the opportunity to visit the entire critical care department in Karolinska. Due to my previous working experience in Italy I was particularly interested in Neuro-ICU, General ICU and ECMO unit.
Since the beginning Charlotte Förars, one of the Neuro-ICU most experienced nurses, was in charge of the activity plan for me. She firstly organised a quick general visit to the hospital with a colleague followed by a day by day round in the above mentioned wards. I felt always welcomed and everybody put a lot of efforts to make me feel comfortable and to speak English in order to be as much as possible involved in the nursing process.
Furthermore, after the bedside “training”, nurses showed me other beautiful areas and projects of the hospital: I visited the Emergency Department, the trauma bay, I spoke with the nurse in charge of ECMO worldwide retrieval team, I also had the pleasure to meet a colleague specialized in delirium and comfort care, and again I saw the really important work of the physiotherapists in the ICU. It has been a real pleasure for me to speak with the colleagues about the COVID pandemic focusing on their perceptions, their experiences and what have been the strongest moments. I strongly believe that this exchange is again really important and it’s very beautiful to understand in the end that even with different cultures and different language we, as nurses, everywhere try to assist our patients with commitment, passion and love for our job.
Since I started working in Critical Care in UK, one of my dreams was to participate to the EfCCNa Exchange Programme, as I firmly believe that European Healthcare systems should promote cooperation between each others in order to integrate knowledge and therefore, improve the quality of care we deliver in the critical care area.
EfCCNa is a great organization which makes this opportunity a reality. I choose to visit the Cardiocentro Ticino in Lugano (Switzerland ) as I am a specialized Cardiothoracic intensive care nurse and I am an Italian speaker. Ian Naldrett, the EfCCNa representative in Uk, contacted Paul van der Heiden from Switzerland. Luckily, Paul works at the Cardiocentro Ticino, therefore the process was easy and smooth.
I had the most amazing work experience I could dream of, Paul was exceptional, he made an excellent schedule for me and he went above the expectations. We both prepared presentations of our units, how we work and the services we provide; we shared ideas and professionals opinions.
I certainly recommend the EfCCNa Exchange programme, as it is a pure moment of professional growth and promote awareness of the different practice in the critical care across Europe. Cooperation between European countries is the key improve and shape future of the Critical Care.
Through EfCCNa’s homepage, I found the “Exchange programme” and contacted EfCCNa’s Norwegian contact person Mathilde Christensen who contacted Belgium’s contact person Arnaud Bruyneel. He suggested some hospitals from which I could choose. However, some of the hospitals had an absolute demand that I could speak French, one of the official languages in Belgium – which I do not. Nevertheless, I finally ended up at CHU Brugman where Yves Maule made an excellent schedule for me for an interesting week.
I will most definitely recommend the exchange-programme. Having insight in other work cultures is most rewarding and raises awareness to the work in your own unit.
Start the process early. Make your self an opinion on what you want from the exchange. Prepare a presentation of your own unit. Show photos and statistics on the population you serve and average days admitted, days on ventilator and such. This is always interesting to others with similar work and makes a basis to compare. Remember that this is an exchange – and it works both ways.
Talk to your colleagues before you go on an exchange, to find out what do we want to know? How do others solve their challenges? What are their procedures on different tasks? It is always interesting to know how others approach issues, and are their approach different from ours?
After meeting qualified specialists from Norway at the EfCCNa congress in Belfast in February 2017 the possibility occurred to use the exchange program of EfCCNa to think outside the box – how do critical care nurses work in Norway? What are the differences to Germany?
The most important structural differences to Germany are the framework conditions for the Norwegian nurses with regard to the numbers of employees present at one shift. Because the intensive best care practise for the patient is the primary focus in Norway, there is a minimum of a one-to-one-ratio in care done by critical care nurses in every of the three shifts. For every four patients, there is additionally another qualified personnel nurse to support the critical care nurses at the bedside. Apart from that each shift has always one shift supervisor who is responsible for organisational tasks.
As a result the intensive care patient is in every scope of his treatment safeguarded. Best practice, continuity in care, high awareness of hygiene for a sanitary working environment, infection prevention, a faster achievement of the therapy goals especially the weaning can be designed to be more targeted and focused through intensive care. The critical care nurses use a more efficient, multi-disciplinary way of communication and relatives are also included in certain duties of this patient-centred care approach in Norway every day.
Because of these conditions the individual care for every patient with the current applied nursing and medical standards are ensured. The most important principle is that the patient will be never left alone by a nurse. Are there medical tasks to fulfil like drawing up the syringe in a special pharmaceutical room or the responsible critical care nurse has to take the mandatory break there will always be a critical care nurse present with the patient.
During my work shadowing I have enjoyed to be a part of this top quality and respectful way of working at the intensive care unit in Tromsø. Thank you very much to all of my colleagues at the Universitetssykehuset Nord-Norge for the impressive days and the open admission to your team.
The Exchange program was for us a great opportunity to show how there is one of the best intensive care in Europe. We had the opportunity to gain new experience and comparison of our knowledge and skills to the knowledge and skills of our Swedish colleagues.
The level of nursing care in Sweden is high - Swedish nurses have the capacity and conditions to ensure that the patient be able to comprehensively cultivate. In intensive care it is very important to realize how important the interdisciplinary approach to the patient with the appropriate amount of staff among others in the prevention of infections, for the safety of patients and their welfare and safety of personnel.
In Sweden, this consciousness exists. In addition, we had the opportunity to meet many wonderful people who served us help and tried to do everything that we benefited as much as possible during our stay in Karolinska Hospital and Danderyd Hospital.
To sum up, this was a really enriching experience, and that's why I encourage other colleagues to join the programme. It is the way to experience first hand that nursing care is not the only thing that makes a difference; it is also factors such as the organizational structure and inter-professional communication. Each team, in their context, has their strengths, threats, opportunities and weaknesses.
Nowadays, in Spain, we are in a context of economic difficulties that undoubtedly would influence health outcomes, but we have a great innovation, creative potential and motivation to improve the processes of care to our patients. The EfCCNa exchange programme is another opportunity to expand horizons.