We're Back Baby!

 Did the Novelty Wear Off?

Why did it take me this long to write my first blog post this year? It's not that the novelty wore off, it's that I have been busier this year and have been doing more... and thinking. That is the best way I can put it. 

The first time you visit a place, there are no true expectations, right? This includes expectations surrounding the first time you teach a class, the first time you visit Cleveland Clinic London, etc. I know there is much to be learned from the internet, but still, no real, expectations. This year I hd expectations. And they have been met and exceeded. Since there is so much to report, to get caught up I'll have to make a few posts today and a few posts tomorrow (hopefully).

Travel

This time I traveled by day instead of overnight. I highly recommend it when traveling by day that you leave very early (I had a 6 AM flight) and force yourself to stay awake on the plane. It really helped get me on track. I refilled the oyster (travel) cards, hopped on the train, and was checked into my flat by 10:30 PM local time.

Day One - Picking the Students Up

For the size of the group (6vGraduate students, 13 traditional nursing students, and one accelerated student), I have to say that getting them to the hotel, and checked in, was not as cumbersome as I thought it was going to be. Now, if you asked the students, they may give you a different answer. Especially because some of them do not have my gift of being able to sleep on planes

We discussed expectations for the week and then set out exploring.

Then, I personally wanted to get a run-in. It's a great way to explore and do a windshield survey – which the students will be doing all week. London has runners EVERYWHERE. I don't think I've ever been out and about without seeing quite a few.

I walked around a bit before setting out and then did a run in Regents Park - which is kind of like a mini Central Park. Then I headed to Camden Market because the "thrifting" bug grabbed me. This starts the first story of my expectations being exceeded this year.

The American Expat

While at Camden, I passed a store for Crisis London, a charity shop, raising money for rough sleeping Londoners. I walked around for another hour, observing and shopping, but for some reason was drawn back to the store.

When at the checkout was my singular butterfly scarf, I recognized that the woman ringing me up, did not have an English accent. Turns out, she is from California. Without me telling her about the purpose of my trip, she was very candid and sharing her battles with multiple sclerosis, and that she was paying thousands less per year for her care and for a better quality of life here in the UK in comparison to back home. There are stories about wait times and long lines within the NHS, but this has not affected her in the least.

She was volunteering alongside of very proud, clinical nurse specialist, and we spoke about the differences and similarities and nursing between our systems. While regulations for advanced practice nursing need to be implemented in the UK to standardize the scope of practice, I could hear the immense sense of pride and heart in the work that she does. Many nurses in the UK will volunteer their time, even after working long hours in their hospitals. Hence, this is how I met her at the Crisis London shop, where most of the workers are volunteers.

This brings me to day two lectures and discussion with the students.

Lectures at Morehouse School

I didn't know it when I booked the classroom, but Morehouse School is in Knightsbridge - the wealthiest neighborhood in London. And you could tell the walk to the school had an entirely different vibe as if you could feel the privilege. The interior of the school reminded some of us of Harry Potter, with loads of stairs, nooks, and crannies and tight, twists and turns.

The classroom itself though felt like home - 

especially with Totoro and Florence (if you know you know!).

Just like last year, Dr. Good and I lectured on the UK's education

system and pathway to nursing respectively. This year the lectures led to a robust discussion of nursing workforce culture. We talked about the average length of time in RN spends at the bedside (around three years) and the fact that in many of the undergraduate, clinical rotations, students are hearing from bedside nurses to not enter the profession at all. This is completely different from when I was in school. We all understood how hard it would be, but at no point did any nurse try to dissuade any of us from entering the field.

Conditions for UK nurses are not much better. To say the NHS to spread thin is a massive understatement. The writing is on the wall; both of our countries will have to rely on bringing in nurses from other countries to fill the gaps, there is just simply no way around this.

On a final note for the day of lecturing, the take away from the students' conversations is that they are well aware of the journey they are starting and the difficult yet rewarding road ahead. They are committed to making a difference in not just patients' lives, but in the workforce itself. We need to have a better bedside culture that leads to better policy, and whenever it is necessary, we need policies that lead to a better bedside culture. The students certainly seem to grasp these concepts well.

After the lectures, the jet lags snagged a few of us (it kind of feels like a mini flu), so it was off to bed to prepare for the next two days.

American Health Care in London?

Yes! For those who don't already know, the Cleveland Clinic has several international locations - 

Toronto, Abu Dhabi and now London. 

This was the part of the trip I couldn't wait for. How does a giant like the Cleveland Clinic, that was born and raised in a privatized health care system, play well in the sandbox with England's system? As it turns out, very well indeed so far. They were celebrating the 1 year anniversary of their opening the week we were there.

First, we were greeted by Sheila Miller, DNP, MBA, RN, NEA-BC the new chief nursing operator of CCF London. 

She presented to the students how the Cleveland Clinic got the nursing operations up and running in London. This was no easy task. Nursing fundamentals are the same worldwide, but our scope differs by country. Additionally, the clinic worked with English personnel to expand upon its  mission and vision to meet the expectations and standards of all parties involved. The clinic will even be able to help with a backlog in NHS elective surgeries/procedures that are still lingering because of the pandemic. It is an exciting time to witness; I am especially interested to see what the future has in store. 

We were given an educational tour by Warren Little, Nurse Educator for Perioperative Services at Cleveland Clinic London. Here he is with his American counterpart Heidi who is Nurse Educator of Surgical Services for the Akron Campus of Summa Health. 

It was no surprise how knowledgable he is given his current position. 

The tour was well thought out (geared to what nursing students would want to see), and he patiently and thoroughly answered every question we had for him. 

We also met some other personnel along the way, including Lauren - a nurse from Ohio 😀

I always used to joke with my friends that (pardon the expression) you would have to blow up the current American health care system and re-construct it in order for it to work properly. Many European countries were forced to do this because of the two World Wars, and the NHS is a product of intentionally building a system from scratch that you want to benefit all citizens. There was similar intentionality in the collaboration between CCF and the English government. It's an exciting time for the organization there.

During the tour, we note how close to Buckingham palace the clinic is (almost literally across the street).

So I decided to go see it. It's not exactly on my bucket list, but if you're in London, you can't not see it right?

Out of sheer luck, I arrived before the changing of the guard. Lucky me! 

Next day, Mayo Clinic. another international health care system that also has a satellite in Abu Dhabi and London.  

Anya, a nurse working in England coming from the Republic of Ireland would be our first guide of the day, led us to the Executive Lounge to tell us about Mayo's place in the London system.

Mayo went through a similar process to CCF getting up and running in London. While the Mayo Clinic's operation is smaller (they have no inpatient beds), they have been in operation longer. They opened in 2019, about 6 - 7 months prior to the start of the pandemic. Anya has been with Mayo since the beginning, and recounted what it was like coming to work when London was shutdown. We all shared stories of lockdown before moving on to a patient room.

Our black squirrel's routine visit earned him a clean bill of health!

The last stop for the group, before heading to dinner, was Harley Street. Our tour guide was Richard from the Mayo clinic. This is where I personally learned the most. 

While England has health care for all, there are still gaps between the haves and the have-nots. The gap is most evident in Harley Street, a street named after the 2nd earl of Oxford and Earl Mortimer (click HERE for more info). Starting roughly in the 1880's, private physicians and specialist began setting up shop in this area, and it is now a centralized area of private health care services. 

You can get routine services, MRI's, elective surgeries, you name it. You can come here for anything except emergencies, and many consider it "better care."

The biggest surprise for me was that there is an American health care company that has been in London for the better part of 20 years. HCA Healthcare (to my surprise) surpasses the Veteran's Health Administration as the largest health care system in the United States. It has locations in 20 states (not Ohio) and has quite a few locations in London - enough that, according to Richard, the English government has had to intervene to prevent monopoly-building behaviors. That is absolutely going to be my deep dive for next year. 

But alas, that brings us to the end of this year's trip. I'll do one more post about a week or so after I've been home with my puppies and family. It gives the students a moment to chill and send me their final reflections. I'll answer what went well, what can we do better and what we are already planning for next year.

Professor and Fangirl

Yesterday I had the growth moment. Today I had a "fangirl" moment. 

The first order of business for the day was a short lecture from patron and cofounder of Equality Trust Richard Wilkinson. Richard Wilkinson retired in 2008, but he continues to be very active with consultations and speaking engagements. His research on health disparities and social determinants of health contributed greatly to the income inequality discussion worldwide.

I'm not sure the students truly understand who he is and that's OK. Most of his work is a little before their time. I have one of his TEDTalks embedded in my Community Health Nursing class, and it will remain there until it is no longer relevant, which will be in approximately 1000 years. Click HERE to see it. If you're interested in reading his works, click HERE to be directed to a list of his books. The reason why I am such a "fan," is because people like Mr. Wilkinson help to prove what many of us (prior to going off to college) don't even think of studying. 

We all know money matters. Social epidemiologists help us understand the why's and how's and that's really important because it helps develop a much deeper understanding of the true nature of social mobility and immobility.

After learning about how income inequality affects the health of citizens (by the way, it should come as no surprise the America has the highest income inequality of the OECD countries), a small group headed to Brighton. 

Dr. Good and I wanted to do an out-trip from London to see life outside of the capital city and speak to someone from social services there, but our initial contacts fell through. I still wanted to venture out of the city for a day, and a few students opted to come with me. I'm so glad they did. Mikaela found this most excellent spot for lunch and it was the best fish-n-chips I've ever had - BY FAR. The gentleman we talked to in line stated he's been all over the states and our fish n chips are rubbish - haha! After tasting this, I only slightly disagree - he's never been to Twin Lakes, OH 😉

We also had a great time with the lad taking our order. 

He's from Northern Ireland and bonded with our black squirrel. 

Then we headed down to the Brighton Pier, a mini Cedar Point. What I loved while there is that even though it was pretty cold, there were quite a few visitors (although, not in this photo). You can tell the pier and beach are loved.

There was one other attraction I wanted to visit prior to leaving Brighton, and that was the Royal Pavilion and Garden. To give a little history, this is the only former English royal residence; in other words, the only one that the family no longer owns. However, the primary reason I wanted to visit was because it was a hospital for wounded Indian soldiers in WWI. 

Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland

Alas, this proved to be a bit of a propaganda scheme to drum up support for the war, but this effort let to the space being used for limbless men to convalesce. 

Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland

Some take aways for the day for me personally: 

The students noted how diverse London is. Only a short train ride away and the landscape is completely stripped of that diversity. While London has an approximately 50% (including what they call "British white" and "white other"), Brighton is 85.5% white. And honestly this makes sense to me. 

The other takeaway - dress REALLY warm if you're headed to the UK side of the Atlantic Ocean in March.

The Intangible Products of Education

This won't seem like a study abroad post at first, but bear with me. I promise it'll all come together in the end.

Yesterday was a rich day for the group. But it was an uncharacteristically long day for me, and it ended with me having a sort of unexpected growth (existential?) moment. Apparently that can still happen in your 40's. At the end of the day, the group split off into three separate groups. Actually, two groups and then me. I alone went to see the Phantom of the opera at her Majesty's Theatre.

About 10 minutes into the production, it hits me - I have a love-hate relationship with this musical.

I love it for its nostalgia as this was one of the first musicals that I fell in love with and sang from start to finish. I hate it because it is absolutely the dumbest storyline of all times. I also hate it now because I have experienced and performed far superior pieces of music (I was an oboist prior to becoming a nurse). 

All this underscores close to three decades of growth since I fell in and out of love with that musical, and none of that would have been possible without certain opportunities afforded to me because of education.

I think a large portion of the students on this trip have started a growth journey similar to that. This day  started with another lively discussion about the vast differences (and some similarities) between the education systems of the UK in the US, and how one's path is essentially chosen in a younger age in the UK than it is in the US leading to a decreased possibility of upward/downward social mobility. Or so we we should think.

The second half of the morning's lecture was dedicated to the path to nursing in the UK versus the path to nursing in the US. We also talked about Advanced Practice Nursing, which looks very different in the US versus the UK. In the UK,  "Advanced Practice Nurses" are not truly providers: they do not diagnose diseases/illnesses, nor do they prescribe medications. They are expert nurses, but this does not help Britain achieve what it intended to, which is to add more general practitioners (primary care providers) to the workforce to increase access.

But let's get back to the students and their journey. We have quite a few first-generation students in this group. Students just like me who look for every opportunity to expand their horizons. During and after the lecture there were so many poignant conversations about education, social capital and determinants, and policy and politics (of course!). There are too many to even highlight really. 

Those conversations continued at the Florence Nightingale Museum where we had a pretty good time beating Florence at one of her own games (she made forty words - we made forty - TWO!)

I'm happy that the students are increasing their depth of knowledge and relationship to education and healthcare policy, but what is equally important is that intangible product of certain types of educational environments. The students are learning from each other and from the locals that they run into and have conversations with. They are picking up tools to forever have in their cultural toolbox. They are forging and cementing connections with each other - some that will last a lifetime.

And I bet 20 or so years from now, they have similar moments of nostalgic enlightenment that remind them of how far they've come. At least I hope so.

 Ready!

I left out tales of yesterday because it was mostly a day of travel and getting settled in. 

Say hi to Anna and Micaela on the Heathrow Express. 

It was so fast and convenient - if you listen to the announcements.We made it to Regent's, then met up with the others to take a short campus tour and get settled into our digs. Or I should say, the students settled into their digs. This old-timer is not sleeping in a dorm. 

I was pleasantly surprised by my airbnb - which is called a flat even though it's basically a studio apartment. I am personally an open air kind of gal, so the thing I like about this space is that despite how small it is, it doesn't feel small because of all the light. And there is even a patio (garden). My daughter, who loves little nooks and crannies, would love this place.

But the best of all is that it is extremely affordable, and very close to the students - an approximate 7 minute walk.

Today we finally got things up and running as far as a formal course lecture.  It was a lively discussion. 

Here's what the classroom looks like: 

Prior to the start of the trip, the students learned about United States, health care policy, how our government functions and the major drivers of our policies. They also learned about the National Health System of the UK. So after Dr. Good's lecture on London's cultural makeup, we hit the ground running with some lively discussion comparing the UK and American value structures, which of course go much further than just health care. Those discussions will continue this week of course.

There is great diversity in this group (including geographic background - which matters!, age, gender, etc.), and this leads to rich discussion usually. Today was no exception. There are certainly no "wallflowers" in this group. Everyone participated with some strong statements about how they feel about where our country stands on health care (not all bad by the way). 

After the morning's lecture/discussion, I unleashed them onto London to do the windhshield survey. Most of these students have done the windshield survey for their Community Health Nursing course, and this survey will look VERY different from the ones they have done. Even if they only do one block.

Then we all scattered to do some of the "touristy" things. I went to Camden market, where I got just slightly lucky.

I stopped at one of the Indian food vendors, and tasted something that for the life of me I could not understand the pronunciation of. Then when I tried to pay the woman, it was 5 GBP (pounds). I handed her a 10 (I am positive of this). She handed me back 15. No matter how hard I tried, she would not take the 10 back. So I basically was paid to eat was chicken in a sauce that was the perfect blend of sweet and spicy, and again, I have no idea what it was!!

Tomorrow I am especially looking forward to. We'll lecture in the morning and head to the Florence Nightingale Museum. Then on my free time that evening, I'll see Phantom of the Opera. I landed on that choice because of its London connection. Andrew Lloyd Weber - ahem, I mean the Lord Lloyd-Weber is English, and Phantom of the Opera debuted in Her Majesty's Theatre in October of 1986. It has been playing there ever since.

Good evening!

Getting Ready

 Time to pack!

Thanks to my husband who loves exploring and to my daughter, who is competitive dancer, I travel around the states and Canada a lot. But I haven't been overseas in a loooooooong time. So I visited a few sites to help me prep. Rick Steve's London Guide was a good place to start. Its focus is on tourism, but there is still a lot of great info there. 

Even though we are not planning on any major hiking, my FAVORITE site for expert packing advice comes from REI. I followed all advice except skipping toiletries. I'm not super fancy or high maintenance, but my skin disagrees with this statement.

Flight status: on time

Next step - check in. I recommend, even for domestic travel, to check in to your flight as soon as you are able. My flight leaves tonight at 6:39, I checked in yesterday at 6:40! My boarding pass is already in my apple wallet. It will make life so much easier. 

I arrived to CLE pretty early and breezed through security, so now I have a pretty long wait.

I started writing this at 6:45 am. So I had a decent amount of time open to straighten the house a bit, play with the pups and finish my planning. I have the itinerary completed for the students, but all my evenings are currently open!

So I need to decide between the following for my free evenings:

Phantom of the Opera - this was my first favorite Broadway show, but I've only ever heard the Sarah Brightman version...

Les Miserables - also a favorite. And I feel like I need to see it in person to erase Russel Crowe's Inspector performance from my brain.

The Book of Mormon - I love South Park. So inappropriate, but so much fun. 

and finally, Hamilton. I've seen this in the theater a few times, but it's a favorite. 

Which one would you see? 

I can't wait to get this long flight out of the way and explore Regent's Park before taking a much needed nap.

Why Take Nursing Students To London?

 I'm Just Getting Started!   

I doubt you've stumbled upon this blog accidentally, but if you have, welcome! Let's get the brief  introduction out of the way. My name is Taryn Burhanna. I am a faculty member at the College of Nursing at Kent State University in Kent, OH. I have taught many clinical rotations and didactic courses in collaboration with other brilliant faculty members. My favorite courses to teach are Pharmacology II (miss you Professor Davis!) and Community Health Nursing, of which I am the course coordinator. I am also a Nurse Practitioner at a Federally Qualified Health Center providing primary care services to underserved populations in my area.

Why Take Nursing Students to London?

    One of the principles central to nursing, whether it be bedside nursing or population and community health nursing, is an understanding of how health care policy influences certain social determinants of health. Therefore, students here at KSU's CON are required to take a health care policy course, and concepts of health care policy are heavily woven into the Community Health Nursing course. So to be honest, my journey to London began when I accepted the position to teach Community Health Nursing.

Prior to the pandemic, I was interested in real-time comparisons between the health care system of the United States with other developed nations whose health outcomes are better that ours; especially considering we spend a lot more than they do. Seeing COVID widen the gap of disparities was heartbreaking for me. We are one of the richest nations in the world, so why is our life expectancy lower than similar countries' rates? Why is our infant mortality rate higher?  I know what the studies say (we don't value universal access to care, we focus on sick care versus preventive medicine, we have problems with cost and quality, etc.) It still doesn't answer why? And more importantly, how do we close the gap? 

Do you get it - we're headed across the "pond?"

For perspective, I wanted to visit one of the first nations to implement national healthcare with good outcomes. Germany did this first, but I don't speak a lick of German, so that's out. So let's go to England - they weren't too far behind time-wise, and their healthcare system is a model that many nations look to emulate. Plus, I'll be able to understand most of what I hear there! Im not necessarily looking to answer the impossibly difficult questions posed above. What I'm really looking for is the type of cultural experience, for me and my students, that deepens one's understanding of their world. 

My goals for this inaugural trip are to: 

1. Provide a rich, diverse learning environment for a select group of nursing students.
2. Learn more about the NHS (England's National Health Service) in a real sense from citizens who live in the system and breathe that air - not from the books I read over here.
3. Cultivate overseas connections to create a lasting program that can create social change agents on a micro and macro level.

Not ambitious at all, right?

Join me, Dr. Curtis Good and 15 nursing students from all walks of life on our journey. I will post every evening March 25th through March 31st. Especially to my students past and present - I welcome your comments and interaction.