Sunday, June 21, 2009


Took the team with the rooms far from the nursing station again today. Started with 9 patients, then there were 3 discharges after doctors rounds and no new admissions, leaving a total of 6 patients at noon. Arrived earlier this morning to do the medications to-do list and pharmacy billings in advance, but did not complete the pharmacy billings before taking report.

4 staff, 2 on each team, plus ward manager (NO) this morning. At report taking, the NO stated that given my inexperience, I have SEN MY on my team who can give nebulizer, flush IV lines, change IV drip, off IV cannula, discharge patients, etc. However, in reality, SEN MY was reluctant to act beyond a HCA role today. Perhaps she was also too busy with her runner's tasks. Each time she does something that is not a HCA's job, she would remind me loudly, "I helped you to ... already." For any concerns raised by parents, she kept saying, "I tell you already, ah." and left the issue as that. Even when I told her I was too busy to attend to the issue immediately, she did not step-up to the challenge and cover the matter as an EN. When I requested her to perform a task or to inform me of any febrile or low-grade fever cases, she didn't look happy. I overheard her complaining loudly to someone (probably another colleague) that she cannot find me, when I was in the treatment room preparing IVs for the patients. This reminds me of the times she accused me loudly, "You always don't switch on the light (in-attendance indicator), I cannot find you."; and how she sometimes switch-off the indicator without first checking if there is another staff in the same room attending to another patient, and then turnaround to accuse the staff (e.g. me) of not switching-on the indicator.

The above would not be such a problem if I am an experienced SN. However, as a newbie, I needed help to gradually ease into my role. Today, 1 doctor was upset because he omitted prescribing a rash cream that a patient's parents asked for, the parents had asked SEN L for it. I was busy when she reported the matter to me, so I checked the IMR and told her that the doctor has not prescribed it yet. It was over an hour when my colleague SN L helped me by calling the doctor to confirm the missing order via phone. Add to that, annoyed another doctor today because I was not quite ready with all the stuff that he wanted on-the-spot for wound dressing and I did not know his preferences as it was my first time assisting him. Perhaps, I did the wrong thing by allowing the mother to observe us when the doctor was reviewing and dressing the patient. I was told by my colleagues who assisted him the past few days that he is a DIY-guy, so I was surprised when he wanted me to assist him. I wanted to prepare gloves for him, but the NO said no need, so I did not prepare any and had to rush to the nursing station to get when he asked for it.

On a happy note, I managed to give all the medications on time, except oral medications for the patients who are discharged for home. Their medications and IMRs had been sent down to the pharmacist for dispensing back to them if needed. The NO or SN L helped me with some of the discharge paperwork. I did 2 of the discharges and SN L helped me with one. Thereafter, HCA K helped checked through that the case notes were transferred properly into the case history files. I was surprised and thankful for SN L's support today. Happily, I had time for a 15 minutes lunch break. In addition, I finished the 6 outstanding pharmacy charges 10 mins after the official shift ending time. Had to call the ward after work about 1 item that I missed billing and an instruction from a patient's parent that I omitted in my taped team report.

At the end, just before I left, I received another dampener. Apparently, the mother of the emergency operation case confided with a night-shift colleague, who then informed my NO. On the morning of the emergency operation, the NO put SN J in-charge and instructed me to take team. SN J received a phone call from the doctor to prepare for the emergency operation and she rushed me to get the consent for operation from the mother immediately. I hesitated for a moment, but decided to trust SN J since she was in-charge. Unfortunately, the doctor had not informed either parent yet, so it came as a shock to the mother when I informed her about the need for surgery. Today, when the NO mentioned about the matter, I admitted to my part. However SN J just kept quiet and did not even offer to clarify that she was the one who instructed me get the surgical consent without first checking if the doctor has spoken to the parents. Sigh, result of trusting the wrong colleague, miscommunication and bad timing. Luckily, the NO just instructed us not to give bad news to the parents so fast in future.

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