Tuesday, June 30, 2009

Made it through June, yeah!

Today is the 19th day of taking team for me. Made it through June, yeah!

Took the team with the rooms near the nursing station today. Started with 5 patients, of which 2 discharged by mid morning or early afternoon. Then 2 new cases arrived after noon, so the final total was still 5. Managed to complete the blank pharmacy billings and medications to-do list right after report passing.

2 SN (L and I), 1 HCA M and 1 SEN IV as runners (SEN IV on my team), the ward manager (NO) was in-charge. The admin staff M was also on-duty. The morning started off rather well. My patients were all in stable conditions. Served medications on-time, assisted 3 doctors on their rounds, discharged 2 patients, completed ward billings, answered call-bells, answered phone calls to the ward, reviewed case notes, documented events into nursing notes, and completed my flowcharts for the 3 remaining patients all by 1240pm. I even had time to assist the runners with meal ordering and entering, replacing missing patient information boards in the patient's room and preparing a room for new admissions.

Just as I was starting to tape my team's report around 1pm, there were suddenly 3 new cases of which 2 were for my team. From then the confusion started with the numerous admission related tasks to be done, diagnostic tests, referrals and medications to follow-up. SN L was busy with the new case on her team and could not help. Even with assistance from SEN IV and admin staff M, I did not finish with the items related to the new cases and had to pass report orally for the afternoon staff to follow-up. Luckily, my preceptor was on-duty in the afternoon and she reassured me that she will take-over and complete the outstanding tasks. I am really grateful to have her support.

2 challenges faced today.

1. NO's ideal expectations vs reality. This morning there was a doctor who came while the SNs and EN were busy with the morning routine. Given that we were busy, the doctor told us to continue with our work and that he didn't need any assistance. The admin staff offered our assistance again and the considerate doctor declined. SEN IV and I carried on with our work. The NO saw and insisted that we drop our work and assist the doctor instead. I grabbed the case notes and we (SEN IV and I) rushed after the doctor who was already at the patient's doorway at the end of the corridor. Then the NO came after us and lamented that we should be leading the doctor, not running after the doctor. I passed the case notes to SEN IV for her to assist the doctor. I was preparing an IV antibiotics that was due, so choosing to assist the doctor may result in a delay in medication that would provide fuel for another lament.

2. Simultaneous admissions of new cases during critical ward-busy time. There were 2 new admissions to my team, both arriving around 1pm. Confusion started with the arrival of the 1st child. Because the child vomited on the journey to the ward, the NO instructed SEN IV to bath the child immediately as per the mother's request. I completed the on-admission nursing assessment, administered the initial nebulization, prepared the oral medications and the diagnostic test forms for the case. The mother requested to delay the oral medications as the child was sleeping. SEN IV took the child's vital signs and applied Elma cream and while the admin staff called for the diagnostics staff to arrange for CXR. Even after the diagnostics staff returned the child from the CXR, the mother had not registered the child for admission, and thus the child's case labels were not available. By then the child was awake and I administered the 1st dose of PO medications. Since the consulting paediatrician was coming for a review of the case, I decided that there was no need to call the RMO (extra charges) for the blood tests and IV cannulation ordered. By then, the 2nd child arrived and I showed them to their room. I was looking at the specialist clinic's notes on the 2nd case and preparing the diagnostic test forms, when the 1st child's paediatrician came. Without even finding out why, she commented, "why so slow" that the child's IV cannulation was not done yet. Anyway, the NO and I assisted her with the IV cannulation and set-up the drip which she only ordered on-the-spot. Then the mother decided to upgrade to the deluxe room and HCA M and I moved their items to the new room because SEN IV was busy. This resulted in a delay in attending to the 2nd new patient. Seeing that I would not be able to complete this admission and the outstanding nebulization due for a current patient, I tasked SEN IV to do the initial nursing assessments. I quickly started the nebulization for the current patient, and returned to the 2nd new case to administer oral medications and started the nebulization. Then diagnostics staff came to collect the 2nd new patient while the nebulization was in progress. The NO instructed that we interrupt the nebullization to let the child go for CXR 1st. I hesitated, the IMR record of the nebulization timing would have to reflect this non-standard interruption. Fortunately the NO changed her mind and said to finish the nebulization first. Thereafter, I went to pass oral report for my team to the afternoon staff.

Had time for tea, but did not have time for lunch or toilet break. I was actually somewhat hungry, but did not feel like eating at the staff room after a stressful early afternoon. In the end, I took my packaged lunch home and ate only around 4pm. Emoticon for the day :-|

p.s. I was surprised to see SN L sitting at the bus-stop when I knock-off half an hour after my official shift time. I went over to chat with her, to ask her why she was still there despite having left earlier. It turned out that she was so tired that she fell asleep while waiting for the bus and would have continued if I had not approached her. My experience is similar. I often fall asleep on the bus journey home even though it is a short trip of less than 15 minutes.

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