Saturday, June 27, 2009

Pay day!

Took the team with the rooms near the nursing station this afternoon. Started with 7 patients, including 1 new case admitted in the early afternoon pending the doctor's review during report passing. After 2 discharges in the mid/late-afternoon, left with 5 patients. Went in earlier to review the pharmacy billings and prepare the medication to-do list.

There were 2 SN (L on double-shift and I), SEN IV as runner (for both team 1 and 2) and SSN R as in-charge. The ward manager was on-call, and was physically in her office until evening. During report passing, the blank IMR for the new case was taken by the reviewing doctor to write her prescriptions. In addition, another doctor arrived and took the IMRs for his 3 cases. Thus during report passing, I had only 3 of the 7 IMRs for reference and felt a little confused. Right after report passing, there was 1 IV cannulation and other follow-up actions for the new case, 2 discharges, and 2 cases of fever spike all happening together on my team. Luckily my colleagues helped. SEN IV autonomously managed the neonate fever case with cold compress and tepid sponging as there was no antipyretic prescribed due to its age. SSN R helped me with the paperwork for the discharges and discharged 1 case, while I followed up the new case. Even SN L offered help. Parents of the new case wanted to stay overnight but their son is above our cut-off age, and thus an overnight companion is not allowed in a shared room without medical justifications. More about this later. 1 delay to the early afternoon medication as the IMR was stuck with the doctor doing his reviews. Fortunately by mid-afternoon the confusion settled down. Managed to follow-up the rest of the medications on time, explained the for-home medications to the parents of a discharged patient, updated events in the nursing notes, added items to the pharmacy billings, and entered the ward billings into the system. As the runner was busy when the dinner trolley arrived, I served dinner for the ward. Near the end of my shift, I completed my flow charts and taped my team's report.


The new case was a 13 year-old boy turning 14 this year. His mother was fussing about him in the early afternoon while he seems to be sleeping away. When she was told of the hospital policy initially by my morning colleague, she requested for a single room so that she could be a paying overnight-companion for her son. However, a single room was not available at that time. When I took over and advised her that a suite was available, the mother insisted on speaking to the supervisor about making an exception for her request to stay overnight with her son (i.e. without additional charges in the shared room) instead of considering the suite. Later, even when a single room was available, the mother still did not want the room but wanted us to make an exception for her, claiming that her son was too young to be left alone. Yet, she left her son alone in the mid-afternoon. After she left, her son was actually more awake and alert, spending his time watching TV. In the evening, both parents returned. When I asked the father if he still wanted the single room, his 1st concern was whether his son coped with being alone that afternoon. I replied the parents that their son seems fine and was watching TV. Then the father decided that neither parents need to stay to accompany the son that night.


Did not have tea or toilet break, but had time for dinner. Nevertheless felt rather contented at the end of my shift. Was also very happy to receive my payslip today. It reminds me that I have survived here for almost 1 month. It would not be possible without the help and support of my colleagues.

p.s. SSN R, who has her own teenaged son, commented that the mother of the new case pampered her son too much. She felt that at 13-turning-14, a teen should be more independent, otherwise the boy would not survive NS (national service conscription). I agree. My mother molly coddled one of my brothers. My brother never mentioned it, but my sister heard from other sources that he did not fit during NS. Now even as an adult in his 30's, he still lives like a dependent child with my parents.

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