Sunday, June 28, 2009

Period blues

Took the team with the rooms near the nursing station today. Started with 6 patients, of which 3 discharged mid-to-late morning. Went in earlier to prepare the blank pharmacy billings and the medications to-do list.

SSN R and I were taking teams. HCA K was the only runner today for the whole ward of 13 patients, including 1 elderly adult lady. SSN Y (my preceptor) was in-charge. Before the shift started, I thought today would be a breeze, given that the 6 patients were rather stable and 1 was confirmed for discharge, and I did not have any medication pending supply urgently. Early in the shift there was a delayed medication in the morning. More about it below. Then accompanied a doctor on his patient review. Then in view of the confirmed and KIV discharges, I started entering the pharmacy billings forms and ward billings. The breakfast trolley arrived while I was updating the billings and preparing a morning dose of IV antibiotics for a neonate, and HCA K was busy taking the 6am round of vital signs monitoring (which was normally done by the night staff). For some reasons, SSN R instructed me loudly to serve the breakfast 1st, then my preceptor SSN Y heard and and repeated the same instructions. I didn't feel good about it. I was planning to serve breakfast once the antibiotics was ready. However it seems that the SSNs did not understand so, even given my usual initiative on such matters. After the rush to serve breakfast, I forgot about the interrupted antibiotics preparation and attended to other matters instead. Then my preceptor reminded me to get it done stat. I quickly completed the IV antibiotics and continued with preparing PO medications for the neonate. While I was doing that, another doctor arrived to review another child and I had to attend to her. The doctor decided to discharge the other child, so I started with the discharge paperwork. However, I was interrupted to attend to call bells, phone calls, and medications due. With interruptions upon interruptions, I missed out the housekeepers' request for the air-con man to clean a vacated isolated room's air-con, despite their repeated requests. I don't feel good about it. In the end, the discharges were completed by my preceptor. By late morning, I was exhausted and wondering if I would even have a toilet break, as I suspect my period had arrived. Managed to give all the other medications on time, completed the pharmacy billings and ward billings, the flow charts and taped my team's report before the end of the shift. However, in my attempt to append to my team's report, I accidentally cleared my earlier report and thus had to pass report orally instead.


There was 1 medication due in the early morning postponed from the night shift staff because the child was sleeping and the grandmother wanted to wait for the child to wake up. It took several attempts spread over 3+ hours to complete that dose. When I first checked on the child at 730am, he was still sleeping. When the child awoke, the grandmother insisted on adding the medications into 200 ml of milk which child completed only half. Then the grandmother insisted on waiting until after the child had his breakfast porridge before feeding the child the remaining medication. However, the doctor came in for review and the grandmother noted to her about the incomplete medication. The doctor probably wasn't pleased, because my preceptor instructed me to top-up for the shortfall stat, by PO neat. In an attempt to coax the child to drink, the grandmother fed the child with fair amount of water immediately prior to the PO neat medication. While struggling against his medication, the child vomited a fair amount of fluids and undigested porridge together with the PO neat medication. Thus we had to wait another 30 minutes to an hour for the child to digest before a next attempt. Thereafter, I warmed up the remaining 100 ml of milk because grandmother wanted to feed the medication-in-milk instead, but the child refused to drink. At my next attempt, the physiotherapist was about to suction the child for mucus for diagnostic tests. I helped with the suctioning which was quick and, of course, the child struggled. Then the grandmother warned the child angrily that if he refused to swallow the medication, he will have to undergo further suctioning. Finally the child co-operated and swallowed his PO neat medications. By then it was almost 11am.

Lessons learnt: Always advise care-givers to give medication before food, not after food, unless otherwise indicated. In addition, medications should be taken with minimal fluids, to reduce changes of regurgitation by child.


Did not have a tea break. Finally after 12 noon, I took a quick toilet break to wear a sanitary napkin for my period. My panty was already stained but fortunately not my uniform. Thankfully, a housekeeper offered to pack lunch for me around 12 noon and around 1pm I had a chance for lunch (which was also interrupted). At the end of the day, I felt exhausted and blue. I put it down to a combination of having high expectations of the day which fell through, not enough sleep due to the PM to AM shift switch, and the arrival of my period. I have 2 weeks to go before the new nurses orientation and training. Am counting down to it.

p.s. A major challenge of an SN is the numerous interruptions-upon-interruptions to her work. At some hospitals where there are more supporting staff (admin staff, ENs and HCAs), the SN on medication-round wears a vest indicating that she is not to be interrupted. This and other work processes to structure an SN's time are not implemented in my hospital. This is probably due to limited staffing and the customer service expectations (from consulting doctors, their patients, and the patients' visitors) of a small private hospital. Given the hierarchical staff structure of the wards, being an experienced staff in the ward also helps to manage the interruptions.

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