Monday, July 13, 2009

Hi-tea cruise

Went for a hi-tea cruise organized by the hospital's staff club recently. Almost didn't make it because SEN L and I were both taking team on the morning shift and we had to leave work slightly earlier to get to the pier on time. Luckily, SSN R (who was in-charge that morning) and the afternoon staff took over from us earlier.

The whole cruise boat was booked for about 150 people, consisting of staff and their family members. We paid $20 each, inclusive of the gifts, prizes, food, island trip, cruise, professional games and entertainment organizers. I think the hospital subsidised the trip. Everyone had a door gift of a bottle of baby powder. Out of work habit, some of us checked the expiry date on the bottom upon receiving it :-P . There were G-rated games organized on the boat as well as on the island. People were somewhat shy at the games. The teams draw, and thus everyone took home a simple prize. The food was ok. The entertainment, especially the singer on electric keyboard, was good. The lucky draw prizes were simple. The top prizes were a 1-day all expense paid trip to Batam for 1. Being used to seeing my colleagues in uniform, everyone looks different outside of the uniform. The natural light showed that many ladies had medium to thick make-up. As always, there were the minority who talked about work even while away on a resort island. However, majority were there for fun. They seemed to enjoy the simple stuff.

As the boat returns to the Marina South pier, the view of the CBD (Central Business District) came to sight. It occurred to me that this is quite a different crowd from my previous industry.

Saturday, July 11, 2009

The accused

Have had a series of :-| days. Have been taking team each time I'm on-duty since 1st-July. Guess it's time to write a post about human behaviour in the wards.

1. I am tired of being "the accused". I realised that it's nothing personal. Most new staff assigned to wards suffered from this "accused" period. In addition, everyone gets to play this role when a bad situation arise with real/potential complaints. At least in my ward, the nurse manager (NO) would investigate personally for the serious matters and she is (IMHO) fair. Thus, it's only the petty matters that arise day-to-day.
  • When a case file is missing from the counter for a new case for which I am assessing for admission to the ward, the staff looking for the case would claim that I brought the whole file into the room. I admit, there was once during my student days when I did bring the whole case file into the room by mistake. However, there was another time when it was another staff who brought the file into the room and left it there. Later, I brought it out and was then accused of bringing it in. Today, the case file was misplaced at the counter and I found it for the doctor. In both cases, I am innocent but have to be the “啞子吃黃蓮,有苦難言” ["The mute eating bitter-gourd cannot verbalize his suffering."] because it is easier to accept blame than to fight over such petty matters. From my experience, if one stand up against their wild accusations over petty matters, one can expect them to bite at one over every small matter.

  • When a staff is looking for me but cannot find me, the staff may accuse me of "always" not switching on the "engaged light" indicator for the room I'm in. In reality, there are times when I did switch on the engaged light but the staff just can't be bothered to enter the room to find me. This is especially if I'm behind the curtains in a shared room. There are also times when I did not switch on the engage light in my rush. Then there are other times when another staff switches off the engage light when she left the shared room after attending to the other patient. Thus, I may be the one who switched on the engage light but became accused of not doing so because the other staff -- who did not switch it on -- had switched it off instead. Actually, the persons who most frequently accuse me loudly of this matter are HCA K and SEN MY. HCA K has toned down on such accusation after I told her off while I was still a student at the ward, but it did cut into our relationship for a period. SEN MY still accuses me of such matters. However, I came to realise that she, being a new and unpopular staff, is often merely being defensive or trying to push the blame away. Unfortunately, HCA M has started using this accusation too. This is not a good trend.

2. Nurses tend to be busybodies
  • Recently, Senior SN R noticed that my job grade was written in the shift schedule as the higher of the 2 SN grades. Then she went into much discussion with the admin staff M over the matter. Frankly, it was probably a typographical error or a misinformation. It surprises me that it does not concern SSN R and yet she spent so much time with admin staff M to mull over my job grade.

  • Staff will mull over the shift schedule and lobby to change shift depending on whoever else is on duty. E.g. I have heard staff telling the admin staff M not to put SEN MY on their shift.

3. Nurses from old-style training (i.e. School of Nursing) like to thumb down modern nursing training.
  • I have heard SSN exclaiming how easy our nursing training is now compared to their days. That even as student nurses, they were put in-charge of 30+ or 40+ patients. And they manage to do the tasks. Frankly, I learnt the other side of the story from my lecturers who went through their training. In the old days, patients are often not discharged till they were completely well, thus the average patient acuity level at the wards was much lower back then. The old nursing system was task-based nursing. Thus, if one were the dressing nurse, one would only do dressing for all the patients. There were other staff to attend to other interventions required by the patient. Nowadays, a SN is expected to assess the patient top-to-toe and perform all the needed interventions. In addition, in the old days, nurses are seen as authority figures. Nurses' words are the commandment to which patients and their relatives follow without question. Nowadays, caring for the patient is a collaborative effort between the patient, the relatives, the nurses, doctors and other healthcare staff. Patients and relatives are more knowledgeable about healthcare than before and have their preferences that need to be respected. Thus, comparing the census is like comparing apples to oranges.

  • When things go wrong or are done differently from the old-style nurses' norm, the old-style nurses would complain to the ward manager (NO) and remark loudly to other staff, "I don't know what they learn in schools these days". Yet the old-style nurses -- who are often senior -- would send the new-style nurses to handle the overflow cases that are not the speciality of the ward (e.g. maternity cases in a medical/surgical ward, adult cases in a paediatric ward). The old-style nurses would excuse themselves claiming that they are not trained in that specialisation and thus should not be expected to know. Yet, they would loudly raise issues when new-style nurses fumble over the cases that they do not wish to handle personally.

The most important lesson I've learnt from nursing to-date is not to take this day-to-day pettiness to heart. Do not expect thanks when you reach out to help out the other busier team, do not expect help when your own team is busy, do not take it to heart when others comment that you are so slow (when you've spent time attending to their tasks or their team's patients in the name of teamwork).

End of another :-| day.

Wednesday, July 01, 2009

H1N1 arrives

The inevitable has finally arrived. We have our 1st confirmed case of Influenza A H1N1-2009 virus. This child came in for bronchitis and was isolated because of his high fever on admission and travel history. Upon confirmation of H1N1 this morning, he is transferred to KKWCH as per existing MOH policy. Due to the importance of this matter, the ADON and the Infection Control staff were present at the ward this morning.

Our ward is now designated for isolation. All staff must wear N95 mask and monitor their health closely even on their off-days. Previously we had a choice to use surgical mask instead of N95. Most of the staff at or related to our ward (e.g. our housekeepers, our regular paediatric physiotherapist, the diagnostic staff handling the case) are now on the contact tracing list. We are not required to be quarantined for now.

This is inevitable as parents prefer to consult paediatrician specialists about their children's illness and be admitted to a private hospital for the better service while awaiting the test results. The parents' perspective makes sense as there have been several cases where the lab confirmed that they were not H1N1.

1 month old

Today is day 20 of taking team for me. And I have made it through 1 month, yeah!

Took the team with the rooms far from the nursing station again today. Started with 6 patients. There was 1 discharge near noon and 1 new admission around 1pm, and thus the total remained 6 at the end of the shift. Managed to create the blank pharmacy billing forms and but not medications to-do list right before report passing.

2 SN (L and I), 1 HCA M and 1 SEN IV as runners (SEN IV on my team), the SSN R was in-charge. The admin staff M was also on-duty. The morning started with a snit, see minor things below. Fortunately I moved on quickly and got on with the tasks of the day. Besides her regular runner duties, SEN IV offered to help me with one perineum swap and PP wash, so that saved me some time. Served medications on-time, assisted 3 doctors on their rounds, discharged 1 patients with patient education, completed pharmacy billings, completed ward billings, answered call-bells, answered phone calls to the ward, PS for pharmacy supplies and collected the supplies, reviewed case notes, trace lab reports and documented events into nursing notes. As I had 3 IVs and 1 nebulizer due near the end-of-shift peak (1+ pm), I decided to avoid the last minute rush by completing my flowcharts and taped my team report at 12+ pm. There was again a new admission around 1+ pm when SEN IV was busy with taking the 2 pm vital signs, and I was busy with the IVs and nebulizer. In the end, SEN IV did the admission assessment, SN L transcribed the doctor's orders and labelled the tests to be done, SSN R called up for the diagnostic staff for action, leaving the medications for me to follow-up. Luckily I taped the team report in advance, so I passed the new case verbally and followed up with the new case's medications at 2+ pm while the afternoon staff listened to the taped report.

There are minor things that happen that I don't mention. One example would be this morning. SN L missed her bus and would be slightly late for work. For the past 2 days, SN L and I have been on the same shift. She took the team with the rooms far from the nursing station while I took the team with the rooms near the nursing station. However, our team assignments were switched over this morning. Since it would be easier for her to continue with the cases that she is familiar, especially given that she was rushing on her way to work, I offered to SSN R (as in-charge) that I do not mind switching teams. SSN R did not acknowledge the good intention of my offer, instead she gave an irritated reply to stick to the assignment book. I decided to treat it as a miscommunication at work and leave things as that. From my experience of the nursing culture, the more one tries to clarify in an unfavourable situation, the worse matters become. This is a reflection of how others interpret your intentions due to their own thoughts and past experience.

Another snit at the end of my shift today. My preceptor was in-charge for the afternoon shift. She feedback to me on items to note and improve. For some reason, I acknowledged but did not thank her for the feedback. Think she did not take it so well.

Today has been an ok day for me, despite the commotion over the confirmed H1N1 case under SN L's team. Had time for tea and toilet break, although I only ate lunch at around 2:40pm after my shift was over.

Last month I disciplined myself to blog daily about my shift, to de-stress and also to give myself a realistic tally of the good days, the moderate ones and the bad. Given that my shifts are now more stable with moderate ones like today, I have decided to discontinue my self-enforced daily blogging. I still get "newbie doubts" of course, but they are not so overwhelming as in the earlier part of my 1st month. I hope that with time I will be develop into a capable colleague and build good relations with my colleagues.