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.

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