Sunday, August 02, 2009

2 months old

I have passed the 2 months-old milestone and received my 2nd monthly paycheck, yeah! I am getting more used to the job, although I still get stressed when my team's census hits around 8 of the typical acuity for my ward.

For 2 weeks in July, I attended my hospital's nurses orientation. As the orientation programme was suspended during the early months of Influenza A H1N1-2009, there were many nurses (ENs and SNs) who had been at their wards for several months. During the introduction, it became apparent that many wards didn't have a culture of welcoming and supporting new staff. There is widespread existence of new staff being taken advantaged of or even bullied. Upon sharing about ward practices, it became apparent that there are non-standardised practices (sometimes even between nurses in the same ward), gaps in policy, and difficulty of applying changes (e.g. very experienced nurses who insist their existing out-dated methods still work and demanding that new staff adopt their existing methods; and foreign staff insisting on following their own countries' nursing practices). Thus, many new staff faced difficulty fitting into their wards, especially if their preceptors were not supportive. A few left the hospital even before they attended the orientation programme.

In a way, I am comparatively lucky. I did much of my student clinical training at various wards in this hospital. Thus, the problems that the new staff face did not surprise me. I faced many of them as a student. As such, I also had the opportunity to discover which wards were relatively supportive of new staff. As a result, I requested for a ward where I was more likely to fit into.

Nevertheless, I still face "people" challenges as a new staff.
  • E.g. Unexpected competition from foreign trained Registered Nurses in their home countries who are downgraded to Enrolled Nurses when in Singapore.
  • E.g. Returning to my ward after the 2 weeks orientation, I find myself sharing several shifts with SEN M where she was the runner assigned to my team. For some reasons, she refused to do tasks that an EN is capable of, e.g. changing IV infusion drips, flushing IV lines, and initial patient assessment upon admission. She even avoided tasks that a HCA does, e.g. answering call bells and making beds. Now that she is mostly assigned the runner's role, she claims that she found the team leader's job less stressful. She excused herself by suggesting that maybe her heavily pregnant state made a runner's job tough and tiring. Honestly, I would have accepted her excuses at face value if not for her loud insinuating questions (at the nurses' station in the presence of my preceptor who was in-charge) that I could not even manage the medications (at the end of a shift where my team was full-house with 12 patients and 1 new admission after another patient was discharged, and SEN M skived on her job as my runner). I decided to take it as a challenge to practice the Chinese philosophies of “与世無爭” ["not to fight with the world"] and that “路遙知馬力,日久知人心” ["A long journey reveals a horse's strength, a long time period reveals a person's heart"]。 As it turns out, the ward manager was in-charge the following morning and SEN M was again my assigned runner. At a busy period, she instructed me to delegate tasks to my runner, but my runner SEN M was no-where to be found. The NO was not happy that I did not know the whereabouts of my runner, but she was even more unhappy with SEN M for being missing-in-action.
Met up with some classmates for tea on Nurses' Day. We are from different job environments and face different challenges at work. In my case, I faced experienced staff under me who are still adjusting to the switch from ordering me around during my student days to me as an SN assigning them tasks. In addition, due to head-count constraints, I do not have a chance to be shadowing another staff who is in-charge of a team. A classmate in the public hospital faces difficulty of hostile foreign SN interrupting her report passing frequently with questions raised in a challenging tone. In addition, her C-class ward is almost always full-house with wait-list, and some patients have difficulty getting family support for their discharge. Another classmate in a step-down care facility faces the concern of losing her acute care nursing skills as her patients are transferred to acute care hospitals if their acuity increases. In addition, being the few staff nurses at her sub-acute hospital, there is a higher SN-to-patient ratio. She also had to deal with an agency staff not performing care according to the specified instructions. As the agency staff was well-connected to higher management, the ward manager did not dare to reject her services despite the difficulties the ward staff had with her.

After considering all the challenges faced by others and myself, I was quite happy that I had a good day today. The ward was understaffed during this shift. SSN R was in-charge, SEN L was taking team 1 (patients near the nursing station), I was taking the other team and HCA K was the sole runner for all 15 patients and she even had to help take meal orders for the 5 patients on the adjacent ward. I had 8 in-patients (of which 1 discharged in the evening) and 1 day surgery lodger for discharge in the night shift. HCA K was fantastic given her high workload. In addition, SEN L and SSN R were very supportive, helped me with the doctors' rounds, admissions and discharge. I even had breaks for tea, toilet and dinner, time to document my per-shift patient's assessment outstanding from the day before.


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