Wednesday, November 04, 2009

5 months old

Last week was alright, a mix of busy and not-so-busy days. I do not know if my "honeymoon" period is over, but I find myself getting cynical about my current workplace as I passed my 5-months milestone.

Today SSN Y was in-charge, on double shift this afternoon. SEN M is back from her maternity. Before the shift started, I saw her making a big show of missing her "mother" (SSN Y) and giving her big hugs at the nurses counter. For some unknown reason, at the start of the handover report, SSN Y (the mutual preceptor for both myself and SN RB) remarked snidely in front of the whole afternoon team, "Know everything already, very clever already ah, new SN".

To which SEN M rejoined, "How? More and more new SN". [Note: Bear in mind SEN M was the one who complained in my face about feeling unhappy whenever they see fresh new SNs joining the ward, taking higher pay and yet are less skillful than them. And SSN Y was the one who told me about how SNs petitioned against ENs recruitment years ago.]

For some reason, the team assignment was not done for this afternoon's shift. SN J, although more experienced than me, opted to take the team with the much lighter patient load. While SSN Y sounded surprised over it, she did not mention anything.

New staff SN RB was assigned to be runner for SN J, and (IMHO) was bullied around without guidance from her preceptor SSN Y or her team leader SN J.
  • E.g. A specialist came to review her patient under SN J's care. SN RB had just taken the parameters for that patient. As I was busy with a urgent issue with my patient, I passed SN RB the case notes for the patient and instructed her to follow the specialist on her review first. I quickly popped into the staff room where I found SN J sitting around doing nothing in particular. I informed her that a specialist is here to review her patient and SN RB was with the specialist then. Her response? "SN RB is with the doctor? Then ok." No attempt to move from her seat.
  • E.g. SSN Y passed SN RB the DDA order book and told her to collect DDA drugs from the pharmacy, but gave no further instructions. SN RB turned to me for help because she was new to this hospital and has never collected DDA drugs before. I approached SSN Y for the DDA key to get the DDA stock booklet which is required together with the DDA order book for collection of the DDA drugs. I wonder if SSN Y accidentally forgot about the DDA stock booklet or she was testing our knowledge as new SNs.
Some thoughts about SN J and the nursing culture in my ward.

New staff RB told me that she almost made a medication error the day before (on Monday) because SN J, who was in-charge, suddenly assigned her to take the team of patients far from the nursing counter. This team is usually the heavier team in terms of workload. When SN RB needed someone to countercheck the new prescription, there was no one available.

This brings to mind another time when experienced SN SB from the adjoining ward confided in me with a similar complaint about SN J. In SN SB's case, SN J was supposed to be responsible for the back team and someone else was supposed to be in-charge. For some unknown reason, SN J assumed the role of in-charge after the handover report and instructed SN SB to take the back team. This was fine until SN J ordered SN SB around for runner's tasks for much of the shift instead of allowing her to focus on her role as the staff nurse taking team. SN SB does not know this but according to SSN R, SN J had complained about SN SB's black face over her "runner's job". When I probed SSN R about it, I realised that SN J did not mention that she had actually assigned SN SB to take over the back team from her.

I don't understand why the typical on-the-job training in this hospital is to assign new SNs to be PCAs and ENs and throw them into RN roles on an adhoc emergency basis. IMHO, this has 2 effects.
  1. Experienced staff (from SSN to SEN to senior PCAs) complain about new RNs being not up to standard.
  2. Experienced ENs and PCAs climb over the heads of new SNs, ordering them around. It is one thing to for RNs to understand the scope of their "juniors' work", it is another thing to perpetuate a bullying culture in the name of learning humility.
From what I heard about restructured hospitals, the SN, EN and PCA roles are well-defined. New RNs are guided by in-house clinical instructors (CIs who are experienced registered nurses) and eased into their work-role by gradually increasing the number of patients they care for. [See also here for 27-Oct thoughts about new RN training roadmap.]

SEN M was assigned to be my runner today. PCA M was supposed to assist between the 2 teams, but spent more time at the back assisting my patients. She even offered to assist me with nebulization (i.e. holding the nebulizer mask for an infant patient) so that I can attend to a more urgent matter. Which made me wonder what SEN M did today, besides swapping perineum for one of the patients. At about 8pm, SEN M decided to tape my team's report on my behalf. Frankly, I don't feel comfortable with that, thanks to my past experience with her. But I didn't have a choice because she was unwilling to help me with a post-op case that arrived at 7:50pm and I had the evening medications to be dispensed. Thus, I gave her some face by openly thanking her for her help. Let's see what that gets me...

I actually had time for tea break but did not want to go into the staff room which seemed perpetually occupied by 2 or more of the following staff, SSN Y, SEN M, and SN J today. Thus I skipped tea. Same happened around dinner time. Thereafter, my post-op case came and I was busy.

I stayed a while to help the night staff with an IV cannulation and left at 10:30pm. I like this pair of permanent-night staff SSN L and SSN R. They are both very skilled and willing to teach. While they do check and question one's work, they do not kick a big hoo-hah over the mistakes made. They often advise on the corrective/preventive steps to take. A few months ago, SSN R ever asked if I would consider taking over her permanent night shift as she is considering changing to day-shift. I did not consider the idea at that time because of the long night-shift hours (10 hours) and night-shift runs on skeletal staff. Today, I seriously think that it might be help me to avoid the day-shift politics and the problem of enough staff but the diffusion of responsibility phenomenon (social psychology theory).

p.s. Ironically, the “吃蛇” [skiving] staff are often cited by the ward manager and the SSNs as being efficient when they want to criticize the performance of new staff. SN M from the adjoining ward, EN IV and myself have experienced such criticisms before.

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