Friday, November 27, 2009

More on my talk with ADON

Bone Collector's comment drew me to recall what I learnt from my "talk" with ADON G. That is, ADON G is not a leader whom I want to model after.


ADON G came to my ward one morning telling me that she wanted to see me after my morning duty was done. She mentioned that she may not be at her office, so to call her first, but she needed to talk to me at her office that day.

I was tired out after working 7 consecutive days (I happened to have 12 consecutive work-days this fortnight, including 2 double-shift days). In addition, after my AM-shift work was completed at 3pm, I had to wait for the ADON to be available after 4pm.

ADON G, "Do you know what I want to talk to you about?" (It seems to me that ADON G has the habit of asking people what she wanted to talk about instead of going straight to the point.)

I replied honestly, "You asked me to see you, but I do not know what the matter is regarding."

It turns out that due to a "medication error" incident report, ADON G "puts it nicely" that she is merely speaking to me over the matter because it's her role as the ADON in-charge. Then ADON G started lecturing me over my medication error. My ward manager had already spoken to me about the incident some days ago, for which I am genuinely sorry and learnt from.
Actually the medication error is another story. While I was passing my shift report verbally to the afternoon staff, a post-op patient on my team was received by my preceptor who then rushed off to a meeting. The patient complained of severe pain and had low SpO2. Ward manager took over from my preceptor, reviewed that patient, instructed the newbie SN RB to collect the painkillers stat from pharmacy, and then told me to give O2 and the painkillers stat. Then she also went off for the same meeting. (A few days later, the admin staff told me that she saw the ward manager instructing me as such, and that she can be my witness). Anyway, I checked the case notes and misinterpreted the doctor's notes that 1 of the 2 PR (per rectal) painkillers were given in OT. I noted that my preceptor wrote in the IMR "given in OT" for both painkillers, so I thought she wrote wrongly in her rush to attend her meeting. Then I gave the other PR painkiller to the pt and made the serious mistake of canceling out my preceptor's "given in OT" note for that PR painkiller and initialled against my cancellation. SEN M who took over from my shift, kicked a big fuss over the matter.

ADON G's tone of voice was sharp and demanding. She did not at any point ask for my side of the story. Then she demanded that I DO NOT MAKE ANOTHER MISTAKE again. At that point, I got fed-up and told her, "If that's the case, then there's nothing to talk about". I got up and stepped out of her room.

ADON G raised her voice, "You are very rude, you know. How can you walk out just like that when I'm talking to you?"

At last, some non-bullshit words from her. I stepped back into her room and told her, "I am only human. As a human speaking to another human, I cannot promise you that I will not commit another mistake."

ADON G went hysterical, "I am your ADON, how can you raise your voice and speak to me like that."
I would have laughed in-her-face if not for the gravity of the situation and my tiredness. ADON G's miniscule world of nursing may be larger than my whole world of nursing for now, but IMHO her exposure to good leadership seems rather limited. Only lousy leaders demand to be respected based solely on their position. The true-blue leaders that I've worked for/with do not need to rely on their position to be respected. Their very presence and reputation for effectiveness earn them their staff's respect. In addition, my "ang-moh cultured" ex-bosses value candid feedback from their staff, it doesn't matter if they agree with the staff's view or otherwise.

Anyway, sad to say, I was very stressed by the whole event, so I broke-down. I told ADON G that people talk when we (new staff) check on the case notes to verify seniors' instructions. I am not the only one who experience it.
Yes, the nursing culture here is that if a senior instructs you to do something, you're supposed to just blindly obey stat. Not withstanding that ward nursing is not A&E or ICU where the urgency of interventions is critical. If you check the case notes or with another staff, they feel insulted and then they gossip about your "lack of trust" behind your back. E.g. The staff gossiped about SEN MY's "lack of trust" in my presence, but sadly none of them had the guts to tell SEN MY face-to-face about their displeasure.

I told ADON G that as a new staff I am struggling to survive. I don't even know how long I would last in the hospital, but I am definitely leaving after my bond. (I didn't want to tell her the reality that I could pay up my bond and quit stat if I wanted).

ADON G then said to me that it's like that in nursing, all newbies struggle and that I'm too sensitive to others' comments. When I told her that it does not have to like that, at least not in my previous industry. She said to me, "Of course it's different. You only deal with machines in IT." At that point, it struck me that I was talking to someone who knows zilch about software consultancy.

I asked then, "If nurses need to improve their communication, how about we have communication courses for all nurses, not just on SBAR, but to recognize the different personality types and the different communication styles?" [Edit: E.g. MBTI and DISC]

ADON G wrote it off immediately, "It is not possible to send all staff on training courses. That's why all the senior managers, we are working very hard on template formats for standard conversations. I believe that you may know about it too. Your Sister L contributed to it".
Note 1: Yes, my ward manager had asked me to research and write up a word document for self-introduction to patients. She was very pleased with my work.

Note 2: I don't know if ADON G was missing my point about inter-staff communication/rapport intentionally or the concept simply flew over her head. I asked about possibility of training staff on inter-personal communications because such training makes attendees more aware and appreciative of different communication styles. I was willing to share from my past exposures at such courses with my fellow colleagues. It struck me, "No point throwing pearls to swine."

I let ADON G launch into her stories of how tough it was for her during her early days as a new SN at a neural ward, how mean the doctors were, how lucky I was that the consultants for my ward are mostly reasonable compared to the consultants of the other wards under her care, and so on.
IMHO, it's the same-old "we survived the system so it cannot be bad, the toughness weeds out the weak" attitude of old nurses in Singapore.

Then she said that I was lucky that my ward manager Sister L, is a good and very experienced manager. I thought, "Sister L is not perfect, but she stands tall where it matters. At least ADON and I can agree on one thing, ha ha!"

ADON G went on to rebuke me for not raising my issues to her. She claimed that since she took over my ward from another ADON earlier this year, she has been taking care of our interests. "You staff are just like SSN L, just throw your frustrations at us and resign. It's not fair to me. I don't even know of your issues."

I thought, "Huh? Why am I being linked to SSN L's immediate resignation?". Anyway, I replied honestly, "When I have issues, I speak to Sister L (my ward manager) and I trust her to solve my issues. I am trying to follow the line-of-hierarchy."

ADON G then chastised others (like SSN L who quitted) and me for having a negative attitude. Blah, blah, blah.

To reassure ADON G, I told her honestly, "The best part of my job is my patients."

Then ADON G said, "Then you have the passion for nursing. Why do you let others kill off your passion?" (Okay, some truth to her statement, but of course she doesn't know that my exit plan is not out of nursing but out of nursing in Singapore.)

That started her off again about her nursing experience. E.g. How they saved a patient's life, how the patient was so grateful that he converted his religion, blah blah blah.

I also took the chance to "drive" ADON G into action about a case where an unhappy patient complained about his missing asthma MDIs (metered dose inhalers).
[Addendum 27-Feb-2010: After the patient was discharged, the housekeeper found the missing MDIs sitting on the window ledge, hidden by the window curtains next to the care-giver's chair. It turns out that the patient rested on the chair and placed the MDIs there but forgot about them. Thus, it proves that all the staff are innocent. It also proves that the patient was not trying to cheat the hospital of giving him free medication, as suggested by ADON G during her personal lecture to me].

It was evening twilight when we finished. I would give her a 4.5 out of 5 for effort, but only 1 of 5 for effectiveness. It was supposedly a pep-talk for me, but frankly I went off thinking that I do not want to work for this boss nor the organization for long.


A fool never learns from anyone's experience,
A regular person learns from his own experience,
Only the wise learns from others' experience.

- Adapted from H.G. Wells' quote -


  1. Well, tell ur ADON that if the past is to be used as a yard stick, it is not so long ago that nurses are taking 12 patients for an AM shift (in my hspt at least- nt sure abt others. FYI, we are taking 6-9 every shift, exclude ND). it is also not so long ago that my hspt spent a bomb on converting paper IMR to electronic IMR.


    the need to change ma~ (not tt with the EIMR, med errors dropped to zero. haha)

    personally, i hate the sentence "if others can do it, so can you"

    we are individuals with different capabilities. we are not batches made from the same mould.

    ur ADON needs to change the system instead of blaming the staff. tsk.

  2. winking doll>> i think you should tell your ADON that she's dreaming!! using the past as a yard-stick is so of a past and if she does not pull up her own sock it meant that she lacks the foresight and means to deal with the challenges of nurses the current era...

    If one do not rock the boat, nothing gets change..these people just sit on their chair and warm then till they retire!!

    are u sure l don't want me to email your ADON???? they sld be taking some constructive feedback as well!!!! would be great if they come from ME!! hahaha

    l would love to tell/share these people my 2 cent viewpoint!

  3. Hi Anonymous at SATURDAY, NOVEMBER 28, 2009 9:58:00 PM,

    Yes, changes are good if improves work situations and/or reduces error. There are also changes that are good only in theory, ha ha :-D

    Wow, 6-9 patients per shift! We have that only occasionally if the whole hospital is having a lull time. Otherwise my ward will have patients spilled-over from the other wards. My colleague's black humour was that as paediatric nurses, we are very flexible, we can nurse from neonates to adults (e.g. adolescents). That's why within a single shift, we may be nursing a mix of neonates, paediatrics, adults medical/surgical, maternity, geriatrics, and HDU (high dependency unit) patients.

    We currently have a maximum of 12 patients per SN per shift, not counting the in-charge. However, we have only 1 supporting staff (EN or HCA) per SN per shift, and even that is sometimes shared between 2 SNs. In addition, there will be new beds added next year, so the maximum will increase to 14 patients per shift. The night that SSN L quit, she had to handle all the patients (including several new admissions!) with help from only 1 HCA, because there was no replacement for her SSN partner who was on MC.

    Sometimes though even if the organization refuses to change, change will be forced upon it. E.g. 2 of my day-shift SN colleagues (both nice ones) have already indicated that they will leave next year.

  4. Hi Bone Collector,

    I suspect the problem is not just at the ADON level, the nursing culture is entrenched by the staff who survived the system.


    E.g. Some days after SSN L quit, I had an interesting conversation with an ex-staff from my ward who left for a sister-organization, but is planning to return to the ward. A snippet of our conversation below.

    "Is the ward really understaffed?", ex-staff asked.

    "What is enough?", I asked in reply.

    "5 staff in the morning, including the in-charge and 4 staff in the afternoon. Don't you have that?", ex-staff replied.

    Note: Each team (i.e. each SN) has a maximum of 12 patients. 5 morning staff means 1 in-charge (which is either the NO or an experienced staff nurse), 2 team-leaders (which is either SN or a senior EN covering as an SN), and 2 runners (which can be a newbie SN or an EN or a HCA). 4 afternoon staff means 1 in-charge, 2 team-leaders and 1 runner shared between the 2 teams.

    "Yes, we have that but it's not enough if we have highly acute patients. E.g. Patients that come in with every 15 minute nebulization and pre-neb SaO2 monitoring", I replied.

    "But we have always worked with that level of staff in the past," was her defence.


    > If one do not rock the boat, nothing gets change..these people just sit on their chair and warm then till they retire!!

    Yes, that's what some staff who have more than 10 years of service plan to do! The day my preceptor got her 20 years long-service award, I was thinking to myself if I would even stay 20 months. ;-)

    l would love to tell/share these people my 2 cent viewpoint!

    Your pearls of wisdom would be cast away, and thus wasted on the swine.