Monday, June 14, 2010

Controlling behaviour

In response to StorytellERdoc's blog entry titled "Who am I treating?".


We get such controlling behaviour rather regularly in Singapore. Unfortunately, management and the work culture (it's a private hospital) tends to bow down to patients/NOKs who raise hell, so it becomes a recurring pattern on their future admissions.

I am in the Paediatrics, so parents have an "excuse" to provide information regardless of the child's age. Some parents seem to think that their treatment demands should be met, although our professional assessment of patient may indicate otherwise. It can be an annoying situation. [Edit: Come to think of it, even the consultant doctors face such demands. Although they face it less frequently than the nurses, IMHO, due to parents having more respect for a doctor's assessment.] Then again, IMHO such controlling behaviour often extends beyond just treatment demands (e.g. demand to jump queue for private room).

E.g. Recently there is a case that should rightfully belong to High Dependency Unit (HDU) but is nursed at acute ward levels. Ostensibly it was for the hospital's compassionate image in catering to the parents' budget issue. However, it results in overloading the ward nurses with HDU work in a busy acute ward short on trained staff.

The child was admitted because of infection from a previous ventricular shunt inserted at an overseas hospital. The mother was obsessed with the patient's temperature, because she wanted to keep the child afebrile to have a ventricular shunt inserted sooner and to prevent seizure. The child was still suffering from on-and-off low grade fever, and we followed our nursing protocols.

One day the temperature spiked from afebrile to 38.2 degC (100.8 degF) in-between an hourly temperature monitoring. The patient's mother was verbally nagging and blaming the nursing staff non-stop (especially me since I was in-charge of his medications that shift) for not monitoring him more frequently (on-demand) and not giving him the anti-pyretic while he was afebrile. She was demanding that I give paracetamol STAT via NGT, while I was preparing the patient's STAT IV Albumin drip order at his bedside. [Edit: I told the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment. Nevertheless, she went on threatening and complaining of poor nursing care.] I finally told her, "I am handling a very important treatment for your child, please can you give me a few moments of peace to ensure that this goes correctly?"

The mother screamed "You cannot talk to me like this!" and repeated her broken record of why because of our treatment that her son is now having "high" fever. [Note: her son came in due to an infected shunt inserted overseas and had been febrile on-and-off since admission.]

The mother never paused for a moment to let me focus on her son's more important STAT Albumin treatment. I hit my tolerance limit. [Edit: I reiterated to the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment.] I told her firmly that we have our protocols for managing a patient's fever, especially in preparation for operation, we don't want to mask any underlying infection and we were handling her child as per protocol. She disregarded my explanation and still raised her voice and continued to blame us. Finally, I told her that if she is not happy she could lodge a complaint. That I was there to help her child get well, if it were for her, I won't care either way. I continued with my work while her husband spoke to her in their language (presumably telling her to tone down), and then she continue running her broken record at a lower volume.

When the patient's consultant PHK came, we informed him of the incident details after he reviewed the patient. Fortunately for me, this consultant was fair to nurses. He returned to the patient's bed and told the mother that we the nursing staff are competent in our work and had been doing her family a huge favour in cost savings by treating her child at the ward. She had been privileged to received such good nursing care at lower cost (and free doctor's consultations). However if she insists on demanding interventions her way, he will re-assign the patient to HDU and she will have to foot the full bill.

That lecture bought us some peace for a while. I was glad the consultant was the one who dealt with the parents. Sadly, I am not confident that my hospital management would have been so supportive of its nursing staff.

Sunday, June 13, 2010

Time to change tune

I have had sore throat and cough for more than a month. It's the longest that I've been coughing persistently since childhood [when I coughed over 3+ months, and I suspect, resulting in asthma]. Over the past 5 weeks and 6 trips to my hospital's A&E, my diagnosis has changed from:
  1. URTI, to
  2. URTI with Eye Infection, to
  3. ?Sinusitis, to
  4. Rhinitis [after Sinus-XR ruled out sinusitis], to
  5. Acute Bronchitis, to
  6. Acute Bronchitis with Asthma.
After 3 rounds of antibiotics [Augmentin, Ciprofloxacin, Zinnat], switching between cough suppressant and expectorant, loads of mucolytic and lozenges, some painkillers and Sofradex eyedrops, I am still having chesty phlegmy cough on-and-off, resulting in persistent sore throat and an attack of bronchospasm (on my 1st night-duty, self-diagnosed based on pain radiating from right sternum to the right middle lobe of lung). Yet, over the 5 weeks, I have been given only 1 + 2 + 2 = total 5 days of sick leave. Knowing the hospital's HR policy and culture, the resident doctors are reluctant to give any more than 2 days of MC each time. I wonder how it can be cost effective for the hospital not to give staff a week's sick leave to fully recover from illness. I know I'm not the only one returning back to work just as my health improved slightly, only to get worse. SSN Y also only got 2 days MC and returned to work with a hoarse throat. Similarly for my ward manager.

Given the hospital's severe shortage of nursing staff [and now even the resident doctors], the message I get from its actual operations is that staff's health can take a back seat to reaping in the profits, regardless of whatever management or its policies state. In fact, down the line of hierarchy, someone somewhere would re-interpret the policies to suit their vested interests.
E.g. There was a recent incident where we had an physically+verbally abusive 7 year-old girl with brain tumour and her equally verbally abusive mother. Despite what the DON said to me about taking staff abuse (physical or verbal) seriously, my ward manager's response [my guess is to keep her own image that she runs her ship well] combined with the other staff unwillingness to report the abuse they suffered [despite widespread complaints amongst staff and, I heard, even on Facebook over this patient], resulted in me being the only person to log an incident report. You can guess where the blame goes to from there.
I decided that it's time to change my tune. As people who meditate would attest to, the mind is like a magnet which draws into one's life whatever one focuses one's energy/attention on.
E.g. The ward manager was returning from a long annual leave and had a double shift on her 1st day back to work. Given my non-optimal health condition and the ward's chaos [yes, it's still chaotic after 1.5 months since the new rooms opened], I hoped that I would not have to work with the ward manager in-charge on her 1st day back [IMHO, my ward manager has a Type-A personality.]. Just before the end of my 2 days MC, SSN Y called asking me to be the only SN in-charge of 3 days of night shift, because several of my (S)SN colleagues are on sick leave as well. Thus, I got what I wanted, since the ward manager is not on night-duty. [In fact, 5 of 8 day-shift SN/SSNs have taken sick leave since the new rooms were opened.]
I am spending more of my time-off researching about my future home, enjoying my small collections of various stuff [which I would have to pack for shipment], planning my finances for relocation, reflecting on and getting tickled by simple serendipity in life.
  • E.g. There was a day when I got ~666 and 088 in my queue number at 2 different service counters.
  • E.g. At an ATM queue standing behind a lady (probably grandmother) of a toddler (approximately 1 year old). The toddler dropped the brochure that she was holding and I picked it up for her. She repeated, I picked it up again, but putting it on her stroller beyond her reach this time. I stood observing the girl, she is so beautiful. As they were about to leave, the toddler turned around and sent me a flying kiss. Her grandmother remarked, "You are so lucky, she doesn't do it to just anyone, not even for me!"
  • E.g. Looking a my list of diagnosis above also brings a chuckle.
Yes, I am sick of ranting. Time to change my tune for now, until I get sick of being chirpy, ha ha.