Saturday, August 28, 2010

It's not so simple

Had dinner with my friend WP recently. We were chatting about migration, work in Singapore, and training bond. WP shared about her friend X who was a nurse.

X was sponsored by a restructured hospital for a 3 year diploma in nursing course. Upon the completion of her course, she worked in a ward at her sponsoring hospital. One day, not long into her job, she made a mistake at work and her supervisor threatened to terminate her. X was distraught, for she did not have the money to pay up her bond should she be terminated. Fortunately for X, there was a nurse manager that helped her out and she was re-deployed to serve the remaining of her bond in the administrative department. It was a godsend for X.

After I heard the story from WP, I told her that things are not so simple in nursing. When a mistake is made in nursing, it is often a failure in a system of checks and counter-checks, rather than that of a single wilful or careless nurse. However, where the lion's share of the blame falls depends on the person in-charge. I cite the following example of medication error for WP.


During my nursing training, we were taught that when a medication error occurs, the lion's share of the blame will go to the nurse who administer the medication. At my ward, it is similarly practised as the person who signed off on the medication administered will get the most blame.

This incident happened while I was serving my 1 month's resignation notice. I was about to administer a medication to my patient when I found another medicine in the patient's locked medicine drawer instead. The colour of the syrup medication is similar to that of the intended medication, however the function is totally different. The medication was dispensed from the ward stock, and based on the shift schedule it may have been dispensed by the new staff SN S. According to the inpatient's medication record (IMR), the first and only dose of the wrong medication was administered by my ward manager L who signed off on the IMR.

Since neither SN S nor the ward manager L was on duty during that shift, I first spoke with SN J who is SN S's preceptor about the matter. SN J advised me that since the ward manager was involved, to throw away the wrong medication, replace it with the right one and forget about the matter. I decided to report to the matter to the in-charge for that shift, Senior SN S. SSN S tried to avoid the issue altogether. When I pushed her regarding the proper procedure, she advised me to inform the ward manager myself. Thus, I left a note and the wrong medication in my ward manager's office.

The next day, during report passing, the ward manager L gave us a long briefing about how medication errors can occur. While she briefly acknowledged that she signed off for the wrongly administered medicine, she emphasised (i.e. > 90% of the lecture time) on the breakdown of the pre-administration checks. From the failure of the staff who put the medication into the wrong shelf when topping up the ward-stock, to the new staff SN S who did not countercheck properly. When she mentioned that I did the right thing by checking the medication before administering it, I could only give a wry smile.

Then, my ward manager L instructed me to log an incident report for the matter and told me that she will speak to the consultant doctor in-charge of the patient herself. From my understanding, the staff involved in the incident (i.e. contributing to the mistake or in-charge when the incident occurred) is responsible for logging an incident report. My other understanding is that staff performance may be penalised for incidents logged. Thus, I asked in my mind, "Why me? I'm not the cause of the problem."


WP asked if I had checked if my ward manager actually logged a medication error incident report for the matter. I told her that by then, I couldn't care less. My main intent was to observe the reactions of the people involved, especially the lead actress.


  1. As a student nurse in Singapore, I bore witness to the most horrifying situation that happened in the hospital. There was a patient which was coding, and there were only 2 student nurses (one of which is myself). The emergency button was pressed. Guess what...a registered nurse (foreign trained) appeared but she took a look and walked off saying she needed to fetch her patient from OT. Needless to say , patient died because there were only 2 of us to do cpr and suction the bloody emesis while yelling for help after she left. Worse timing was it happened during break and the other nurse was in the private room doing a tracheostomy dressing. After she heard us, that nurse ran out of the private room and immediately took action. I reported that foreign nurse.

    HO HO HO. I got blacklisted for pushing the matter. The senior nursing officer was telling me to keep quiet if I wanted my career. I stuck to my principles. Worse of all , I was bonded. So you can imagine what happened to me.....

    When they made my life a total misery and told me that I was the most useless nurse etc , that I will never make it anywhere else ...etc ....making my rosters 12 days in a row and one day off at each end. Even better, making me work when I was having a fever and landing me in ED with a 40 degree fever and a fit. THEN telling me that if I take more than 3 days leave , I can forget about my performance review. That went on for more than 3 months.

    It broke me down. For doing the right thing, I got marked. All the time, I kept it from my family until my father found me at the edge of our study window deciding whether I should jump or not. He decided to buy out the bond.

    Even better when I sent the resignation letter in, matron called me down and asked me if I can 'even afford' to pay off and I would be 'stuck' with the debt as well as saying 'you know....your family is not that rich and you might need to wash the dishes ' when she did not even know my family background. I looked at her and said "cash ,cheque or credit card? Which payment option to take". She retorted at me "how dare you talk to me like that girl...your family is poor and you want to drive them into debt".

    The day after my father came, suddenly I was called down.....the matron met my father. HAHAHAHA She asked me if I told him anything about the hospital and the complaints I was making. I looked at her and informed her that whatever I said to my father is covered under lawyer client privilege and I know my rights. She was frightened. My father's old classmate was the CEO of that particular hospital and he told me while the matron was coming out, the CEO was just walking out to lunch and greeted him. HAHAHAHAHAHAHAHA

    Suddenly the matron decided that I was the poor nurse getting bullied by senior nurses and she will discipline them ...and that every ward would be happy to take me in if I decide to withdraw the cheque and my resignation. My final words to her : Go to Hell.

    I was naive and never used my dad as a connection. Had I revealed who my father was sooner, perhaps they would have licked my ass and gone after the incompetent nurse.

    1. Hi Anonymous at Thursday, November 07, 2013 8:14:00 AM:

      Thanks for sharing with your story.

      > It broke me down.

      Yes, it gets to one's self-esteem, especially the horizontal aggression (bullying) that occurs in nursing. My 1+ year of Singapore nursing work experience still weighs on my psyche. Recently I broke down and cried, questioning my own ability to be a good nurse after a particularly bad day at work (in BC, Canada). My boyfriend DD told me that it was just one bad day amongst so many ok/good days, that I was perhaps too quick to write myself off. He was right.

      > Guess what...a registered nurse (foreign trained) appeared but she took a look and walked off saying she needed to fetch her patient from OT.

      Such stories no longer surprise me. I have since learned while re-entering nursing here in BC Canada that in a certain major "nurse-exporting" country, job-seekers have to pay bribes to get a nursing job. So some have sought to pass-off their work experience as a unit clerk as nursing experience.

      > Had I revealed who my father was sooner, perhaps they would have licked my ass and gone after the incompetent nurse.

      Facts of life, especially the sar-kah nature of nursing bureaucracy in Singapore. My Singapore NO, for example, somehow heard that I was interviewed directly by my DON (nursing job interviews were usually done by the respective ADONs), so initially she had "great expectations" of me. Of course things changed once I revealed that I planned to leave.

      Lucky for you that you have your rich and well-connected lawyer dad. I didn't and I had to deal with a load of crap when breaking my bond. Such is life.

      Still happy that another Singapore-trained nurse got out of that hell-hole of nursing in Singapore, and flourished overseas.

      Thanks for visiting and sharing your story.

      Cheers, WD.

    2. p.s. The stuff that I wrote on my blog about nursing in Singapore has already been "censored" by me to avoid stuff that may cause lawsuits to my previous employer, etc. So I am not surprised at all by the stuff that you shared.

      All I did was give my feedback at the exit interview (which frankly I doubt they would take it seriously) and share with the world the potential ugliness behind the "Everyday people, extraordinary lives", so that others considering this profession would hopefully not be so naive.