Showing posts with label Ethics. Show all posts
Showing posts with label Ethics. Show all posts

Wednesday, December 04, 2013

Barbaric posse

I just saw a shocking photo of how "Passers-by catch, tie up 'thief' at Chong Pang Market" in Singapore today. You can read The Straits Times online news article here and see The Straits Times Facebook photo here.

IMHO, it is shocking how some commented that the accused deserved the barbaric treatment. From the photo: the accused was tied like an animal for slaughter and his hands and legs looks like they've turned purple -- a clear sign of insufficient blood and oxygen flow. Who will support this guy if his hands and feet are amputated due to tissue death? What makes Singaporeans think that it is ok to be a barbaric posse -- regardless of the crime committed?
[Note: I am not opposed to tying the thief up, but the posse should ensure that it is done in a way that does not harm the suspect. Deterrence should be just enough force applied, not excessive, otherwise IMHO the "deterrence" is really a flimsy excuse for assault.]
In contrast, another story (from Oklahoma, USA) shared on the same Facebook thread by another commenter illustrates how the story could have had a different ended. Long story short: Man stole woman's wallet, woman caught man, offered to pay his groceries, man cried and apologize profusely.
"The last thing he said was, 'I'll never forget tonight. I'm broke, I have kids, I'm embarrassed and I'm sorry.'" -- Yahoo! Shine, Ellen's Good News, Tue Oct 22, 2013.
Think again. Has Singapore devolved back to the Charles Dicken's era?

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[Extracted from The Straits Times online]
Published on Dec 04, 2013 at 8:33 AM

Alert passers-by foiled a theft yesterday, when a man allegedly tried to steal a fishmonger's takings while he was serving a customer.

The 50-year-old stall worker, who gave his name as Mr Ye, had been chopping fish when the thief was said to have snatched about $200 from a container on the counter at Chong Pang Market.

"He stuffed it into a plastic bag, turned around and ran," Mr Ye told Chinese evening paper Shin Min Daily News. "That's when I shouted for help."

His plea caught the attention of other tenants and passers-by, who caught the 55-year-old man and restrained him with cable ties.

Tuesday, November 19, 2013

BC stands for Beautiful Community

In my previous blog entry "The Suay Kuan" ["the unlucky ones"], Xianlong (Frugal Introvert), Gintai and DotSeng all commented about the "big fish will always eat small fish" culture that prevails in Singapore and that anyone who does not toe the line risks being "blacklisted".

As I've replied, my view is that we are society -- each of us, as individuals, contributes a sliver of behaviour that aggregates into "social norms". Each person has to make his/her own choice and live with his/her conscience. There is no right or wrong answer.

Just to share an upcoming donation drive in B.C., Canada, to illustrate the kind of community that I chose to be a part of.

[17-Nov-2013 Poster for Blanket BC drive]

"The BC in Blanket BC actually stands for beautiful community", said Gregory Ould, the founder of Blanket BC.


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To quote Brian Hare, an assistant professor of anthropology at Duke University, as interviewed by Discovery.com on 07-Feb-2011:
http://news.discovery.com/human/psychology/shrinking-brains-intelligence-110207.htm

"The chimpanzees are violent because they want power, they try to have control and power over others while bonobos are using violence to prevent one for from dominating them," Hare continued.

"Humans are both chimps and bonobos in their nature and the question is how can we release more bonobo and less chimp.

"I hope bonobos win… it will be better for everyone," he added.

Sunday, November 10, 2013

The Suay Kuan [The Unlucky Ones]

Just to share a real-life story from Anonymous who commented on Thursday, November 07, 2013 8:14:00 AM on my blog post "It's not so simple". If you want to believe how Singapore's healthcare system is "world class", then perhaps people like Anonymous and I are the just "the suay kuan" [i.e. "the unlucky ones"]. Otherwise, you'd question whether the occasional reports that leak about the aggression and violence faced by healthcare workers (nurses in particular) in Singapore are really the tip of the iceberg of an endemic issue.

Thank you, Anonymous, for sharing your personal story.

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[The following is copied from a comment left by Anonymous on Thursday, November 07, 2013 8:14:00 AM on my blog post "It's not so simple". Changes in font size, bold, italics and underline are added by me for emphasis.]

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 [checked, I have experienced that]. Even better, making me work when I was having a fever [checked, I have experienced that too], 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 [again I have a similar experience]... your family is poor and you want to drive them into debt" [again similar to my experience].

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.

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To my readers: 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 Anonymous shared. Nursing in Singapore has a long way to go before it is truly a respectable profession.

Sunday, July 07, 2013

Privatized healthcare vs universal access

While chatting with my boyfriend DD today, he mentioned that one of the factors (amongst several) of his decision to return to Canada was the way healthcare system works in USA (pre-Obamacare). [Note: USA was a country with better job prospects in his industry compared to Canada at the time of his relocation.]

I shared with DD that, IMHO, the Singapore healthcare system is even more "right-wing" than USA's. E.g. A couple, who despite having bought insurance for their child and both holding well-paid professional jobs, going into credit card debts to pay for healthcare for their child with congenital issues. E.g. An elderly childless-woman who was told to sell the remaining lease of her 3-room HDB apartment (leaving her with no home of her own and having to live under her niece's equally small HDB) before she could apply for Medifund funding for her repeated acute hospital care.

As I am currently working in paediatric home health nursing in B.C., Canada, I can see the difference in the kind of support (from the provincial government) given to parents with children who lucked out on rare, chronic or deadly illnesses. In addition, Uncle Wing's (bless his soul) own experience is testimony to how the B.C. healthcare system takes care of its seriously ill elderly. [Click here to see my year-2009 blog entry about BC nurses petition against healthcare underfunding and Singapore's privatization of healthcare.] While I do not deny that Canada's system has its weaknesses, I feel that it caters well to “不怕一万,只怕万一。” ["Not afraid of the common scenarios (that one can plan for), but fear the exceptional scenarios."] After all, how many of us would choose (for the sake of maximizing our usage of universal healthcare): 
  • to be involved in major road traffic accidents (and thus requiring extended intensive care and probably repeated restorative surgery and extended rehabilitation); or
  • to have children with rare, chronic and/or deadly illnesses; or 
  • to have elderly parents with chronic, debilitating and/or incurable illnesses?
Yet there will always be Singaporeans who would defend that the Singapore healthcare system is better (e.g. more efficient and/or more cost-effective, or more equitable because specific-user-pays instead of risk-sharing) than Canada's, Australia's, UK's, etc. [Just check out the comments on those blog posts.] I hope that these "loyal", "patriotic", defensive Singaporeans will never have to encounter any major/repeated healthcare issues personally and/or amongst their loved ones.

Another issue I have with the way private healthcare works in Singapore is that until recently (see below), there was little control on the runaway costs/mark-ups in private healthcare. Note: I have met a significant number of private specialists who would waive/discount their fees to help the "needy" patients, thus it would not be fair to tarnish all kind-hearted doctors because of one black sheep. Nevertheless, IMHO, it is human nature to compete to be the better paid specialist. After all, it is so very much in Singapore's culture to judge people by the size of their income.

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Dr Susan Lim loses appeal against SMC's guilty verdict
Published on Jul 01, 2013 1:39 PM

By Selina Lum And Kc Vijayan

The highest court in Singapore on Monday dismissed an appeal by general surgeon Susan Lim against her conviction on charges of professional misconduct over the amount she charged a patient from the royal family of Brunei.

In a 109-page written judgment, the three-judge Court of Appeal said Dr Lim's case was "clearly one of the most serious cases - if not the most serious case so far - of overcharging in the medical profession in the local context". The court dismissed her claims that she was justified and there was no ethical obligation to charge a fair and reasonable amount and pointed out her approach showed she had shown no remorse.

In the judgment, the court ruled there is an objective ethical limit on medical fees that operates outside contractual and market forces, The court found that, given a doctor's specialised knowledge and training, there arises an ethical obligation on the part of a doctor not to take advantage of his patient. And this ethical obligation to charge a fair and reasonable fee is not superseded by a valid agreement between the doctor and his patient, the court held.

In 2012, Dr Lim was found guilty of 94 charges of professional misconduct by a Singapore Medical Council (SMC) disciplinary committee for charging about $24 million for the services provided to Pengiran Anak Hajah Damit Pg Pemancha Pg Anak Mohd Alam for 110 treatment days from January to June 2007. Dr Lim was then given a three-year suspension and fined $10,000 - which was upheld by the appeal court.

Tuesday, April 23, 2013

On forgiveness

After a long absence*, I have a "calling" to do a psychic healing again. Along the process I started healing myself simultaneously. I will not elaborate on the actual healing done, but I will share some thoughts that came to mind.

Although I am not a Christian, I love something about the "Our Father" prayer since I came across it as a child. Especially the part where it goes, 

"... forgive us our trespasses, 
as we forgive those who trespass against us. 
And lead us not into temptation, 
but deliver us from evil. ..."

The essence of forgiveness. Many talk about it. Many claim they believe it. Many claim they practice it. Indeed, many do practice it to some degree. However, few are able to practice it widely. The few Christians who do so, whom I come across personally in my life, I have always admired deeply.

I shall close with 2 songs. Songs which speak of certain life philosophies that help us to release the emotional baggages that we inevitably pick-up in life.

峰迴路轉 -- 劉德華
["Turning point" by Andy Lau]


笑看風雲 -- 鄭少秋
["Laughing at Life's Fortunes" by Adam Cheng]


Have a good day!

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*p.s. : Okay, maybe not "that long" an absence. That said, for the previous healing that I did, I only sought "psychic permission" to heal as the person was at that time not even well enough to give me permission physically (e.g. verbally or through body language). As such, I only healed up-to the point where he no longer hung between life and death.

Thursday, March 07, 2013

Class Action - Abuse in Residential Facility

At the end of last month, I met someone (L) over a social group's brunch. L happens to be a lawyer interested in legislative law, human rights law and similar areas. At one point, we started a general discussion about systemic abuses/atrocities. E.g. Those mentioned in the "Woodlands Class Action" law suit (see appendix below).

Although that happened almost 20 years ago (the residential Woodlands School was closed in 1996), I asked L regarding my concern (speaking as a foreign-trained nurse myself) that with a flood of foreign-trained nurses who often carry with us different cultural views on nursing ethics, how can we ensure that such systemic abuses/atrocities are not repeated?

L is of the view that training is important. Training to ensure that foreign-trained nurses and other healthcare workers understand and adhere to the Canadian standards for ethical healthcare delivery. I am inclined to agree with her that training is important. That said, from my observation and experience, the cultural aspects of healthcare delivery is one of the challenging areas to "train".

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[Extracted from Klein Lyons Personal Injury & Class Action Law website on 07-Mar-2013.]

Overview

This is a class action for former residents of Woodlands School in New Westminster, British Columbia. Woodlands School was a residential facility operated by the Province of British Columbia for mentally disabled children and adults. The school closed in 1996.

A review of Woodlands School commissioned by the Province and conducted by a former provincial Ombudsman, Dulcie McCallum, found that there had been widespread sexual, physical and psychological abuse of Woodlands residents and that there were systemic problems with the Province’s operation of the school:

Names of the residents and staff involved with the incidents will remain private. Details of the physical abuse found in the records include hitting, kicking, smacking, slapping, striking, restraining, isolating, grabbing by the hair or limbs, dragging, pushing onto table, kicking and shoving, very cold showers, very hot baths resulting in burns to the skin, verbal abuse including swearing, bullying and belittling, inappropriate conduct such as extended isolation, wearing shackles and belt-leash with documented evidence of injuries including bruising, scratches, broking limbs, black eyes and swollen face.
A follow up investigation conducted by the Office of the Public Guardian and Trustee reached similar conclusions:

Stories that were told by the former residents included physical abuse such as being slapped or beaten, sexual abuse by staff or by other residents, having to work on the wards or for other businesses, being confined in side rooms or placed in restraints and losing their privileges. Residents talked about being afraid to speak up for fear they would be punished. They also spoke of the fear of watching or hearing another resident be abused. Some of the residents described how scary it was to live on a ward where they felt that the other residents were dangerous.
The Woodlands Project Team reviewed approximately 100,000 pages of resident files. Nearly 20% of the documents revealed at least one issue of concern. These issues ranged from actual reports of abuse, unexplained injuries or illnesses, unexpected behaviour changes, sexually transmitted diseases, sterilization and the use of birth control in Woodlands, heavy doses of medication, overcrowding, chronic infectious diseases like hepatitis and salmonella, forms of punishment including seclusion, restraints, restricted visits with family and withdrawal of food and privileges like being able to have coffee or to go out on the grounds alone.

The class action was originally certified as including all former residents but the class definition was recently limited to persons who lived at Woodlands on or after August 1, 1974. This is due to the operation of British Columbia’s Crown Proceeding Act which came into force on that date. The decision to limit the class is currently under appeal.

For information about the We Survived Woodlands Group:

http://wesurvivedwoodlands.org/

For information about the BC Coalition of People with Disabilities Woodlands Campaign:

http://www.bccpd.bc.ca/campaigns/woodlands/default.htm#over

Court Ruling Excludes Pre–August 1, 1974 Residents From Lawsuit

People who lived at Woodlands, but moved out of the School before August 1, 1974, have been excluded from this lawsuit by a series of court decisions. [For more details, please refer to the Klein Lyons webpage on Woodlands Class Action.]

Sunday, January 06, 2013

A great Singaporean mystery

I just have a simple question.
If the Prime Minister of Singapore is too busy attending to matters of "national importance" to call for a by-election in Punggol East SMC (Single Member Constituency), ... 
Then how come he has time to read a blog article, AND all 21 comments following the blog article, AND analyze the alleged defamatory nature of the contents AND then dispatch his lawyer to threaten (in-writing) to take legal action against the blogger for alleged defamatory content?
I guess the above is one of those great Singaporean mystery that needs a "uniquely Singapore" multimillion-per-year-talent to crack.

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By the way, I mentioned about this to a couple of elderly Canadian Mensans.

I said, "You know, there is a blogger in Singapore who was threatened with defamation suit through a lawyer's letter..."

They looked amused.

"By none other than the Prime Minister of Singapore!" I added.

Their eyes popped.

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[Addendum on 07-Jan-2013]

For analysis of the potential fallout from the legal action, click here for Yawning Bread's (the very blogger who was sued) and here for flâneurose's.

Monday, December 31, 2012

Street Protest

I just want to share what an organized peaceful street protest looks like. 

18-Dec-2012. We were on Vancouver, West side, waiting for the bus when this street protest passed by us. There was police at the start, middle and end to direct the traffic (and even on the opposite lanes). There was also a public transport police car at the end to ensure that the buses, although delayed with the reduced traffic speed, would keep-in-line for the safety of the protestors. It was a long procession (I think it stretched between 2-3 blocks), causing a huge jam along the normally busy West Broadway, Vancouver, from Heather St to Yew St (if I remember correctly).

A street protest to save Hotel Rainier, 
a shelter for homeless women in DTES.


For those who would like to read more about the underlying trigger for the protest, Google for "missing women inquiry" and "serial killer Robert Pickton". Hotel Rainier was launched in 2009. I guess budget cuts are threatening its existence.

Of course, there were people who grumbled about the delay to bus services and the long time it took for them (trapped in the bus travelling behind the protestors) to arrive at their destinations. That said, the bulk of the complaints were related to the timing (pre-Christmas week), route (a road with busy traffic), size/method of the protest which contributed to the traffic jam. I guess implicitly, people recognized that although the issue (raised by the protestors) mainly affects the homeless poor females in DTES (Down-town East Side), it means that everyone shares the problem (or at least people had the decency to keep quiet otherwise).

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Anyway, just a few thoughts with regards to what Singaporeans have surrendered over the years.
  • The right to protest peacefully to bring attention to issues of widespread/public concern.
  • The critical thinking faculty to recognize that "protest" does not equate "violence".
  • The "helicopter vision" to recognize that problems of the "poor" are not just the responsibility of the underclass to "shape-up or ship-out", but each member of the society shares a responsibility in the laws (and politicians) we support.
Will Singaporeans, and thus Singapore, change for the better in 2013? Your bet is as good as mine. [Click here for a prediction that echos my sentiments.]

Thursday, December 20, 2012

When nurses hurt nurses

Since I get some hits from Singapore and Canada regarding nursing (e.g. search on the "Nursing in Singapore" blog category or Goggle for "IEN SEC"), I would like to share about relational aggression in nursing and an article on how to deal with bullies in the workplace.

I have recently finished reading a book, "When nurses hurt nurses - Recognizing and Overcoming the Cycle of Bullying" by Cheryl Dellasega. IMHO, it gives a good overview of relational aggression that was (and still is) so commonplace in nursing (especially in Singapore) such that it contributes to common refrains like "nurses eat their young".
About the author: Cheryl Dellasega, PhD, CRNP, works clinically as a nurse practitioner and researches extensively on relational aggression. Her published books include "Surviving Ophelia" and "Mean Girls Grown Up".
IMHO, ultimately the patients suffer when relational aggression in nursing is not addressed. At least in B.C., Canada, there are laws and organizations (e.g. nurses union) that push for and support policy changes to reduce systemic factors. In Singapore, with labour policies that supports discrimination and suppression of labour rights, one can't help but to ask, "What has changed? What will change?" My hopes are not high.

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[Extracted from Appendix F - Nurse-to-nurse bullying: the RN way of RA]

Some examples [of relational aggression] include the following:
The Joint Commission for Accreditation of Healthcare Organization (JCAHO), which is responsible for regulating acute care organizations, takes this issue so seriously that as of January, 2009, they require policies to be in place that will help detect and address relationally aggressive behaviours.

[Unfortunately in a really bad environment, the nurse manager may well be the bully himself/herself. Extracted from page 134 "How Managers Bully" - Nurse-to-nurse bullying: the RN way of RA]

These (managers' bullying tactics) include behaviours such as the following (to name a few):
  • Publicly discipling nurses who have made mistakes
  • Threatening consequences if nurses don't do what the manager wants
  • Playing favourites
  • Setting up certain workers to fail by withholding information
[Dellasega, C. (2011). When nurses hurt nurses - Recognizing and Overcoming the Cycle of Bullying. Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing]

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I have seen a lot of ugly behaviours while nursing in Singapore -- the stuff that I wrote in my blog about workplace bullying is just the tip of the iceberg; i.e. stuff that won't get me or my previous employer (hospital) into legal trouble. I recognize that I have occasionally behaved as a bully too while surviving as a nurse in Singapore; and I am not proud of myself for that.

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What should one do when one finds oneself working amongst these sharks dressed as angels-in-white? Barbara A. Broome, PhD, RN, wrote an interesting article of practical advice - "Dealing with Sharks and Bullies in the Workplace". Here's an extract of her advice.
  1. Assume all unidentified fish are sharks. ... In other words, you don't really know who or what you are dealing with, so be on guard.
  2. Do not bleed. ... In the case of bullying, remove yourself from their presence. Giving way to crying, using defensive behaviour or trying to provide an explanation only provides more opportunities for aggression.
  3. Those who cannot learn to control their bleeding should not attempt to swim with sharks for the peril is too great. When attacked, control your anger and state only the facts. Controlling your anger changes the power of the bully. The bully will be confused as to whether or not the attack has injured you and will be unsure of their advantage. ... Always document the interaction.
  4. Counter any aggression promptly. Sharks and bullies rarely attack without warning. Usually there is some tentative, exploratory aggressive action. It is important that one recognizes that this behaviour is a prelude to an attack and take prompt and vigorous remedial action. The appropriate countermove is a direct discourse about the inappropriate behaviour.
  5. Avoid ingratiating behaviour. One may mistakenly believe that an ingratiating attitude will dispel an attack. This is not correct; such a response provokes a shark attack.
  6. Use anticipatory retaliation. One needs to develop the skill to counteract inappropriate behaviour. A constant issue is that the bully will forget and may attack in error. ... This memory loss can be prevented by a program of anticipatory retaliation. ... Your response to inappropriate behaviours is unexpected and serves to remind the bully that you are both alert and unafraid.
  7. Identify disorganized and organized attack. There may be more than one bully acting in concert. ... It is essential that one know how to handle an organized attack. Confront the behaviour. Make it known that the behaviour is unacceptable and will not be tolerated. If the behaviour continues, a written complaint should be filed in human resources with the dates, times an details of each event. If there are witnesses to the event, their names should be included. A copy of all written communications should always be kept as a record of filing of the complaint and actions. As a last resort, legal action may be necessary. [IMHO, I am sorry to say that "legal action" is unlikely to work in Singapore, no thanks to its labour policies that supports discrimination and suppression of labour rights.]
[Broome, B.A. Dealing with Sharks and Bullies in the Workplace. ABNF Journal, Winter2008, Vol. 19 Issue 1, p28-30, 3p]

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Mean Girls: Four Ways to Respond - by Susan Fee

Friday, December 14, 2012

Singapore's union says no to equal pay for all nationalities

I am referring to this report from the Business Times dated 15-Dec-2012.

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[Extracted report from The Business Times dated 15-Dec-2012.]

NTUC says 'no' to equal pay for all nationalities
'Same job-equal pay' rule will put local workers and families at a disadvantage

BY ONG CHOR HAO

THE labour movement has rejected a call for workers of all nationalities to get the same pay for the same job, and recommended instead "fair and reasonable wages" for all.

Labour chief Lim Swee Say, addressing a range of labour issues at a press conference, said: "We are highly uncomfortable with this idea of 'same job-equal pay', because we feel that this will actually disadvantage our local workers and their families, and we think this is not the way to go."

The "same job-equal pay" clamour arose when a group of SMRT bus drivers from China held an illegal strike last month to signal their unhappiness about their pay being lower than that of their Malaysian counterparts, among other things.

Mr Lim, the secretary-general of the National Trades Union Congress (NTUC), said it was a sensitive, complicated issue but noted the issues to consider.

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See what Lucky Tan and Kristen Han (#spuddings) wrote about why that million-dollar minister's logic is flawed. IMHO, even an 18 year-old A-levels economics student would probably have a better grasp of basic economic principles of running a business than that million-dollar minister.

On other note, I am glad my foreign-talent friends ZS and JX (both from PRC and worked in Singapore for years) decided to give up their Singapore PR. They are indeed better off in Canada, given such government-endorsed discrimination in Singapore. In other words, with such government-backed discrimination, the kind of foreign workers that Singapore would attract and retain in the long-term are the rejects (at the bottom of the barrel) rather than the crème de la crème.

As for the nurses in Singapore, brace yourself that relational aggression resulting from such inequity will continue within the multi-national nursing workforce -- either until you retire/quit from nursing in Singapore or there is political change in Singapore.

Thursday, September 06, 2012

GNIE: Bevel Up

Today in nursing school we watched a section of the documentary film "Bevel Up". [Click here for to watch it and other related videos online.]


The above was shown to us to educate my class of Internationally Educated Nurses about how the 4 Pillars of Primary Health Care (Teams, Access, Information and Healthy Living) based on Canadian values drive the delivery of non-judgemental primary health care. As my Canadian nursing lecturer puts it, the issue is not drugs per se, but poverty*. Recognizing how the social determinants of health have a huge impact on the population's health outcome means that advocating for social justice is an important part of a Public Health Nurse's role.
*Note: There are rich drug addicts and poor drug addicts. There are drug addicts who are productive members of society (i.e. people who hold jobs -- think of some movie stars, Wall Street traders, etc) and those who are "cast aways". For those addicts who have income to support their habit, the effects of their addiction are "hidden" from the public. Thus the issues that the public often associate with drug addiction are really issues related to poverty.
Indeed, many years ago in Singapore, I used to have a room-mate who was a drug user. I do not know which drugs she used exactly -- my guess is that it was probably "recreational drugs". She ended up being my room-mate because of some "emergency" issues which led her to turn to my landlady (who was a long-time friend of hers) for help. The fact that she is rich meant that her drug use and its impact was not seen by the public. Years later she "cleaned up" and started running her mother's business empire which she is slated to inherit.
Personally, I know of some Canadian friends/acquaintances who use hash (i.e. smoke pot). A few even offered/recommended their stuff for me to try, reassuring me that it is not addictive; but I turned down their offer anyway. That said, it is easier for me to remain neutral as a friend since my value is that "my friends are responsible for the consequences of the choices they make in their lives" and I am not affected in any way by their personal lifestyle choices. I wonder how I would react if that happened in a professional context.
I realize that it is easier for me to be non-judgemental towards the girls living in a teenage shelter that I used to tutor as a volunteer back in the 1990's Singapore. I listened their stories and learned about life through them; I recall one was involved with gangs by age 13. Back then, I recognized that at that age, they probably landed up where they were because of a lack of guidance (many came from dysfunctional families) and their socio-economic background.
I do not think that I will choose to be a "Street Nurse" at this moment. I do not think that I am able to be that non-judgemental as yet, given my background. I recognize that I am challenged on my personal values in this topic -- I can imagine myself as an ER nurse (Emergency Room) getting angry at drug addicts who repeatedly utilize health care resources that could otherwise be spent on those who are more motivated to improve their lives. That said, I am very happy to watch and learn from the above documentary. I feel that being introduced to Canadian values and understanding how those values guide the provision of health care (e.g. by examining ethics in a professional nursing context) is a very practical and valuable part of the GNIE (Graduate Nurse, Internationally Educated) programme.

Saturday, June 09, 2012

GNIE: Calling out a bully

A friend laughs and cries with you. A friend gives you support, but also calls you out when you veer off-course. 2 days ago, on Thursday, I had the unenviable task of doing the 4th duty of a friend. 

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During Nursing Theory class, lecturer H decided to collect suggestions from the class for the semester 1 GNIE students who would be heading for their first clinical attachment under the GNIE course. Suggestions flowed on as lecturer H moved her focus from one side of the class to another. 

When lecturer H came to my corner of class, LP suggested that students should help each other instead of focusing on finishing their own task. 

My PRC classmate PY countered immediately that everyone has his/her own tasks to be done; if the person cannot even finish his/her own task, then he/she will delay everyone; so it is important to get one's tasks done before helping others.
[I took it that PY meant that helping others should be circumstantial, because personally I do not find PY selfish. That said, my interactions with her is limited to classroom activities.] 
PY then added that people should not talk about others behind their back; instead they should bring the issue out to the person involved [and talk openly and directly about it]. Lecturer H gave a quick "Aha!" look, and then she just noted down the comments but did not add any remarks.
Some background notes: LP, IJ, PY and a few other classmates were in the same clinical group. LP and IJ have LPN experience in Canadian hospitals, so when it came to clinical, they were the stronger players. Unfortunately, LP and IJ seem to have issue with one person or another from their clinical group at various points in time. The Filipinos in my sub-group would hear them complain every now-and-then over our lunch together.
I am in another clinical group with AP, IT, JC, PT and others. As AP, IT, JC, PT and myself are part of the Filipino lunch group, we have heard of the conflict in LP's clinical group. When we met up for clinical, AP, IT and I would remark to each other that we were glad that our clinical group is made of comparatively agreeable people and is rather cohesive. Even our current semester's Clinical Instructor remarked that we are an unusually cohesive group who helped each other out and waited for everyone to go for break together. 
Personally, I have minor issues with someone within my clinical group, but I try to close one eye and keep the matter confidential (between AP and myself) because I treasure the camaraderie within the group and I don't want to spoil it. I believe everyone in the group holds a similar approach.
When it came to IJ's turn, he gave some other suggestions. But knowing his issue with his CI, I recognized it as a veiled criticism of the CI. In the pursuing discussion, it became more and more obvious that IJ and LP were complaining about their CI. PT, another Filipino classmate who is in my clinical group, actually added oil to the fire by saying, "Ya, K is like that..."

Again lecturer H just noted down the comments but did not add any remarks. At the end of the feedback collection, lecturer H remarked, "That's all? I thought you guys are going to give me some tips on how to tackle the clinical instructors."
Frankly, I don't know if she was joking or being sarcastic, given that the other sub-group (in my class) had complained against lecturer H before. Nevertheless, I was disappointed that lecturer H did not use her position of influence to offer a neutralizing perspective. Yes, I recognize that as adult learners we are responsible for our interpersonal interactions, but I thought that a comment from her "position of authority" as a lecturer to counter the veiled attack would have helped, even something simple like, "You guys are adult students. You should know how to resolve conflicts amongst yourselves." But it did not happen, the fire was not doused.
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We then had a short break. I took the chance tackle IJ's issue with his current semester's CI, KH. Both IJ and LP had been complaining about KH for the past few weeks. 

My clinical group had KH as our CI during the previous semester. My group had no major issues with KH as the CI. We were grateful for her support and flexibility. In fact, at the end of our clinical, my group gave KH a "Thank You" card and we celebrated together at a Japanese restaurant (she wanted to pay her share, but we insisted on treating her).

So I asked IJ what his issue with KH was. He said, "She is always here-and-there" [i.e. he could not find her]. To which I replied, "It depends on what you expect from the CI". I told him that my group like KH precisely because whenever a student requested for her check/guidance/support, she would follow the student to the client's bedside. I added (someone from the other sub-group told me) that another clinical group was unhappy in the previous semester because they (allegedly) had a CI who declined to supervise students by the patients' bedside, always sitting at nurses station instead. I followed with asking IJ, "Have you raised this issue with KH?" To which he replied negative. LP joined in and said that there was no point (in raising the issue) since they had only a few of weeks of clinical left, and they would rather just "suck it up". I told them that, if they were upset enough to complain in class, then they should raise the issue with KH and talk with her face-to-face.

Next I asked IJ if he had any other issue with KH. Then he said that she was picking on himself and LP. I asked, "What happened?" IJ said that he and LP were only a few minutes late one morning, but KH "talked" to them about being late right after that. IJ then cited that they were technically speaking not late since the report has not started yet. Further, IJ claimed that other students who were later than them were not given the "talk". Thus, KH was not being fair in handling the students.

I was a little puzzled but I decided to share based on my groups' experience with KH. First of, I asked, "Did you agree on a specific reporting time?" IJ replied negative. I told IJ that my group had established an agreement to report by 7:20am (actually, it slowly shifted to 7:25am by the clock at the clinical unit). Nevertheless, KH had been flexible with the late comers so long as we inform her (e.g. send a text message or verbal message from our classmates) of our situation. [Indeed, a few in my clinical group, including me, had done so in the previous semester, without any issue.] Thus I suggested that IJ bring up the matter directly with KH and to establish a benchmark for punctuality. IJ started wriggling his way out of establishing a reporting time with KH, to which I countered with an explanation on the need for a benchmark for an objective approach to Performance Appraisal.
In my 1st IT job, my company provided excellent training, including many in-house training videos. One of the most beneficial ones I watched was on Performance Appraisal. Basically for Performance Appraisal to be done objectively, one has to establish the KPI (Key Performance Indicators), how to measure the KPIs and the (measurable) standard to meet for each grade. Then the employee and supervisor each makes their evaluation of the employee's performance based on the agreed standards. Finally, the 2 meet together to discuss the grades, and for any discrepancies, to explore the causes and negotiate the grade. 
I shared how using that tool greatly benefited me in one situation. We were mostly young (under 30's) folks in the team at that time, including my supervisor J then. Another female colleague CML had some issues with me over a male colleague that she had fancied. I was in the development team reporting to J, while CML was in the testing team reporting to KT. CML spread negative comments and gossips about me, especially to J who was infatuated with CML back then. When it came to performance evaluation, J initially rated me 4-5 on all KPIs and gave me an overall grade of 4+ (on a scale of 1-5, 1 being "outstanding" and 5 being "needs improvement"). At each KPI, all J had was CML's comments and feedback, and his personal opinions to support his evaluation. I was aware that J, as a newly promoted supervisor, was keen to be seen as fair. Thus, I challenged J to specify the SMART objectives as per the company's Performance Appraisal approach for each KPI. He took several hours to do it, but when he was done, I showed him the evidence that I met all his criteria cited. At the end, my KPIs were mostly rated 1-2 (I think there was only 1-2 items with a rating of 3, meaning "Met Expectations") and the overall grade was 1+. We were originally scheduled for a 1-hour review of my performance appraisal, but it took 8 hours instead. We finished at 12-midnight. I might not have liked J personally any better, but at least he earned some respect from me for putting in the effort to be objective.
With that example, I re-iterated how important and effective it is to establish objective standards. IJ wriggled again. To which I cut straight to the chase and asked, "Look, you want to pass the course, right? So why don't you establish measurable objectives upon which you would be evaluated?" At which point, IJ went tangential and started accusing/labelling KH, "But she is...". To which I replied, "It doesn't matter". The cycle of "But she is..." and "It doesn't matter" repeated for several rounds. Until IJ finally gave up.
I wonder if IJ realized that I was using the "Broken Record" method of assertive communication on him. We learnt that in GNIE semester 1.
I concluded our discussion with a re-iterated suggestion that IJ and LP speak openly and directly to KH about their issues with her instead. I recognized at that point that IJ and LP were, for some reason, unwilling to acknowledge their parts in causing the issues and role in resolving the issues. I told IJ that it was not good of them to bring up their issues with their CI indirectly during class (with another lecturer/instructor) instead of speaking directly to KH, the CI involved. IJ tried to excuse/justify his actions, stating that he would never mention names.

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After lunch on Thursday, we had nursing lab with the lab instructor JNT. IJ and LP started asking JNT questions about what should and should not be done. E.g. "Do nurses percuss the abdomen?" E.g. "Should we auscultate the abdomen before or after palpation?"

On their own, the questions seem like innocent clarifications of nursing skills. However, knowing the background issues driving their questions and from the tone of their questions, I recognized that they were seeking another avenue to complain about CI KH.

JNT answered both questions in their favour but did not stop at that. She deduced from the follow-up commentary from IJ and LP that the questions were related to conflicting instructions from a CI. JNT started asking questions and making statements that were critical of the conflicting instructions. Then she started playing the "student advocate" role* and asking the class if they had any issues at clinical. IJ and LP immediately took the bait and started giving negative comments about their CI. There was an awkward pause. Then IJ asked, "Come on guys, back me up!" and another classmate from his clinical group spoke in agreement. JNT then fished for more and more details. Finally, she asked, "Who is your instructor?"

At which point, IJ hesitated for a split second and then slowly replied, "KH."

JNT then said that she would raise the issues on their behalf to the person in-charge of clinical posting. That person is away at the moment, but JNT promised that she will follow-up with her. In addition, JNT said that she will also raise the issues with the Course Co-ordinator L. After some other side matters, JNT declared a break.
[*Note: This afternoon when AP came to bunk over at my place, we discussed what happened on Thursday. Both of us find JNT's behaviour beyond what is appropriate of a "student advocate". We both think that there is more to JNT's motive than simply being a neutral advocate. It is not the first time that JNT had been "fishing" for "tinder". It first happened when there was a complaint against lecture H and she asked "How did your theory class go?" The week after the incident against lecturer H, she fished for complaints about clinical. This Thursday, her nose sniffed blood in the air from IJ and LP.
AP said that it seems that JNT has something at the back of her mind but AP could not figure out what it is. I gave a guess that based on the 1st semester's lab lecturer LA's information, it is hard to get a regular/permanent job from the university. Even LA, who had been getting good performance reviews for years of contract work with the university, is still not offered a permanent position. Maybe JNT's behaviour is symptomatic of workplace politicking.]
At which point, while a few classmates were streaming out of the classroom for the break, I turned over to IJ and LP and said sternly (in the presence of the other Filipino classmates and JNT), "You know what? You guys should seriously have a face-to-face talk with KH if the issues are bothering you that much. What you're doing is [a form of] bullying. Why do you go around complaining and complaining (to others) instead of talking to KH directly?"

IJ and LP both looked surprised, as if it never occurred to them that their actions/behaviour were those of bullies. LP then gave excuses that, "If we complain (to her), she would fail us?"

To which I thought, "Obviously they do not trust on the professionalism of their CI. It's a sad reflection of their own mindset." Nevertheless, I replied, "You can document that you have made a complaint to her, then she cannot fail you because of that."

IJ or LP (I cannot recall which) asked, "You mean like in the anecdotal notes?"

I said, "No. Like document down for the record."

The above excuses and counter-argument went several rounds. Finally, they kept quiet, but I could tell that they were not ready to hold their peace yet. Anyway, break was over soon enough and lab lesson continued.

At the end of the day, I didn't feel like talking to anyone, especially not the Filipino gang, so I headed out quickly.

On the bus journey home, I decided that I have to reinforce my point. Thus, I sent IJ a text message.
"Hi IJ, I seriously think that you and LP should consider raising your issues directly with KH. As your friend I am ashamed of your actions this afternoon. Gossiping about someone behind their back is bullying. Remember how angry you and LP were when the other group complained about H to L behind her back? Is there any difference between that and what you're doing now? I hope for and expect more maturity from the both of you. WD"
About 1/2 hour later, I got a reply from IJ.
":) thank u for making me aware of that [WD].. i hope itll (sic) all work out for me. it is a stressful situation, so im thankful for your guidance in this process. sorry for having acted inappropriately, it will not happen again."
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When I logon to Facebook late on Thursday night, I saw that IJ felt vindicated by JNT's replies to his questions earlier that day and posted the following on FB (around the time when I sent him that text message about bullying).

IJ: RNs don't percuss. LoL

WD [replying late that night] : Such regulations are specific to legislative zones. In UK, they do. In Singapore, some with modern training do. I was trained in Health Assessment by someone who ever worked in UK.

WD: Which is also why we need the GNIE programme. Standardization of RN scope, skills, roles & responsibility in the Canadian context.
[Note: I grabbed the opportunity to drumroll about the benefits of the GNIE program. IJ and LP have been and are still complaining about the need for GNIE and stirring others' frustration over the program. In fact, both of them were so frustrated about the perceived "discrimination against foreign nurses" that they were trying to write on that theme for their Sociology assignment.]
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Today (Saturday), AP told me that over dinner on Friday, she also talked to IJ about not going overboard in his complains. AP suggested to IJ to "suck it up" and show the CI some respect if he wanted to pass. [Note: AP did this independently, she didn't realize that I had sent IJ a text message on the matter.] IJ seemed a little less defiant this time, asking AP if it was that bad. AP said to him that his words do hurt others sometimes. Then according to AP, unlike IJ's usual habit, he did not complain about a ginger slice in his drink at the Japanese restaurant.

Getting LP to turnaround would be more difficult. AP and I agreed that IJ is a smart person and LP, on the other hand, wasn't quite so. To quote AP, LP's behaviour is that of a typical Filipino - complaining and gossiping about issues. I would reckon that without IJ's chorus, LP is unlikely to push her agenda further because LP has enough street-smarts to know that she is unlikely to succeed without IJ's brains.

Neither AP nor I know how things will play out. We both hope that things will work out for IJ, LP and their clinical group. Once again, we concluded that we are blessed to be in our clinical group which seems to have no major issues. *Fingers crossed* and *knocking on wood*.

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[Addendum on 14-Jun-2012]

IJ informed me today that he had spoken with his Clinical Instructor KH and set-up some agreed benchmark standards for the clinical performance evaluation. Apparently KH agreed that she should have done that right at the beginning of their clinical rotation. IJ told me that he was concerned that he only had 2 weeks left on clinical to meet the standards (and wondered if he might be penalized for the earlier weeks' variances from the post-dated standards). I re-assured him that from my clinical group's experience with KH, she is unlikely to fail him just because they had not set-up those standards until this late in the clinical rotation. I advised him to just do his best to meet those agreed standards over the final weeks of clinical and he would probably be alright.

Friday, March 16, 2012

GNIE: Workplace bullying

My recent experience of workplace bullying and the responses made me think...

"Nursing in Canada" is to "Nursing in Singapore"
as "Heaven" is to "Hell".

My emotions are not fully settled yet. Nevertheless recent events give me hope against my greatest fear of nursing as a career.

Saturday, August 28, 2010

Psychic nurse

I contemplated for awhile before writing this entry. The main reason is that this entry touches on a topic that elicits a wide range of responses -- from reverence, to indifference, to ridicule for lunacy. Well, I decided that my usual readers would probably have a grasp of my mental health status, so here goes.

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Prologue: Over 4 years ago

A colleague came in to work with a bad neck sprain. He was in pain but refused to see a doctor due to work exigencies.
[Note: Generally, I keep my personal life, especially my psychic practice, apart from my work life. Although there was once when another colleague Google for my name and found an article about my psychic work.]
After struggling at work for a while, my colleague was still noticeably in pain. At which point I offered, "Would you like a healing? It does not involve physical contact, but it's non-orthodox."

After some rounds of hesitant queries and answers, he agreed to let me work on his neck. At the end of the session, he asked, "What are you doing here [Note: i.e. in I.T.] when you can do that?"

To which I shrugged and smiled.

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At the start of my nursing training, I decided that I should focus on the nursing tools and skills. After all, as professionals, nurses are advised to practise evidence-based nursing. Thus, I decided to avoid using my psychic skills during the course of my nursing duties. The keyword here is "avoid", because there were times when it slips in. I shall share 2 examples below.

Example 1
There was a girl admitted for chest infection. The initial blood tests indicated only the usual infection markers. Her intake was poor and physical activities reduced as expected of her condition. Subsequently, her CXR showed significant pneumonia, but not something which we have not handled before. Typical of children adjusting to hospitalisation, the patient was refusing her medications and had to be coaxed.

What puzzled me was, while nursing her, I got a strong psychic message from her, "I don't want to live anymore, I want to leave this body." Nevertheless, wearing my "nurse's hat", I continued to give her parents hope and support.

The next day, she had several repeat and additional blood tests. Her latest blood tests indicated a sudden severe turn in her condition and she was transferred to another hospital. We heard from the consulting doctor that she passed away subsequently.

Example 2
It was my second last day at work. A CCU (Critical/Intensive Care Unit) colleague had admitted her son for bronchitis. Being a CCU trained nurse, she preferred to perform nasal suctioning for her son herself and has been doing so during the hospitalisation. Her husband was holding the boy while she suctioned. I happened to pass-by and helped to hold the boy's head. When she was done with a couple of rounds of suctioning, she asked me if her son's nose was clear.

Visually we could see that the boy's outer nares were clear. There was more mucus extracted from the left than the right nostril. I put my ear next to the boy's head to listen closer to his breathing. The boy's breathing still sounded a little blocked but I had no clue as to the left or right nostril [Note: unless the parents allowed me to experiment and closed off one nostril at a time, ha ha]. The mother asked, "Is his nose still blocked? Where?"

As I lifted my head up, I visualised by chance "blocked energy" at the patient's right inner nares. I replied, "Yes, more on the right nostril."

The mother suctioned one more round and there was thick whitish mucus extracted from the right nostril.
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p.s. If anyone outside of my circle of close/psychic friends asks me, I shall totally deny the matters written here.

Tuesday, February 02, 2010

See no evil, hear no evil, speak no evil

I met my nursing buddy for a short chat after work today.

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Some days I feel like the 3 "no evil" monkeys - "see no evil", "hear no evil", and "speak no evil". There are things that happen in the wards and in the hospital that one has to be a monkey to not stick out one's neck to be chopped. E.g. Isolation policies that are "generously" bent, medication administration guidelines that are not followed, etc. Yet, once a decision is made by a higher authority, a monkey like myself can only keep my fingers crossed and hope that no incident crops up. This is because if an incident were to occur, we the new nurses are at the bottom of the "medical professionals' food chain" and may face the blame lecture, losing our license or worse.

That's where having my nursing buddy counts. We could offload the weight of such "corporate secrets" on our shoulders to each other. Things that we cannot tell anyone outside of our hospital. Yet, due to our differing schedule and other commitments, we could only manage a brief meeting once in a few months.