Made it through June, yeah!

Today is the 19th day of taking team for me. Made it through June, yeah!

Took the team with the rooms near the nursing station today. Started with 5 patients, of which 2 discharged by mid morning or early afternoon. Then 2 new cases arrived after noon, so the final total was still 5. Managed to complete the blank pharmacy billings and medications to-do list right after report passing.

2 SN (L and I), 1 HCA M and 1 SEN IV as runners (SEN IV on my team), the ward manager (NO) was in-charge. The admin staff M was also on-duty. The morning started off rather well. My patients were all in stable conditions. Served medications on-time, assisted 3 doctors on their rounds, discharged 2 patients, completed ward billings, answered call-bells, answered phone calls to the ward, reviewed case notes, documented events into nursing notes, and completed my flowcharts for the 3 remaining patients all by 1240pm. I even had time to assist the runners with meal ordering and entering, replacing missing patient information boards in the patient's room and preparing a room for new admissions.

Just as I was starting to tape my team's report around 1pm, there were suddenly 3 new cases of which 2 were for my team. From then the confusion started with the numerous admission related tasks to be done, diagnostic tests, referrals and medications to follow-up. SN L was busy with the new case on her team and could not help. Even with assistance from SEN IV and admin staff M, I did not finish with the items related to the new cases and had to pass report orally for the afternoon staff to follow-up. Luckily, my preceptor was on-duty in the afternoon and she reassured me that she will take-over and complete the outstanding tasks. I am really grateful to have her support.

2 challenges faced today.

1. NO's ideal expectations vs reality. This morning there was a doctor who came while the SNs and EN were busy with the morning routine. Given that we were busy, the doctor told us to continue with our work and that he didn't need any assistance. The admin staff offered our assistance again and the considerate doctor declined. SEN IV and I carried on with our work. The NO saw and insisted that we drop our work and assist the doctor instead. I grabbed the case notes and we (SEN IV and I) rushed after the doctor who was already at the patient's doorway at the end of the corridor. Then the NO came after us and lamented that we should be leading the doctor, not running after the doctor. I passed the case notes to SEN IV for her to assist the doctor. I was preparing an IV antibiotics that was due, so choosing to assist the doctor may result in a delay in medication that would provide fuel for another lament.

2. Simultaneous admissions of new cases during critical ward-busy time. There were 2 new admissions to my team, both arriving around 1pm. Confusion started with the arrival of the 1st child. Because the child vomited on the journey to the ward, the NO instructed SEN IV to bath the child immediately as per the mother's request. I completed the on-admission nursing assessment, administered the initial nebulization, prepared the oral medications and the diagnostic test forms for the case. The mother requested to delay the oral medications as the child was sleeping. SEN IV took the child's vital signs and applied Elma cream and while the admin staff called for the diagnostics staff to arrange for CXR. Even after the diagnostics staff returned the child from the CXR, the mother had not registered the child for admission, and thus the child's case labels were not available. By then the child was awake and I administered the 1st dose of PO medications. Since the consulting paediatrician was coming for a review of the case, I decided that there was no need to call the RMO (extra charges) for the blood tests and IV cannulation ordered. By then, the 2nd child arrived and I showed them to their room. I was looking at the specialist clinic's notes on the 2nd case and preparing the diagnostic test forms, when the 1st child's paediatrician came. Without even finding out why, she commented, "why so slow" that the child's IV cannulation was not done yet. Anyway, the NO and I assisted her with the IV cannulation and set-up the drip which she only ordered on-the-spot. Then the mother decided to upgrade to the deluxe room and HCA M and I moved their items to the new room because SEN IV was busy. This resulted in a delay in attending to the 2nd new patient. Seeing that I would not be able to complete this admission and the outstanding nebulization due for a current patient, I tasked SEN IV to do the initial nursing assessments. I quickly started the nebulization for the current patient, and returned to the 2nd new case to administer oral medications and started the nebulization. Then diagnostics staff came to collect the 2nd new patient while the nebulization was in progress. The NO instructed that we interrupt the nebullization to let the child go for CXR 1st. I hesitated, the IMR record of the nebulization timing would have to reflect this non-standard interruption. Fortunately the NO changed her mind and said to finish the nebulization first. Thereafter, I went to pass oral report for my team to the afternoon staff.

Had time for tea, but did not have time for lunch or toilet break. I was actually somewhat hungry, but did not feel like eating at the staff room after a stressful early afternoon. In the end, I took my packaged lunch home and ate only around 4pm. Emoticon for the day :-|

p.s. I was surprised to see SN L sitting at the bus-stop when I knock-off half an hour after my official shift time. I went over to chat with her, to ask her why she was still there despite having left earlier. It turned out that she was so tired that she fell asleep while waiting for the bus and would have continued if I had not approached her. My experience is similar. I often fall asleep on the bus journey home even though it is a short trip of less than 15 minutes.

Relaxing day

Took the team with the rooms near the nursing station today. Started with 4 patients, of which 1 discharged by late afternoon. Managed to prepare the medications to-do list before taking report.

2 SN (L and I), 1 HCA M as runner and my preceptor as in-charge. There were a total of 11 patients at the start of the shift. Today was a breeze. Had time to check through the pharmacy billings by the morning staff, update the ward billings along the way, serve medications on-time, answer call-bells, answer phone calls to the ward, review case notes, document events into nursing notes, assisted with an IV cannulation, top-up supplies in the treatment room and medication trolleys, help to serve dinner, and monitor some vital signs. I off-ed some hourly monitoring as soon as possible to cut down the sole runner's workload. By 8:40pm, I completed the flow charts and taped my team's report. While the night shift staff were taking report, a new case came and I handled the admission assessment.

At one time, my preceptor, SN L and I chatted at the treatment room as we made custom splints for infant use. Then a doctor arrived to review his patient. Although the doctor's patient was under my team's care, I did not move as I did not recognise him. Thus SN L stepped forward to assist the doctor instead. One of my areas for improvement is to recognise the regular consulting doctors.

Had time for tea, toilet and dinner break. HCA M shared some snacks from Australia as she had visitors arriving from there. SN L, HCA M and I are on-duty together again tomorrow morning. The ward manager will be in-charge. SN L and HCA M are genuinely helpful and supportive. Glad to be working with them. I am also thankful for the support and supervision from my preceptor.

Period blues

Took the team with the rooms near the nursing station today. Started with 6 patients, of which 3 discharged mid-to-late morning. Went in earlier to prepare the blank pharmacy billings and the medications to-do list.

SSN R and I were taking teams. HCA K was the only runner today for the whole ward of 13 patients, including 1 elderly adult lady. SSN Y (my preceptor) was in-charge. Before the shift started, I thought today would be a breeze, given that the 6 patients were rather stable and 1 was confirmed for discharge, and I did not have any medication pending supply urgently. Early in the shift there was a delayed medication in the morning. More about it below. Then accompanied a doctor on his patient review. Then in view of the confirmed and KIV discharges, I started entering the pharmacy billings forms and ward billings. The breakfast trolley arrived while I was updating the billings and preparing a morning dose of IV antibiotics for a neonate, and HCA K was busy taking the 6am round of vital signs monitoring (which was normally done by the night staff). For some reasons, SSN R instructed me loudly to serve the breakfast 1st, then my preceptor SSN Y heard and and repeated the same instructions. I didn't feel good about it. I was planning to serve breakfast once the antibiotics was ready. However it seems that the SSNs did not understand so, even given my usual initiative on such matters. After the rush to serve breakfast, I forgot about the interrupted antibiotics preparation and attended to other matters instead. Then my preceptor reminded me to get it done stat. I quickly completed the IV antibiotics and continued with preparing PO medications for the neonate. While I was doing that, another doctor arrived to review another child and I had to attend to her. The doctor decided to discharge the other child, so I started with the discharge paperwork. However, I was interrupted to attend to call bells, phone calls, and medications due. With interruptions upon interruptions, I missed out the housekeepers' request for the air-con man to clean a vacated isolated room's air-con, despite their repeated requests. I don't feel good about it. In the end, the discharges were completed by my preceptor. By late morning, I was exhausted and wondering if I would even have a toilet break, as I suspect my period had arrived. Managed to give all the other medications on time, completed the pharmacy billings and ward billings, the flow charts and taped my team's report before the end of the shift. However, in my attempt to append to my team's report, I accidentally cleared my earlier report and thus had to pass report orally instead.

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There was 1 medication due in the early morning postponed from the night shift staff because the child was sleeping and the grandmother wanted to wait for the child to wake up. It took several attempts spread over 3+ hours to complete that dose. When I first checked on the child at 730am, he was still sleeping. When the child awoke, the grandmother insisted on adding the medications into 200 ml of milk which child completed only half. Then the grandmother insisted on waiting until after the child had his breakfast porridge before feeding the child the remaining medication. However, the doctor came in for review and the grandmother noted to her about the incomplete medication. The doctor probably wasn't pleased, because my preceptor instructed me to top-up for the shortfall stat, by PO neat. In an attempt to coax the child to drink, the grandmother fed the child with fair amount of water immediately prior to the PO neat medication. While struggling against his medication, the child vomited a fair amount of fluids and undigested porridge together with the PO neat medication. Thus we had to wait another 30 minutes to an hour for the child to digest before a next attempt. Thereafter, I warmed up the remaining 100 ml of milk because grandmother wanted to feed the medication-in-milk instead, but the child refused to drink. At my next attempt, the physiotherapist was about to suction the child for mucus for diagnostic tests. I helped with the suctioning which was quick and, of course, the child struggled. Then the grandmother warned the child angrily that if he refused to swallow the medication, he will have to undergo further suctioning. Finally the child co-operated and swallowed his PO neat medications. By then it was almost 11am.

Lessons learnt: Always advise care-givers to give medication before food, not after food, unless otherwise indicated. In addition, medications should be taken with minimal fluids, to reduce changes of regurgitation by child.

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Did not have a tea break. Finally after 12 noon, I took a quick toilet break to wear a sanitary napkin for my period. My panty was already stained but fortunately not my uniform. Thankfully, a housekeeper offered to pack lunch for me around 12 noon and around 1pm I had a chance for lunch (which was also interrupted). At the end of the day, I felt exhausted and blue. I put it down to a combination of having high expectations of the day which fell through, not enough sleep due to the PM to AM shift switch, and the arrival of my period. I have 2 weeks to go before the new nurses orientation and training. Am counting down to it.

p.s. A major challenge of an SN is the numerous interruptions-upon-interruptions to her work. At some hospitals where there are more supporting staff (admin staff, ENs and HCAs), the SN on medication-round wears a vest indicating that she is not to be interrupted. This and other work processes to structure an SN's time are not implemented in my hospital. This is probably due to limited staffing and the customer service expectations (from consulting doctors, their patients, and the patients' visitors) of a small private hospital. Given the hierarchical staff structure of the wards, being an experienced staff in the ward also helps to manage the interruptions.

Pay day!

Took the team with the rooms near the nursing station this afternoon. Started with 7 patients, including 1 new case admitted in the early afternoon pending the doctor's review during report passing. After 2 discharges in the mid/late-afternoon, left with 5 patients. Went in earlier to review the pharmacy billings and prepare the medication to-do list.

There were 2 SN (L on double-shift and I), SEN IV as runner (for both team 1 and 2) and SSN R as in-charge. The ward manager was on-call, and was physically in her office until evening. During report passing, the blank IMR for the new case was taken by the reviewing doctor to write her prescriptions. In addition, another doctor arrived and took the IMRs for his 3 cases. Thus during report passing, I had only 3 of the 7 IMRs for reference and felt a little confused. Right after report passing, there was 1 IV cannulation and other follow-up actions for the new case, 2 discharges, and 2 cases of fever spike all happening together on my team. Luckily my colleagues helped. SEN IV autonomously managed the neonate fever case with cold compress and tepid sponging as there was no antipyretic prescribed due to its age. SSN R helped me with the paperwork for the discharges and discharged 1 case, while I followed up the new case. Even SN L offered help. Parents of the new case wanted to stay overnight but their son is above our cut-off age, and thus an overnight companion is not allowed in a shared room without medical justifications. More about this later. 1 delay to the early afternoon medication as the IMR was stuck with the doctor doing his reviews. Fortunately by mid-afternoon the confusion settled down. Managed to follow-up the rest of the medications on time, explained the for-home medications to the parents of a discharged patient, updated events in the nursing notes, added items to the pharmacy billings, and entered the ward billings into the system. As the runner was busy when the dinner trolley arrived, I served dinner for the ward. Near the end of my shift, I completed my flow charts and taped my team's report.

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The new case was a 13 year-old boy turning 14 this year. His mother was fussing about him in the early afternoon while he seems to be sleeping away. When she was told of the hospital policy initially by my morning colleague, she requested for a single room so that she could be a paying overnight-companion for her son. However, a single room was not available at that time. When I took over and advised her that a suite was available, the mother insisted on speaking to the supervisor about making an exception for her request to stay overnight with her son (i.e. without additional charges in the shared room) instead of considering the suite. Later, even when a single room was available, the mother still did not want the room but wanted us to make an exception for her, claiming that her son was too young to be left alone. Yet, she left her son alone in the mid-afternoon. After she left, her son was actually more awake and alert, spending his time watching TV. In the evening, both parents returned. When I asked the father if he still wanted the single room, his 1st concern was whether his son coped with being alone that afternoon. I replied the parents that their son seems fine and was watching TV. Then the father decided that neither parents need to stay to accompany the son that night.

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Did not have tea or toilet break, but had time for dinner. Nevertheless felt rather contented at the end of my shift. Was also very happy to receive my payslip today. It reminds me that I have survived here for almost 1 month. It would not be possible without the help and support of my colleagues.

p.s. SSN R, who has her own teenaged son, commented that the mother of the new case pampered her son too much. She felt that at 13-turning-14, a teen should be more independent, otherwise the boy would not survive NS (national service conscription). I agree. My mother molly coddled one of my brothers. My brother never mentioned it, but my sister heard from other sources that he did not fit during NS. Now even as an adult in his 30's, he still lives like a dependent child with my parents.

Runner

Today I am the runner for both teams 1 and 2. Started with 12 patients. There were 2 new admissions, 1 arrived early afternoon, the other late afternoon. Added to that, 1 case transferred-in early afternoon and was discharged by mid-afternoon. Of these, there were 2 elderly "risk for fall" adult females (in 4-bedded), and 2 adult males in a double room. Of the paediatric cases, there were 5 isolation cases, of which 2 required gowns, gloves, and mask.

Limited staffing today. Only 3 SN (L, O, and I) and my preceptor in-charge. Thus I was the only runner (literally) for the whole ward of about 14-15 patients. Managed to serve tea and dinner, complete the outstanding meal orders, monitor the 4-hourly vital signs, chart and sum the intake-output, monitor some patients hourly (off 1 case that was no longer critical), enter a couple of ward billings and attend to some call bells. Had to spend a lot of time assisting a risk for fall case to toilet, urine collection and body sponging. In the end, SN L and O had to cover some of the hourly monitoring entries, call bells, etc.

Glad that the day is done. Fortunately I managed to have tea, dinner and even 1 toilet break (towards the end of the shift). I am so physically exhausted. Luckily I turned down the request to do double-shift tomorrow. I need the extra sleep-in tomorrow morning to recover from today's busy shift.

p.s. The housekeepers mentioned today that they like having me around, because I would still be cheerful when the ward goes crazy-busy.

A good day

Back to work after day-off yesterday. Took the team with the rooms near the nursing station this afternoon. Started with 7 patients, including 2 adults post-op. 1 child was discharged in the mid-afternoon and 1 adult in the evening. Then there was 1 new child admission for a minor surgery in the late-afternoon. Thus ended my shift with a total of 6 patients under my team's care, of which 1 is an adult post-op case. My morning colleague did the pharmacy billing forms already, so I just added on the stuff that I used. I went in earlier to draw up the medications to-do list before taking report.

2 SN (J and I), 2 experienced HCA (M on my team and K for SN J), and my preceptor in-charge. Fortunately, the post-op cases where rather stable, and so were the paediatric cases. SN J helped me by assisting a doctor for a dressing at the male private part. Later at the staff room, she shared with us how the ang-moh wasn't shy to openly show his penis even with his wife around. In addition, she was amazed at his huge penis. We had a good time laughing over it. Later I saw the penis when discharging the patient, it is only average size for ang-moh males. My preceptor helped me with the paperwork for both discharges. I discharged both cases, and did the complete set of case notes for the new surgery admission case. Ok, I missed out some fields in the consent form and my OT colleague called me to complete it :-P All medications were done on time, entered items for the ward billings and the pharmacy billing forms along the way, popped down to pharmacy twice to collect medications before they were due. I even had time to prepare milk for a child and clean and sterilize some milk bottles. Near the end of the shift, I completed my flow charts and taped my team's report.

Today is a good day. I had time for tea, collect dinner from the staff canteen, and dinner break. My preceptor and fellow colleagues were very encouraging. While waiting for the night shift report passing to be completed, we chat about possible themes for this year's Christmas decoration. Our ward had been a winner for the past 2 years, so the ward manager is hoping to win again this year.

p.s. Today the parents of a paediatric patient in a double room suddenly requested for a single room when the surgery case was admitted to the other bed of the double room. My colleagues told me that it is the trend with some parents. They are ok to be paying the lower rate of a shared room until another paediatric patient takes up the other bed(s).

Day 14

This is my 14th day of taking team. If you are wondering why I had not taken team as part of my student training, it is because my sponsor's management did not support student nurses functioning as acting-SNs. Thus during my student days, I was assigned to EN or HCA roles. It was only occasionally when the SN is generous or too busy that I was allowed to handle some medications.

Took the team with the rooms far from the nursing station again today. Started with 9 patients this morning, the same 9 that were there when I left yesterday night. That helped, as I was getting familiar with the patients and their parents' preferences. There were 3 discharges, of which 1 patient whose parents cancelled the discharge and decided to stay 1 more day. I went in earlier in the morning to get the blank pharmacy billing forms ready and managed to complete the medications to-do list before taking report.

The admin staff M and 5 nursing staff were on-duty. 2 SN (J and I), 2 experienced HCAs (M and K) and my preceptor as in-charge. HCA K was assigned to my team. Managed to give all the medications on time, except for the delays requested by the parents. Followed 3 doctors on their rounds and did the follow-up. I still have problems recognising the infrequently-visiting doctors and thus ended up running after them to the patients' bedside. My preceptor and SN J helped with the other 3 doctors' rounds, co-ordinating 1 patient's trip to a doctor's clinic (maybe this was done by the admin staff) and the paperwork for 3 discharges. My preceptor also did a wound dressing on my behalf as I was busy with medication and discharging a patient. Finally, just before report passing time, I managed to finish the flow charts and taped my team's report. During report passing, I did rounds with a doctor and the follow-up. When I was done, my afternoon colleague told me give the 2 pm IV medication for a patient. This is because they are passing report at that time and thus I should cover all medications until my shift is officially over. [Morning shifts are from 7:00am to 2:30pm, afternoon shifts: 2:00pm to 9:30pm, and night shifts: 9pm to 7:30am.]

Did not have any time for tea, lunch or toilet break. After my shift was officially over, I ate my lunch, filled up the pharmacy billings forms and entered the ward billings into the system. It was 3:15 pm when I was done. Still, I am glad that I've survived another day. I am very thankful for my colleagues' help, especially my preceptor's support. I am very lucky to be assigned to her.

One more day!

Took the team with the rooms far from the nursing station again today. Started with 8 patients* (including 1 transfer), then there was 1 admissions near the end of the shift. Arrived earlier this afternoon to draw up the medications to-do list. Managed to do it except for the 1 transfer patient whose IMR was switched over to my team during report passing itself. Due to the need to get pharmacy supplies, 2 IMRs where sent down during report passing after my review.

3 staff plus in-charge for a total of 10 patients*. Besides the 1 SN for each team (J and I), there was only 1 experienced HCA K as runner and my preceptor as in-charge. Was quite ok today. Managed to give medications on time except a little delay for an IMR sent to pharmacy for new supply. Took a 10 min tea break at 5+pm. Around 6+pm, I even have time to serve meals with HCA K and a quick chat with the housekeepers. Then I started preparing for 7pm medications, followed by a 15 min dinner break. I had 1 IV antibiotic in-progress, 4 nebulizations and 1 more IV antibiotics to administer. However, right after I had dinner, it started being rather chaotic. 1 patient's parents requested delaying his medication because he just had dinner. 1 room at the far-end had a spoil call-bell, which resulted in several trips to the room to check if it was a real request or a false alarm, and a call to maintenance. 2 set of parents spent some time voicing their concerns and/or preferences to me. A patient X had moderate fever, and her father rejected a 2nd fever medication, insisting on having a cold pack and waiting for the next dose of his daughter's 1st fever medication. More about him later. By 8:30pm, my preceptor decided that I wasn't going to make it in-time for the flow charting, report passing and billings, and thus helped me with them. Then 1 patient's parent complaint of her child's sudden tongue ulcer and I called the doctor for his phone-ordered prescription. Then a new admission came, and luckily the other SN helped me with it. Thereafter, I settled the oral gel for the ulcer patient, and nebulizer and medications for the new patient.

When the night staff in-charge took over, she questioned me why a TDS medication was given all by 11am and why I did not question the morning staff over it. Yes, I puzzled over that too, but I didn't question the morning staff as she was busy filing her pharmacy orders at report passing. However I have learnt from my student days that it is better to keep quiet in such cases. This is the typical nursing culture in Singapore. Many "old-school" experienced nurses and/or foreign-trained nurses ask rhetorical questions to push the blame, not to clarify an issue.

At 930pm, patient X's father demanded why we did not give his daughter the 4-6 hourly 1st fever medication on-the-dot after 4 hours at 9pm. He then blamed the minor increase (38.0 degC at 8:30pm to 38.2 degC at 9:30pm) in temperature on the 30 min delay in medication. While I understand his concerns over his daughter, I really do not like this father's attitude. He was the one who rejected the 2nd fever medication, insisting on having a cold pack instead. Now he turned around to blame us for a minor increase in his 12 year-old daughter's temperature when frankly her fever is not even considered high by hospital standards. HCA K told me that he was still kicking a big fuss to his wife about the matter when she went in to take the girl's temperature immediately after medication. He even demands additional temperature taking as-and-when he wishes (e.g. before and after medication) when his daughter is already put on hourly chart, which incidentally is not needed given that her fever is not serious. [Note to self: To off-this unnecessary hourly monitoring 1st thing in the morning. No point giving extra service to such FON clients.] If the father was really so concerned for his daughter, the least he could do was buy a thermometer and take her temperature as-and-when he wishes. After all, an electric axilla thermometer costs only $5 these days, definitely affordable to this white-collar working couple. Plus, the parents have a treat-nurses-as-maids attitude from their just sitting there and wait for the nurse to serve their darling daughter water after her syrup medication as per her preference. Actually water immediately following medication not encouraged by my NO, but I did it because I wanted to encourage the girl to take more fluids. Honestly, if he wants a nurse who can be at his beck-and-call, he should pay for a private nurse (a nurse dedicated to attending only to his daughter). Incidentally, going by their names and accents, this family is from PRC. It is this type of foreigners that I as a born-and-bred Singaporean do not welcome, no matter how rich or talented they are. Fortunately, most parents have more social grace than this PRC couple.

One more day to my day-off! I am so looking forward to it.

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[Addendum on 09-Dec-2011]

*Note: If you're wondering about the seemingly inconsistent patient numbers 8 vs 10, here's the explanation. That day, I was assigned 8 patients + 1 new admission, whereas SN J had only 1 patient for the whole day. However, the in-charge decided that there was no need to balance the workload between the 2 SNs. Other than instructed by the in-charge to attend to the new patient admission at the end of the shift, SN J did not help me at all. However, if her team was suddenly flooded with new admissions, I would have been tasked to assist her. I leave it to my readers to draw their own conclusions on the dynamics of my ward.

Dampeners

Took the team with the rooms far from the nursing station again today. Started with 9 patients, then there were 3 discharges after doctors rounds and no new admissions, leaving a total of 6 patients at noon. Arrived earlier this morning to do the medications to-do list and pharmacy billings in advance, but did not complete the pharmacy billings before taking report.

4 staff, 2 on each team, plus ward manager (NO) this morning. At report taking, the NO stated that given my inexperience, I have SEN MY on my team who can give nebulizer, flush IV lines, change IV drip, off IV cannula, discharge patients, etc. However, in reality, SEN MY was reluctant to act beyond a HCA role today. Perhaps she was also too busy with her runner's tasks. Each time she does something that is not a HCA's job, she would remind me loudly, "I helped you to ... already." For any concerns raised by parents, she kept saying, "I tell you already, ah." and left the issue as that. Even when I told her I was too busy to attend to the issue immediately, she did not step-up to the challenge and cover the matter as an EN. When I requested her to perform a task or to inform me of any febrile or low-grade fever cases, she didn't look happy. I overheard her complaining loudly to someone (probably another colleague) that she cannot find me, when I was in the treatment room preparing IVs for the patients. This reminds me of the times she accused me loudly, "You always don't switch on the light (in-attendance indicator), I cannot find you."; and how she sometimes switch-off the indicator without first checking if there is another staff in the same room attending to another patient, and then turnaround to accuse the staff (e.g. me) of not switching-on the indicator.

The above would not be such a problem if I am an experienced SN. However, as a newbie, I needed help to gradually ease into my role. Today, 1 doctor was upset because he omitted prescribing a rash cream that a patient's parents asked for, the parents had asked SEN L for it. I was busy when she reported the matter to me, so I checked the IMR and told her that the doctor has not prescribed it yet. It was over an hour when my colleague SN L helped me by calling the doctor to confirm the missing order via phone. Add to that, annoyed another doctor today because I was not quite ready with all the stuff that he wanted on-the-spot for wound dressing and I did not know his preferences as it was my first time assisting him. Perhaps, I did the wrong thing by allowing the mother to observe us when the doctor was reviewing and dressing the patient. I was told by my colleagues who assisted him the past few days that he is a DIY-guy, so I was surprised when he wanted me to assist him. I wanted to prepare gloves for him, but the NO said no need, so I did not prepare any and had to rush to the nursing station to get when he asked for it.

On a happy note, I managed to give all the medications on time, except oral medications for the patients who are discharged for home. Their medications and IMRs had been sent down to the pharmacist for dispensing back to them if needed. The NO or SN L helped me with some of the discharge paperwork. I did 2 of the discharges and SN L helped me with one. Thereafter, HCA K helped checked through that the case notes were transferred properly into the case history files. I was surprised and thankful for SN L's support today. Happily, I had time for a 15 minutes lunch break. In addition, I finished the 6 outstanding pharmacy charges 10 mins after the official shift ending time. Had to call the ward after work about 1 item that I missed billing and an instruction from a patient's parent that I omitted in my taped team report.

At the end, just before I left, I received another dampener. Apparently, the mother of the emergency operation case confided with a night-shift colleague, who then informed my NO. On the morning of the emergency operation, the NO put SN J in-charge and instructed me to take team. SN J received a phone call from the doctor to prepare for the emergency operation and she rushed me to get the consent for operation from the mother immediately. I hesitated for a moment, but decided to trust SN J since she was in-charge. Unfortunately, the doctor had not informed either parent yet, so it came as a shock to the mother when I informed her about the need for surgery. Today, when the NO mentioned about the matter, I admitted to my part. However SN J just kept quiet and did not even offer to clarify that she was the one who instructed me get the surgical consent without first checking if the doctor has spoken to the parents. Sigh, result of trusting the wrong colleague, miscommunication and bad timing. Luckily, the NO just instructed us not to give bad news to the parents so fast in future.

Another day done

Took the team with the rooms far from the nursing station again today. Early in the afternoon, there were 2 new admissions, making a total of 9 patients. During report passing, several IMRs for existing patients were missing as they were clipped to the case notes for doctors' rounds. Thus I could not complete my medications to-do list in advance.

The 2 new admissions were mainly handled by my preceptor and the SENs. Although SEN L was assigned to another team, she helped me out with the pharmacy billings and getting ward-stock for new cases, when she saw that I was floored by the returned "missing" IMRs and those of the new cases. At one stage, even SN O who was taking the other team, came to my side of the ward to help answer call-bells. Then SEN MY who was reputed to care only for her own tasks, surprisingly offered to help flush IV cannula after antibiotics. My preceptor did the billings and the handover report. Near the end of the shift, my preceptor joked that with 4 people helping me, I will have support whichever direction I fall. Thank goodness for their help.

My colleagues kept reminding me to take my dinner break. I managed to take a 15 min dinner break today. :-) Yes, I managed to cover all the medications on time too!

The 3 musketeers

Took the team with the rooms far from the nursing station today. During report passing, there were 3 patients transferred to my team. Thus, I had 8 instead of 5 patients. Then mid-afternoon, another 1 more patient was transferred over, making a total of 9.

Started-off ok. Then I lost track of time after following 2 doctors on their rounds. Some medication was delayed as a result. Luckily, a very experienced HCA K was assisting me, so she helped me keep close tabs on the patients. SEN L, who was on the other team, even offered to cover me so that I may eat my dinner. I thanked her for the offer but decided that I had to continue so as to improve my skills. Later, when it looks like I wasn't going to complete on-time, my preceptor and the capable SEN L came to my rescue. Thanks to them, things were reasonably completed at the end of the shift.

SEN L joked that it will be my preceptor, her and me, "the 3 musketeers" again for tomorrow's afternoon shift. I still did not have any toilet, tea or dinner break today, but I ended work feeling happy. I am very grateful to have supportive colleagues guiding me. Hope I will make the cut and be an effective member of the team.

L-plate

Still struggling today. Under my care: started with 9 patients, then 2 discharges, and 4 admissions. Would be full-house if not for 1 double room converted to single. Only 1 SEN on the team, but L is a very capable lady. Managed to give all medicines on time, so there's a bit of improvement today. However, relied heavily on my preceptor and colleagues' support for the other matters, e.g. discharges, admissions, doctors' rounds, pharmacy charges, billing, etc.

My beginner's jitters is still there and is slowly creeping up on me. I have to remind myself that I am still on L-plate.

p.s. I still did not have time for any tea, toilet or lunch break. I am thankful that today the housekeeper helped me to pack lunch, which I ate at 3:30pm (1 hour after my shift officially ends).

Doubled workload

First thing that I noticed as I stepped into the ward this Wednesday afternoon was the tense atmosphere. My guess was it had been a busy day for the morning staff. Then I learnt that the toddler that I wrote about on Sunday had another emergency operation this morning. He only returned to the ward at 4pm, drowsy from the medication. Hope that he will get better soon.

Had be taking team daily since 15th June. For the past 2 weeks, the census was low at 1 to 5 patients under my team's watch. However, there were 9 patients this afternoon. I struggled through today's shift. Several parents requested to delay medications. They also wanted to air their concerns over their children's health. A "please supply" request sent to pharmacy had surprisingly returned without the medication, even though it was written as supplied. Unfortunately, I did not realise till the medication was due. The IMRs repeatedly missing or disordered.

In addition, something seems to be affecting my interaction with SEN M on my team today. Initially it was another SN taking her team today, but just before the handover report the ward manager swapped me over. During the handover report, she snatched the IMRs from me before I had completed reviewing them. She helped me to check that the morning team had completed their medications as required. However, she did not return the IMRs to me when she was done. When the post-op patient returned, the SEN kept ordering me to do the hourly NGT aspirate even though she was able to do it. Then she informed me about a parent's request for medication. She could, but did not, explain to the parent that it can be given together with other medications at a later time. On my side, I made the mistake of not communicating this fact directly to the parent involved either. Thus, SEN M claimed that the mother was very upset (although the mother was rather nice to me when I attended to her subsequently). I do not know what is happening between me and SEN M. During the past fortnight, she spoke to me in stern tones about things that can go wrong with various details but I took it as her way of guiding me. Today while the ward manager is around, SEN M felt like a hawk over me. At other times, I could not locate her for assistance. At the end of the day when I thanked her for her support, she didn't acknowledge me.

In honesty, I am not proud of my performance today as an SN. My incompetence had resulted in some delay in medication timing, although nothing serious. Hope things will be better tomorrow.

p.s. I did not have any tea, toilet or dinner break throughout today's shift :-(

Feelings at work

I started taking team as part of my on-the-job training to step-up to a staff nurse's roles and responsibilities. Fortunately, the census was low and the cases simple. With much help and guidance from my colleagues, I managed to take team 6 times in the past 1+ week.

Then early yesterday morning, there was an emergency operation for an in-patient whose condition had deteriorated suddenly during the night. The child's mother was naturally very affected by the need for an operation. Her tears flowed uncontrollably. It was to be the second operation in this young toddler's life.

I had grown to love this joyful, active and loving child. Even as I comforted the mother, I had to stop myself from feeling the mother's pain. For I had to get on with the day's work and I knew my low threshold for holding back my tears from my student days. [Note: Back then, I had to excuse myself to cry in the toilet when an elderly patient passed away.]

Fortunately, the child was stable post-op. I prayed in my heart for a speedy recovery for the child.

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28-June-2009 Addendum: The child recovered and was discharged a couple of days ago. It is really wonderful to see the child back to his usual cheerful, active and loving nature. While it was nice to receive a customised gift of appreciation from his parents, I was even happier to have played a small part in improving a child's life and appreciate the parents' trust in our care of their child.

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August-2009 Addendum: The child came back for a visit with his parents late one evening. After chatting awhile, he became tired. Then he pointed to his hospital room and said, “躺躺！” ["Lie down, lie down!"]

His father explained with amusement, "He is tired and wants to sleep back at his old [hospital] bed!"

Another friend leaves the red dot

Just spoke with my friend LC. We have known each other since 1996, but have met less than 5 times. Typical of many colleagues-turned-friends from MNC environments, we hardly meet face-to-face. Our rapport was build through voice, messages, and email.

The financial boom of mid-2000's brought him to Singapore. However, with the financial markets now in doldrums, he has to return to Europe to await for a comeback. Good thing about this friend is once he envisioned a target, he is hardworking and very adaptable. He is one of the few people I know who made a successful major career switch, from civil engineer to financial dealer. My hat's off to him for that!

Getting started

I was getting used to my idlic lifestyle. Then 2 weeks ago, my course manager informed me that I will be able to graduate together with my classmates despite the delay in my completion. That kicked-off a series of events which led to my starting work this week.

On the 1st day, after spending half the morning at HR, I returned to my ward. With a new hair cut, new uniform colour and wearing a surgical mask, some of my colleagues mistook me as a Staff Nurse from another ward. E.g. HCA M said, "Yes, can I help you Staff Nurse?" We had good laughs over it.

On the 2nd day (1st full shift), I realised the almost 2 months break made me somewhat rusty already. E.g. One doctor wrote "FBC CM". I was looking for the investigation test represented by the short-hand "CM". After a while of fruitless search, I gave up and asked my in-charge SN J. She replied, "FBC CM."
"What test is CM?"
"FBC coming morning!"
And we had another round of laughs.

Don't know yet if I will make it as a staff nurse, but am sure glad that my colleagues are supporting me on my learning curve.