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.