Taxi! Get me to work

It's a sign of my declining morale at work. I have taken a taxi to work 4 times in the last 3 weeks. Mainly because I was dragging my feet in heading for work.

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[Addendum on Wed 04-Nov-2009]

Took taxi to work again on 31st October, thus giving a total of 5 times in October.

It's only the beginning of November and I already took taxi to work once in November. That is, today Wed 4th November.

Flash mob. Wish I was there!

Someone posted Flash Mob at Raffles Place 23.10.09 online. Wish I was there!



Quite honestly I cannot imagine my current colleagues taking part in a flash mob. They were rather non-sporting participants in a Michael Jackson imitation dancing contest during a company cruise. That is, to describe in Singlish, they "kenna arrowed" and then they "bay-lek bay-lek".

Suddenly, I miss my ex-colleagues from my previous career in the CBD (Central Business District, including Raffles Place). I can imagine us joining in the Flash Mob if we were there. Unfortunately, most have left Singapore, either back to their homeland or for better shores.

Unbearable pivot of not-here, not-there

I don't feel so good about work recently. The following e-mail to my friend provides a summary of my thoughts.

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Hi [edited],

I just spoke with the [edited] High Commission officer this afternoon of Tuesday 20-Oct. She informed me that she has received my passport but not my medical check-up package. As she wanted to process my application quickly, she enquired about the date of my medical check-up. After we hung up, I called the doctor's clinic and they told me that the High Commission's Immigration Section has already received and signed for the package on the Friday 9th October. Unfortunately I was unable to call back the [edited] High Commission officer to inform her of the update from the doctor's clinic. I'm keeping my fingers crossed that my medical check-up package is sitting in someone's in-tray and would be found and processed accordingly.

I have read further on the [edited: overseas location] requirements to be an RN. It seems like it may not be so straight forward. [Edited: snipped off details of the process.] Still I am so looking forward to move over.

Air my grievances a bit here. Recent days at work were somewhat frustrating.

• My ward manager wants to create High Dependency Unit in our ward. However we are understaffed at RN levels. Thus when HDU cases come in, the priority of getting their treatment done often results in compromised/delayed treatment to the regular acute patients. Of course, nobody wants to highlight this problem because no one wishes to face investigation into his/her nursing care.
• Another issue is the unclear boundaries of EN roles in my ward. One of the SEN told me directly that the SENs (especially those who are foreign RN-trained but downgraded to EN in Singapore) feel unhappy whenever they see fresh graduate RNs joining the ward, taking higher pay and yet are less skillful than them. In addition, the hospital is now putting emphasis on developing the RNs, and thus, the SENs feel neglected as second class employees. As a result of some unpleasant past experience (before my time), the SEN told me not to expect them to perform beyond HCA-level work for me or any new RNs when they are assigned to our teams. They are only willing provide EN/RN assistance to Senior RNs or the ward manager. While I appreciate the candidness of that SEN, I feel that she is misplacing the focus of her problem. Taking out her frustrations on the new RNs will not improve her future.
• Coincidentally, my preceptor chatted with me on a related topic one day before the SEN complained to me. My preceptor is a Senior RN who had been in the ward for 20+ years. She told me that previously there were only RNs and HCAs. Before the ENs joined the ward, the RNs petitioned against their recruitment. The reason was that the RNs did not want an EN level with an unclear scope of duty. In the end, ENs were still recruited to the ward.
• The ward staff also had some issues with a specialist doctor recently. According to my ward manager (NO), that specialist is trying to control the ward nurses by making us look and feel bad, so that he has someone to push the blame to if his fussy patients lodge a complaint. My NO also said that part of the problem is that nurses do not have a union and when incidents occur, they tend to back-stab each other instead of supporting each other. The solution was to have a strong nurses' union, which unfortunately does not exist in Singapore. [Edit: In fact, Singapore's workers' union is a joke, but that's another story.] My reply was, "it will change", to which the other experienced nurses (including my NO and my preceptor) gave cynical smiles. Actually, in my mind my thoughts were, "It will change. At least for me, it will.

" Of course, my ward manager does not know that I have migration plans.None of the above is really my problem, of course, but it makes my work less pleasant as a new RN. For now, the only thing that keeps me cheerful at work is when each child gets well and runs around happily.

Oops, sorry for my long-winded venting. Hope things are good with you. Will keep you posted of any further news.

Best Regards

Ma-ma scolded auntie this morning

I chatted with a 2 year old boy while giving him his last dose of IV antibiotics before his discharge this morning. I happened to enter the room at a bad time, when the mother was scolding the maid fiercely over something. The mother quickly paused from lecturing the maid, as I informed her about the last dose of antibiotics. While fixing up the syringe driver, I asked the boy about his morning activities to check on his intake and output. An extract of the conversation went as follow.

"What did you eat for breakfast?"

"Pancakes, and xxx, and yyy."

[And we went down the list of breakfast items.]

"So did you like the pancakes?"

Boy smiles, "Yes, mmm."

"And, what did you do after eating the pancakes?"

The boy's face changed from happy to upset. He blurted, "Then ma-ma scolded auntie."

An awkward silence. The mother was embarrassed. The maid stood away, looking anxious. I quickly switched the topic to the syringe driver, "Hmm, ok. You see this, it is to push the medicine slowly into your body..."

Later, the mother informed me that they had lost the TV remote control. It was last seen on the sofa bed early this morning. The mother verbalized that the maid said that the remote was gone after another nurse entered the room early this morning. As I needed to attend to another patient, I assured her that we will find it later. We may get the housekeeper's help for it. Then the mother thought of pushing out the sofa bed and searching the floor behind the bed. Just as she started to push one side of the sofa bed out, she saw the remote. It had slipped between the folding joint of the sofa bed and landed into the supporting base of the bed.

IMHO, a missing TV remote is too small a matter to be scolding the maid harshly over. I wonder if the boy had not blurted out the remark, would the mother realize the example she is setting for her child? Good parenting is no easy feat indeed.

Lucky for this ma-ma, the boy showed empathy even at his tender age of 2+. Such snippets of children's innocence and sincerity makes working at paediatrics a blessing.

Stupid

We had a 12 year-old girl with a proliferated appendix who went for an emergency appendicectomy on Monday. She had be on Nil-By-Mouth since post-op. In addition, she had an NGT (nasogastro tube), IDC (indwelling catheter), 2 IV drips (one Dextrose Saline for fluid intake and one Normal Saline with KCl for ml-by-ml replacement of NGT freeflow drainage+aspirate), a syringe pumping Morphine and 8 hourly IV antibiotics.

Today while assisting my colleague to change her hospital gown, I accidentally touched her NGT and she remarked audibly, "Stupid!"

I kept my cool and ignored her remark. Labelling the very people whom she depends on to get well as stupid? She doesn't realize the irony of her remark. Besides, unless her IQ prevails over 99% of the population, calling me stupid would mean she's even more so. Of course, she doesn't realize that too, ha ha!

Anyway, I shared about her remark with some of the afternoon staff when they came for work. Apparently this child has been rude to the other staff members yesterday too.

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After interacting with many children at work, I am beginning to understand why my ward manager often cite poor parenting as the cause of lack of social grace. I would reckon that 90% of the children we get are well-behaved considering their illness. The remaining 10% often have caregivers/parents that fall into the following categories.

• Parents/grandparents who treat the maids with poor social graces and the children copy likewise,
• Parents who assume that their maids will discipline their children without delegating to them the authority to do so,
• Parents who show strong favouritism towards one child over another, and
• Overly protective parents/grandparents.

While we cannot blame our parents for our behaviour as adults, I am persuaded that the foundation is laid during our formative childhood years. It would take much conscientious awareness on our part for change to occur. Sometimes though, serendipity plays a part.

New staff

I was taking team for the patients away from the nursing station today. SEN L was my runner today. We started with 9 patients under us, followed by 1 discharge, and 3 new admissions.

The adjoining ward wasn't open, thus SSN F and SN M were around. SN M was taking team for the patients near the nursing station. SSN F helped around for both teams. SN RB, a new employee freshly graduated from my local nursing school, was assigned to learn from me today. Although I had to spend some time showing SN RB some of the stuff, she had been a great help to me this morning. Add to that SSN F stepped-up to help me for stuff like NG aspirate, IV flushing, and patient's admission where SEN L wasn't willing. Even SN M covered me on a doctor's round while I was taping my handover report and HCA M, who was SN M's runner this morning, assisted to answer call bells. I am really lucky to have their help. Yet, despite the luxury of all the support I got, somehow we were still very busy this morning on my side.

Rumours are that the staff from the adjoining ward will be returned to their original wards when the adjoining ward closes permanently. I will miss them. Despite their laments to me about my ward, they have been personally supportive of me at work and voluntarily help me when they see that I'm busy.

SEN L was grouchy as usual. Her attitude is beginning to affect the quality of her work. I noticed a quite few temperature taken where the patients' temperature is recorded as 36.0 degrees Centigrade. Since she is a locally trained EN, I expect that she knows that this is not an acceptable temperature for children who are not warming up post-OT. I will observe her further before deciding on what is to be done to address the issue. I need to assess if this is a once in a blue moon event, or she does this slip-shot standards only when assisting me, or if it becomes a trend for her.

Topless sunbathing beds

I was assigned to take care of the ward's assets listing. On the recent asset audit day, finance lady NL and I searched high and low for 2 missing beds, but failed.

Today the ward manager NO and the admin staff M went around the hospital hunting for the 2 missing beds. It turned out that they were sitting outside the repairmen's workshop. NO described them thus.

"How can the beds be lying in the open air, under the rain and the sun? Gathering rust? Moreover the beds are without mattresses. It's like the beds are sunbathing topless!"

"If you say that to the xxx [repairmen's dept] people, they will tell you that they [the beds] are ang moh sunbathers [i.e. Caucasians who sunbathe topless].", I replied jokingly.

Good times, bad times, and fitting in

The ward census was not high since last Sunday. As a result the adjoining ward was closed, and their staff deployed either to my ward or other wards. In addition, my ward was opened for admission of adult patients.

Generally my past few days were pleasant other than this afternoon's FON mother and an FON adult female patient discharged 2 days ago. In a way, I am fitting into the ward.

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However, the same cannot be said of the staff from the adjoining ward who were deployed to join my ward. For example, SN SB told me her grouses yesterday morning at several brief intervals.

Sometime mid-morning, ADON G came to our ward. As several of the staff were at the staff room, ADON G saw SN SB at the ward area and asked her, "You know about the incident, right?"

The night staff had passed to us several issues, the most important of which was that a patient's uncle had complained of a water jug with an odd smell. SN SB replied, "Yes, you mean room XYZ who complained of the water jug with a smell?"

The ADON looked surprised and raised her voice asking aloud why no one told her about that incident.

SSN Y was in-charge that morning. According to SN SB, SSN Y was upset that SN SB leaked the cat out of the bag. SN SB was upset by the ADON's and SSN Y's reactions, especially since her information to the ADON was unintentional. Thus she shared her grouses with me. She told me that she plans to leave the hospital soon.

Then later at around 130pm, SN SB asked if I had taken lunch. I told her that I did not pack lunch from the staff canteen today because I intend to eat only after work. SN SB told me that she has not packed her lunch yet. I was surprised. I told her that our ward's housekeepers went around offering to pack lunch for us, which is the ward's norm. It could be that the housekeeper missed out SN SB because they were not familiar with her. SN SB then told me that she felt excluded because the other nurses knew that she was around and yet did not inform her about the arrangement nor did they tell the housekeeper to ask her. That added to her grouses.

I feel sad that SN SB didn't feel like she fitted into the ward and plans to leave the hospital. She is an experienced staff nurse and a wonderful teaching SN when I was a student nurse at her original assigned ward. She was subsequently transferred to the adjoining ward and now "kicked" (to use her own words) into my ward.

Another thought I had was that many of the nurse mangers and my ADON G need leadership training. Their common habit is to raise ruckus whenever they hear of any incident, instead of keeping calm and gathering the facts. Their behaviour may get one much attention and, hopefully, fast response. However, such a habit of making mountain out of every incident, regardless of it being a Mount Everest issue or a molehill, encourages staff to be on the defensive and thus impeding and/or defeating the problem solving process. In this regard, my NO is an excellent example to follow. Sadly, as I understand from my ex-nursing lecturer who previously worked in the hospital's sister organization, leadership training is sorely lacking at my hospital.

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After our shift ended yesterday afternoon, I sensed that SEN L was waiting around to speak to me confidentially. Finally after the other staff had left the staff room, SEN L asked me if I was interested in joining her at some events. It turns out that she joined an MLM company as she was interested in their beauty courses. At one point, SEN L said, “人此職的原因只有兩個，對工做沒興趣或者沒有前途。“ [Employees resign from their jobs over 2 reasons. Either not interested in their job, or there is no future in the job.]

I understood where SEN L was coming from. The school for registered nursing turning down her application for training to be an RN has had a big impact on her hopes. However, as I've mentioned to her on another occasion before, her nursing future is not limited to being trained and practising in Singapore. Thus I responded teasingly, “前途是自己創造的嗎！” [The future is in one's hands.]

To which she replied, “不只是“前途”。我講的還有“錢途”。” [Not "future", but "monetary rewards". Note: Both are homophones in Chinese Mandarin.]

I understand what SEN L was talking about. Nursing pay in Singapore is not high (click here and search for "nurse"). Even at managerial levels of NO, one can only expect around SGD4-5K/month gross pay. The highest paid are those trained and practising in highly specialized areas like OT and CCU nursing where SGD 7K-9K is a possibility after many years of experience, with overtime thrown-in. This is miserable compared to the pay of other "professional" fields where specialized training is a pre-requisite. There isn't a single nursing-based job listed on Singapore's top 100 best-paying jobs across all industries in 2009. Thus, nursing while labelled as a noble job, is not seen as a rewarding job by the Singapore society in general.

To quote one patient's grandfather words to me yesterday morning with regards to nursing, “這種工做，吃力又不挑好。” [This type of job, takes so much effort and yet is unrewarding.]

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Nursing is like that. With good times, bad times, problems with fitting-in, (hopefully) eventually fitting-in, handling one's ups and downs at work, and ultimately ownership of one's own work behaviour and career expectations.

Nursing is making me racist

Just so pissed off with another FON mother early this afternoon.

Her child was admitted last night at 10+pm for vomiting. Her child regurgitated 3 times after feeds yesterday, each time a small amount of undigested feeds. However, the mother insisted that the child was vomiting and insisted that the night staff charted it as vomiting. Since the mother insisted that the child vomited, the doctor's order is to stop feeds and rest the GIT. The night staff had a difficult time with this mother and noted to us in the handover report.

This morning, only her maid was around when the specialist reviewed her child at 9+, almost 10am. Both parents were not around for the child. The mother called around 1020am and asked for updates about her child. Since I was the staff nurse taking care of her child, the admin staff passed me the phone. I informed her of doctor's instructions that her child can start feeding and other updates. She requested that we provide her child the milk and bottles since they did not bring any on admission. I explained that we could only provide 1 milk bottle and the complimentary milk powder if we have stock. She agreed. We happened to have the milk powder, so I brought 1 tin and a milk bottle into the room. I informed the maid that she could make milk for the child using the hot and cold water provided in the room. The maid nodded her head. I further stepped into the room several times during my shift. Each time the child was still sleeping.

The mother came around 1+pm. First thing she did was to ring the call bell and kick a fuss to my colleague HCA M asking why her child was not fed this morning. As my colleague HCA M informed me, I went into the room to clarify the matter.

"Are you the child's mother?"

"Yes, I am. Why nobody told my maid that my child could be fed this morning?"

"Remember? You called this morning. I was the staff nurse who spoke with you and I explained to you that your child could take milk? I provided the milk and a bottle as you've requested..." [Note: I was interrupted by the mother.]

The mother widened her eyes and raised her voice, "Yes, it's only logical that if the milk and bottle are provided, that the child can drink. But, my maid is from the village. These village people wouldn't know anything."

"When I brought in the milk and bottle, I informed your maid that she could make the milk for the baby. I even pointed to the water flasks and explained that she could use the water for making milk. She nodded her head to indicate that she understood. If she claims that no one told her that your child could take milk, then I'm sorry, I have nothing to say."

"The doctor didn't tell my maid that the child could drink."

"Normally the doctor will explain to the parents if they are around." [Note: Both parents were not around that morning. This particular doctor prefers to do his rounds alone, so there was no witness on whether the doctor did explain to the maid or otherwise.]

Now switching to next line of tackle, mother said "Well you're nurses right? Why no one checked if my child has taken any milk since then? You know, my child has gone hungry since 1030pm last night. How can you let a child go hungry for so long?"

"I came into the room several times this morning. Each time your child was sleeping..."

Mother interrupted again, "Well the maid may not know that she has to feed the child once the child wakes up. Why didn't anyone check if my child has been fed? It's not just about my child. In any hospital, you would have to ensure that the child is fed, right?"

"I came into the room several times this morning. Your child has been sleeping the whole morning." [Note: In fact, the child was still sleeping at the time we were speaking. Anyone knows of a hungry child that sleeps soundly?]

The mother ran out of line-of-attack and changed topic to how much to feed her child. I replied accordingly.

I moved on to serve other patients. At around 230pm, HCA M informed me that the mother complained to her that no one informed her maid that the child could be fed and as a result the child was not fed in the morning. This after I have already explained to her? I was pissed. SSN R who was in-charge this morning asked me what happened, I updated her and SN J who was in-charge in the afternoon. SN L heard my update. She had dealt with the parents yesterday. She informed me that the father has arrived and he is more reasonable. Then I went into the room and spoke to the mother again. As noted by SN L, the child's father was also present by then.

"My colleague told me that you complained to her that no one informed your maid that the child could be fed. I already explained to you what happened this morning, right?"

Mother now switched to getting-sympathy mode, "Well, I am not feeling well myself. I feel like vomiting. I am very worried about my child. All she had was this. What's this? Does this have glucose?" Mother holding the IV drip bag, trying to read what was administered to her child.

"Yes, it's a combination of glucose and salt solution. Your child probably didn't feel hungry because she has the drip. You don't need to worry about her hydration. Anything else that you would like to clarify?" [This is me asking with a fake smile because I was really pissed off by the mother's attitude by then.]

"No, I don't have any further questions now. I am really feeling not well..." and she went on complaining about her condition.

Since she had mentioned that she was nauseous, I gave her some plastic bags for puking.

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This is the second mother from the same ethnic group to raise ruckus unreasonably recently. Add to that an FON adult female patient of the same ethnic group earlier this week. The adult patient was incidentally under the care of SN J's team and of the same ethnicity as SN J, but she ignored the call bells of her "difficult patient" on the morning of her discharge.

As much as I'd like to be nice and treat everyone fairly, it seems to me that those of this ethnic group think that being polite makes one a small fry to be trampled upon. Well, thank goodness my colleague HCA M who is from the same ethnic group behaves differently from the lot.

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[Postscript on Sunday 11th Oct, 2009]

While taking report this morning, SN J informed that during the afternoon shift on Saturday 10th Oct, she noticed the mother sleeping on an adult bed in their 2-bedded room. Since SN J was in-charge, she went into the room and informed the mother that she cannot sleep on the bed as it was meant for another patient to be warded subsequently. The mother then verbalized to SN J that a staff nurse told her that she can sleep on the adult bed and had arranged some staff to give her that bed. SN J was surprised by the matter and thus reported it this morning.

It turns out that the mother is twisting her words again. When she told me that she was feeling nauseous, she asked if I could give her some medication for it. I explained to her that our hospital policy is that we cannot dispense medication without a doctor's order. I recommended that she visit our A&E dept for a consultation. Then if our A&E doctor assesses that she needs to be warded, we can arrange for her to be assigned to the same room on the bed next to her child since he is in a 2-bedded room. The mother then verbalized with a slight mocking tone that she planned to go KKH (the restructured hospital for treating women and children). Subsequently, the runners needed a cot bed for a new admission, so they swapped out the cot-bed next to her child and replaced it with an adult bed. At no point did any staff offered her a patient's bed for free!

I was glad that SN J brought the matter up. It showed the mother's behavioural pattern clearly.

Migration medical check-up done

Just completed my medical check-up for migration today. According to my friend who has already received the confirmation of her PR, it will take 3 weeks for the confirmation of PR to arrive if all goes well. I'm keeping my fingers crossed!

While reviewing my medical notes, the doctor joked that perhaps I'd marry a white man there. He's not the only one to joke about it. Even my former nursing lecturer teased me about that too. My only reply, "It's hard to say."

Given that I do not have a preference for any particular ethnic group and I'm heading to a place where half its population are a visible minority, the probability is around 50% statistically speaking. That is, IF I found someone whom I wish to marry and vice versa. It's a BIG "IF".

Census W curve

Yesterday the ward was full during the morning shift. The ward manager (NO) was in-charge, admin staff was on-duty, I and SN O took the teams near and far from the nursing stations respectively, with SEN S and SEN MY as our respective runners. Thanks to the converted single rooms and 1 adult patient in a double room, I had 8 patients. Unfortunately for SN O, her side was full-house, and even had new admissions taking over the rooms vacated by the discharged cases. This is similar to my previous experience here and here. It was crazy busy for SN O yesterday. As she puts it, "NO as in-charge, SEN MY as runner, I wouldn't want to work with this type of lousy combination next time". At the end of our shift, there were still new paediatric patients awaiting for rooms, so the sister-on-duty spoke with the adult patient and arranged for her to be transferred to another ward. Thereafter, a few of the paediatric patients awaiting for rooms could be transferred over.

There were many discharges yesterday evening and this morning. SSN Y was in-charge, I and SN O took the teams near and far from the nursing stations respectively, and only 1 runner HCA K. When I arrived for duty this afternoon, the total census was 10 patients. My side started with 5 patients. Near the start of the shift, one patient was transferred to SN O's side because of their request for a single room. Towards the end of my shift, there was a new admission on my side. Thus, for most of today, I had only 4 patients, all in stable conditions. SN O started with 5 patients, had 1 transfer case from me, 1 new admissions mid-afternoon, 1 discharge and then near the end of the shift another case transferred from another ward. Thus total census at the end of our shift today was 12. I had time for tea, dinner and even chat with my preceptor SSN Y.

According to my preceptor that's the way the census is for paediatric ward. It can swing suddenly between busy and relaxing and vice-versa. Such an extreme W shaped curve. Hmm, it reminds me of the stock market :-P

4 months old

Had a series of busy mornings and double shift this week, with extra work due to various audits -- documentation, ISO, assets. Today was another busy morning for me at the ward. I started with 6 patients and had 2 new admissions this morning.

On duty this morning were the ward manager (NO), the admin staff, I and SN J -- taking teams near and far from the nursing stations respectively, HCA K and SEN MY for our respective runners. I arrived just-in-time to take report as I was overslept. NO briefed us during report handover due to the ISO audit to be done today. She wanted us to follow-up with various document and equipment checks.

There was a constant flow of admissions since yesterday evening, of which 2 admissions were assigned to my side of the ward. Majority were GE related cases. It was Children's Day yesterday, so it made me wonder what the children ate during the celebrations on the eve of Children's Day that may have caused their GE. Both team had many IV medications this morning -- probably correlated to our GE incidences -- and we did not have enough syringe drivers to go around between 10+am to 11+am.

Just after the shift handover report, there was an IV cannula that leaked. HCA K and I tried to save the IV cannula site but it couldn't work. Immediately thereafter, a new admission arrived for my team. I admitted and orientated the patient and her parents, assist the specialist who came to diagnose the patient's illness, follow-up with RMO for IV cannulation, IV drip and blood investigations. All that work took about 1.5 hours of my morning. Add to that following specialists on their rounds. By the time these were somewhat settled, it was already just past 10am. Unfortunately, many of the new medications (including IV medications) since yesterday night were not supplied and were not available from the ward stock either. Thus, I had to quickly put in my pharmacy requests. Thankfully, the night staff managed to give the morning doses of the TDS oral medications, and there wasn't any febrile cases, so I did not have to rush for the morning TDS medications, except for nebulization. Then I did one round of medications. Before I could administer the IV medications for those that were available, SN J came to borrow 1 of my 2 syringe drivers as her cases were slightly overdue. The rest of the morning was various medication follow-up when available or due, interruptions from both the NO and the admin staff to correct various documents and workplace items before the ISO audit. I was pretty stressed and hungry by 12+ noon, as I have not had any break. In addition, I was still pending several overdue IV medications due to a combination of medication and/or syringe driver unavailability. Then another new case arrived for my team. The admin staff instructed me to admit this new patient. I was already over-my-head with overdue medication and IV, so I told her to get the NO to admit instead. The NO helped. Seeing that I still looked stressed at 1+pm, the NO came over and instructed me to take a break, saying, "工作永遠做不完得。” ["Work will never be finished."]

Then I took a break and ate the bread that I brought from home. After my break, I did my mid-day round of medication and continued with my outstanding IV medications. While I was taping my handover report, I was interrupted for the pre-ISO audit briefing by the NO to all staff. Thereafter I continued to tape my report while the afternoon staff were listening to the other team's tape. Unfortunately I could not pass report for the second new case which I have not seen, and who went down with the case-notes for ultrasound investigations. Actually, I should thank the NO, the admin staff and my runner HCA K for handling this new case for me.

Thus I am 4 months old but I still struggled through today despite my side of the ward not being at full capacity. In the end, I only left work at 4pm after completing my documentation, pharmacy forms and ward billings. I am so tired!