Fill-up that A-hole

Sales is brisk this week given the holiday seasonal promotions. My colleague R and I were re-stocking the fast-moving electronic games shelves. The games are divided into sections and arranged alphabetically within each section.

Being more experienced, he was up on the ladder picking up the titles for re-fill. My role was to scan through the shelves and shout to him the sold-out titles -- a.k.a. "holes in the display wall" -- that need to be replaced by new titles. We were quickly running out of new titles.

When we were almost done, I shouted, "We still need something to put into the 'A' hole."

Colleague R, still up on the ladder, turned around and laughed, "You're funny!"

I looked somewhat puzzled.

R, still tickled, teased, "That's a naughty thing to say."

"Oops, I didn't mean it that way!" I replied. And I started laughing too.

Financial Consumer Agency of Canada

This is a place-mark entry for those interested in migrating to Canada.

Financial Consumer Agency of Canada is a good website to learn about managing one's finances in Canada. There are interactive tools for selecting loans, bank accounts, etc.
http://www.fcac-acfc.gc.ca/eng/consumers/ITools/default.asp

IMHO, the "Which bank accounts are right for you?" --> "Which chequing account is right for you?" tool is pretty cool.

2nd month's expenses

My total expense for the 2nd month (1st to 30st November) is around CAD1,140, broken down as follow.

Amount (CAD) : Category

Once-off expenses - Nil

Monthly expenses

• 500 : November room rental
•  31 : Mobile phone bill
• 110 : Transport - Monthly 2-Zone Farecard
•   0 : Transport - Others
• 149 : Food/groceries
•  68 : Clothings
•  26 : Household Items (including tioletries)
• 127 : Recreation/Entertainment/Restaurant
•  83 : Meals/Drinks
•  31 : Personal Grooming & Make-up
•   5 : Stationery/Postage
•  10 : Others (Lottery, Gifts, Books, Donations, etc)

Stayed at a friend's place for about 5 days, which jacked up my expenses due to eating-out and entertaining more. On the other hand, friends treated me to several meals which help to keep the expenses down.

Looking forward, December expenses may be higher due to Christmas entertaining and gifts. It will probably take me some more months to figure out a stable and realistic monthly budget.

Canadian work culture

Last week, I started my first Canadian job.

I like the fun work environment. Colleagues here are supportive. On my first day, the assistant manager took the time to explain my job tasks to me and asked how I was doing, if I was ok, if I had any questions, every now and then. Even on subsequent days, the senior-staff and/or managers would come round to offer support to all the new staff. In addition, the manager-on-duty really respects break times. He/she made sure everyone got their breaks for an 8 hour shift. At the end of each shift, staffing level is such that staff get to leave their positions on-time, i.e. no extra 5min, 10min, etc.

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On Saturday afternoon, I received a call asking if I would like to work for 4 hours on Sunday. It was so respectfully done, the assistant manager (AM) put it across as a request.

AM: "Would you like to work on tomorrow?"
Me: "I have appointments on Sunday already."
AM: "How about in the evening, say 5pm-9pm?"
Me: "Hmm, I can re-arrange my appointment for it."
AM: "So to clarify. Would you like me to schedule you on Sunday evening or would you like me to call another person?"
Me: "Okay, I will come on Sunday 5pm. See you then!"

This is so different from my experience in Singapore. Click here for a sample of call-back in Singapore.

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On Sunday evening, I worked on the closing shift. The store was tidied up by 8:45pm. Since there was else nothing to be done, the store manager gave us the go-ahead to leave earlier; 15min before the end of our shift.

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I really like this workplace. I am tempted to stay if I can somehow have another source of Canadian income to make enough for my living expenses and future plans.

Starting Canadian Experience soon

Went to a toy store for a walk-in interview on Monday. Luckily for me, both interviewers acknowledged my transferable skills given my background in paediatric nursing, and they were friendly and supportive. On Tuesday evening, I got a phone call that I got the job. Although it's only for the Christmas/Year-End season and the pay is considered "low", I'm glad I got the job because it will start my "Canadian Experience" on my resume. Plus, hopefully this local exposure to children will be give me an edge when I return to Paediatric Nursing.

Which brings me to the CRNBC IEN SEC (Internationally Educated Nurses' Substantially Equivalent Competency) assessment. Silly me! I should be used the Canadian "turnaround" time by now and request for a scheduled test date earlier. When I applied today, the response* was the assessment slots are fully booked until mid-January 2011. Thus, I am requesting for a end-January 2011 test date instead. My guess is that I would be done with the seasonal job by then.

*p.s. I am rather impressed by the immediate response that I received from my nursing school on the matter.

Week 5 - The Week of Nothing

Not much done last week.

Had a quick chat with SL today. We both came to the conclusion that we are too focused on getting a job and integrating into the local society here, that we have forgotten to just go-with-the-flow and have some fun. Interestingly, we came to the same conclusion independently despite having different and mostly separate activities while here. Then we laughed, "Perhaps it's the norm for a new migrant? That we will come to this conclusion after 5 weeks?"

Vancouver is like London, one can live the high-life or the budget-life, both ways are still comfortable. Currently, I have applied to volunteer with an organization and also to join another social club. Pending their answer. It would be a good step to meet diverse people with similar interests.

------------------------------

Met a new friend over the weekend. It's nice to meet people who are not bitter* about Singapore after leaving it. This friend's theory is that it is usually the men who get hung up about Singapore even after leaving it. The women vote with their feet and get on with their lives. Hmm, maybe he is right?

* It's a nice reminder to myself to let go of any "baggage". :-)

10 ground rules for love

Have done a psychic reading for a friend about career and love life recently, it brought to mind a recent email to an ex-boyfriend.

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My dear X [name edited],

I don't know what to say. Please keep yourself warm and healthy, and be happy. You are a good man, we have had some nice time in the past. I hope that you will find the love that you want some day.

On turning 40, I have thought a lot about my life and my relationships. I realize that I am pretty happy alone. To have someone else brings with it hope and heartache, besides the practical inconveniences of having to adjust to another person in one's life. Thus, I decided on some ground rules.

1. He must be single* and available. No "separated", no "just broke-up", no flings.
2. He must be financially able to sustain himself. I don't need him to be rich, but I will not respect him if he needs others' charity to live-on in the long-run.
3. He must love me as I am. I am not perfect. I have my flaws. I need someone who can accept and love me as a whole.
4. He must love me enough to want to marry me. We will get married legally as soon as it is convenient. No grand weddings, they are often a source of headaches!
5. He must love children or nature. It does not matter if we have any or otherwise. It is just that I don't think much of the kindness/humanity/gratitude of a person if this person cannot bring himself/herself to love children or nature.
6. As an extension of the kindness/gratitude rule, he must care about the people related to himself and me. He does not have to agree with them or like them, but basic fellow human concern is expected.
7. He must live/work in the same city as me for a long enough period. That is, until after marriage and the relationship is strong enough to withstand the distance.
8. I must be able to trust him. He must trust me too. This takes time to build, thus the rule about living in the same city.
9. He must be able to forgive. Not necessary to forget, for we learn life lessons from our experience. But in the long run, a willingness to recall the past without anger, bitterness or heavy regret is important to being happy.
10. He must be a non-smoker. It is not just about his health. My nose cannot stand the smell of a chronic smoker's breath.

As you can see, you passed all except for rules 4 and 7. ... [Edited] Still I wish you well. I hope to see your happy face on Facebook someday. After all, we are still friends, right?

With lots of love (i.e. as friends),
[Edited: Winking Doll]

[*Addendum on Sunday 12-Aug-2012: By "single", I mean single, divorced for over 1 year or widowed.]

1st rejection email

I got my first rejection email from my job applications today. It was for an RN position. Obviously I didn't expect to land it since I do not have the local RN certification yet. But still, to be totally honest with myself, I was a bit disappointed.

Add to that, I submitted a job application for a part-time cleaner* position via a settlement service agency. I edited my resume and cover letter, as previously advised by job agent S, careful to exclude any mention of my IT experience and qualifications. But I left my RN experience on my application. I described it as I "have experience in handling human waste" and felt that my nursing experience should prove that I'm not afraid of "dirty" work.

Job agent S returned my application today. He suggested that I drop the RN qualifications because I would be deemed as overqualified. I found this suggestion acceptable. However, I disagreed with his other suggestion to write that I "worked as a cleaner in a hospital". IMHO, there's omitting "irrelevant" facts, and there's outright lying. I drew my line there. I felt that S being an immigrant himself for only a few years, was viewing my application from his Asian perspective. Thus, I felt frustrated as I cannot submit my application direct to the employer because the job posting specified to go through that settlement service agency. [Note: I have checked the company's website for openings, the cleaner position is not listed.**] And I am blocked... by this job agent whom I am currently "assigned to" from this largest settlement service agency in BC. While I understand the good intents of job agent S -- to guide me to get a job ASAP -- I don't feel that we are a good client-agent match.

I took a break from job application and cheered myself up. Then a friend called me about a reading I had done for her recently, and she cheered me up. Later, another friend CS, who migrated from Hong Kong to Canada 18 years ago, discussed with me her perspective. I am glad that she too would draw the line on writing "worked as a cleaner in a hospital".

My 2 cents.

1. Some may view being a cleaner as a lowly job that anyone can do and therefore can successfully lie about it. It actually requires very specific knowledge and skills. I used to chat with my housekeeping colleagues and I respect their knowledge and skills in the cleaning domain. IMHO, it is as dignified a job as any.
2. I do not wish to lie outright for a job. I think it degrades the job and myself.

* Note: I was and still am inspired by Singapore Serf's blog adventure of migration and integration.

** Note: Just as well, because I found other positions listed there that I can apply for.

1st month's expenses

I budgeted for a rather generous "Settling-In" allowance for the 1st month; in anticipation of the numerous diners/outings to meet new friends, and so that I would not feel miserable about moving to the cold.

My total expense for the 1st month (4th to 31st October to be precise) is around CAD1,950, broken down as follow.

Amount (CAD) : Category

Once-off expenses

• 250 : Rental deposit (refundable)
•  15 : Taxi from airport
•  79 : CRNE prep guide

Monthly expenses

• 500 : October room rental
•  40 : Mobile (will be less next month)
• 110 : Transport - Monthly 2-Zone Farecard
•  31 : Transport - Others
• 235 : Food/groceries
• 263 : Clothings
• 103 : Household Items (including tioletries)
• 105 : Recreation/Entertainment/Restaurant
•  99 : Meals/Drinks
•  37 : Stationery/Postage
•  84 : Others (Lottery, Gifts, Books, Donations, etc)

Henceforth, it will be back to a more realistic budget.

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p.s. Originally I wanted to format the above in a table, but somehow the Blogger's table display sucks on Firefox. So it's back to the simple unordered list.

My guardian angels

As mentioned in my previous post, I had neither kin nor kith when I first applied to migrate to Canada. Strangely enough, along the way, at the right place and the right time, my guardian angels appear.

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First off is PN. PN and I were both sitting at the front row of chairs at the Singapore Central Police Station back in August-2009. We were clutching our Canadian High Commission letter requesting for police clearance, waiting for our ticket number to be called. Glancing to our left, right and back, there were others headed the same way. Out-of-the-blue, in an untypically Singaporean character, we started to chat. PN was methodical in her migration plans -- right down to checking the best price for the medical check-up, cheapest way to transfer funds, most cost-effective personal items shipping, best deal for air tickets, best time to land, and renewing her Singapore passport before leaving. [Note, in case you're wondering about the passport: In Canada, there was is no Singapore High Commission, Consulate, Representative Office, whatsoever. Zilch!]

[Edit on Nov 29th, 2011: Since May 12th 2011, after GE2011, Singapore appointed a Honorary Consul-General in Vancouver.]

------------------------------

Then on my final month in Singapore, friends and family started passing me whatever Canadian-based contacts they had. Plus, online friends linked me to Vancouver-based contacts that could be my safety-line if needed. If any of you happened to read this, BIG THANK YOU!

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The weekend before I fly, I passed my outstanding Singapore paperwork to my younger sister LF, who helped me to follow-through. My elder sister LY gave me her 2 large luggage bags and her London winter wear. The luggage bags were great, just large enough to fit all the remaining items and gave a total weight that just met the check-in luggage limits [2 pieces of maximum 22kg each]. The winter wear is a life-saver, I am dressed in them daily.

------------------------------

When the plane touched-down at Vancouver airport, the elderly Taiwanese lady, whom I sat next to and chatted with, turned around and pointed out SL who was sitting 5 seats behind me. “她也是新加玻人，也是新移民到加拿大。” ["She is also a Singaporean. She is also a new migrant to Canada."]

It turned out that SL was sitting next to and chatted with this same Taiwanese lady on the Taipei-to-Manila leg of their journey. SL and I clicked right-away. We "landed" as new Canadian immigrants on the same day, from the same plane. In the recent days, we found so many similarities in our lives, despite her years away from Singapore and her high-flying and jet-setting career. She told me that as she was traveling to Canada without kin or kith, she prayed to God for someone... and I'm her first friend in Canada!

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Thank you, my guardian angels.

Why Canada?

When I first applied for migrating to Canada back in end-2006, I had neither kin nor kith there. I did not know anyone personally in Canada. Till then, I have only met one ethnic Chinese Canadian at work in Singapore some years back. But we did not become friends because I did not like him personally.

Some friends asked me this -- Why did I, someone known not to tolerate cold, choose Canada of all eligible places for migration?

It was a process of elimination.

First off, I am not rich nor particularly business-savvy. Thus business/investment migration was out of reach for me. That pretty much scratched out the many pretty island countries such as The Bahamas. :-)

I wanted to go to a first-world country where the rich-poor gap was not so great. I wanted a country with not so much poverty or extremely poor regions. I wanted a country with a mature democracy, press freedom, independent judiciary, more liberal outlook and great natural sights. That scratched out most of Asia. That also scratched out USA, South American and African countries, Russia and the previous Soviet bloc, the Arctic and the Antarctic.

I like some aspects of USA, but not its extreme capitalism and its health care system. So scratched USA. [Addendum on 18-Dec-2011: Click here for charts illustrating the rich-poor gap in USA.]

I also wanted a country where there would be respect for personal life/choices and policies that support work-life balance. Where people are not constantly under pressure to be cheaper, better or faster. Thus, Japan was scratched out because it was a pressure cooker at the workplace and its general demand for conformity.

I loved UK. But UK was part of EU. The policy of EU countries is to give priority to Europeans. With the flood of Eastern Europeans, my chances seem slim. So scratched all European countries.

That left me with Australia, New Zealand and Canada.

Australia looked tempting. I have several people whom I know personally there. I've been to Sydney and liked the place. However, it is a huge piece of dessert (generalizing, of course!). I was concerned about how it would cope with its water resources given global warming.

That narrowed down to NZ and Canada. NZ had a glowing report on how global warming would be beneficial to its economy. However, I could not qualify for its skilled migration class back in end-2006. Given my petite size, my chance of being a seasonal farm-hand was slim. So say goodbye to the kiwis and the sheep. Baa baa! [Bye Bye!] :-P

That left me with Canada. The fact that Canada is officially bilingual interests me. I deduced that it would make the country more tolerant of diversity. I sent out my application with shaky hope. I was not sure if I would survive the cold here. But then, with global warming, it should get warmer, ya? Oops, it turns out otherwise. Today, a shop owner just told me that it is forecasted that this Canadian winter will be the coldest in 1000* years! What are the odds? So if I survive this winter, I should be here for good.

*Note: This is an exaggeration. Apparently Environment Canada, the Canadian weather office, had predicted that this winter will be the coldest in 15 years due to the effects of La Nina. The global warming trend still holds, just that the La Nina brings minor fluctuations to that trend.

------------------------------

If you're interested in coming to Canada, do check out the Federal Skilled Migrants list of desired skills. Do it fast! They introduced a quota in 2009 early-2010 for 29K migrants under this category for the next 12 months, but in June-2010 it was further tightened to 20K.

http://www.cic.gc.ca/english/immigrate/skilled/apply-who-instructions.asp#list

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Ever got the feeling that you're in the right place, at the right time? I am feeling it now.

Canadian nursing boards and association

I have had several nurses in Singapore asking me how to get a nursing license in Canada. See below for sections on British Columbia (BC), Ontario, Alberta, and  Canada-wide information.

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(I) British Columbia

This section is for the nurses who want to come over to British Columbia, Canada.

In Singapore we have Singapore Nurses Board. In British Columbia, there are 3 4 nursing boards depending on the type of nurse that you are.

College of Registered Nurses of British Columbia (CRNBC)
www.crnbc.ca
[Note added on 25-Mar-2013: For more information about obtaining registration with CRNBC, please attend their free "General InformationSessions" (every 3rd Friday of the month) held at CRNBC office.]

College of Registered Psychiatric Nurses of BC (CRPNBC)
www.crpnbc.ca

College of Midwives of British Columbia (CMBC)
www.cmbc.bc.ca

College of Licensed Practical Nurses BC (CLPNBC) - The equivalent of Enrolled Nurses in Singapore
www.clpnbc.org

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(II) Ontario

Toronto, Ontario is also a popular migration destination. Here's the nursing board in Ontario.

College of Nurses of Ontario
http://www.cno.org/en/

See also: Ontario Immigration - Working as a Nurse in Ontario
http://www.ontarioimmigration.ca/en/working/OI_HOW_WORK_NURSE.html

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(III) Alberta

Alberta is a booming province, thanks to oil. Lots of job opportunities, no provincial tax and better minimum wages.

College and Association of Registered Nurses of Alberta
http://www.nurses.ab.ca/Carna/index.aspx

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(IV) Canada

The equivalent of Singapore Nurses Association in Canada is similarly named.

Canadian Nurses Association (CNA)
http://www.cna-aiic.ca/en

[Addendum 27-March-2011]
The following url from CNA gives an overview to international applicants on becoming a Registered Nurse or Midwife in Canada.
http://www.cna-aiic.ca/en/becoming-an-rn/work-in-canada

[Addendum 27-March-2011]
For the other Canadian provinces and territories, please refer to the following link from CNA for the relevant Registered Nurses regulatory bodies.
http://www.cna-aiic.ca/en/becoming-an-rn/regulation-of-rns/regulatory-bodies

Landed in Canada

Day 1 (4-Oct): Received "Information for Newcomers" and "Welcome to Canada" guides from the C.A.N.N. (Canadian Airport Newcomers Network) at the airport. The C.A.N.N. lady was very helpful and informative. She went through step-by-step what I needed to get done for the next few days and where/how to get help. PR card application completed by Immigration Officers at airport. Taxi to home. Unpacked luggage.

Day 2 (5-Oct): Bought groceries. Settled my SIN (Social Insurance Number) at a Service Canada Centre. The Service Canada officer gave me a "British Columbia Newcomers' Guide to Resources and Services". It has good information and a checklist of things to be done by newcomers. Obtained the Richmond Library card and a Canadian mobile phone.

Day 3 (6-Oct): Opened bank accounts and applied for credit card. Tagged the Vancouver Library registration to the Richmond Library card. Hung out with new friend HC, went to Oakridge and Metrotown.

Day 4 (7-Oct): Laundry and drying done. Bought Monthly FareCard for travel on all public transport. Sent out MSP (Medical Services Plan) application. Dinner and movie at Vancouver with another new friend SL and her Toronto friend. I suspect SL invited me because she wanted me to play gooseberry.

Day 5 (8-Oct): Jet lag finally hit... I am totally sleepy today. Thankfully no headache. Now that all the critical paperwork are completed, I allowed myself to rest for the day.

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Think I'm settling down ok. Distances that looked long on Google Map are actually nearer in reality. E.g. A 20 min walk estimated by my landlord is actually only 10-15 min. Or maybe I walk very fast for a Canadian pace?

Still acclimatising to the cold. Nevertheless, I'm improving. Needed 5 layers on top (thermal top, long-sleeve T, cashmere sweater, thin padded coat, mid-thigh length down-padded coat) initially for a 14 degree Centigrade weather, but I'm ok with 3 to 4 layers now. Still 3 layers at bottom (thermal bottom, leggings, jeans/pants). Socks and long boots for footwear. Well, I have a good excuse. I have just arrived from Singapore, where the coldest temperature is around 24 degree Centigrade.

Richmond is very Asian. Chinese and Cantonese are commonly heard. Many shops have both large Chinese and smaller English labels. I think my non-English speaking parents will be so at home here, ha ha!

While I like the friendly and relaxed suburban feel of Richmond, I prefer the more cosmopolitan mix of Vancouver. However, people in Vancouver are more hurried and less friendly than Richmond (although still better than Singapore). Perhaps it's due to Vancouver being a city/downtown area. Maybe I will check out Burnaby in future.

細水長流

Amidst packing to migrate, I took a break to attend 戲劇合 “噓．．．与社區有約” [Drama Box's "Shh... a date with the community"], a public theatre performance last weekend. Click here for information about the censorship on the original production planned.

I enjoyed the performance. The Forum Theatre segment got the audience involved in thinking of and presenting alternative solutions. IMHO, it is an excellent stimulus for thinking deeper about issues. Perhaps with more such community stimuli, Singapore may someday develop into a truly cosmopolitan city -- not one with only a cosmopolitan facade that hides its parochial attitudes.

At the sing-along session, the oldies reminded me of songs that I learnt during schooldays. One particular song “細水長流”* made me all misty-eyed.


* Note: “細水長流” literally means "small streams of water flows continuously" and refers figuratively to "friendship runs deeply". The English equivalent of the above song would be "Those were the days". Ahh, another memory filled song for me.

The Little Prince

Re-read The Little Prince [Le Petit Prince] by Antoine de Saint-Exupery before giving it away. I love the story for its observations about human behaviour. There are several parallels in my life too. E.g. The narrator who gave up drawing at a young age. E.g. The little prince's feelings as he was about to leave his planet.

He believed that he would never want to return. But on this last morning all these familiar tasks* seemed very precious to him.

*Note: The "familiar tasks" refer to cleaning his home planet and putting it in order.

Packing memories

I spent the day packing, but only managed to clear 1 drawer (49.5cm L x 35cm W x 35.5cm H) of stuff. The problem with packing is the memories. Of who I was, my old interests/hobbies, my old habits, etc. Of people whom I encountered in life... there must be thousands of them by now. And some who walked-in and stayed.

It's hard to describe the feeling. Perhaps this song by 张艾嘉 - “飞向异乡的747” [Sylvia Chang - “747 to an alien land”] comes close.

Facebook exchange: What it means to leave Singapore

I had an exchange with JN over Facebook. It clearly shows the ravine between our political views. Extracted here for the record, should he decide to remove it.

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[Facebook exchange on JN's childhood photo with him sitting in front of the National Theatre]

WD: National Theatre... build with donations from people from all walks of life. Such a pity that it is torn down instead of re-furbished.

JN: Part of the bigger plans lah....

WD: When there is the will, there's a way. E.g. Take apart and relocate. It's a lack of will that causes our history to disappear.

JN: Anyway, we have got the aircon Durian with MRT connections. Much much better.

WD: Not so. The significance of the National Theatre (and also the Nanyang University) was that people from all walks of life contributed to it. When was the last time Singaporeans from all walks of life come together for a common goal?

WD: The spirit of Singapore is dying, fast.

SY (JN's friend): Totally agree that demolition of National Theatre is a big loss to S'pore history. The PM emphasized on S'pore identity during Rally today. What's left of S'pore if the govt continue to tear down buildings of historic significance like this in the name of development?

JN: old guards also leaving one by one, so will most old buildings. Afterall, we have limited land lor.

WD: Take a leaf from the refurbishment of old Cathay. You can keep the facade while changing the interiors dramatically to meet modern needs. We just need a good architect and the political will... hmm, the late ex-President Ong Teng Cheong Chong comes to mind ;)

WD: See wikipedia link on "Structure Relocation" below. When there's the will, there's a way.
http://en.wikipedia.org/wiki/Structure_relocation

JN: Just like you, the will to leave Singapore but yet has so much things to say.

WD: Just an intellectual discourse from a between-jobs person, ha ha. After all, my family is still in Singapore, so I hope that life will improve in Singapore for their sake.

JN: with you departing, now there will be an excuse to hire 3 more FT to replace you . Wonderful lah.

WD: 3? I am not that efficient at nursing lah. Unless you mean 3 to replace me in my previous IT functions, ha ha.

JN: Nursing lah. for that price they pay you, i think they can hire 3. Hehehe

WD: Oh, then you don't know how sad my current pay is. Cannot even apply for credit card leh.

JN: neither do they leh. just go to money changer to remit $$ back home only mah.

WD: Your comments very PAP-style, leh. Are you saying that we should empty out the Singapore economy of skilled workers and replace them with younger, cheaper but unskilled workers? What good is that for the long-term progress of Singapore's economic structure?
*Sakes head, wondering why I even bother to ask this question*

JN: No need to look at the big picture but just "you are going away for good" is enough. The thing is that you are quiting Singapore. A skilled and qualified person leh. So who is gonna replace you in this short instant ? there are those in the hospital that needs to be cared for leh. Afterall, to train you to be a SRN takes 3 years or something. So poach from other countries lor. Given your "low pay scale" is already many time more than what they will be likely to earn, so come lor. But maybe, we will need 2-3 to replace you. Afterall, they can be cheap to hire (assuming that training are the same competency level and all speaks english). chey, so simple logic also cannot understand meh. What PAP like ? Chey.

WD: Oh, to replace a SRN with foreign nurse, cannot pay so low lah. Don't forget, I'm only given fresh diploma holder pay, so it's not enough to pay for 2 foreigners willing to downgrade to EN (forget about 3).

JN: still, it is more than 1. They win. ^-^

WD: I would gladly let them win, given the work culture such a system creates :) You want talent, you have to pay for it.

JN: make sure that I don't see you crawing back to SGP looking for a job here ah....

WD: Don't curse me like that lah. You also relocated out of Singapore yourself, mah.
Btw, you're wrong about my replacement. They employed another Singaporean, almost fresh diploma holder, to replace me. After all, you're taking about service industry here, very hard for newly-arrived foreigners to hit the ground running.

JN: Yup. I relocated. Can't complain about FT but being one myself lor. Expat package. Plus me in SGP is easily replaced, no special skills or training or licence needed, so unlike you. They won't missed me here or anywhere in the world lah.

WD: They will need you back... to produce the next generation of loyal Singapore citizens, ha ha.

JN: Past sell-by age liao.
Anyway, since you hate the SGP & PAP government so much that you are leaving. Than go, set up the better life elsewhere, FB us to make us envy you.
Don't turn back. Don't comment on the past here, as it is no longer yours to comment nor can you contribute anything useful lor. 好马不吃回头草

WD: I disagree with you that "it is no longer yours to comment nor can you contribute anything useful"
Why does the govt pay big $ to foreign consultants for advice, if they are not local? Because their thoughts, criticisms and comments have value. [Exclude of course the silly $ PAP govt spent to rename "Marina Bay" to "Marina Bay". Ha ha]
I may be gone from Singapore soon, but my family is still here. And for various reasons, some are unlikely to leave. It is only right for me to wish for a better life for my family members who remain. I left Singapore because I do not like the government's policies, it does not mean that I dislike ALL Singaporeans, things Singaporean. Least of all, it should not mean that I have to disown my family which is Singaporean. Got it?
Like I said, you are very PAP-style in your comments without even realising it. IMHO, it has to do with the pathetic nature of debate and critical thinking education in the typical local schools. :P
Try reading some of the well-written local blogs. E.g. Yawning Bread.
http://yawningbread.wordpress.com/

JN: you sounded like a pinoy hor. BTW, I don't read the rubbish blogs of noise makers. just too many out there to waste my precious them and intrude into my personal space.

JN: It is as if you are better schooled than us. The way you are not able to accept my reasoning and calling me PAP-thinking shows that you are even of a more narrow vision. Bo chap than dun kau pei here lah. It is a photo of my childhood and you are talking rubbish. Just like how you are on my late-father's photo*.

[*Note: It was a photo of his late-father's watch where he commented that the watch had stopped at the exact moment when his father passed away. I commented on the parallels with the story from a children's song "My Grandfather's Clock". JN took it as an insult. IMHO, he has limited literary sense, lah.]

U also product of local system mah. Chey. If you dun like the policies and then just exit, isn't this like that big bird with small head that sticks into the ground. "See no evil and hear no evil." And leave your poor family behind to continuously "suffer" the disliked policies ? Stay back, make a stand and do something lor. 好马不吃回头草 orh. On what you say here earlier, I will hold you to it orh. Dun pray-pray orh. Hheeheh.

WD: From my personal observations, the average Filipino is more loyal to his/her home country than the average Singaporean... despite all the troubles and the corruption in their homeland. Once you get to know them well enough, they can and will openly criticise their govt and its policies and their home situations. Yet, they are proud to be Filipinos, even after years away from their homeland.
How did the PAP govt failed to instil love for Singapore despite its self-proclaimed success and unique abilities? Why must PAP govt and its supporters chastise all who leave the country for a better life?
Reading more to trigger deeper thinking does not mean you have to agree with what you read. It's a way to push oneself to develop further in one's thinking skills. Learning and thinking are supposedly lifelong activities.
Of course, being stuck at your current thinking is ok too, given that it fulfils what PAP proscribed for the plebeians... only the basic physiological and security levels of Maslow's hierarchy of needs.

WD: Yes, IMHO, I was luckier than you. I had better teachers. A stroke of luck.
I did not say that I'm better. You are sensitive yourself, so you said so. You're the one who started this whole political debate on your photo, not me. I have my right to give my 2 cents retort. If you don't like, you can always delete my comments.
Just don't be a sore loser.

JN: so well inked ah. Maslow somemore.... I think you should start one of those noise making blog lor. Afterall, they cannot pull you in for questioning after you have left the country ^-^

WD: Next step, use of fear to intimidate. Very clever and PAP-style hor.
I won't waste my time with a sore loser. If you dare, leave the comments here for others to judge.

JN: Aiyo. Name calling now ah.
I seriously think that you are a vegetable head quitter. Before you go, then decided to fleece their fellow countryman by taken an expensive & taxpayer-subsidized course with no intention returning good service to the Singapore society by at least serving your time in the hospital.¹
Your decision lor. Ok lor, i am sure you did your maths well and let others be the judge of this too.
好马不吃回头草, will be the one phase that i just tag you, a quitter.

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I do not look down on others in general. In fact, I respect those who are willing to argue their stand logically or base their arguments on the impact on people, even if our stands may be diametric. But to hit below the belt at my family and to use the threat of being arrested? Well, suffice to say that JN has just lost my respect.

The other thing I dislike is the stand taken by some Singaporeans against those who leave to build a better life. It is such hostile attitude that makes one not want to come back to contribute to Singapore even if one happens to be successful in future.

p.s. For those who don't know, I (a Singapore citizen) repay repaid my bond according to its exit clause. Any PR (i.e. foreigner) on the same bond would have to do the same*. Thus, JN's accusation that I "fleece their fellow countryman by taken an expensive & taxpayer-subsidized course with no intention returning good service to the Singapore society" holds no water.²

*Note: According to internet anecdotes, some foreigners on other even more expensive "Singapore taxpayer-subsidized" scholarships have absconded. Information on such cases are the government's "official secrets", never to be published in the media.¹

[Addendum on 3rd June 2011]

My 2 cents:

1. I am amazed at the PAP-government instigated public hatred (through ministerial comments published in the mainstream media) against Singapore citizen bond-breakers. It stands in stark contrast against their silence on foreign bond-breakers. Is this an example of why it is better to be a foreigner than a citizen in Singapore?

2. If you read my blog on my nursing experience in Singapore, you would have an inkling why I decided to pay up my bond instead of completing it. It was a difficult decision. Nevertheless, once a decision is made, one just moves on and hopes for the best.

Farewell gift

After my confrontation with my ward manager, my ward admin staff insisted that I apologise to my ward manager. She had served for more than a decade under the ward manager. She felt that I had hurt the ward manager's feelings, especially in tendering my resignation a couple of days after the confrontation. I refused to, after all my ward manager was aware of my pre-planned resignation date long beforehand.

Unlike the ward's usual practice, there was no farewell party for SN O nor me. Both of us had been from the nursing career-conversion course. SN O left after the completion of her 3 year bond, whereas I left after 1+ year. When SN O left, her farewell party was cancelled with the admin staff's message that her farewell party will be held in conjunction with mine.

[Addendum on 15 Aug 2011]

SN O's final month at the hospital was when we had the new rooms opened. During one of those shifts when we were both taking teams, SN O remarked to me repeatedly in frustration that she would rather pay back her final month of bond than to accept such work conditions. Subsequently she mentioned that she would be sure to vent her dissatisfaction at her exit interview with HR. I do not know if she made her complaints to HR at the exit interview. As far as I know, she completed her bond as originally planned.

During my resignation notice period, I suspected that there will not be a farewell party for us. During those last few weeks, a nice consulting doctor TT kept asking me when my last day would be, and reminding me that he shall be away but would be back in Singapore in-time for my farewell. If only he knew...

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Since I was packing my home for migration, I made a request via the admin staff to my colleagues [and I also spoke directly to some colleagues] -- not to buy me any farewell gift for it would add to my baggage. If they should insist on giving me something, then I would prefer cash or gold for portability and retention of value. The admin staff informed me that the ward staff has agreed to my request and will be giving me a cash gift on my last day of work.

On my second last day of work, I bought my colleagues a box of chocolate candies with a note of thanks. The admin staff insisted that I should present the gift to my ward manager. I said, "No, this is meant for the staff" and left it in the staff room.

On my last day of work, my ward manager passed me an angpow. At that instance, the admin staff jumped up from her desk, flipped opened a small printed brochure from her desk and read ostentatiously from it.

Admin staff read, "The love of money is the root of all evil."

I quietly replied, "Not really. It depends on what you do with the money."

My ward manager awkwardly signalled to the admin staff, and turning to me, she pointed to the Chinese words on the angpow and said, "We wish you 福 [good fortune] and 滿 [full/enough] 。”

I took it and simply said, "Thank you."

Call me petty, unrealistic, or whatever. I do not wish to keep a gift if any of its contributors were insincere, especially when I am not in need of the gift. Thus, I donated the full $105 to a charity in the name of the "Staff of XYZ ward (ABC hospital)". I shall be sending them the receipt with a note that I'm "paying it forward" with regards to their blessings.

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.

It's not so simple

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

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

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

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

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

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

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

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

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

Comments on Bone Collector's blog

I made a few long comments on Bone Collector's blog recently. Just an entry to gather the links to the long-winded comments.

The problem with raising the bar

l am sick...again!

The 'masking effect'

Countdown: 5 workdays left

Finally can count the number of remaining workdays on one hand.

I had not been getting enough rest recently, dealing with the practicalities and emotions of leaving. Thankfully, things are progressing. A friendly housekeeping staff from another ward told me some grapevine news about me today. [Note: Cannot share about it for now.] Made me laugh inside because I know the initial spark of fire 2 days ago that generated the smoke. HA HA HA :-D

Countdown: 10 workdays left

Countdown: 10 workdays left!

Coincidentally, my final days at work coincide with the Singapore 2010 YOG (Youth Olympic Games). The online outrage over the food for YOG volunteers created a storm recently.

In the hospital setting, we have a similar situation. Sometimes we have patients and/or next-of-kin who love the hospital's food. They are aware that the staff can buy meals in-house using staff meal coupons. They remarked that we are very lucky to get the delicious hospital food at such low costs. Then, they looked surprised when we clarified that staff's food is different from the patients' food. Fortunately, the staff's food is not as bad as the YOG volunteers'. In fact, on some days, it is so good that some staff secretly pack some back for home consumption.

Leftover scraps for a dog

Imagine this scenario.

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Prologue: 4 months ago

See 2nd comment in an earlier blog entry.

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Part 1: 3 months ago

Your ward has been facing high patient census. Your ward staffing is so stretched that staff has been asked to do double-shifts and agency nurses called-in on an almost daily basis.

One colleague has been transferred to another department in a last-ditch attempt to retain her with the hospital. Another has announced her plans to leave after her marriage, which coincided with the completion of her bond with the hospital. Others have verbalised (amongst fellow colleagues) plans to leave at various time in the second half of the year.

You inform the ward manager that you plan to leave in 3 to 12 months' time due to plans for migration. You explain to the ward manager that although you're only required to give 1 month's notice, you're informing her in advance because you understand the difficulty and time-lag in recruiting staff replacement. You explain that given the high patient census and the 2 planned staff departures, you do not wish to further aggravate the situation by leaving suddenly. You will submit the resignation letter when the required notice period is due.

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Part 2: 2 months ago

Mid-year review. Your ward manager explained that she is pleased with your performance. Your training shall be in-place as planned.

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Part 3: 1 month ago

You found out that you have been scheduled to be on-duty on the 1st of 2 days for which you had previously been scheduled for the training. It is the only* nursing skill course that has been approved for you for this year. You question your ward manager about the course. She tells you that the DON instructed** her to cancel your training because there is NO NEED** for it.

The course in question? IV venepuncture and cannulation. You secretly attended the final hours of Day 1 and the whole Day 2 of the 2-day course with the instructor's permission on your own afterwork hours and day-off. However, because you've missed 1/3 of the course and are not an official participant, you will not get the certification.

* Note: I do not consider the in-house nursing communication training as a nursing skill course, because it lacks the professionalism/depth of a proper communications training/workshop.

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Part 4: 2 weeks ago

It was an afternoon workday with only 4 staff. One "new" SSN as overall in-charge, you and another less than 1-year old SN and 1 SEN as runner. Total patient count: 24. At handover, there were several new admissions with IV cannulations to be done and treatments/investigations to be started. The SSN refused to request for more staffing, insisting that 4 is enough.

You got fed-up. You told the ward manager (who happened to stay around after her morning shift) that she is overworking her staff. You told her that if this continues, you can and will resign with immediate effect. She was surprised by the outburst and wanted to know more about what else makes you want to resign with immediate effect.

You told the ward manager that you are not happy that your training was being cancelled unlike previously agreed in the 2009 year-end performance review and approved by HR, without even informing you. Ward manager then claimed that the DON gave a GENERAL** standing instruction to cancel all training for staff who has resigned. At that point you have yet to submit your resignation notice, since it was not due. Thus you asked pointedly, "Have you received my resignation letter yet?".

The ward manager then "clarified" that the DON was referring to all staff who has reported INTENTIONS TO LEAVE**. Thus, she was only following instructions when she instructed the administrator to cancel your training. To make amends and prove that she is a good and caring boss, she will fight on your behalf for your training to be re-scheduled for the 1st day of training missed. [Note: There were other issues raised too, but let us keep this scenario simple.]

** Note: See the change of rationale?

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Part 5: Today

Your ward manager spoke to her manager. You are given the choice to use your own day-off or annual leave to attend the 1st day of training that was missed out. Your ward manager recommend that you take up the opportunity given to you. You agreed. The administrator then happily informed you of her efforts to convince another colleague to do a double-shift in order to cover you.

You checked with the training department who informed you that you will need to repeat both days of training to get certified. You do not wish to waste your annual leave and another day-off just to get a certificate that you may never use. Afterall, you have already caught up on the missed 1/3 of the contents from fellow course-mates at the previous training.

You tell the administrator that you have changed your mind because attending the missed 1st day would not make any difference to you. You remark, "What's the point?"

Your ward manager and administrator did not look happy with your decision.

**Addendum 16-Aug-2010: You also noticed that despite the ward manager's earlier claim that there was "NO NEED" for you to be trained in this nursing skill, she has sent another colleague (who was also new-to-nursing and joined a few months after you) for the same course this month. This other colleague was previously not registered for this training course. You know, because you had previously advised that colleague to try to get this certification and LSCN done for her long-term career prospects, despite your ward manager's view that these training are not necessary for your daily work.

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The above is a real scenario. It happened to me in the last 3 months.

Why is it that today, at part 5, I feel like a dog that is given leftover scraps from my master's table and is expected to be thankful to my master for the "generosity" of her scraps?

Counting down on National Day

On National Day last year, I completed my emigration forms.

This year on National Day, I am counting down to my final days at work and in Singapore. To be honest, it is not in my original plan to be in such a rush. There is so much yet to be done... things to pack, friends to meet, arrangements in Canada, etc. Yet, somehow I feel it in my guts that NOW is the time. Something that I can, at best, describe logically as "I decided to just go while I am still healthy and before I become too settled into the comfort-zone at my current job and life".

The song "My Way" sung by Frank Sinatra seems apt here.

Assessment report from CRNBC

Received CRNBC's reply. I am required to undergo an Internationally Educated Nurses' Substantially Equivalent Competency (SEC) assessment in General Medical-Surgical Nursing (a 2-day assessment). On the bright side, only 1 of 4 possible areas* are required of me and the SEC assessment is at no cost to me. The CRNBC even provides a letter to non-Canadians/PRs to visit Canada for the purpose of SEC, although I won't need it.

Will go ahead with the migration plan. In the meantime, I may apply for other jobs, just in case. Keeping my fingers crossed.

[Addendum 20-Feb-2011]
*FYI, the 4 possible areas are Medical/Surgical, Maternal Child Health, Pediatric Child Health, and Mental Health/Psychiatric Nursing. It would take 5 days for assessment in all 4 areas.

[Addendum 03-Aug-2011] Click here to see my "CRNBC IEN SEC assessment result".

Nurses' Day

1st of August is Nurses' Day in Singapore. Here's my humble 2 cents on modernising nursing in Singapore:

1. Eradicate pay discrimination based on passport.
2. Same qualification exam and registration standards for BOTH local and foreign-trained nurses. E.g. CRNBC's CRNE approach.
3. Extend SNB's scope, RE: doctors' SMC. E.g. Evaluate hospitals on nursing standards.
4. Strengthen SNA, RE: doctors' SMA. More support for independent nurses. Legislate SNA with the powers of an independent nurses' union.
5. Re-educate nursing management on "nurses as professionals". E.g. Nurses do NOT exist to boost doctors' egos.

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Just discovered from the "Nurses' day out on Flyer" news article that there are 22,389 nurses nation-wide. I suppose it includes ENs and RNs. 22K for a population of 5 million, works out to approximately 1 EN/RN for every 220 persons. I wonder what the RN-alone ratio is like.

[Addendum 5-Aug-2011]
See my comment on nofearSingapore's blog entry on "Nurses' Day 2011". Despite the challenges that I face in getting my nursing registration in B.C., Canada (partly exacerbated by my early exit from nursing in Singapore), I still count myself lucky to be able to leave my unhealthy Singapore work environment.

No! No! No!

We had a 2 year-old boy with a Caucasian daddy and Chinese mommy admitted for Influenza A, and thus required to be isolated. As anyone who has handled active toddlers will know, it's hard to keep an active toddler happily entertained in a small room for days.

It's day 4. The boy was crying to go to the playroom this morning. Daddy called for the nurse to enquire if the boy could spend some time there since he was to be discharged for further management at home. Unfortunately, the boy was still not cleared to be de-isolated. Then, daddy tried to trick boy into drinking his milk (given his reduced intake for the past days) by making it a pre-condition to playing outside.

Daddy, "Do you want to drink your milk? You can go out to play only after you drink your milk."

Boy, "No!"

Nurse (me), "How about Ribena?"

Boy, "No!"

"Water?", "No!", "Milk?", "No!", "Apple juice?", "No!", "Orange juice?", "No!". And on it goes with the "terrible twos". Fortunately, daddy has patience and a sense of humour.

Finally, I teased, "How about some beer?"

Boy, "No!"

Daddy chimed in, "Champagne?"

Boy, "No!"

Daddy remarked with mock surprise, "You don't want some champagne? What a pity!"

We both laughed.

Blind outsourcing = a race to the bottom

Reading Lucky Tan's post, especially the comments, reminded me of the state of my previous industry in Singapore.
http://singaporemind.blogspot.com/2010/07/12b-still-get-monkeys.htm

Blind outsourcing = a race to the bottom + managers' (i.e. decision makers) unwillingness to take personal responsibility and risks

Unfortunately, the kia-su 怕输 + kia-si 惊死 culture is pervasive in Singapore. IMHO, it is also apparent in the entrenched dominant political party. See spoofs of its PR failures here, here and here. That is why I do not hold high hopes for the future of Singapore.

Of course, as Anonymous at 16/7/10 22:59 commented on Lucky Tan's blog, it does not have to be that way. At least not at the company level, e.g. in the decisions made by HQs based outside of Singapore. Or at the immediate supervisor levels, e.g. I've had bosses who held their stand well [but none were Singaporeans and all have left Singapore].

Ghosted in translation

SN L and SEN MY are both from the same nation, one which borders China. SEN MY is half-Chinese and grew up near at a border village which frequently trades with travelling Chinese merchants. Thus, she speaks fluent Chinese. SN L, on the other hand, understands only a few Chinese words and has an English-speaking Indian grandfather.

One day, a patient's grandmother was speaking to SN L in Chinese. She probably thought that SN L understands Chinese based on her nationality. SN L only caught the keywords, “有很多．．．？” and “小孩” ["Are there many?" and "children"].

Thinking that the grandma was asking about the patient census, SN L replied, “很多，很多。” ["Yes, there are many."]

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The next day (day 3 of admission for the patient), the patient was for discharge. Of course, most parents are eager to bring their children home. In this case, the patient's father chased the staff several times for discharge immediately after the doctor has reviewed and approved it (while the doctor was still reviewing other patients). I thought that he was extraordinarily eager to get his pre-schooler out of the hospital.

Towards the end of the shift, SEN MY gave me the answer to my puzzle. She was tickled and eager to share her joke. It was due to what patient's grandmother told SEN MY earlier that morning.

On the 1st night of admission, the patient was fretful and refused to sleep. The next day (day 2 of admission), the patient told the grandmother about seeing "someone" under her bed, which was near the door. Thus, the parents insisted on changing to the bed nearer the window (in the 2-bedded room) when the neighbouring patient was discharged that morning. The grandmother asked SN L in Chinese if there are many ghosts in the ward and if any of the children were frightened. “這里有很多鬼嗎？小孩害怕嗎？“

As mentioned above, the meaning was lost-in-translation and thus the ward became (haunted) "ghosted"-in-translation. The patient's grandmother then expressed her concern over the ghosts to SEN MY on day 3 of admission, the morning of discharge. SEN MY had to explain that the ward is not ghosted, but the grandma remained sceptical. Thus, I think that explains the patient's father's eagerness to be discharged.

Fast play, slow motion

Have not been posting for awhile. In fact, have not been reading my regular diet of favourite blogs. Not sure what it is, but just felt like switching to printed reading materials for a while and giving my body extra rest-time where possible.

Wanted to write about lots of stuff, but somehow just didn't get through the inertia to do it. A fast-play of some stuff that I wanted to write about...

• My niece born in May-2010 and her very interesting name. According to my sister (her mommy), it's an original derivation of a famous mathematician's surname.
• The boy who first presented to me crying in pain with guarded abdomen muscles. A drama king who role-played an exaggerated sensitivity to IV antibiotics, but then grinned widely when I praised him on his dramatic skills. His over-the-top, big farewell wave and loud "bye bye" upon discharge.
• The cheerful adult female patient with cats named LKY and LHL. Her humour was like sunshine along the now-windowless ward corridor.
• How we laughed about SSN Y's 7 months of actual workdays a year. Due to a combination of her annual leave quota (from her decades of long service), a weekly double-shift arrangement to get 2 days-off per week, and the 10 days of public holidays per year. She finally got over her aviatophobia (acquired from the days when airplanes rattled while in-flight). Now she is jet-setting with a vengeance.
• The friendly doctor with a cool pony tail. The first doctor in Singapore that I have met who actually break from the conventional Singaporean male's short-hair cut.
• We suddenly have 3 new staff in July. A freshly graduated EN A, an SN LZJ with 1 year's experience at a doctor's clinic, and an ex-staff SSN S who re-joined. I had previously blogged about SSN S here. As the ward census are lower this fortnight than usual, this batch of new-comers are luckier than the previous new-comer SN S who joined during our overloaded period. Headcount-wise, we have SN S replacing SN O's headcount, SN LZJ who replaces mine, and EN A who replaces SEN L's. SSN S seems to be an extra headcount, but then other SSNs have already gossiped about their intentions to leave and the NO is also planning for her succession. Well, for now, the understaffing situation [click here and here] is temporary resolved.

On the other hand, things on the immigration front are on slow-motion to me. Still awaiting for assessment results from CRNBC. Meanwhile, even setting-up a Canadian bank account is in slow-motion compared to the Singaporean pace. Better get used to it! :-P

Controlling behaviour

In response to StorytellERdoc's blog entry titled "Who am I treating?".

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We get such controlling behaviour rather regularly in Singapore. Unfortunately, management and the work culture (it's a private hospital) tends to bow down to patients/NOKs who raise hell, so it becomes a recurring pattern on their future admissions.

I am in the Paediatrics, so parents have an "excuse" to provide information regardless of the child's age. Some parents seem to think that their treatment demands should be met, although our professional assessment of patient may indicate otherwise. It can be an annoying situation. [Edit: Come to think of it, even the consultant doctors face such demands. Although they face it less frequently than the nurses, IMHO, due to parents having more respect for a doctor's assessment.] Then again, IMHO such controlling behaviour often extends beyond just treatment demands (e.g. demand to jump queue for private room).

E.g. Recently there is a case that should rightfully belong to High Dependency Unit (HDU) but is nursed at acute ward levels. Ostensibly it was for the hospital's compassionate image in catering to the parents' budget issue. However, it results in overloading the ward nurses with HDU work in a busy acute ward short on trained staff.

The child was admitted because of infection from a previous ventricular shunt inserted at an overseas hospital. The mother was obsessed with the patient's temperature, because she wanted to keep the child afebrile to have a ventricular shunt inserted sooner and to prevent seizure. The child was still suffering from on-and-off low grade fever, and we followed our nursing protocols.

One day the temperature spiked from afebrile to 38.2 degC (100.8 degF) in-between an hourly temperature monitoring. The patient's mother was verbally nagging and blaming the nursing staff non-stop (especially me since I was in-charge of his medications that shift) for not monitoring him more frequently (on-demand) and not giving him the anti-pyretic while he was afebrile. She was demanding that I give paracetamol STAT via NGT, while I was preparing the patient's STAT IV Albumin drip order at his bedside. [Edit: I told the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment. Nevertheless, she went on threatening and complaining of poor nursing care.] I finally told her, "I am handling a very important treatment for your child, please can you give me a few moments of peace to ensure that this goes correctly?"

The mother screamed "You cannot talk to me like this!" and repeated her broken record of why because of our treatment that her son is now having "high" fever. [Note: her son came in due to an infected shunt inserted overseas and had been febrile on-and-off since admission.]

The mother never paused for a moment to let me focus on her son's more important STAT Albumin treatment. I hit my tolerance limit. [Edit: I reiterated to the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment.] I told her firmly that we have our protocols for managing a patient's fever, especially in preparation for operation, we don't want to mask any underlying infection and we were handling her child as per protocol. She disregarded my explanation and still raised her voice and continued to blame us. Finally, I told her that if she is not happy she could lodge a complaint. That I was there to help her child get well, if it were for her, I won't care either way. I continued with my work while her husband spoke to her in their language (presumably telling her to tone down), and then she continue running her broken record at a lower volume.

When the patient's consultant PHK came, we informed him of the incident details after he reviewed the patient. Fortunately for me, this consultant was fair to nurses. He returned to the patient's bed and told the mother that we the nursing staff are competent in our work and had been doing her family a huge favour in cost savings by treating her child at the ward. She had been privileged to received such good nursing care at lower cost (and free doctor's consultations). However if she insists on demanding interventions her way, he will re-assign the patient to HDU and she will have to foot the full bill.

That lecture bought us some peace for a while. I was glad the consultant was the one who dealt with the parents. Sadly, I am not confident that my hospital management would have been so supportive of its nursing staff.

Time to change tune

I have had sore throat and cough for more than a month. It's the longest that I've been coughing persistently since childhood [when I coughed over 3+ months, and I suspect, resulting in asthma]. Over the past 5 weeks and 6 trips to my hospital's A&E, my diagnosis has changed from:

1. URTI, to
2. URTI with Eye Infection, to
3. ?Sinusitis, to
4. Rhinitis [after Sinus-XR ruled out sinusitis], to
5. Acute Bronchitis, to
6. Acute Bronchitis with Asthma.

After 3 rounds of antibiotics [Augmentin, Ciprofloxacin, Zinnat], switching between cough suppressant and expectorant, loads of mucolytic and lozenges, some painkillers and Sofradex eyedrops, I am still having chesty phlegmy cough on-and-off, resulting in persistent sore throat and an attack of bronchospasm (on my 1st night-duty, self-diagnosed based on pain radiating from right sternum to the right middle lobe of lung). Yet, over the 5 weeks, I have been given only 1 + 2 + 2 = total 5 days of sick leave. Knowing the hospital's HR policy and culture, the resident doctors are reluctant to give any more than 2 days of MC each time. I wonder how it can be cost effective for the hospital not to give staff a week's sick leave to fully recover from illness. I know I'm not the only one returning back to work just as my health improved slightly, only to get worse. SSN Y also only got 2 days MC and returned to work with a hoarse throat. Similarly for my ward manager.

Given the hospital's severe shortage of nursing staff [and now even the resident doctors], the message I get from its actual operations is that staff's health can take a back seat to reaping in the profits, regardless of whatever management or its policies state. In fact, down the line of hierarchy, someone somewhere would re-interpret the policies to suit their vested interests.

E.g. There was a recent incident where we had an physically+verbally abusive 7 year-old girl with brain tumour and her equally verbally abusive mother. Despite what the DON said to me about taking staff abuse (physical or verbal) seriously, my ward manager's response [my guess is to keep her own image that she runs her ship well] combined with the other staff unwillingness to report the abuse they suffered [despite widespread complaints amongst staff and, I heard, even on Facebook over this patient], resulted in me being the only person to log an incident report. You can guess where the blame goes to from there.

I decided that it's time to change my tune. As people who meditate would attest to, the mind is like a magnet which draws into one's life whatever one focuses one's energy/attention on.

E.g. The ward manager was returning from a long annual leave and had a double shift on her 1st day back to work. Given my non-optimal health condition and the ward's chaos [yes, it's still chaotic after 1.5 months since the new rooms opened], I hoped that I would not have to work with the ward manager in-charge on her 1st day back [IMHO, my ward manager has a Type-A personality.]. Just before the end of my 2 days MC, SSN Y called asking me to be the only SN in-charge of 3 days of night shift, because several of my (S)SN colleagues are on sick leave as well. Thus, I got what I wanted, since the ward manager is not on night-duty. [In fact, 5 of 8 day-shift SN/SSNs have taken sick leave since the new rooms were opened.]

I am spending more of my time-off researching about my future home, enjoying my small collections of various stuff [which I would have to pack for shipment], planning my finances for relocation, reflecting on and getting tickled by simple serendipity in life.

• E.g. There was a day when I got ~666 and 088 in my queue number at 2 different service counters.
• E.g. At an ATM queue standing behind a lady (probably grandmother) of a toddler (approximately 1 year old). The toddler dropped the brochure that she was holding and I picked it up for her. She repeated, I picked it up again, but putting it on her stroller beyond her reach this time. I stood observing the girl, she is so beautiful. As they were about to leave, the toddler turned around and sent me a flying kiss. Her grandmother remarked, "You are so lucky, she doesn't do it to just anyone, not even for me!"
• E.g. Looking a my list of diagnosis above also brings a chuckle.

Yes, I am sick of ranting. Time to change my tune for now, until I get sick of being chirpy, ha ha.

URTI

I am down with URTI again (upper respiratory track infection).

My ward had H1N1 and H3N2 flu cases for the past week. I wore a surgical mask at work most of the time for the past 2 weeks. Mainly out of fear of sneezing, coughing or dripping fluids from my running nose in front of the patients and spreading my pathogens to them. Afterall, the surgical mask does not provide adequate protection to the wearer from airborne pathogens. No one in my ward wears the N95 mask since the H1N1 flu was downgraded in severity. The only exception that I have seen recently was a respiratory specialist consultant while attending to her adult patient at my ward. [Note: Doctor JY also happened to be my attending consultant for my pneumonia episode.]

Back to my symptoms. Had been having running and congested nose on-and-off for the pass 2 weeks. Appetite is less, but still Fair. However, from Thursday onwards, the symptoms took a turn for the worse. I had an acute sharp pain at my chest where I had a history of minor atelectasis. Onset of cough which became more chesty over the days. Mucus and phelgm turned yellowish and of mucoid consistency which is worse in the morning. [Note: Not uncommon, given my history of asthma.] Thankfully, SpO2 is within normal range. Significant drop in appetite. I only manage to take 1/2 share of 1 main meal each day. Thus, I supplement my intake with snacks, juices, electrolyte drinks and nutritional supplements.

Finally, this morning, my sleep was interrupted at 3+am due to nasal congestion and a painful, itchy and scratchy swollen larynx (i.e. sore throat). The throat was so bad that I could barely take some fluids for breakfast. I couldn't get back to sleep, so I did my laundry and other chores instead. Then around 7am, my tired out body finally rested for 3 hours. I woke up to run some errands before I went to my hospital's A&E.

My hospital's HR is more willing to accept MCs (medical certificate for excuse from duty) from its Medical Officers. Up to 3 days of MCs from GPs (general practitioners) are accepted by HR. Thereafter staff are required to consult with the hospital's A&E MOs for an extension of MC.

Although the A&E was not particularly crowded (maybe around 20 patients), the combination of my low-severity and my arrival at 1+pm led to a long waiting time. According to the agency nurse at triage, the A&E staff held-up the cases from 1pm onwards until the agency nurse started her shift at 2pm. Thus, my hospital visit took 3+hours. I requested for Doctor Y, one of the Medical Officers on-duty, since he is somewhat familiar with my medical history. [Note: He happened to be the attending MO when I had pneumonia, and was also my pre-Employment check-up doctor.] Besides auscultation and the visual throat assessment, his check with the otoscope reviewed that my ears are also partially blocked by mucus. He asked how many days of MC I needed. Ha ha, typical of the service-oriented doctors in the private sector! Anyway, I requested for 1 day of rest for tomorrow, since it's my day-off today. If needs be, I could always return to the A&E for a review.

My ward manager had mentioned previously that, due to an increase in staff MCs for respiratory infections during the past months, the DON had requested the admin staff of every ward to report all respiratory MCs directly to her. Guess I'm on the list now! The increase in respiratory cases amongst staff does not surprise me given that ADON G discouraged staff to wear masks at work, other than for Isolation cases. She claims that the it muffles the enunciation and blocks-off the lower facial visual communication. Now her direct report, the DON, has to personally track staff's respiratory MCs. What a farce!

I wore an N95 mask from my entry into the A&E until I returned home. I was offered a surgical mask at the A&E entrance, but I wore my own N95 saved from a previous training session instead.

Yes, I know that the N95 and other masks are supposed to be single-use only. But to save costs for the hospital, the Infection Control Officer instructed us to save the "clean" N95 masks for a future use.

On my way home, few people noticed that I was wearing a mask. And even if they did, they turned their gaze away quickly. Most are absorbed in their own worlds. I wondered what makes Singaporeans, myself included, reluctant to wear masks in public whenever they have coughs/colds? A lack of awareness on the purpose and usage of a mask perhaps?

E.g. While I was at the A&E Isolation Room, a family -- consisting of grandma, mom, daughter and son -- arrived after me. They were there because the boy was coughing for a week without improvement after several visits to their GP (general practitioner). Initially all 4 of them wore surgical masks. When I informed the grandma that she was wearing the surgical mask upside-down, she cheerily disregarded the information saying that she's not the one who is sick. Subsequently, while waiting to collect the medication in the general A&E area, all of them took off their surgical masks. The grandma even chased her coughing grandson out of the Isolation Room to join his sister and mother in the general A&E area. Sigh! Infection control failed.

New rooms opened

The inevitable has arrived. The new rooms at my ward were opened 2 days ago. There was a demand for single rooms and an upsurge in admissions. Thus the management gave the go-ahead to open the new rooms for use.

It was a whirlwind morning -- a mayhem of room transfers, discharges and admissions. I lost count of the actual numbers, but I think it was 7, 6, and 5 respectively for the ward, of which majority affected my side of the ward. Lucky for me, I was the runner, SN L was the staff nurse handling medications for the team. The other team's runner Senior HCA M and the admin staff assisted with some of the room transfers. Also fortunately, SN O was the other team leader (i.e. SN in-charge of medications) and SSN Y was the overall in-charge, thus everyone remained professional (but brisk) even though we were flooded by the workload.

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The patients and families who got the new rooms were initially very happy. The new rooms had Disney cartoon wall murals, brand new furnishing and were better equipped. However, it became apparent by early afternoon that the toilets' plumbing were choked.

The admin staff confided in us at the staff room, "Apparently all the new rooms on the other floors also have the same problem. That's why the [note: plumbing dept] staff is under tremendous stress to fix it."

I asked, "Are we the first to open the new rooms?"

She replied, "No, we are the last."

I asked further, "So all the other floors had choked toilets when they were opened, and management is aware that the problem is not fixed [yet]?"

She nodded.

I asked rhetorically, "Why then did management approve of opening our [floor's] new rooms when they know that it will cause more problems? Now, if we need to find rooms to temporary 'park' the patients while the problem get fixed, we cannot, because the hospital is full!"

The admin staff gave an exasperated smile.

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Near the end of my shift, the admin staff informed me that I had "lots of double shift next week" due to a shortage of staff. [Note: SEN L is officially transferred to another department and SN RB was scheduled to clear her annual leave next week.] I simply told the admin staff that I will not accept any double shift assignment because the stress of taking the additional workload [note: 14 patients per SN] is not worth the additional shift allowance.

The admin staff said worriedly, "Then we will have to call in agency nurses."

I replied, "So be it. Management have to be aware of our staffing shortage. If we continue to pick up the slack [Note: i.e. cover the shortage of staff by doing double shifts], management will simply assume that we have enough staffing and refuse to hire more as [i.e. which] is the situation now."

Apparently, SN L, SN RB and I were the last few trained staff still willing to do some double shifts. All the other trained staff [Note: ENs and SNs] vehemently refused to take on any additional workload.