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.