GNIE: Oh happy day!

Just finished the last school day of my 1st semester of the GNIE course today. The final exams will be in a week's time.

This period, just before exams, has always been my favourite, even from primary (elementary) school. No homework, and thus having time to idle, play and enjoy some distraction (ok, and squeeze in some studies to assuage my guilt). This is because I am not particularly ambitious about getting A's. Although I occasionally aim to get them when I think they are well within reach, I won't stress myself over them; i.e. I don't believe in using 80% effort chasing the final 20% score. I would much rather spend the remaining 80% effort to enjoy life!

Obviously I'm not the royal flush straight-A's scholar type. You can tell from my undergraduate grades, ranging from D's (just pass those subjects that I don't care for) to A's (for those subjects that I'm interested in).

That said, the 1st semester of GNIE has been particularly enjoyable for me, thanks to a confluence of factors.

1. Fun-loving and generally collaborative, rather than competitive, classmates. Yes, there is 1 super-kiasu person, but everyone kind-of avoids her now precisely because of her attitude. As for me, after the initial couple of tests when it was leaked that I was one of the top performers, people used me as a benchmark and kept asking me how many marks I got after each test result is released. Eventually I was annoyed and I complained to my classmates IJ about the "sense of competition building up to an unhealthy level". Somehow (I suspect IJ did something) people started to cool down on the marks comparison thereafter.
   
   I think my Singaporean readers already know from experience how kia-su and competitive the typical Singaporean classroom setting is, so I won't elaborate on it. For those who need a clue, Goggle for "Singapore education kiasu", OR read blog entries on the Singapore education system by Yawning Bread or LIFT OR read my comment in another of LIFT's blog entry (click here) on my experience of "teamwork" with some of these kia-su folks.


2. Major difference between nursing culture in Canada vs Singapore regarding the consequence of making mistakes.
   
   Right from the start, my GNIE lecturers kept emphasizing that "You won't fail the course just because you made a mistake in clinical", "No one loses their RN license because of a single medication error", and "If an RN tells you that she has never made any medication error, [then] either she is lying or she has never worked before". Therefore, it is part of the CRNBC professional standards for the nurse involved to report his/her own mistake, so that the system can be examined to prevent similar mistakes in future. Ya, I can speak from my student clinical experience here that one can actually cite one's self-reporting action after making a mistake as meeting the CRNBC's standard of "Responsibility and Accountability"!
   
   That doesn't mean that Canadian nursing students don't fail clinical, of course. We were told that students generally fail clinical when they make the same mistake repeatedly despite being given advice, warning and guidance repeatedly.
   
   Now compare this to my Singapore nursing student experience. Right from the start, we were warned to be careful about making mistakes in clinical. Even as "matured learners" (that is what the "career conversion" students are sometimes called), we were given solemn warnings and examples of how so-and-so students were failed by their clinical instructors (CI) over one medication error or an incident that requires reporting. In fact, recently I had a friend who underwent that torture of facing possible failure. Fortunately for my friend, a nursing manager from the ward pleaded on his behalf and he passed.
   
   [Click here and here for my rants on the issue of how nursing mistakes are swept under the carpet in professional clinical settings in Singapore.]
   
   You know what the Singapore nursing clinical system breeds? It breeds kia-su & kia-si students who are NATO -- no action, talk only. It is easy to score points with a CI using "beautiful" detailed nursing care plans and "in-depth" research on the patient's diagnosis; and by avoiding ("siam") the actual nursing tasks, the chances of an implementation mistake is minimized. E.g. I heard from my fellow classmates that a classmate SD who won the distinction award for excellence in clinical is an archetype NATO student nurse. Since I didn't work closely with SD on clinical settings, I initially put it down to idle green-eyed gossip. Some months after graduating from nursing school, I heard another gossip about SD. Apparently, SD couldn't deal with the actual RN work at her originally assigned acute ward and had to be transferred to another department (a simpler, less busy, day-clinic role) to serve the remainder of her training bond.
   
   Btw, GNIE students are not graded on their clinical performance, just a "Pass" or "Fail". IMHO, given the huge variety of clinical settings that students are assigned, there really isn't an equitable ground for comparative grading.


3. [Addendum on 12-Apr-2012] Major difference between Canada vs Singapore in handling workplace bullying.
   
   I will delve more into this in future with its own blog entry. Suffice to say for now that in Canada, workplace bullying is illegal -- not only will the offending person potentially lose his/her job, the organization that allows workplace bullying to happen repeatedly will be dealt with by the law. [Click here and here for B.C. policies.] In Singapore, workplace bullying is often swept under the carpet or, worse, rationalized as the "right" way!


4. Enforced cross-cultural interaction. We were not allowed to form our own groups in my class. The lecturer assigned us to groups with the intention to mix students from different countries of origin. This brings variety to our group discussions and teaches us to practice respecting each other's differences.


5. Enforced use of English. We were threatened by our lecturer right from the 1st lesson that we could be expelled from the course for speaking in our "native languages" while on campus ground. It forces everyone to keep practising their English and one can see significant improvement in oral English for those who were weak in the beginning. IMHO, an important part of assimilating into the Canadian society is being enforced here.
   
   According to my classmate IJ (who works part-time as an LPN, a.k.a. Assistant Nurse, in a hospital here), one can lose one's nursing license if one is caught repeatedly speaking in non-English to colleagues while at work. It is disrespectful to others who do not understand that spoken language, and thus breaks the CRNBC "Provision of Service in the Public Interest" professional standard by failing to "communicate, collaborate and consult with nurses and other members of the health care team about the client's care". I am not sure if this is true. If so, I would deem it positively because I have personally witnessed foreign-trained nurses in Singapore ganging up to bully a specific target (who is usually not of their nationality or ethnicity) by speaking in their own language at work.


6. Fun revision classes that wrap up a semester of fun-filled lessons. At Nursing Theory class, the lecturer played a modified game of Jeopardy with competing teams of students. At Pharmacology class, the lecturer went through general study and exam strategies.
   
   In Singapore, the "revision class" is often a review session focused on giving students "tips" about what would likely appear as exam questions. To those unfamiliar with the Singapore tertiary education, I kid you not. You see, if too many students didn't pass because "there was too much to study" or if too many kia-su "must-get-A's" type of students complain that the exam was too tough, the lecturer has to write a justification for "why so many students failed" and/or "why no one got an A", "bell-curve" the results to shift the passing mark and grades, and perhaps set a re-test.


7. Instructors treat us with respect as adult learners. In fact, some instructors told us that they specifically chose to teach GNIE students. E.g. An often cited reason was GNIE students bring into the classroom a vast range and amount of clinical experience, diversity of culture and backgrounds, which contribute to interesting discussions. E.g. One said that she liked the GNIE students because the motivation to succeed is already there, i.e. the "lack of motivation" is hardly ever an issue for the GNIE students. Yup, for many of my classmates, their quality of life in Canada depends heavily on them entering the nursing profession here successfully. Thus, the motivation is strong, alright.
   
   This is similar to my nursing student experience in Singapore as a "career conversion" nurse-to-be. My lecturers also felt that we "matured students" were a highly motivated group and treated us differently from the usual teenage Polytechnic nursing students. We were trusted to self-supervise for a lot of tasks and were given more leeway in various activities. I have my lecturers and the nursing school's support staff to thank for that.


8. I've moved out of the Maslow's levels of survival needs, given my low-cost simple lifestyle. From kindergarten to my undergraduate days, my main goal was to get a degree and use it as my ticket out of the poverty cycle. [Note: I first graduated in the early 1990's when a degree was still a door-opener to well-paid jobs.] Thus, like it or not, there was some amount of self-directed pressure to ensure that I met the requirements to get onto the next rung, all the way to a Bachelors. Whereas now, I can enjoy a simple life here in Metro Vancouver even as a minimum wage worker. Thus, I don't feel as much pressure as some of my classmates to do well in this course. It is mostly personal satisfaction that drives me to complete the course and give a good shot while at it.


9. Much of what I have learned in my Singapore basic nursing training is applicable in the Canadian context, with some minor differences. Thus, this semester's classes feel like one big revision for me. Some of my classmates are not so fortunate. E.g. Some did their basic nursing training more than a decade ago, and generally nursing training has changed greatly since. E.g. Some were surprised that they have to learn about "Professional Communication" in Nursing Theory. E.g. Some were disappointed that their experience in delivering babies as part of their basic nursing training -- a component that they viewed with pride -- is not valued here.

So I am happy and relaxed, enjoying the warmth of the spring sun and the freshness of spring blooms. Simple bliss! Ahhh, contentment once again!