Inter-department incidents

I had 2 inter-department incidents today. One was with a medical/surgical ward and the other with the intensive care unit.

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The medical/surgical ward Sister A complained to my ward manager about linen items taken from their shelves without permission yesterday. My ward manager asked me what happened. I was the runner on-duty yesterday with Snr SN R in-charge and SN L and SN O taking teams. There were a sudden influx of adult surgical cases booked into my ward. Since my ward is really for paediatric patients, we have only a few OT gowns (all used up) and no adult pyjamas in our linen cupboard. Snr SN R instructed me to borrow a test-tube rack with test tube from Sister A's ward and SN L instructed me to borrow some OT gowns and 1 pyjamas together. When I arrived at the ward, there was only their ward admin staff on-duty together with a Snr SN B and another SN M, who was seconded to that ward for the shift. The moment I walked to Snr SN B and started saying that "I am from X ward, I would like to borrow...", she rushed away in the direction of the patients' room (without any call-bells sounding), ignoring me. Then I turned to the only other SN in sight, SN M. I told her that I'm here to borrow a test-tube rack and some linen items. SN M replied that she don't know where the items are stored. To which I replied, "I know, can I go help myself?". To which SN M acknowledged. As I was leaving the ward with the test-tubes with rack and 1 pyjamas, 3 OT gowns and 3 kimonos, Snr SN B stopped me. She claimed angrily that she only gave permission to borrow test-tubes with rack and demanded that we cannot borrow their linen. I explained to her that my colleagues have sent me up and they have already sought permission for the items. She claimed angrily that she only gave permission to borrow test-tubes with rack and not the linen items. I informed her that we have an overflow of adult patients for surgery and we have run out of gowns. I also reassured her that I have checked that their linen cupboard is well stocked before I took the items. However, she was unappeased and pressed that the pyjamas have to be billed and we should have called the linen dept for items that we want. I told her ok, I will bill the pyjamas.

After my ward manager heard my story, she laughed. She explained to me that the only billable linen item was the 1 set of pyjamas. She could not believe that the ward people would be so hung up over one billable linen item and other shared linen items. She has arranged with the linen dept to send over to Sister A's ward whatever linen they demanded as "compensation" from my ward. Fortunately I was honest to my ward manager and told her that I had previous run-ins with Sister A's ward while I was a student nurse there. Then my ward manager told me that she understand, she was a student nurse before. Haha, my ward manager was a student nurse almost 30 years ago, yet she still remembers how it was like. The ultimate irony is that when I was a student nurse at Sister A's ward, her staff would send me all over the hospital to borrow linen items without first calling in-advance to seek permission. Now, they twist over and roast me for borrowing items from them. What hypocrisy! Glad that I am at my current ward, and not under Sister A. From my experience as a student at her ward, she is easily swayed by her staff's gossips, not a leader nor a problem solver. Interestingly, Sister A has graduated from my nursing school just over a decade ago, but it seems that she has already forgotten the challenges faced by student and new nurses.

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In the early afternoon, I saw an ICU staff wheeling a patient down to my ward into a room unaccompanied. It is not my ward's style to not escort patients to their rooms. I quickly rushed over as I was expecting a patient from ICU who booked that room. However, when I entered the room, I realized that the patient is not the one with the reservations. Then I instructed the ICU staff to call her dept to confirm if the patient is meant for this room while I stay with the patient in the room. She went out of the room to check. After a while, she came back into the room and apologized that it was a mistake, the patient was meant to go to Sister A's ward. About half an hour later, ICU called to complain that I did not let patient enter the room when their staff wheelchair the patient down. Fortunately for me, my in-charge Snr SN Y saw the ICU staff wheeling the patient into the room, so I have a witness. In addition, luckily the patient was nice and did not complain about the moves. In fact, he complimented me to the another ICU staff present when I had to send him back to the ICU for further monitoring as per doctor's orders.

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Fortunately my team's workload was not so busy today. In addition, I had help and support from Snr SN Y, SN O, and HCA K. Otherwise I would have been stressed out by multiple incidents near the start of my shift.

Running faster, working harder

"Running faster, working harder: repairing the care" is a 15 min video explaining health care underfunding in British Columbia, Canada. In the video, Dr Pollock mentioned education, employment, welfare, healthcare and housing are interdependent political solutions for the problems of ignorance, idleness, wants (poverty), disease and squalor.

Sadly, Singapore has gone further down the privatisation (profit-driven) road than Canada and UK. E.g. Free education (albeit with bond) for FTs but driving out Singaporeans, cheap foreign labour competing for jobs at all levels, no welfare, KPI-driven restructured hospitals, "market-subsidy" HDBs. For healthcare in Singapore, the "sustained under-investment" to orchestrate a "crisis" did happened. The show is now repeated to launch the Minister of Health's solution for elderly care.

It's so sad that the film above describes exactly how things are in Singapore. I have seen healthcare from the insides of both restructured and private hospitals. Patient care is compromised if one benchmarks against the standards set by our local nursing schools. A major contributing factor is that nurses in Singapore are overloaded. E.g. In acute medical/surgical wards, Singapore has a typical 1 RN : 12+ patients ratio, compared with the mandated maximum ratio of 1 RN : 4 patients in Australia.

Due to corporate policies, we cannot let our patients know the truth. Instead, it takes a concerned patient's kin to raise the issues. "Are Hospitals Safe?-What killed my dad?". It is a shame.

Migration thoughts on National Day

When I was in my twenties, I could not have imagined myself thinking and feeling the way I do today.

"I am happy to be filling in documents for migrating to country X on Singapore's National Day. The Singapore that I grew-up in and dreamed-of no longer exists. I have to make that leap for my long-term welfare, especially for my golden years. I am happy to be quitting Singapore."

Here is a blog entry by Lucky Singaporean that expressed very well my sentiments about being a Singapore citizen.

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[Addendum: 23-Aug-2010]

I sent in my application in November 2006. In those days, one fills up a simple summarised form at the initial application and then wait until one's form reaches the front of the queue. Then, and only then (approximately 2-4 years down the road), will one need to furnish the complete set of application forms and supporting documents.

Fun day at work

Had a good time at work today. The ward manager left work after the afternoon report handover. SN J was in-charge, I was taking the back team (7 patients, including 1 night discharge) and SEN L was taking the front team (4 patients), with 1 runner SEN MY. The mood was casual and the ward was rather peaceful. Perhaps most patients' parents were distracted by the National Day Parade broadcast. We, the nurses, had time to chat and joke amongst ourselves. SN J helped me with 1 night discharge. From around 5 pm onwards, SEN MY was somewhat whiny about her workload as the sole runner, even though SEN L and I helped with the call bells. Anyway, at the end of the shift, all of us left on time happily.

:-) Interestingly, I was the only Singapore citizen on-duty at my ward during that shift.

2 months old

I have passed the 2 months-old milestone and received my 2nd monthly paycheck, yeah! I am getting more used to the job, although I still get stressed when my team's census hits around 8 of the typical acuity for my ward.

For 2 weeks in July, I attended my hospital's nurses orientation. As the orientation programme was suspended during the early months of Influenza A H1N1-2009, there were many nurses (ENs and SNs) who had been at their wards for several months. During the introduction, it became apparent that many wards didn't have a culture of welcoming and supporting new staff. There is widespread existence of new staff being taken advantaged of or even bullied. Upon sharing about ward practices, it became apparent that there are non-standardised practices (sometimes even between nurses in the same ward), gaps in policy, and difficulty of applying changes (e.g. very experienced nurses who insist their existing out-dated methods still work and demanding that new staff adopt their existing methods; and foreign staff insisting on following their own countries' nursing practices). Thus, many new staff faced difficulty fitting into their wards, especially if their preceptors were not supportive. A few left the hospital even before they attended the orientation programme.

In a way, I am comparatively lucky. I did much of my student clinical training at various wards in this hospital. Thus, the problems that the new staff face did not surprise me. I faced many of them as a student. As such, I also had the opportunity to discover which wards were relatively supportive of new staff. As a result, I requested for a ward where I was more likely to fit into.

Nevertheless, I still face "people" challenges as a new staff.

• E.g. Unexpected competition from foreign trained Registered Nurses in their home countries who are downgraded to Enrolled Nurses when in Singapore.
• E.g. Returning to my ward after the 2 weeks orientation, I find myself sharing several shifts with SEN M where she was the runner assigned to my team. For some reasons, she refused to do tasks that an EN is capable of, e.g. changing IV infusion drips, flushing IV lines, and initial patient assessment upon admission. She even avoided tasks that a HCA does, e.g. answering call bells and making beds. Now that she is mostly assigned the runner's role, she claims that she found the team leader's job less stressful. She excused herself by suggesting that maybe her heavily pregnant state made a runner's job tough and tiring. Honestly, I would have accepted her excuses at face value if not for her loud insinuating questions (at the nurses' station in the presence of my preceptor who was in-charge) that I could not even manage the medications (at the end of a shift where my team was full-house with 12 patients and 1 new admission after another patient was discharged, and SEN M skived on her job as my runner). I decided to take it as a challenge to practice the Chinese philosophies of “与世無爭” ["not to fight with the world"] and that “路遙知馬力，日久知人心” ["A long journey reveals a horse's strength, a long time period reveals a person's heart"]。 As it turns out, the ward manager was in-charge the following morning and SEN M was again my assigned runner. At a busy period, she instructed me to delegate tasks to my runner, but my runner SEN M was no-where to be found. The NO was not happy that I did not know the whereabouts of my runner, but she was even more unhappy with SEN M for being missing-in-action.

Met up with some classmates for tea on Nurses' Day. We are from different job environments and face different challenges at work. In my case, I faced experienced staff under me who are still adjusting to the switch from ordering me around during my student days to me as an SN assigning them tasks. In addition, due to head-count constraints, I do not have a chance to be shadowing another staff who is in-charge of a team. A classmate in the public hospital faces difficulty of hostile foreign SN interrupting her report passing frequently with questions raised in a challenging tone. In addition, her C-class ward is almost always full-house with wait-list, and some patients have difficulty getting family support for their discharge. Another classmate in a step-down care facility faces the concern of losing her acute care nursing skills as her patients are transferred to acute care hospitals if their acuity increases. In addition, being the few staff nurses at her sub-acute hospital, there is a higher SN-to-patient ratio. She also had to deal with an agency staff not performing care according to the specified instructions. As the agency staff was well-connected to higher management, the ward manager did not dare to reject her services despite the difficulties the ward staff had with her.

After considering all the challenges faced by others and myself, I was quite happy that I had a good day today. The ward was understaffed during this shift. SSN R was in-charge, SEN L was taking team 1 (patients near the nursing station), I was taking the other team and HCA K was the sole runner for all 15 patients and she even had to help take meal orders for the 5 patients on the adjacent ward. I had 8 in-patients (of which 1 discharged in the evening) and 1 day surgery lodger for discharge in the night shift. HCA K was fantastic given her high workload. In addition, SEN L and SSN R were very supportive, helped me with the doctors' rounds, admissions and discharge. I even had breaks for tea, toilet and dinner, time to document my per-shift patient's assessment outstanding from the day before.

:-)