Students on work exposure

Our hospital is hosting some GCE 'A' levels students (i.e. 16-18 year olds) for work exposure this week. Some were from the junior colleges and some from the Integrated Programme.

3 students came by my ward around 2pm this afternoon, expecting someone to show them around. The sad truth is there is the nursing staff here are already stretched with their own duties. Unlike some hospitals, there is no Clinical Instructor at the ward with the time to show them around. I asked if they could come back another day or time, but it seems that they had a specific time-slot scheduled (2-5pm today) to be at my ward.

At 3+pm, I finished the outstanding work from my morning duties. The 3 students were still standing in front of the nursing station awaiting instructions, and looking lost as to what to do. Finally, I checked with my preceptor SSN Y who was the afternoon in-charge and offered to show them briefly around. I showed them our facilities, equipment, some paperwork and processes, the staff, etc.

One male student asked the typical questions raised to a paediatric nurse, "Is the job stressful? Is it very stressful to hear the children crying all the time?"

I joked, "Wow, like job interview questions like that".

Then I continued, "It depends on individuals. For me, I have taught at a childcare centre before, and I don't find the crying stressful. Of course, if you find it stressful, you can choose another specialization. During our nursing training, we are exposed to different wards, so you'd have an idea what you prefer. Some prefer to handle children while others prefer to talk to the elderly. Nowadays, the HR departments for nursing are quite open, and they will consider their employees' preferences when assigning the ward. For example, my male classmates prefer A&E, they were assigned there and are enjoying themselves."

He said, "Yes, where the action is."

"Yes, and minimal report passing", I added.

"Yes, minimal report passing" he reflected with a wide grin and we laughed.

Getting to the point, I told them, "Nursing is not just caring for the patients, but we also handle other administrative work. E.g. Room assignments, for which we may have to deal with irate parents awaiting for the limited number of single-bedded rooms. The stress also come in when you have several patients that need your attention simultaneously. E.g. If one patient's oxygen level suddenly drops, another needs attention on the IV, etc. That's why team work is important. We cannot survive without teamwork here." (Actually the example I cited happened earlier that afternoon, just before the students arrive. Ha ha!)

At one point during the briefing, my afternoon colleague HCA M distributed payslips to the 2 afternoon SNs and I at the nursing counter. We all had a big smiles on getting our payslips. I joked to the students, "Yay! The happiest time of the month."

We were done at 4:10pm and I signed their orientation forms. I told them cheerfully that they could have an early-off. They then looked at each other, uncertain as to what to do. It occurred to me that these are hardworking and keen-to-learn students, where ideas of leaving early or “吃蛇” or ponteng in Singlish (pronounced as "pond-ten") are remote concepts. They lingered for a while more until some students assigned to the other wards joined them.

After they left, a consultant, who observed part of my briefing, teased, "Don't make it sound so easy to them. It's not that easy."

I replied, "They are young, only 16 or 17. Must give them hope, mah!"

My preceptor chipped in, "These are the bright kids, future doctors whom we may have to work with."

We laughed.

Crying ladies

We had 2 staff who cried while on-duty today.

Firstly it was the admin staff M who cried upon arrival. She was disappointed with her son's PSLE (Primary School Leaving Examinations) results. PSLE being a major examination for typically 12 year-old children in Singapore. SSN R who was in-charge spent some time counselling her. At the end of her shift, the admin staff shared with me about her concerns.

At around 1pm, I walked into the staff room and saw SSN R pacifying SEN M who was crying. I left the room immediately as I did not wish to interfere. I have no idea what SEN M was crying about. Thereafter, SSN R gave permission for SEN M to leave work earlier at the end-of the shift.

SSN R has a fierce look and voice when she doesn't smile, but she is motherly at heart. As a nurse groomed on the old-style nursing training (i.e. School of Nursing), she has a tendency to whine about the new nurses by comparing with the past. However, after one incident when I confronted her for bad-mouthing about me behind my back, she has been supportive since.

As the in-charge, SSN R was willing to give some flexibility to staff depending on situation. After today, my respect for her increased. It is not easy dealing with a busy ward, overbooking by Admissions resulting in unhappy parents, and yet have to handle 2 staff with personal crisis.

NBM, NPU

Sometime last week, I met SN JM on my way to work.

SN JM is the best "informal" nursing preceptor I had throughout my student training. When we first met, she was an EN. From what I heard, she is a foreign-trained nurse who was downgraded locally to become a HCA, and was then promoted to EN, SEN and finally an SN after passing the SN qualification tests at Nanyang Polytechnic. Although SN JM came from the same country as SEN M, they have very different attitudes towards students and new staff. Unlike SEN M, SEN JM treats all new-comers well and was willing to share the secrets of the trade.

I asked how SN JM how she was. She replied, "So busy until NBM and NPU."

Note: For those not in Singapore nursing; NBM = Nil By Mouth (i.e. do not eat/drink), NPU = No Pass Urine. Please note that the acronyms may mean different things in other countries' nursing documentation. E.g. In B.C., Canada, NBM = No Bowel Movement (i.e. no stool), NPO = Nil Per Oral (i.e. do not eat/drink).

We laughed at how that would be a serious problem for our patients, but we nurses have to bear with such physical conditions. Then we talked about how the hospital was bursting at its seams for that few weeks. SN JM had this joke to share.

"One day we had a patient that just passed away and his family was gathered around the body, dealing with the loss. Admissions already had another patient waiting for the bed!"

More on my talk with ADON

Bone Collector's comment drew me to recall what I learnt from my "talk" with ADON G. That is, ADON G is not a leader whom I want to model after.

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ADON G came to my ward one morning telling me that she wanted to see me after my morning duty was done. She mentioned that she may not be at her office, so to call her first, but she needed to talk to me at her office that day.

I was tired out after working 7 consecutive days (I happened to have 12 consecutive work-days this fortnight, including 2 double-shift days). In addition, after my AM-shift work was completed at 3pm, I had to wait for the ADON to be available after 4pm.

ADON G, "Do you know what I want to talk to you about?" (It seems to me that ADON G has the habit of asking people what she wanted to talk about instead of going straight to the point.)

I replied honestly, "You asked me to see you, but I do not know what the matter is regarding."

It turns out that due to a "medication error" incident report, ADON G "puts it nicely" that she is merely speaking to me over the matter because it's her role as the ADON in-charge. Then ADON G started lecturing me over my medication error. My ward manager had already spoken to me about the incident some days ago, for which I am genuinely sorry and learnt from.

Actually the medication error is another story. While I was passing my shift report verbally to the afternoon staff, a post-op patient on my team was received by my preceptor who then rushed off to a meeting. The patient complained of severe pain and had low SpO₂. Ward manager took over from my preceptor, reviewed that patient, instructed the newbie SN RB to collect the painkillers stat from pharmacy, and then told me to give O₂ and the painkillers stat. Then she also went off for the same meeting. (A few days later, the admin staff told me that she saw the ward manager instructing me as such, and that she can be my witness). Anyway, I checked the case notes and misinterpreted the doctor's notes that 1 of the 2 PR (per rectal) painkillers were given in OT. I noted that my preceptor wrote in the IMR "given in OT" for both painkillers, so I thought she wrote wrongly in her rush to attend her meeting. Then I gave the other PR painkiller to the pt and made the serious mistake of canceling out my preceptor's "given in OT" note for that PR painkiller and initialled against my cancellation. SEN M who took over from my shift, kicked a big fuss over the matter.

ADON G's tone of voice was sharp and demanding. She did not at any point ask for my side of the story. Then she demanded that I DO NOT MAKE ANOTHER MISTAKE again. At that point, I got fed-up and told her, "If that's the case, then there's nothing to talk about". I got up and stepped out of her room.

ADON G raised her voice, "You are very rude, you know. How can you walk out just like that when I'm talking to you?"

At last, some non-bullshit words from her. I stepped back into her room and told her, "I am only human. As a human speaking to another human, I cannot promise you that I will not commit another mistake."

ADON G went hysterical, "I am your ADON, how can you raise your voice and speak to me like that."

I would have laughed in-her-face if not for the gravity of the situation and my tiredness. ADON G's miniscule world of nursing may be larger than my whole world of nursing for now, but IMHO her exposure to good leadership seems rather limited. Only lousy leaders demand to be respected based solely on their position. The true-blue leaders that I've worked for/with do not need to rely on their position to be respected. Their very presence and reputation for effectiveness earn them their staff's respect. In addition, my "ang-moh cultured" ex-bosses value candid feedback from their staff, it doesn't matter if they agree with the staff's view or otherwise.

Anyway, sad to say, I was very stressed by the whole event, so I broke-down. I told ADON G that people talk when we (new staff) check on the case notes to verify seniors' instructions. I am not the only one who experience it.

Yes, the nursing culture here is that if a senior instructs you to do something, you're supposed to just blindly obey stat. Not withstanding that ward nursing is not A&E or ICU where the urgency of interventions is critical. If you check the case notes or with another staff, they feel insulted and then they gossip about your "lack of trust" behind your back. E.g. The staff gossiped about SEN MY's "lack of trust" in my presence, but sadly none of them had the guts to tell SEN MY face-to-face about their displeasure.

I told ADON G that as a new staff I am struggling to survive. I don't even know how long I would last in the hospital, but I am definitely leaving after my bond. (I didn't want to tell her the reality that I could pay up my bond and quit stat if I wanted).

ADON G then said to me that it's like that in nursing, all newbies struggle and that I'm too sensitive to others' comments. When I told her that it does not have to like that, at least not in my previous industry. She said to me, "Of course it's different. You only deal with machines in IT." At that point, it struck me that I was talking to someone who knows zilch about software consultancy.

I asked then, "If nurses need to improve their communication, how about we have communication courses for all nurses, not just on SBAR, but to recognize the different personality types and the different communication styles?" [Edit: E.g. MBTI and DISC]

ADON G wrote it off immediately, "It is not possible to send all staff on training courses. That's why all the senior managers, we are working very hard on template formats for standard conversations. I believe that you may know about it too. Your Sister L contributed to it".

Note 1: Yes, my ward manager had asked me to research and write up a word document for self-introduction to patients. She was very pleased with my work.

Note 2: I don't know if ADON G was missing my point about inter-staff communication/rapport intentionally or the concept simply flew over her head. I asked about possibility of training staff on inter-personal communications because such training makes attendees more aware and appreciative of different communication styles. I was willing to share from my past exposures at such courses with my fellow colleagues. It struck me, "No point throwing pearls to swine."

I let ADON G launch into her stories of how tough it was for her during her early days as a new SN at a neural ward, how mean the doctors were, how lucky I was that the consultants for my ward are mostly reasonable compared to the consultants of the other wards under her care, and so on.

IMHO, it's the same-old "we survived the system so it cannot be bad, the toughness weeds out the weak" attitude of old nurses in Singapore.

Then she said that I was lucky that my ward manager Sister L, is a good and very experienced manager. I thought, "Sister L is not perfect, but she stands tall where it matters. At least ADON and I can agree on one thing, ha ha!"

ADON G went on to rebuke me for not raising my issues to her. She claimed that since she took over my ward from another ADON earlier this year, she has been taking care of our interests. "You staff are just like SSN L, just throw your frustrations at us and resign. It's not fair to me. I don't even know of your issues."

I thought, "Huh? Why am I being linked to SSN L's immediate resignation?". Anyway, I replied honestly, "When I have issues, I speak to Sister L (my ward manager) and I trust her to solve my issues. I am trying to follow the line-of-hierarchy."

ADON G then chastised others (like SSN L who quitted) and me for having a negative attitude. Blah, blah, blah.

To reassure ADON G, I told her honestly, "The best part of my job is my patients."

Then ADON G said, "Then you have the passion for nursing. Why do you let others kill off your passion?" (Okay, some truth to her statement, but of course she doesn't know that my exit plan is not out of nursing but out of nursing in Singapore.)

That started her off again about her nursing experience. E.g. How they saved a patient's life, how the patient was so grateful that he converted his religion, blah blah blah.

I also took the chance to "drive" ADON G into action about a case where an unhappy patient complained about his missing asthma MDIs (metered dose inhalers).

[Addendum 27-Feb-2010: After the patient was discharged, the housekeeper found the missing MDIs sitting on the window ledge, hidden by the window curtains next to the care-giver's chair. It turns out that the patient rested on the chair and placed the MDIs there but forgot about them. Thus, it proves that all the staff are innocent. It also proves that the patient was not trying to cheat the hospital of giving him free medication, as suggested by ADON G during her personal lecture to me].

It was evening twilight when we finished. I would give her a 4.5 out of 5 for effort, but only 1 of 5 for effectiveness. It was supposedly a pep-talk for me, but frankly I went off thinking that I do not want to work for this boss nor the organization for long.

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A fool never learns from anyone's experience,

A regular person learns from his own experience,
Only the wise learns from others' experience.

- Adapted from H.G. Wells' quote -

Sian!

ADON G lectured me for 2 hours, starting with a medication error made by me (for which my ward manager has already spoken to me about). One Singlish word: sian!