My (perhaps) Self fish and Limited views, on what nurses managers, and Directors should be doing.

After the previous post, my brain hadn't stopped thinking. I'm thinking over and over what is the situation here. I do feel that something has to be done, from the top. I've been trying to analyse the situation, (with the much limited capacity of my brain) why is nursing in Singapore so not comparable to other developed countries with flourishing economy like ours. I know, I will cause controversy yet again, but is it not through comparison, that we see where our weakness lies and we do something to overcome it, formulate a solution and improve? I believe that is what it meant to be constantly changing, not only in terms of medical technological advance, new pharmacological knowledge, but also how the system will flow.



There are probably people who are comparing me to the voters in the recent election in Singapore, who all wanted to see some changes, and got accused that they are ingrate, forgetting all the present system and government had done for them. Before we proceed to condemn such people, we need to understand, there will not be smoke if there is no fire. If we get complacent and contented, then changes will never occur, we will lagged behind, we will be overtaken. Is that how Singapore was founded on ? We moved from a third world country to one of the top economies in the world. Singapore has nothing, not natural reserves, yet in the span of just merely half a century, we have one of the strongest economy in the world, how is that possible ? Reason is simple, we choose to change, and keep changing and moving forward and that was how we achieved what we have now.



So what makes nursing that indifferent? We're satisfied with how things are, things are much better compared to olden days etc. The older nurses will always say that today nurses life are so much better. Comparison. Why compare to the past ? We cannot change what has happened in the past, so there is no use comparing, we should compare it with the "future". "Future" in the sense of how others are doing better then us. The others will feel that our current practice and system is in the past, so to us, their practice and system is the future. When one starts to get complacent and conceited, they will not seek change. A lot us are very used to our comfort zone, thus not many are willing to leave that comfort zone, and explore a brand new zone. If you do that, you have to start from scratch, you have to try hard and work harder again. If we are all that selfish, then nothing will ever change.



Nursing has so many great virtues values etc. Are we really that great ? One of the thing that people will agree about nurses; selflessness. They put patients before themselves, all for the patient. That is the mark of a supposed good nurse. Yes, the catch here, SUPPOSED good nurse. Why do I say so ? Are nurses only selfless when it comes to their patients ? So it means that nurses should and can be selfish when it comes to their colleagues ? How many of the nurses are guilty of making a din and complaining that the other staff did not finish their previous shift work ? How many of us are guilty that we go and find that staff involved and probably gave her or him hell on earth ? Frankly speaking, I'm guilty at times. I'm not saying that nurses should be perfect, I'm not, I'll be the first to admit. At the very least, we can just try. I tried to be tolerant and selfless, I help you, you will help me back. Not that I am demanding or expecting you to do it, but it is just a natural response.



I still remember when I was a new staff, this SN helped me a lot during my adapting period, therefore, there was once where I was on morning shift, she has yet to finish her things from the previous night, and it was already 7.30 am, her shift was over by 30 minutes. She passed the report to me and we served the medications, and she continued to stay on till 8 am plus, I shooed her home and force her to hand everything she had not done over to me and I get it done for her, even though it is not necessary my duty. Nurses, we should not just only be nice to our patients, just to show nurses care, this is just like a facade. How you treat others privately, out of the public view, is who you really are. So have you just proven you're an angel or had you just shown that you're a devil walking on earth ?



Why has this situation occured ? Our upper authorities allowed it to happen. They will always claim that they are unaware of what is happening on the ground, then if that is the case, why are you a director, or manager? What is your job scope ? Your job scope is one that also covers what is happening on the ground, understand what is happening and help to change for the better. And all you people, of all people, said you DON'T KNOW? You don't know can solve everything? Your "I DON'T KNOW" can probably bring world peace now. I believe strongly is not that you're unaware, genuine unaware, but selectively unaware. Argue for all you want, but that is how I sees it. If you have to intervene and manage, implement change, it is going to be hell load of a work. Of course, if you're receiving a big fat pay now, you would rather do less and get more. Typical Human mind set, unavoidable for some poor people. I simply cannot understand how some people can take such money, claimed it as their hard earned, when it cannot be justified by common people like us that it should be given.



Accepting a title is another ridiculous issues I want to talk about. Adjunct AP? (Associate Professor) What rubbish is that ? Is either you're a Associate Professor or you're not, what shit about Adjunct ? Come on, read the word adjunct and understand what it means. If I do not hold the necessary qualifications and I am being awarded such a title and salutation, I will gracefully reject it. This does not makes me someone better or greater, in actual fact, I take it as an insult. Are you implying that I do not have what it take to become an AP ? That I have to be an Adjunct AP? I'll rather commit suicide then accept such rubbish. It is either you show to people you did it with your hard work, or you just humiliate yourself thinking that you're somebody great. Sadly, there are certain of such air heads around.



Precisely of such air heads around, we are suffering. In my previous post, I've mentioned something about nurses pay, so there you go. I wont say Director of Nursing needs to be slap, no, Nurse managers should be slapped. For condoning bullying in the ward. How many new staffs are not being bullied ? A lot of staffs are being bullied by senior staffs. It is an evil cycle you idiots. You (senior staff) bullies me (Junior/ New staff), when I become senior staff, I bully the new and junior staff. So when will the damn cycle break ? Nurse managers, do you have cataract or are you seriously needing help with your vision ?



Director of nursing should not be slapped, what did they do to deserved to be slapped ? They don't, just crucify and burn them on the stake, that is all. Yes, you of all people, should be fighting for the nurses, and you end up being some whiny pussy and did nothing for your people. It is like Abraham is supposed to lead his people to the promised land, he did according to the bible, but the DON didn't, they lead you to hell instead of the promised land. You want to deny ? Take a look at your staff turn over rate statistic before you talk crap. How many local staffs you have compare to foreign staffs? Don't bull shit me that local don't want to do etc, I'm a local, I hold a pink IC, I did 2 years of NS to protect some useless piece of junks. I love nursing, yet I wouldn't want to do it locally as much. Why, you think you can and should treat us like those foreign staffs from overseas. Hello? Which part of your brain is not working ? Occipital? Parietal? Cortex or Brain dead ?



Enough talking about DON, we can go the whole night and still come out with more reasons why they should be crucified and burned. Next up. SNB. Totally another organisation that I do not know what should I say. I won't say much, but Nurses, you want another alternative voice ? SNA (Singapore Nurses Association) should be your next choice. I strongly urge nurses to join SNA, and probably kick the directors there, and form a new young team, be like the opposition, create a presence that cannot be neglected, and you will be able to fight for better benefits, a brighter future for the coming generations of nurses.



Our healthcare reforms need to change further, if not we will lag behind. I've been reading up on the changes in Australia and things seems to be very promising and happening there. I do understand of not copying wholesale, but at least model after them, which we are not seeing. I am here by going to EMPHASIZE, you get complacent you're screwed. Look at your APN and Australia's, USA, Canada's etc APN, our APN are simply a joke as compared to theirs, yet qualifications for APN from those few countries are not recognised in Singapore when they have APN earlier then us, doing better then us. THAT IS A RED TAPE issue, so what more do I have to say, our healthcare system will lose, and collapse, and it will, and who suffer the most ? Not us nurses, we can run, but where can our DEAR and MOST PRECIOUS patients run to ? It is about them also, so what are you doing ? Do you think it is time for some reflections here ? Or are you still going to be a stuck up stubborn old fellow ? Your call.



I will and will become someone of importance, where I will implement change without hesitation. I will axe all those useless crap and get things going. I'll not hesitate firing all the old guns if I can. Your only choice now, is either you make sure I die, or if I do survive by chance, you will all be getting a free one way ticket to writing a new resume for a new job, or end up unemployed. I'll have a team, and make sure they go out all over the country and carry the change that is needed.



I'm proud to be a nurse. It is one of my greatest goals accomplished.

God Bless the Nurses, (and blast those losers away if possible.) =)

Self Fulfilling Prophecy by Nurses ?

Ever since I started doing my First University assignment on Nursing knowledge and practice, I've begin to have a different point of view why nursing in singapore was deem some what pathetic. (I am well aware that there will be disagreement on this.) I used to think that Nurses are really poor people, long working hours, meger income, under appreciated and over worked. However, as I research further into my assignment for that unit of study, I found that, it was actually Nurses who chose what they want, which resulted in today nursing scene. I'll elaborate as I proceed further, so do not jump to conclusions yet.



Harvard School of Nursing was a concept that excited many back in the 1800's. There is this Medically trained Doctor, or physician, who was thinking that nursing could transform if it were to be brought into educational institution, where nurses are taught knowledge and trained in skills at the school, rather then in the hospital. However, he was met with much strong resistance from the influential nursing leader of that time. The author suggest that it wasn't feminism or sexist thinking at play as presumed by many, but rather, a power struggle between medicine and nursing. I reflected on it and started thinking, and I came to realise that it really is a power struggle, that lead to the failure of a Harvard Nursing School. If Harvard Nursing school was established back in the 1800's, would things had been different in today's 21st century nursing scene? I'll say not in Singapore at least. I have my reservations and reasons on why it would not affect and work in Singapore.



Advance Practioner Nurse, (APN) was the hype and peak of nursing history when it was first established in the western societies. APN'S holds relatively high autonomy and authority to a certain extend, which sees the APN attending to patient in clinics, titrating their medication dose or prescribing new drugs and performing certain invasive procedures that traditionally are not done by nurses. This was seen as a new image of nursing, that nurses if educated enough, can also perform certain duties of a qualified physician, but to a certain limit. Singapore rode on that wave and APN was introduced in the late 2000's, where there are the first few registered APN in Singapore.



It does sounds good that APN are also recognised in Singapore Nursing scence, but are they really performing to the level of the western societies ? Frankly speaking, Singapore APN's are a far stretch from those of USA, Australia, Canada etc. Our APN, cannot prescribe medication, are not seeing patients in the clinics, which will help the medical physician to free up time to attend more to actue cases, are not doing much invasive procedures that other APN's in certain countries are doing. I feel that it is a pity that Singapore that has a rather good healthcare system in the world, has failed in this aspect. Some blamed that the Medical body has objected to this and feels threaten, all these being said by the nurses, but is this really the case ? I'll tell you the shocking truth. It isn't. Nurses made that up.



I happen to bump into this consultant, (whom I've worked with during my final student days attachment) in my Army Unit. (Yes, currently I'm serving my National Service.) He is oncology trained, and we had a little catch up with my fellow army mate whom is also a nurse and also had worked as a new staff in the oncology setting, all within the same hospital. (I got posted to Cardiology Critical Care when I joined the hospital as a new staff.) We were chatting about how was one of the first few registered APN in Singapore Nursing history is performing, what has she been doing over the years. Not really exciting to hear, seems like another so-so task. However, the consultant told us that his team, are actually pushing for her to perform more. They wanted her to run outpatient clinic, and to call them if there are things that she couldn't handle, but she said, she has to refer back to her Assistant Director of Nursing (ADON), because she is a nurse, and the medical profession shouldn't be interfering. My God, isn't that what should be happening? The Medical body is approving of the APN to carry on more roles, but seems likely the nurses are not keen. (May be too biased to say this.) They wanted to train the APN to set central lines etc, but again, bounded by the limitations of laws of what an APN could and could not do.



Come on Nurses, what are you doing? This is a good oppurtunity for nurses to push themselves a grade higher. (I am hearing some people arguing that nurses should handle bedside care etc.) No doubt that Nurses are meant to care for the patient, but we can express it in a different manner. Who says APN cannnot fulfill her fundamental role of a nurse? The APN could still attend to patients, prescribe drugs etc and at the same time perform nursing education. These are what Overseas APN are doing. The Heamtology and Oncology team of my previous emplyment hospital are so willing to expand the boundaries of the APN, but was rebuffed. The consultant mentioned that, because Nursing directors felt that nurses should just fall into their jurisdication, therefore the Medical body should not interfere. And so the limitation has began.



Another Great example, this same consultants' (lets call him Dr. A) wife is the consultant of pediatric critical care unit. She has saw how hard her nurses had worked, and felt that they should have a pay increament, therefore attempted to fight for pay rise for her Nurses, but the Director of Nursing (DON) just gave her a black face. (A face that, they are my nurses, I've got no need for a consultant to tell me what needs to be done.) So what is up with that Doctors belittle nurses issue? Doctors are supressing Nurses ? They are more then willing to train nurses to fulfill certain duties of doctors if they are adequately qualified. So did Nursing self imposed the pity and pathetic situation on themselves ? Aparrently they did, especially the ADON's and DON's. That is why I have mentioned in my previous notes on Hypocisy in Nursing that these ADON's AND DON's needs to be slapped damn hard on the face.



I went on to further discuss with Dr A on what we can better do to push the boundaries even further. Dr A was very nice and said that we need to determined what the APN could and should do, and how it will make them different from the normal Nurses and yet not being a threat to the medical Doctors. He also mentioned that the APN need to band together from inter discipline, sit down discuss and bring it up to the DON, and make her sees it and have it brought up to other DON in other hospital, so that it can be discussed on a national and ministry level. Are our APN doing this ? I am not seeing it as far as I am concerned. I came to a conclusion that these APN are satisfied that they have become APN, Nicer name with a slightly higher status and a much improved income, so they probably felt it is good enough, but is it really good enough? In the eyes of the younger nurses, no. (These APN are easily over 35, most of the current APN's.) As far as I'm concerned. I'm not satisfied.



Dr. A however has also asked if it was me today, would I take up the challenge, seeing outpatient cases etc. I said I would. When you consistently overcomes people's expectations, that is where you show them you could do it. So why are nurses not doing it ? Dr. A mentioned that it is simply infuriating when nurses tells him that the patient is unwell, and when he ask why is he unwell, they say, not sure, just unwell. Have we just tell the Dr. or others that we suck? We do not know our stuffs ? How many APN really wants to fight for greater autonomy? I'm not sure, but as far as I can see, not alot now. Why?



Randy Pausch, a professor with carnegie mellon university (CMU) [he had passed away] states in his famous "The Last Lecture" video, that a brick wall is there for a reason. It is there for you to prove how badly you want certain things. It is there to stop people who doesn't wants it badly enough. [It is a nice video, available on youtube] So we have a brick wall, there are no medical insurance cover for APN's mal practice, no policies and ministry agreement on expanding APN roles and responsibilities, but are we doing something about it ? Do we want it badly enough ? Or are we just procrastinating and painting a pitiful picture of nursing ?



I am a nurse. I am proud to be one, but looking at the outcomes, I seriously cannot say for definite that I'll stay in clinical nursing. Some people poke fun of me, haven't even have a basic experience, and yet already doing a bachelors. (Havent even learn how to walk, you want to learn how to run.) You can say whatever you want, be jealous that the oppurtunity wasn't there for you, but you can consider of either stopping your jealousy, spend time to think how we can change the system, or spend the time scheming and plotting downfall of people. I cannot change Nursing alone, I need a team of capable people, who sees what I sees, and work together to push nursing to even greater heights and expand the boundaries.



So, do you think that nursing has self imposed the pitiful image? Do you still think that the medically trained physicians are opressing the nurses ? Or do you think that there is more to it, that the People who holds authority to nursing and nurses are controlling it? Decide for yourself, I for one believes, that the old guns needs to leave, its time for the new and younger generation to rise up, and bring it all to another level.



P.S. I am well aware of the controversy I may cause with this post, especially older generations of nurses. No disrespect intended here. I acknowledge the efforts you all have put into the transformation of nursing, maybe it is time to let the younger people with the vibrant energy and ideas to take over. You all can serve as mentor to these young leader, but not making it worse for them. Eventually, my generation will also have to give way and guide the next generation of nurses. Let us put aside our personal agenda for the greater good of nursing. If you still remember why you're in nursing, you will definitely understand what I meant.



God Bless the Nurses.

Nursing will be, and forever be, my greatest accomplishment in my life.