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.
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