I'm a nurse. Ask me anything about nursing

[Lynmei]

@Philipkee is encouraing that govt is recognising the works of healthcare worker. 

But my pov is sometimes is not the pay but is the culture. With the mindset of new nursing we r grooming...there is a real big gab of school culture and on the real work ground.

In a class of 45 students minus 4 mature student -41 young students, I had been daily shaking my head just looking on their maturity to deal with test failure and organise class events.

Now I truely understand, young committed nurses r hard to come by but old, bullying mindset and rude nurses are many...

[Philipkee]

On 3/5/2021 at 6:07 PM, Kklee said:

I just have a question.

Let's say you are in the career after 5 years,  if everything else remains the same and without Covid-19,  what changes would you like to see that would most benefit you. 

Pay increment.  Where I work, hours are ok.  I want to say more autonomy but it is double edged. More autonomy means more responsibility, including legal ones.

[Philipkee]

22 hours ago, Lynmei said:

@Philipkee is encouraing that govt is recognising the works of healthcare worker. 

Now I truely understand, young committed nurses r hard to come by but old, bullying mindset and rude nurses are many...

I have a comment. 

It's been years so things might be different.  These matured students have at least a diploma in another speciality and have working experience outside.  Some might even be managers or above before they joined nursing because of choice or no choice (need a job).

It is not easy for someone to be experienced and was "a somebody" in another field to come down and do a diploma and accept failure pr criticism.  There is also the thing that they are naturally the leaders by virtue of experience and age.

But I am surprised.  I thought matured students go in one class while those normal diploma students go into another.

Unless these matured students are taking a normal diploma and not the accelerated program.  

[Nolicense]

6 minutes ago, Philipkee said:

Pay increment.  Where I work, hours are ok.  I want to say more autonomy but it is double edged. More autonomy means more responsibility, including legal ones.

Would automation, AI systems, mechanization bring more efficiency/better service?

I know much work can be considered menial in nature. however there are always some knowledge related work due to poor information and record keeping because of ugly doctor hand writing etc.

So autonomy of nursing work (I think doctors should be included) is always documented in video like car cam. everything is logged like administering the dosage of medicine.  

[Philipkee]

2 hours ago, Nolicense said:

Would automation, AI systems, mechanization bring more efficiency/better service?

I know much work can be considered menial in nature. however there are always some knowledge related work due to poor information and record keeping because of ugly doctor hand writing etc.

So autonomy of nursing work (I think doctors should be included) is always documented in video like car cam. everything is logged like administering the dosage of medicine.  

Tricky.  I would say there are pro and con to everything.

Automation will definitely help but sometimes it can hinder.  

Example:  Medications can only be dispensed if prescribed electronically by a doctor.  It does not help in an emergency because the doctor does not have time to prescribe then administer.  So some machines have manual override buttons.  But then manual override will defeat the purpose of having the automation on the first place since it can be overridden.  

Cams help but sometimes when doing private procedures, might not be good.  Will be an issue of privacy.   But it does help in certain cases like collection of property.

Now I give a true example.  But this was long time ago and things have changed since then.  When one administers medication and it is signed electronically, the machine must be logged on, duly signed and duly logged off when administering.  The reason is that the computer cannot go to the patient's side due to space constraint and you cannot leave something logged on while you are not at the screen as this is breach of policy cos someone can perform tasks in your name.  So it takes twice as long to perform one task.

But that was a long time ago when it just came out.  Think it's better now.

[Nolicense]

31 minutes ago, Philipkee said:

Tricky.  I would say there are pro and con to everything.

Automation will definitely help but sometimes it can hinder.  

Example:  Medications can only be dispensed if prescribed electronically by a doctor.  It does not help in an emergency because the doctor does not have time to prescribe then administer.  So some machines have manual override buttons.  But then manual override will defeat the purpose of having the automation on the first place since it can be overridden.  

Cams help but sometimes when doing private procedures, might not be good.  Will be an issue of privacy.   But it does help in certain cases like collection of property.

Now I give a true example.  But this was long time ago and things have changed since then.  When one administers medication and it is signed electronically, the machine must be logged on, duly signed and duly logged off when administering.  The reason is that the computer cannot go to the patient's side due to space constraint and you cannot leave something logged on while you are not at the screen as this is breach of policy cos someone can perform tasks in your name.  So it takes twice as long to perform one task.

But that was a long time ago when it just came out.  Think it's better now.

Thanks. didnt know there is such thing for machine logging in out for administering medicine.

I am still thinking injections given occasionally need to be done by humans and not machine.

My idea of automation I think can be:

1. logging of vitals like what you see in the Space centre for astronauts.

2. Video evidence during injection to prove dosage is correct and ordered by doctor.

3. during emergency procedure, video evidence during internal review if something went wrong. or to prove there was no molesting.

 

Many times people have to seek second or third opinions. understandable. it is time consuming and troublesome.

Which is why many people only want to see the specialist that don't use you to test out treatments. (it is an open secret)

Transparency in treatment and patient outcome scores can help doctors and patients.

 

[Philipkee]

12 minutes ago, Nolicense said:

 

1. logging of vitals like what you see in the Space centre for astronauts.

2. Video evidence during injection to prove dosage is correct and ordered by doctor.

3. during emergency procedure, video evidence during internal review if something went wrong. or to prove there was no molesting.

 

Many times people have to seek second or third opinions. understandable. it is time consuming and troublesome.

Which is why many people only want to see the specialist that don't use you to test out treatments. (it is an open secret)

Transparency in treatment and patient outcome scores can help doctors and patients.

 

1 is already done.

2 is contentious cos in your point cos it can show the procedure as being done but not if the dilution is correct unless the dilution is in front of a camera directly.  I am thinking of CCTV not capturing the fine details.  A close up camera, it depends because it's not so easy to ensure everything is captured by the camera.

3. We have CCTV for this.

Problem with second or third opinion is every doctor judges differently.  And sometimes money is a concern - private doctors might request more tests while public doctors test less.  There is no standard way that all doctors follow.

Example.  I have a headache. A GP might just prescribe panadol while a private specialist might suggest a CT scan of the head because of family history of stroke.  So its do your own due diligence.

Outcome scores are subjective because some people recover faster but the doctor has bad bedside manners and get poor rating while a friendly doctor where patients take longer to recover get better ratings.  Even if objectively say who recover faster is not necessarily good cos a doctor can prescribe the best medication for you.  You recover faster under this doctor but your bill is also the highest.

Edited March 26, 2021 by Philipkee

[inlinesix]

1 minute ago, Philipkee said:

1 is already done.

2 is contentious cos in your point cos it can show the procedure as being done but not if the dilution is correct unless the dilution is in front of a camera directly.  I am thinking of CCTV not capturing the fine details.  A close up camera, it depends because it's not so easy to ensure everything is captured by the camera.

3. We have CCTV for this.

Problem with second or third opinion is every doctor judges differently.  

Wear body cam like mata

 

[Philipkee]

6 minutes ago, inlinesix said:

Wear body cam like mata

 

Not necessarily good.  Dont forget nurses also bathe patients.  Can be done but patients might not like it.

Sometimes nurses have to accompany patients into the public toilet.  Public might not like it also.  Believe me, it happens. Otherwise they will smoke in the toilet.

[Philipkee]

2 minutes ago, Philipkee said:

 

Sometimes nurses have to accompany patients into the public toilet.  Public might not like it also.  Believe me, it happens. Otherwise they will smoke in the toilet.

This, btw, is why when I go to the wards to visit people, I dont use the urinals in the toilet. At the main lobby is still ok but in the wards? Up to you.

[Meanmachine]

Dear Philip

 

I like to thank you for your extraordinary sharing of your " Ask me anything on nursing, healthcare and many interesting topics and subjects related , while I do not have any intereaction or parties known or unknown, it gives me great pleasure to know your kind sharing has generated into a topics many has received, acknowledged and appreciated, I'm one of them too, however places like Hospital, Police station, Tax office and Court places, i always avoid going, simply these places cost money, a load of money to pay  . . . Why ?

I have been taught to avoid such 4/5 place since i started working by a wise old man ( accountant trained & tax related matters ), whom my ex-boss regular lunch mates cum buddy. so far i had invested heavily on being eating healthy and play harder each and everyday . Once again, many many thanks Bro Philip. 

[Datsun366]

Basically MM is saying....

 

[Philipkee]

On 3/5/2021 at 6:07 PM, Kklee said:

I just have a question.

Let's say you are in the career after 5 years,  if everything else remains the same and without Covid-19,  what changes would you like to see that would most benefit you. 

One more thing I thought of but it can be very sensitive.  It's the appraisal system.

Nothing demoralises a nurse more than knowing no matter how good a nurse is, most likely the nurse will be marked average cos that's what the bell curve dictates.

I understand ratings is tied to bonus but it can be played around by having a range of bonus for those with same ratings.  My feeling is that if a nurse gets the average bonus but an above average rating, the nurse feels more appreciated.  This as opposed to good bonuses but average rating.

But that's my opinion only.  Don't speak for all.  And I think its the same in other professions as well as long as one is paid reasonably well.

[Nolicense]

38 minutes ago, Philipkee said:

One more thing I thought of but it can be very sensitive.  It's the appraisal system.

Nothing demoralises a nurse more than knowing no matter how good a nurse is, most likely the nurse will be marked average cos that's what the bell curve dictates.

I understand ratings is tied to bonus but it can be played around by having a range of bonus for those with same ratings.  My feeling is that if a nurse gets the average bonus but an above average rating, the nurse feels more appreciated.  This as opposed to good bonuses but average rating.

But that's my opinion only.  Don't speak for all.  And I think its the same in other professions as well as long as one is paid reasonably well.

i find grading on bell curve to be deceptive and lazy way to grade. its never that way and we have been lied to that intelligence and hence everything is distributed on this bell curve.

[Kklee]

12 minutes ago, Philipkee said:

One more thing I thought of but it can be very sensitive.  It's the appraisal system.

Nothing demoralises a nurse more than knowing no matter how good a nurse is, most likely the nurse will be marked average cos that's what the bell curve dictates.

I understand ratings is tied to bonus but it can be played around by having a range of bonus for those with same ratings.  My feeling is that if a nurse gets the average bonus but an above average rating, the nurse feels more appreciated.  This as opposed to good bonuses but average rating.

But that's my opinion only.  Don't speak for all.  And I think its the same in other professions as well as long as one is paid reasonably well.

IMHO.
I would say in certain profession,   a system that cannot accept that everyone or most of everyone  is good, is technically flawed.
If a staff is deemed to be average,  the managing people will need to look at themselves on the failure. 

I sincerely consider nursing ( not doctor ) as a noble profession - it is something that is difficult to do. 
To have locals to ensure themselves to be reasonably paid is unacceptable. 

[Philipkee]

14 hours ago, Nolicense said:

i find grading on bell curve to be deceptive and lazy way to grade. its never that way and we have been lied to that intelligence and hence everything is distributed on this bell curve.

 

14 hours ago, Kklee said:

IMHO.
I would say in certain profession,   a system that cannot accept that everyone or most of everyone  is good, is technically flawed.
If a staff is deemed to be average,  the managing people will need to look at themselves on the failure. 

I sincerely consider nursing ( not doctor ) as a noble profession - it is something that is difficult to do. 
To have locals to ensure themselves to be reasonably paid is unacceptable. 

Not nursing but someone who headed a small department of 5 shared that her team was small and close.  But because of the bell curve, she had to fail one person and explain why.

The following month the staff resigned.  The manager pleaded with her to stay because she was excellent in her work.  The staff replied if I were excellent, why did u fail me? The manager kept quiet and the staff left.

And turnover remains high.

Looking back, it isnt surprising why.

Same thing happens in  nursing in certain places but management is still surprised why the attrition is still high and morale is not so high.

[Nolicense]

1 hour ago, Philipkee said:

 

Not nursing but someone who headed a small department of 5 shared that her team was small and close.  But because of the bell curve, she had to fail one person and explain why.

The following month the staff resigned.  The manager pleaded with her to stay because she was excellent in her work.  The staff replied if I were excellent, why did u fail me? The manager kept quiet and the staff left.

And turnover remains high.

Looking back, it isnt surprising why.

Same thing happens in  nursing in certain places but management is still surprised why the attrition is still high and morale is not so high.

I think this little aspect has been not only over looked, but followed as dogma because people cannot and will not think.

just like the monkey beating any monkey for climbing the ladder experiment

[Lynmei]

On 3/26/2021 at 11:05 AM, Philipkee said:

I have a comment. 

It's been years so things might be different.  These matured students have at least a diploma in another speciality and have working experience outside.  Some might even be managers or above before they joined nursing because of choice or no choice (need a job).

It is not easy for someone to be experienced and was "a somebody" in another field to come down and do a diploma and accept failure pr criticism.  There is also the thing that they are naturally the leaders by virtue of experience and age.

But I am surprised.  I thought matured students go in one class while those normal diploma students go into another.

Unless these matured students are taking a normal diploma and not the accelerated program.  

"It is not easy for someone to be experienced and was "a somebody" in another field to come down and do a diploma and accept failure pr criticism.  There is also the thing that they are naturally the leaders by virtue of experience and age."

Errm u are talking about me? Well not a diploma in nursing but Nitec in nursing but plotting her path all the way to a degree. Well sorry to say this in the whole batch of PCP students at ITE, when u plan to take this journey of re-learn, take all feedback of negative and postive with a pinch of salt. I think with that it will make the learning path more easier and it is not about being personal on that individual itself. I guess when MOHH interview the various applicant they had forgotten these people are holding a high 'ranking' job in their various field and are they really that ready to cast away their pride, ego and acceptence of criticism? Well I guess in the batch of 28 applicants maybe less than 10 had that mindset or had tune their mindset to that.

In PCP for diploma level, yes the PCP applicants is in a class but not for Nitec which we had no idea why double standard. We were mix with the young kids which age range from 17 to 18yrs old. Honestly speaking. the new/younger gen does not really take failure in test very well. The ironic thing is, during lessons all they does is chit chatting all the way 'in competition' with the teachers during lessons. But when comes to test, u can see the few chit chatting culprit start to panic and start to seek for help. The worst part is, when the examiner tell the students on the spot they fail or pass u can see people crying as though like primary school kids fail their first test.

We had a round of stimulation lesson in one of the lab and I was surprise to see one of the young student which is full of confidence of himself had panic and just froze in the midst of the simulation situation. It set me back thinking, able to memorise the whole skill book does not really make u an ACE student. Well I can only say, all these kiddos they have lots to learn from able to carry themselves correctly, to aquiring knowledge and how to react in  real life(When they are at their clinical attachement).

Seriously I have a tiny evil wish, I am interested to see how many will drop out after our first clinical attachment. Cos seriously, a handful of them is in this course just to pass time or just to fulfill their parents wish. (this is one of the dumbest thing a parent can do in my POV) Seriously speaking to get inspired from ER, Grey;s anotomy etc drama series is not a good reason to come into nursing. I seriously doubt their understanding of having a heart to serve people, having a fulfilling job in life aspect and accepting the whole of nursing even the ugly part of the job and not only the glamourous part of it.