Confessions of a nurse: Highly skilled healing hands

SINGAPORE - The critically ill patients aren't the hardest part of the job.

Nor the prospect of dealing with death.

The most challenging bit? Anxious relatives who often take out their frustration and fear on nurses, confesses Madam Doreen Chew, who specialises in acute care at the National University Hospital's (NUH) surgical high dependency unit.

The most innocuous things can set them off.

"Some of them pick on everything, from hospital food to not getting a timely update from the doctor," says Madam Chew.

"But because we are often at the ward, we bear the brunt of their anger," explains the 35-year-old, who has about 13 years of experience under her belt.

"They expect us to be at the patient's bedside 24/7, without realising that we are caring for several people at the same time," she adds.

This married mother of one was first inspired to study nursing some 20 years ago, when her grandmother was repeatedly warded for diabetes, heart and renal problems.

"Then, I thought the job was simply about taking the patient's temperature, the pulse and feeding him medicine," she admits with a chuckle.

Nothing could be further from the truth, declares Madam Chew, who holds a master's degree in nursing from the National University of Singapore.

The recent boo-boo in the Population White Paper, which labelled nursing a "low-skilled" profession, is part of a public perception problem which she initially felt disappointed over.

"I first read about it on Facebook. Then I noticed the outpouring of support and emotion that came in defence of nursing, and felt quite moved," she adds.

"How many people know how to intubate someone, or insert a cannula (the tube often inserted into veins to deliver fluids or medicine)?

"I don't see myself as low-skilled. Those whose loved ones have been admitted into hospital will understand the work we do," she says.

The job of nursing was reclassified in the White Paper.

Sometimes, snobbery also rears its head within the medical fold.

She recounts an encounter which left an unpleasant aftertaste: "I had to clarify something about a patient with a doctor, so I called him on the phone, but he refused to discuss it with me, telling me to ask a medical officer to call him, before slamming down the phone."

But these doctors are few and far between, she says.

The trick is not to take their words to heart.

Madam Chew is one of 18 advanced practice nurses at NUH, who collaborate with doctors to manage acute and chronic illnesses, including providing complete physical examinations, and ordering and interpreting diagnostic tests.

She works 10-hour shifts five days a week and often sacrifices her weekends.

"It's quite common to get gastric problems and forget to go to the bathroom because we're so busy," she jokes.

The passion for the job is what has kept her going for more than a decade.

"It is a very rewarding thing when you earn the trust of the consultants.

"Some of them even tell their junior doctors when we do rounds together that we may know more than them, since we have been around for so long," she says, adding that the role of nurses is constantly evolving to include greater roles and responsibilities.

She speaks about her job with ease and confidence at this interview, but confesses that she was a bundle of nerves when she first began the journey as a junior nurse.

"I remember having to help a dying patient to breathe while his family members bade him the final goodbye.

"It was my first encounter with death while being on the job, and I remember having to hold back the tears and going completely red in the face. The mask I was wearing helped to cover it, though," she says.

These days, she no longer loses control of her emotions. But some encounters with patients still strike a chord.

"I remember a four-year-old patient some years ago, who was warded for some time and seemed to be getting better, but eventually died.

"The child's mother was devastated, and had thoughts of suicide. We had to call the psychiatrist.

"The emotion I felt wasn't guilt, because I knew I didn't make a mistake in handling that case.

"But for some moments I did wonder to myself if there was anything more that I could have done."

Although she does not wish for them to happen, emergencies provide a rush of adrenaline, which she thrives on.

"When a patient collapses suddenly, the ward becomes a bit of a marketplace. Every moment is a difference between life and death," she says.

Years of being railed at by patients and their family members have thickened her skin, she states matter-of-factly.

"I used to take things very hard. When I tried to coax patients by telling them things would be all right in the end, they would shoot back, saying that I didn't know how they felt because I wasn't the one in pain.

"Which is true," she says.

The best way to deal with these raw emotions is to let the person vent until it is all out of their system, says this seasoned nurse.

"Anything you say before that will not help. Once they have calmed down, we quickly try to find the cause of the problem and deal with that."

Secrets of the trade

  1. When being shouted at by a family member of the patient, think of what you want to say back to them, but keep them in your head. Counting to 10 can also help you to keep cool.
  2. In this trade, mistakes are a matter of life and death. When you are unsure, ask. Don't risk it.
  3. When your patients refuse to take their medication, tell them the consequence is that they have to stay warded for a longer period of time. It usually works.

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