If I was an excellent Singaporean Nurse, I would be working in Australia.
In fact, many of our top nursing graduates, best staff nurses and experienced specialist nurses already are.
Why is that? Do they not want to help the uncles and aunties who need them? The uncles and aunties who watched them grow up, their friends, relatives and community? Do they really long to get newly accustomed to people with blond hair, English with an accent, and undertones of racism? Or are they 'quitters', are they 'mee siam, mai hum'?
I say they are real nurses. Nurses who do not wish to be treated like maids.
Yesterday I walked out to the P3 waiting area and was greeted by an auntie who shrieked :"Missieee!!! Milo one cup!!!" Personally, I am much more courteous to the old drinks uncle or the fat and indecently exposed Tiger auntie I usually get my Milo from.
Apart from serving Milo, nurses here are expected to clean and clear, and wait on patients' and family members' every need. They are also expected to write lengthy reports in every file and ensure that stray forms containing blood results from 2 months ago are 'noted' and signed. They are prohibited from giving the 'first dose' of IV medications, and deemed incapable of checking the sticker on a packet of blood against a patient's nametag.
A short plane ride to Australia offers a tantalising prospect, where nursing as a profession is well respected and appreciated by the general public. Where nurses play the role of the 'Houseman', as the first line of medical care for their patients. Where nurses make morning rounds, order investigations and prescribe, (let alone serve the first dose of), medications. Where nurses are paid more than twice of what they are being paid here.
Screw the respect, appreciation and professionalism thing, you say. Is it just about the money, then?
Of course it is. Who would work for less? Yet it goes way beyond that. Pay is the most direct gauge of how much the institution you serve appreciates what you do, how much you and your work is valued, in exact dollars and cents. Our public hospitals turn over patients at a much faster rate than most hospitals in the world, and our nursing staff are expected to maid and write reports for all these patients and be paid what they are paid? How much are they worth to you?
Those who prefer stagnation and choose ignorance will argue about greener grass and brighter moons on the other side. But the trend has been set. I have only been working in the medical profession for just over a year and a half, yet I know so many excellent nurses who are leaving/has left in the prime of their careers. Indeed, those who are there find pastures greener, moons brighter, and some never come back.
And right there, you find the brain drain.
The solution? Easy, as always. The ever widening drain is covered over by nurses and allied health workers from China, Phillipines, Myanmar, Vietnam, you name it. Im not so sure myself if Singapore is a multi-racial or rather a multi-national society anymore.
Foreign nurses aren't necessarily bad nurses at all. They are, however, adapting to a brand new environment, sorting out issues of lodging, transport and other miscellany, and last but most definitely not least, speaking a brand new language - English. Language forms the building block for all communication, and the lack thereof often a source of misunderstandings, fustration and anger. Worse still, while a basic grasp of English is required for all our foreign nurses, unfortunately that is not required for our uncles and aunties admitted to hospital - They speak Mandarin, Melayu, Tamil, Hindi, Hokkien, Teochew, Cantonese and Hakka, and when you don't speak the language they are comfortable with, the patient-nurse or patient-doctor bond is broken immediately. These patients are sick, they are in pain and discomfort, and the last thing they need is someone going 'Har?!' at them in an alien tongue. They feel patronised, misunderstood, neglected, and worst of all, hostile. And it doesn't seem so incredible anymore that houseman are often called for 'a patient who is very breathless and gasping', only to find out on arrival at his bedside that all the man wanted was a glass of water.
Teamwork has always been hailed and emphasised in healthcare, and rightly so. Yet teamwork is not forged through MAGNET (what is that really?) seminars with candy floss and balloons. There can be no team if cliques are formed simply by where you come from. There can be no team if some members adopt an 'iron rice bowl' or 'large pot of rice' mentality, always hoping for someone else to get the job done. There can be no team if members don't even understand what each other is saying.
While the 'solution' appears nice and rosy on paper, while we can proudly report healthy numbers and a decent nurse : patient ratio that will achieve JCI and ACGME and whatever not accreditations, it will be prudent to realise that our patients are people, not statistics. Our patients have needs, more so when they are sick, weak and hospitalised than ever. In a hospital setting which is so unfamiliar and daunting, what our patients really need is a listening ear, a comforting touch, and a familiar face.
The Nurse/Doctor to patient bond is something unique to the healthcare professional, something borne from walking in your patient's shoes day in, day out, understanding them, their culture, their needs and concerns. It is an invaluable tool along and even above excellent medical care for making these patients better. It is a bond most precious to those who bother to seek it. And it is a bond that no Engineer or Administrator can ever understand.
Offer our best nurses a challenging work scope and a competitive payday, and no one will leave. Nobody needs Kit Chan to preach to them that 'this is home, SURELY.' to realise that. Nobody really wants to leave their family, friends, and roots behind. And I am certain that nothing is more rewarding to a healthcare professional than the chance to lend a helping hand and touch the lives of all these people around them.
Many of our hardworking nurses who strive for more have completed further studies and advanced diplomas, yet how many of these nurses are still stuck in the general ward writing reports? They deserve so much more. How many of our most experienced nurses find no way out at the end of the line but administrative work as ward Sisters, where their clinical experience are untapped and wasted? They deserve so much more. And our patients deserve so much more from all of them. Retaining our best talents and providing a challenging and clinical work environment will only lead to happier, more competitive nurses who can take on so much more, and the result of which can only be excellence in nursing care.
On the contrary, letting our talents go, then disallowing those who remain to check blood? Thats loser mentality.
Nurses who take on more deserve more, and a deservedly improved pay means better recognition, social standing, and job satisfaction. It is also the most direct way of letting a young talent contemplating leaving know that her work is appreciated and she is needed here for her clinical work, for which she will be duly compensated.
But where is the 'extra' money going to come from? You might ask.
I am a Doctor, I am not familiar with budgets and policies, so I am unable to answer you. I do read, not too long ago, in the papers that all politicians got a pay rise to maintain competitiveness and prevent a brain drain to the private sector, now where did that 'extra' money come from? And when was the last time a healthcare professional got a pay rise to maintain said competitiveness? I have to consult Prof. Soo or Prof. Nambiah on that. I also read, just recently, in the papers that 387 million dollars was reportedly spent on the YOG. Thats almost 10 per cent of the 4.1 billion healthcare budget for the ENTIRE YEAR of 2010. You tell me.
Nurses are not paid so badly that there are no nurses at all. Yet they are not paid nearly well enough to prevent the mass exodus of local talent we witness today. Who suffers? The non English speaking, C class patient in the general ward suffers. Yet it is that very patient, who voted for this Government, who elected the people in charge of the budgets and policies, who effectively drove our best nurses away from caring for him.
What an insult.
Now, back to the very beginning, if I was an excellent Singaporean Doctor...
