23 January 2006

Nurse With 180 Patients

I read about an article, on the $traits Times last Wednesday (18 Jan 2006), about a certain Nurse Grace Leong who negligently prescribed medicine to a patient, whom the latter was allergic to, and causing the death of the patient. Before I could blog my response to this case, somebody beat me to it with a letter to the $T Forum (See Below).

It is indeed unfortunately that some one died as a result of her negligence. However, one must note that this is a nurse who had to handle 180 patients by herself. What was the management thinking?? Surely anybody with a pinch of common sense would tell you that something is very wrong assigning 180 patients to a single nurse.

Under the circumstances, one cannot help but offer Ms Grace Leong some sympathy. It was definitely not about the money for no nurse would accept such an ardous assignment, if the motivation was purely monetary.

Here we have the possibility of striking her off the nursing registry. Just great! As if we don't have a shortage of nurses already. Granted that a life was lost in the process but surely there must be a better solution. Grace Leong has a set of skills that would contribute greatly to society. Patient Care Giving. It seemed like a waste to just throw it away like that.

I don't mean to belittle the unfortunately death of the patient. I don't mean it that way but I am sure some one out there who totally don't get my point and would point the finger at me accusingly and ask how much was the dead patient's life worth?

My answer is simple. About the same as Grace Leong's.

Striking Grace Leong off the nursing registrar is as good as taking away her livelihood. We already lost a life. Do we need to take another?

Is there another way out of this?

p.s. I am not sure if getting struck off is like having your driver's license revoked i.e. you can get it back if you start over. I hope it would be the case. Can someone verify this? Cinthia? Benjamin?

Date: 21 Jan 2006

« ST Forum »
Nurse with 180 patients: System needs fixing too

I WAS shocked to read that a single nurse could be made to look after 180 patients, especially in a First World nation such as Singapore ('Nurse found negligent but coroner praises her'; ST, Jan 18).

It is hard to imagine how any human being - however competent or diligent - could provide the expected standard of care.

To put the issue in perspective, school students are generally healthier than elderly inmates, yet no school would leave just one teacher in charge of the welfare and safety of 180 students.

While the coroner may have found negligence in the administration of a drug which the patient was allergic to, it is harsh that nurse Grace Leong now faces the prospect of being struck off, while the welfare home has presumably escaped sanction and will continue to operate.

It is true that nurses - while human and thus fallible - owe a duty of care to their patients. Yet care is not provided by individuals alone, but by organisations and the systems set up therein.

When accidents occur, it is crucial to look not just at the individuals involved in making the error but also the system and organisation which permitted such errors to happen.
If there was negligence, we should also look at how a system was set up which placed Madam Leong under such inhuman working conditions.

When workers are overloaded and stretched to the point of exhaustion, the shocking thing is not that such errors occurred - it is that such errors did not occur with greater frequency.

Tan Wu Meng
The Straits Times Interactive
Copyright ©2005 Singapore Press Holdings Limited. All rights reserved.
- Voxeros

1. jaschocolate left...
Sunday, 22 January 2006 10:04 pm
Most organisations just want to get someone to be the scapegoat.. Damn bastards.. remind me of NKF again.. evil management..

2. JayWalk left...
Monday, 23 January 2006 1:06 am ::
Jaschocolate: 180:1 ratio is totally ridiculous. I'd bet management would say it is part of the cost cutting measures.
Is there no sanity left???

3. Jaschocolate left...
Monday, 23 January 2006 7:57 am
There isnt any at the start..

4. akk left...
Monday, 23 January 2006 9:20 am
The system of management in hospitals is sorely abused. I believed that the culprit is actually inertia and the unwillingness to make things better in a working environment, esp as with this type of skilled labour, there is little occurrence of accidents, this meaning that the workers are trained to be extremely meticulous becos it concerns human lives. Thus banking on this trait in this industry, docs and nurses are worked to the bone with lousy shifts and bad hours. Hospitals should wake up now and understand that these professionals are also human beings with their own lives to live.

5. JayWalk left...
Monday, 23 January 2006 10:26 am :: 
Jaschocolate: The cold hard truth is that everything is driven by bottom line even at the expense of risking people's lives.

Akk: I believe leaving Nurse Grace Leong to solely shoulder the entire blame is wrong. The hospital is just as guilty, if not more.

6. Zhe Bin left...
Monday, 23 January 2006 2:59 pm
Sigh, it's always easy to judge and point fingers. I wonder for how long she has been handling this gross amount of patients. I feel 179 patients would be grateful to her all the while she was taking care of them. 180 is really ridiculous. Like, if I open 180 windows with different tasks for the management to do right now, will they be able to? I can't even chat in 10 MSN windows.
And I think AKK has a point. Moreover I think they are like teachers - without the passion for the profession, one simply cannot last long in the industry. And nobody should ever take advantage of that.

7. kIm left...
Monday, 23 January 2006 4:24 pm
eh, i didnt read the papers. But anyhow, what will happen to her? 180 alot leh! I take care of 1 hamster already having problems. What more 180 patients who need one's care?

8. JayWalk left...
Monday, 23 January 2006 5:42 pm :: 
ZheBin: I just felt that justice wasn't carried out properly when I read about this. Hence this blog.

kIm: I had the earlier article but I forgot to save it.
Er... anyone got the article? Can scan for me?

9. vandice left...
Tuesday, 24 January 2006 2:55 am
180 patients in a typical 8 hour day means the nurse spends about 2.66 min per person per day, assuming equal attention is paid to everyone... However, we all know that some patients will require more care than others, plus the added burden of undoubted admin... so my guess is most of the patients receive perhaps just a few tens of SECONDS of attention from the nurse throughout the course of a day. That is atrocious, even animals in the zoo are treated better! IMHO, this was a tragedy in waiting because of the system, not in spite of it...

10. JayWalk left...
Tuesday, 24 January 2006 7:21 pm ::
Vandice: Yes indeed it was a time bomb waiting to go off. The ironic thing is that :
1) They create the time bomb to blow themselves up.
2) The time bomb was obviously sitting there for some time, yet nobody did anything about it.
Sad story.

11. Lynne left...
Tuesday, 24 January 2006 9:33 pm
How about all the patients whom Grace saved/nursed? Doesn't that count? People always focus on the negative's and not the positive's.
I might be a bit biased, 'cos my sis used to be a nurse (ER one somemore), so I know how much they go thro'. Esp during the SARS, one moment, people avoided them like plague, the next they are called heros, can people make up their minds?!?!?!

12. JayWalk left...
Wednesday, 25 January 2006 8:17 pm :: 
Lynne: I agree wholeheartedly that these peeps need to bladdy wake up and realised that we are taking them for granted for too long!
Quit whining and start appreciating!

13. aloe left...
Thursday, 26 January 2006 11:50 am
oo.. i posted the whole story and the subsequent letters from the public to the ST forum on my blog le. :)

14. JayWalk left...
Thursday, 26 January 2006 12:54 pm :: 
Anna: Thanks for posting the article up on your blog!

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