Thursday, December 31, 2009

Bad night

Rough night.
I was exhausted going in, which is never good. One of the downfalls of working nights is that I have to sleep during the day when other people are up and about. Because I have been a nurse for only two years, I do not have enough financial security to own a house or otherwise pay a full rent on my own. I have one official housemate. This particular person has no personal boundaries. One of her habits is to have all kinds of noisy people over the house during the day when I am trying to sleep. The last few days have been such situations.
When I arrived at work, one of the evening nurses explained that she had to leave immediately because she has a husband. Out she went. The other nurse was far behind. Two of her residents had become very ill and were sent out to the hospital; another one fell with no apparent injuries.
Another resident was scheduled to leave for the hospital at 6:30 a.m. for a procedure. In order to send a resident out, either for a scheduled appointment or for an emergency, you need a doctor's order. I have noted that when the resident is scheduled to leave on the night shift, the order is not obtained. Several weeks ago, this resident visited a specialist who recommended the procedure. His office booked an appointment for the procedure at a local hospital. The nurse at the nursing home was supposed to then obtain orders for the procedure and obtain medical clearance from the primary physician. This was not done on the day that the resident saw the specialist and was not done any day thereafter. I noted this potential problem early on and wrote about it on the 24 hour report every time that I was floated to the unit. The only result was that one particular nurse informed me that I'm picky, I'm harassing her, etc.
The evening nurse was quite bogged down, but I explained the lack of orders to her. She wrote them. She needed to because the procedure required a special diet and the administration of certain medications, which had already been given, without an order. She grasped that an order was needed and that the required meds needed to be on the MAR (medication administration record) and signed for. This is a simple concept done for everyone. I do not understand why everyone refused to do it in this situation.
When administration arrived, the assistant director of nursing wanted to know why it was a big deal. She said that it had been brought to her attention, but that she listened to the issue to be polite and never had any intention of addressing the issue because "someone else should do that." She passes the buck, yet she's in charge and praised.
During my shift, a resident fell and was not hurt, thank goodness.
I spoke to Doomsday supervisor about the elbow incident, where another nurse jumped in and documented that I did nothing about the resident's wound- after I treated the wound and told the nurse that I did not get to write the paperwork. As I suspected, Doomsday felt it was my fault because 1- I was not done with all of my tasks before the start of the next shift and 2- I should have been operating in an offensive mode and hidden the chart so nobody could chart ahead of me and write that I failed to address an issue.
With this in mind, a similar situation arose at 6:30 a.m. An aide alerted me to a wound on a resident's ankle. It was black, which is bad, and the foot and lower leg were swollen, red, and hot. That is really bad. I notified the supervisor. Then I took the chart and hid it. I was not going to be able to document about the issue before the day shift arrived at 7:00 a.m., so I had to go on the offense and protect myself. The supervisor and I both felt that the situation was bad because the infection was serious and nobody else noticed the wound which was clearly present for a while.
When the day shift arrived, Nurse Temperamental and the unit manager felt that nothing was seriously wrong with the foot and that I was just trying to make trouble. Someway somehow I was saved because the doctor himself walked in. He said that the wound started first, went untreated, and caused cellulitis, and the situation is now very serious. I said nothing, but they stewed.
The other nurse who took over the unit with the falls has an attitude. She asks a question about how you did not care for a resident, such as, "Was Ms. Smith gasping for air the entire night?" When you reply, "Of course not," she quips, "Don't get an attitude. I was just asking you a question." She's not asking a question for information. She's hurling a baseless accusation in the form of a question.
Her accusation was about the resident who fell on the evening shift. At 9:00 a.m., the resident was complaining of increasing pain in the left knee. The question was, "Why did you let her suffer in such pain all night?" Never mind that I documented that she denied pain and showed no symptoms of pain. I'm tired of these accusations. If the resident were in pain all night, then why did the day nurse wait two hours into the shift before noticing her pain? It's as if they can't believe that something happens on their shift or a condition worsens; everything must have happened on the night shift and the night shift should have corrected it instead of leaving it for the day shift. Even the social worker said, "If she's in so much pain, why didn't you send her to the hospital last night?" Because she was not in so much pain overnight. The pain worsened at 9:00 a.m. It happens. They also don't seem to grasp that I don't work in seclusion. The three aides on the floor also care for and advocate for the residents. If they felt that a resident was in pain or distress, they would tell me. If they felt that I was not responding well to the problem, they would call the supervisor or ask another nurse to intervene. Plus, the supervisor tours every unit frequently and would notice a resident calling out or sobbing. There is no reason why I would not tell the supervisor if a resident had a potentially serious issue.

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