Monday, December 7, 2009

Monday morning- after working all night

I don't mean for this to sound so negative. This was a bad weekend because few regulars were on and the administration comes in early for their Monday morning assault.
Work ended two hours late this morning. Not because anyone was sick or unstable- everyone was okay. There were really two reasons for the delay: Three patients had to leave for appointments and two of my three aides were not familiar with the unit, or familiar with staying awake. They were under the impression that they did not have to do anything unless I stopped what I was doing, told them the specific task, and kept telling them in spite of the "what?" responses.
The unfortunate thing about being delayed into the day shift is that I overlap with the arrival of administration. The unit manager arrived. Her basic premise is: she is always right, everyone else is always wrong, and all of the problems with the unit are caused by someone else. And it's my fault that I'm not done by 7 a.m. because the assignment is too heavy for one nurse, which is my fault for accepting it. She kept interrupting the report to gasp, "You have a supervisor, don't you?" as if I was supposed to report that all issues and problems raised by anyone were fixed by the night supervisor this morning.
They were mad because I didn't reinsert an iv line that had infiltrated last night. The patient gets one iv med at 9 p.m. For the last three days, the heplock infiltrated during administration. The evening shift did not notify the physician and did not reinsert another line. The day nurse was of the opinion that I should have called the doctor and reinserted the iv line. I felt that the reinsertion could wait until evening because the veins collapse so quickly on this patient. The thing that really gets me when they criticize me for not picking up work from another shift is: they see that I am an hour past my shift end time and still have another 30 patients to do. When was I supposed to have time to do the leftover work from three nurses from the earlier shift?
Speaking of leftover work, I was further delayed because I had to call a doctor at 1 a.m. to get an order to transfer the patient to her appointment. The nurse who spoke with the doctor wrote the appointment on the calendar. I can't send her out or make her NPO (nothing by mouth) without an order, which the nurse did not bother to do. Furthermore, the transport ambulance brought a wheelchair for her and I felt she needed a stretcher. Nothing was indicated in the chart as to which was ordered. The day nurse likes to keep information to herself so that other nurses look clueless. She and administration don't seem to care that this affects patient care.
I noted that a patient (still?) had an open sore to her leg. I put a question mark with the "still" because the wound was being treated for all of November. The treatments were for two weeks each. There are no notations stating if the wound healed. So I continued the original treatments for another week. The unit manager said it's a new wound, which requires a ton of documentation, as the old wound was completely healed "when I left her on Friday." As I mentioned, there is no documentation that the wound healed; rather, the treatment order terminated naturally and nobody reassessed the wound. But because she will bully everyone into thinking that the night shift ripped open this woman's leg, it will be a big hullabaloo.
One of the aides did not write down the foley catheter outputs. This is standard operating procedure for certain aides. I waste my time repeatedly asking them to write the outputs. When they leave, I'm always detained in a room and escape only to find no recorded outputs. For the first time, I called the aide at home. I may write her up for not writing the outputs and continuously sleeping during the shift, thus causing me delay every time I had to stop and go wake her up.

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