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.

Tuesday, December 29, 2009

Misplaced fallout

Administration descended upon me Monday morning. I was trying to hurry to get out before they arrived. They must have come in early because they were out three days in a row- Christmas Friday, Saturday, and Sunday. As soon as they arrive, what would have taken five minutes suddenly becomes two hours because of their interruptions, accusations, and innuendos.
The Director of Nursing told me and another nurse that he's "tired of the finger pointing between the two" of us. She was the nurse who wrote up the bleeding elbow when it was actually my incident to document. He did not like that she wrote "Received resident with bleeding elbow . . ." She said that it was the truth and she was not changing anything. The unit manager jumped in, ranting, "She writes what really happened. If you don't like the truth, go after these other nurses who create these situations in the first place."
Nobody wanted to acknowledge that this nurse jumped into my workload and took it over, stating that the elbow had not been addressed. The elbow had been addressed, time permitting for one nurse during the med pass. I did not get a chance to research the issue before she jumped in. The acceptance of her behavior just perpetuates the myth that I do nothing all night and then leave any issues for the day shift to take care of.
If an admission comes in on the evening shift, the nurse is usually not done when I arrive at 11 p.m. I have never documented in the chart or anywhere else that I "received patient with no documentation" or "no orders," etc. If the nurse tells me that he/she is not finished, I wait to act on that patient. If I find something that I feel that the prior nurse should have documented or acted upon, I tell that nurse so that he/she can take appropriate action.

Sunday, December 27, 2009

Bad factors produced a good night

Last night went well, in spite of the factors of a bad night.
I was late because of bad traffic- two accidents, one fire, and a heavy downpour. I'm not usually late and I called in to let them know. Doomsday supervisor was not working, so her replacement was on time and took the endorsement of the floor for me. That ran smoothly. I usually float from floor to floor night to night, but tonight was the third night in a row on the same floor, so I knew what was going on.
My three stooges were two floating night aides who float because they are so unproductive and purposely clueless that no other nurse wants them; along with another aide who stayed over from the evening shift and was unfamiliar with both the night shift and the floor. Somehow, nothing bad happened. Nobody fell. Nobody called for assistance and was left waiting forever. Several residents were so jumpy that they would not stay in their beds all night. At one point, we had several residents awake at the desk, eating, drinking, moving about, talking and hollering. Yet we eventually calmed them and returned them to bed.
One resident complained about her aide in the form of saying nasty things to her and calling her names. It's a shame that workers have to take this, but the situation is really shameful when the residents complain to administration and administration takes them seriously. Administration will then turn on the nurse, saying that I should have followed each aide and monitored every move each of them made the entire night; never mind my own specific duties and tasks. I hope that I headed off such a situation by telling the incoming nurse that, as usual, that particular resident cursed out her new aide and that her behavior was based on her prejudice. So many times we have been in trouble because of that resident. Whenever she is attended by someone new, she claims that she was ignored and mistreated. It makes no sense to me how someone can ignore someone an entire shift and at the same time interact in a poor manner with them, but this makes sense to administration and they run with it every time. They never factor in her senility and manipulative, vindictive personality.

Saturday, December 26, 2009

Two incidents

The night was filled with anxious and jumpy residents, coming down from their highs of the Christmas holiday. One resident fell. She is probably not injured. I have not had a fall in a while. What exacerbated the night was that one of the aides either can't hear alarms or won't answer them- I'm not sure which one. Some residents ring their call bell when they want something; others just get up, setting off their bed alarms. The point of the bed alarm is to get to the resident before he/she falls. This particular aide, unfortunately, does not answer call bells or bed alarms. She falls asleep with them blaring in her ear, seemingly oblivious.
Another resident (also assigned to this aide) was trying to fall out of his bed early in the morning. His linens and diaper were wet. Another aide helped me get him cleaned up. A dressing was on his right elbow. The aides know that nurses are supposed to dress wounds, so only another nurse would have placed the dressing. The dressing was loose and there was slight bleeding. I cleansed the wound and redressed it. When the day shift arrived, Nurse Temperamental found him with a bleeding arm, stating that it was an undocumented wound. I told her that I found the wound at 5 a.m., but with a dressing that only a nurse would have done, so I did not suspect that whoever previously dressed the wound had failed to document it. I told her I would do the incident report as it did not happen on the day shift. She was annoyed, as usual, and stated that she already did it. I'll explain it by stating that I did not get to investigate the history of the wound before the day shift arrived and started the incident report; the resident was not in distress so I dressed the wound and continued on with my med pass. This is true- I was still busy passing meds until 8:00.
This sort of a thing happens all of the time. Other nurses discover an issue and treat it unofficially until some other nurse "discovers" it and is saddled with the incident report.

Friday, December 25, 2009

Weak link

The night went well. Nobody became sick or was injured.
I had three good aides (the total amount possible) and one weak link. Attempts at redirecting her to do work instead of sitting on her butt were met with:
"I have to do [blank]? Nobody told me that."
"Isn't that somebody else's job?"
"But it's only 12:00." Or 1:00 or 2:00.
Repeated reminders to perform tasks were met with sighs and rolled eyes, but little actual work.
The repercussion is that the other aides see her doing nothing and expect me to fix it. I can't make her work. She's the norm, not the exception. Administration will not take a hard line with these do-nothingers. I don't know how else to handle such "workers."

Tuesday, December 22, 2009

Sleepy sunlight

Today was the day of the year with the shortest amount of sunlight. Until the summer solstice, we will increase the amount of daylight each day.
As a night nurse, I need to sleep during the day. I have a hard time sleeping in the daylight. I'd rather be using the natural sunlight to see inside the house for reading, cleaning, and other delights. Traveling is far easier when everything is illuminated by the sun. And sleeping is easier in the dark.
After working all night, I'm exhausted and want to sleep. But then my mind keeps me awake, thinking of all of the things I could be doing in the daylight. When I awake, the sun is gone and I must return to work.

Monday, December 21, 2009

Emergency

The shift went fine until the end. A family member arrived to pick up a resident for a day trip. This was prearranged, but as the only nurse, it's hard for me to dedicate myself to one person because of the incessant interruptions. The family member started to get annoyed.
In the midst of the medication explanation, an aide reported that a resident said that he can't breathe. Breathing problems take precedence over all other matters.
The resident was calm, breathing, and talking, stating, "I can't breathe." "I have a cold." Now there is a big difference between "I can't breathe" and "I can't breathe through my nose." I applied oxygen and took vitals- all normal. Now this is no ordinary resident. He makes up horror stories and his family threatens lawsuits. So the natural course of action was to send him right out to the emergency room. The resident protested, but, given the actual circumstances and the potential for trouble, he had to leave. The paramedics examined him and told me that they did not want to take him because there was nothing wrong with him. I told them to take him anyway, as we cannot risk that his breathing could become worse. The only resource I have is oxygen, and the resident was denying that it helped. A hospital has far more resources to help him breathe better and to maintain him if he crashes.
I told the son over the telephone about his father's transfer. The son's response was, "If anything happens to him, you'll pay." That's an empty threat because something already happened to him- he feels that he has difficulty breathing. Furthermore, his father does not get to live forever without becoming sick or debilitated. When his father does die, it does not mean that someone is to blame, and if I can help it, he won't die at the nursing home.
That's what nursing is- prioritizing. Breathing is high on the list; so is preserving myself.
In the meantime, the family member was still waiting for me at the desk, exclaiming, "Can't another nurse help me?" Silly woman. There's only one nurse and I'm it.

Sunday, December 20, 2009

Perfect timing for my day off

I was off from work last night. It was great to sleep, especially because a snowstorm struck. The evening supervisor called me at 11 p.m. to come into work because so-and-so can't make it. I was asleep and didn't hear the phone ring. That's too bad. If others can't make it in, then how could I? I don't live around the corner. Second, the timing was quite rude. The shift starts at 11 p.m. I did not climb out of my warm bed, take a shower, get dressed, clear off my car, and then drive for who knows how long in the blizzard to reach work, very late and behind schedule.
I've gone in very late when called for the day shift, with the promise that I would be paid starting at 7 a.m. It never happened. Instead, I was chewed out by everyone from residents to aides and administration for being behind schedule. Never again.

Friday, December 18, 2009

"Official" people are putting it into writing:

"[T]he reductions in the nursing home industry are a symptom of a major issue for nurses in the sector . . . That may mean a general move away from the sector . . . which inevitably would hit nurses remaining in the nursing home industry with heavier workloads and less qualified help."
-Paul Wallis, Nursing Homes Cut Back as Budget Trauma Hits Bottom Line, 13 October 2009, nursingjobs.org

Where I work, I know there have been budget cuts, but I think we feel it most with the lack of supplies. No bed alarms, no heel pads, two clean towels for 60 residents for the shift, no ice cream. There seems to be a heavier workload now, and I expect it to only increase. We have to go into more detail for everything and complete more duplicate paperwork. We have the same staffing levels that the more experienced nurses say were in effect twenty years ago, yet the workload has magnified. Most residents are on twenty or more medications and require frequent blood pressure monitoring.

While there are no salary increases, there is overtime because the work can't get done before the shift is over and there are not enough nurses to cover all of the shifts on straight time. I don't think that any nurse is hurting for money, as long as she didn't assume massive debt. The aides, though, are severely underpaid for the amount and type of work that they do. The nursing home industry is not unique in its pay inequities.

I have a few great aides. They are my eyes and ears, letting me know if a resident is sick, unhappy, even "just doesn't look right." They do what they are supposed to do without being told again and again. They know how to properly changed and turn a resident in the bed. They offer fluids. They frequently round the floor to check on the residents. They anticipate needs so that residents are less likely to try to get out of bed by themselves and fall.

Then there is the newer generation of aides. Their first task of the shift is to get to the kitchen to grab food for themselves. Can they also pick up juice and applesauce for the med pass? They forgot and don't feel like going back. Residents ring for assistance- are they supposed to answer that? Like a magical coma, they fall asleep faster than any resident and can't hear alarms blaring next to their heads. When they do eventually change and reposition a resident, they can't see the iv lines or feeding tubes and twist or disconnect them.

One nurse was written up because an aide left the supervised lounge unattended and a resident fell. Her defense was that they company purposely hired substandard employees to save money, this is a natural consequence of that decision, and she is not liable for it. I can't get my own work done in an eight hour time frame, never mind the work of the aides as well.

I went into nursing home care because I enjoy working with the elderly. I so rarely get to spend more than a moment with any resident and they know how pressured I am for time.

Holiday party

We had our night shift "holiday" party in the facility. Nurses and aides who were off that night attended. It was nice.
The company does not have a formal holiday party. Never did. I found that strange.
There was a bigger "holiday" party for all employees last week, but it was at 2 p.m. That's the middle of sleeping for night shift workers.

Thursday, December 17, 2009

Threats

Doomsday warned us to be careful and document on a particular resident whose family had threatened to sue the facility earlier in the day if the resident developed an open area on her buttocks. I have several issues with that.
First, I do not understand why families feel compelled to threaten the people who are caring for their mother (sometimes father). I don't know if they think that it will lead to more or better care. What happens is that communication shuts down on all levels because the staff fears that their words and actions will be twisted around to make for a better lawsuit/action against their professional licenses. Then, as a defense measure, as soon as the resident starts to carry on about this, that, and the other thing hurting/not being attended to, the resident is transferred to the emergency room and not accepted back to the facility. As a result, the resident lacks continuity of care, never gets comfortable or familiar with her caregivers, and the family never develops a good relationship with the caregivers to the benefit of the resident.
Second, if the family was so good at caring for their loved one, she would not have ended up so sick or injured and in a nursing home instead of back home with this all-knowing family.
Third, skin breakdown happens for a variety of reasons, negligence being only one of them. The skin is an organ. Like all of the other organs that a 95 year old possesses, the skin lacks the resilience of its younger years. Skin breaks down just like all the body's other organs. It's like getting mad and blaming others because a 95 year old lacks full lung capacity or has high blood pressure from narrowing, hardening arteries.
Fourth, the threats drive up the cost of healthcare while decreasing the services. Instead of being at the resident's bedside or any other resident's bedside, the nurse must instead spend a considerable amount of time writing defensive charting, in preparation for the lawsuit and action against her license. Furthermore, the resident will be subjected to lots of testing as the facility attempts to demonstrate that it is very attentive to the resident's and family's every whim. Every little achy area is x-rayed, the negative results not believed, and follow-up ct scans ordered; specialists are called in for an episode of nausea following an unusually large meal; sudden dizziness when standing (orthostatic hypotension- quite common in the elderly) is met with an MRI and lots of blood work. Such tests and procedures are difficult for anyone to endure, especially an elderly person, and are not medically indicated and are very costly- to the taxpayers, not the family.
The administration needs to stand up to the threatening families and tell them that threatening the staff is unacceptable and that all legal action can be directed from the family's attorney to the facility's attorneys.

Tuesday, December 15, 2009

Behavior/Psych floor three nights in a row

I worked on the psych/behavior unit for the last three nights. The residents are low-maintenance as long as they aren't acting up. Just a few acted out and it wasn't all night.
One of the residents has paranoid schizophrenia and won't take pills. Someone came up with the brilliant idea of giving her omeprazole (prilosec) every morning. Since prilosec needs to be given on an empty stomach 1 - 1 1/2 hours before breakfast, giving out the prilosec falls on night shift, even though I have to start at 4 a.m. to finish by 6:30 a.m., two to four hours before anyone is served breakfast. Anyway, this resident doesn't take pills because they are poisonous. By day three, she was done being poisoned by me and carried on terribly. Doomsday supervisor showed up. Usually, Doomsday would want full vitals and a call to the doctor, because the resident could be having a heart attack or some other event. It's as if nobody believes that a psych patient with behavioral problems could be having a behavioral problem. I left Doomsday with the resident as she complained that I was trying to kill her. The follow-up was that Doomsday thinks that the resident was not having a medical issue, but rather was acting out because of her mental impairments, and I was not doing anything to try to kill her. That's a first.
One of the nurses on the evening shift is not nice- real tough and rough, for no apparent reason. We aren't street thugs, after all. She usually is standing at the desk, arms folded, glaring at me, as I enter the unit. After about five seconds, she starts screaming for everyone to hear, "What is your problem? You're holding me up. Who the hell do you think you are?" The report is, "Nothing's going on." To count narcotics: "I just counted. It's correct. You don't believe me? You think I'm a liar?" Since she doesn't give report and won't count narcotics, I don't know why she just doesn't leave whenever she is "done" working. I put "done" in quotes because she does not do what she is supposed to do. No documentation. No vital signs. Half the medication records not signed for. I've reported her to Doomsday numerous times, always with the same reply, "So don't hold her up."
The day nurses also have severe attitudes. One of the resident's narcotic pain meds were almost gone. I asked the nurse if she had requested the refill since the sticker was pulled, but the meds had not come in. She replied, "When did I refill that? At home this weekend? That's my number one priority when I'm at home, is making sure that [the resident] has her candy." I told her that it was a yes or no question, and that I float and have no idea what happened in the two weeks I wasn't on the unit. She replied, "No." Later, she felt the issue wasn't addressed enough, and came after me with the signature book for the narcotics, screaming, "See? I don't even give her the pill. Why would I refill it?" I told her that the matter had been settled, as I just requested a refill, but that she may be concerned about managing pain, as is her duty. She walked away, mumbling.
The other daytime nurse avoids relieving me. She makes a beeline for the office, gets on her cell phone, and starts making coffee. Then she looks over the aide assignments, sets up her cart, and starts her wound care. I sat at the desk reading a magazine. I had the keys, so she was going to get stuck soon. Finally she said, "I'm waiting for you and you're just sitting there reading!" She has the wait part backwards. She pulled the same stuff this morning. After coming in twenty minutes late and then talking on a cell phone for fifteen minutes, she started setting up her med cart. She stopped midway and said mockingly, "Oh, let me count with you. I wouldn't want to hold you up." I replied, "That's right. Nobody is allowed to hold anybody up." I tried to not make it personal. For the report, I told her about a violent episode that one of the residents had just had. She replied, "So? She does that to me far worse all day, so why do I care that all that happened to you was that she threw juice at you?" I had not asked her to care about me. I was letting her know that the resident had a violent outburst, which is what we do on the behavior unit.
I've told Doomsday supervisor about responses such as these. Her response is that they are not listening to the message and instead are attacking the messenger. This is my fault because I am not communicating effectively. As a result, resident care is compromised and it's my fault because my communication did not persuade the other nurses to monitor and help the resident.
The unit manager acts along the same lines. She writes incorrect orders- missing routes, doses, non-sensical words, etc.- and indicates "noted" without actually noting the order on the medication record. As the night shift nurse, I have to go over the new orders and make sure that they were correctly transcribed and make sense. When someone writes and incorrect order or fails to transcribe the order, I am in the position of having to make the correction. Lots of times I can't correct because I would have to assume too much to "fix" the order. If I "fix" it the wrong way, I'm in trouble. Such a thing happened *again* last night. Tylenol 650 mg liquid. Not transcribed. The problem is that tylenol (acetaminophen) liquid is 160 mg per milliliter. 20 mL is 640 mg; 20.33 mL is 650 mg. Most people write 640 mg liquid because, in the nursing home business, if 20.33 mL is ordered, then you must give exactly 20.33 mL or it's a med error. You would need a syringe to draw up the correct amount and we don't have syringes for that, or even the time. So if I go ahead and transcribe the order, I'm wrong because nobody can really give 650 mg liquid. If I sign off on it, I'm still wrong because it's not transcribed and because it's wrong as ordered. I showed Doomsday. She photocopied it and said she was going to the Director of Nursing. That's why she's Doomsday. Everybody will be getting in trouble for everything. In reality, nobody gets in trouble for anything and nurses keep making the same mistakes over and over.

Friday, December 11, 2009

Scent

I love to enter (legitimate) contests and have won a few things in the past several years.
Downy Fabric Softener/Procter & Gamble is running a nice contest. You design the scent of a fabric softener and name it. People vote to choose the winner.
At work, we can't wear scents, so when in other places, I pay attention to scent. Scented fabric softener is especially appreciated for the linens and comforter in the bed. Makes that sought-after sleep fantastic.
If you want to check it out or even participate, the link is www.downy.com/en-US/designyourdowny.jspx

Thursday, December 10, 2009

Pamper

Another website I like is flylady.net. It's not specific to nursing but can be used for nursing and many other jobs, as well as your home, which is its intended location.
My initial attraction to the website was its remedy to CHAOS- can't have anyone over syndrome. I grew up in chaos, though clutter was only one of many reasons why nobody could come over.
Fly lady's focus for December is pampering. I'm pampering myself right now because I used a sick day for Wednesday night and am off Thursday night; in addition, I left my cell phone in the car so I'm not hearing the repeated calls for me to come into work.
The sick day was also pampering because of its timing. On Wednesday evening, I had treatments of massage and acupuncture. I've been doing this about twice a month since the summer. I would not call the treatments themselves pampering, but rather medical necessities at this point. After all of the previous sessions, I would rush home, get ready for work, and then go to work for the night, exhausted. I think that schedule did not promote the full benefit of the treatments.
So on Wednesday, I had my treatments and then went to bed, exhausted. I slept from 11 p.m. on Wednesday until 1 p.m. on Thursday. I felt lousy upon wakening (I usually do), but now am feeling pretty good. It will be interesting to see if the benefits are prolonged by sleeping after the treatment.
I rarely call out sick. This time, I didn't even call out sick. I arranged it last week with the supervisor so that adequate coverage could be found. I get one sick day per month and I have to use them or lose them. I cover for other people's sick days, so I know the hardship created by the call outs and did not want to create more myself. Yet I know that not using sick days does not make people like me any better.
At a previous nursing job, I used a sick day. Not only was I not paid for it, I was written up for "unauthorized leave of unpaid absence." It was a county job that was appealing because of all of the paid time off, among other things. The inability to take any paid time off was one of the reasons I quit. But that's for other posts.

Continuing Education

I'm finishing up my yearly continuing education requirements at medscape.com. I have been earning one to two credits per month all year, so I'm not behind. I recommend this site because it's free, easy to earn credits quickly, and has lots of topics to choose from in many different practice areas.

Tuesday, December 8, 2009

Back to school

I'm taking an online course, not for credit, that has nothing to do with nursing. I submitted the first two assignments on time and the third one just went in, two days late. The course is a few more weeks. I wondered about returning to school, either for a masters in nursing or something else entirely, but now I know that now is not the time. I'm exhausted from working nights. Having deadlines is so stressful. Although this blog doesn't have the tone I would like it to have, I find it easier and far less stressful to post here when I get to it. In school, timetables must be strictly adhered to and that's just not for me at this time. Perhaps my need to write is being met with this blog, though not fully, because I'm trying to maintain anonymity and keep the focus just on nursing and its effect on my life.

It's okay to sleep, but only at work

Doomsday, the regular night supervisor, is back from a short time-off. I discussed the very sleepy aide with her. As I suspected, I can't write her up because I called her at home to get the outputs, and the union might consider this harassment.
First, that's a ridiculous excuse for keeping this person employed.
Second, the facility calls me daily with stupid questions. I sleep during the day because I work at night, a no-brainer. I receive several phone calls spaced five minutes apart, with each message revealing an increasingly annoyed caller with lines such as, "I called you five minutes ago. Don't you check your messages?" and "I've called six times in the last hour. What could you be doing? Why don't you call people back?" This behavior isn't considered harassment, at least not by the facility.

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.

Sunday, December 6, 2009

Flake

I was off on Thursday, which meant that I started work at 11 p.m. on Wednesday and worked until 8 a.m. on Thursday, but did not go in Thursday at 11 p.m. How a day off plays out is: I have not slept, so I still need to go home and sleep, wake up in the evening, do some things, and then go back to bed for the night. Upon waking in the morning, I feel refreshed and accomplish some things, but still have to return to bed to sleep because I have to go into work Friday night at 11 p.m.
I slipped in supper with an old friend on Thursday. I had slept a few hours and was secure in knowing that I could return to sleep for the night after the outing. Yet I was still exhausted and she could tell. I was closing my eyes, not following the conversation, agreeing with what was said but not coming up with anything myself.
I was supposed to go out Friday but just couldn't. Even though I was refreshed from having slept Thursday night into Friday morning, I had work at 11 p.m. looming over me. If I went out Friday evening, I would have needed to rush so I could get to work on time, knowing that others were going to sleep while I was going to work for the night. I felt like a flake, again, for missing out.

Saturday, December 5, 2009

Nighttime visitors

The last two nights brought me two important visitors: the director of nursing ("DON") and the assistant director of nursing ("ADON").
The joy of working night is that I don't see these people. I'm not sure what they do, and their visits demonstrated that they don't know that I do anything.
The DON talked about resident rights and new trends that corporate would like us to start following. This talk came in the middle of my heavy 6 a.m. med pass. I gave him two minutes of blowing hot air and then told him that we need to talk, but not during my med pass. He told me that I could read more in the cafeteria. I told him that nurses don't leave the floor at night because there is no one to cover. He said that I could leave the floor at any time because there is nothing to do at night. That's precious.
The ADON appeared without forewarning at 12:30 a.m. She seemed to want us to be shocked that she hit traffic, thus elongating her commute. One of the aides said it best, "What does she think the rest of us hit? Diamonds?" Her inservice stated the obvious: must carry out treatment orders as written; must report and document bruises, skin tears, etc.; and other common-sense methods of conducting oneself. Nobody's perfect, but she and the rest of us know exactly who plays fast and loose and those people should be fired. As I sat there, I was continuously interrupted by staff and residents needing things. That's okay- it's my job and I'm the only nurse assigned to the floor. The ADON grew increasingly annoyed at the interruptions, finally exclaiming that she does not understand why so many people need things in their sleep.
This should satisfy the administration's quota of nightly visits for the rest of the year.

Not my patient

Patient went into respiratory distress- alert, verbally responsive, confused. Given oxygen, get her calmed down. I have to call the doctor and family to see if they want her transferred out. There are two aides on the floor- one for each wing. The one is sitting five feet from the patient's room, but against the wall, so she can't see into the room. I tell her to stay with the patient because the patient is confused and upset and may try to get out of bed and fall. The aide replies, "She's not my patient." I'm trying to hurry- respiratory distress has to be moved on quickly. The other aide appears and I tell her to sit with the patient. She states, "I have to sit with 19." She doesn't even know the patient's name in spite of caring for her for over a year. I tell her that the patient in 19 is asleep and that the patient in respiratory distress needs to be attended. With that, both of them walk away. The supervisor appears and I tell her that someone has to watch the patient and both have refused. She orders one to the bedside. Now they are both pissed.
I understand that I'm the one with the license, but you don't need a ton of education to know that someone who can hardly breathe has to have quick attention and treatment. Those aides are liabilities under my license.

Tuesday, December 1, 2009

Introduction

Hi Everyone.
First post. Hope this is successful.
This blog is about my experiences with nursing- the good, bad, and craziness that you won't see on television.
I'm currently working nights at a nursing home. I just woke up and realized that it's Tuesday and I wrote up a bunch of lab requests for Tuesdays ordered on Mondays. We aren't computerized, so everything is written. I can't call up now and ask the evening nurse to change the dates from December 8, 15, 22, and 29 to 7, 14, 21, and 28 because she doesn't speak enough English to understand the instructions. I'll try calling later tonight and hope that the night shift nurse will understand. I'll be back at work tomorrow, but I don't want anyone seeing the wrong dates in the meantime. Nobody checks the lab book ever, but it would be just my luck that someone looks through it tomorrow.