Monday, August 23, 2010

CPR

I assisted in performing CPR today. I've done it in the past, but not the chest thrusts. The woman was so old and brittle that I felt a rib gently give way. This is why the ancient among us need DNR orders.

Two aides scurried around, scolding me, "Why are you doing CPR on a dead lady?"

When the paramedics arrived, they knew at a glance that she was too far gone. The unhurried EKG revealed a steady flat line. She was declared without much ado.

She was not my patient. I had never seen her alive. I felt strange that my intimate interaction with this person was after she had passed.

Monday, August 16, 2010

Vacation

It's been a while.

I was on vacation. Now Doomsday is on special assignment or a vacation. I don't know what she is doing. All I know is that she is not there. This is wonderful.

They finally made good on their perpetual threat to cut back on the overtime. At least with me. I usually work an extra day each week. Now I don't. But they still need the coverage and did not hire new people. Instead, nurses from other shifts are getting the night shift overtime and I am not. I worked extra because I need the money; not because I need something to do. (There are nurses working out of boredom. I will never be one of them.) I'm nervous about the decreased income.

I attended a nursing career fair in July, where the few hospitals in attendance wanted only "experienced ED or ICU nurses." Not me. I applied to some nursing homes in the area and was told, "We have no positions right now, but we'll hold onto your application." Until they throw it out in a cleaning frenzy next week.

I guess I'm stuck for now. Has the bad economy finally impacted my place of work?

Monday, July 5, 2010

So little to do

So far, doing very little is going well. Then again, Doomsday supervisor has not been on duty.

I am tense and rushed at the beginning of the shift. Once I get the evening shift out, I may or may not update the CNAs. Then I do chart check and the treatment records, when I am fresh and have the most energy. Then I hit the floors for the 12 a.m. meds and the vitals. I document around 2 a.m. (not after 7 a.m.). If nothing is wrong, such as a fall or an illness, I have about two hours to myself. I can't believe it. Around 4 a.m., I fill out the med books, set up my carts, and start the 6 a.m. meds. Done by 7 a.m. with time to spare.

It's difficult to not do "extra" work, but I am succeeding. When I wonder whether or not to do something, I consider whether or not it could result in the loss of my license. Thinning charts: nope. Cleaning the kitchen: nope. So I don't do those things.

Friday, July 2, 2010

Alarms that few can hear

I worked a long-term floor last night, which is so much easier than the subacute. I easily finished and punched out "on time." I skipped a lot of paperwork, but nothing that can't be done by somebody else at some other time. But will not be.

Doomsday Supervisor barely spoke to me. I can't trust her anymore, so I spoke to her only when necessary. She told me that the "alarm situation" was taken "very seriously" and that if a bed alarm is found turned off or otherwise sabotaged, there will be "swift action." That's a load of crap. Nothing will happen. She said that the aide was suspended for admitting to disengaging the bed alarm. No she wasn't. She was sitting in a chair, knitting, talking into her cell phone on speaker, glaring at me when I arrived and began the shift endorsement.

The other issue, important to me only, is that certain aides feel very comfortable ordering me around and screaming at me if I contest. Doomsday didn't mention that part of my complaint and I didn't ask because I'm not conversing with her.

Thursday, July 1, 2010

Fallout continues

I made it through the night and punched out on time. That's quite a feat, especially because I was floated to the subacute floor and it was the change of the month paperwork. The evening shift stayed over, holding me up, telling me I had to wait for them to finish with the books. I did whatever I could until they left. I saw several errors associated with the new month's records, but I had to leave them, as I did not have the time and they can't be associated with me. Under this new "stay out of it" rule, I don't do anything but pass meds and document on my patients.

Doomsday mostly stayed away. She did come to me and tell me that not all of the end of month paperwork had been done on another floor. She said that I did some of the work for the day shift, and she wanted to know why. I attempted to remind her that she told me that when I finished the night shift's papers, I was to help the other shifts. She denied it and said, "This is why you should mind your own business. Because you did some of the work, they assumed that you were going to do all of it, so they overlooked certain charts." I didn't respond. That's her determination- the day shift had not yet returned to explain why they didn't do all of their work. "Certain charts" were overlooked because they are complex and targets for state surveyors. Doomsday has emphasized that the unit manager is responsible for ensuring that all charts are done for the month; I have nothing to do with it. So why is she telling me this?

I don't know what she has in store for me. I just know that I have to move on.

Wednesday, June 30, 2010

I can see clearly now

I have not posted in a while. I did not want to keep writing the same old nonsense.

I have to balance the inequities of working with my need for an income, which provides me with food, shelter, and other items that require cash to acquire. We all must do this.

I work overtime, usually an extra shift per week and an extra hour per shift. Basically said, I could not leave on time if I tried because there is so much work and the clientele is so needy (and slow). I also acknowledge that some nurses leave on time no matter what. The caveat to their prompt departures is that they did not do everything that they were supposed to do.

Call it guilt, call it fear, but I just can't omit certain things that other nurses overlook. Examples include not documenting use of "as needed" (PRN) meds, including allergies on order sheets and medication records, writing names on the orders. If my name is signed to a paper, the information on the page is correct and complete. Other nurses- no.

For a bit of a background on the seeing clearly issue, the residents have orders for foot pads to prevent heel breakdown and bed alarms and siderails to reduce falls. Each nurse for each shift must sign for each item for each resident in the treatment administration record (TAR). As previously written, if my name is on it, then it is in place. In addition, Doomsday supervisor has, on several occasions, written up aides and nurses for not having such protective equipment in place.

The practice of the evening shift is to let things like heel pads, siderails, and bed alarms slide, even though the nurse is signing for them. When I arrive on the night shift, I am required to put all of these into place, as per my signature in the TAR and Doomsday's checking. Supplies run low, and there simply aren't enough bed alarms or heel pads to meet all that are ordered. A while back, Doomsday told me that I can't sign that they are there when they are not- I had to circle and explain their absence. I wasted my time doing that for a few weeks, angering the evening shift because they were signing that something was there and I was "making them look like liars." (Which they were.) So Doomsday wrote me up "as per corporate," because I was aware that supplies were missing and I did nothing to make up for it. She claimed that she never told me to write that heel pads and alarms were "not available." So from then on, I initial that everything is present, even when it is not. At that time, I felt that she wanted to make a valid point with the missing equipment, used me to do it, and then made me the fall guy when corporate didn't see it her way.

Lately, she is coming down on me when the aides fall asleep, ignore call bells, ignore bed alarms, don't change residents, leave trash lying around, etc. If I ask/tell/inform an aide that something must be done, she screams at me and doesn't do it. I explained this to Doomsday and she said that she can't do anything about it unless I write up the aide. So I started the write-ups. The aides are even angrier now and Doomsday is counseling me on my "inability to get along with others." That helped the fog lift, but the next incident let me see.

It's the end of the month. We are not computerized. The pharmacy is. They print out the medication and treatment logs around the 20th of the month. The problem is that orders are entered and changed after the 20th, so they are not reflected on the new logs. They must be changed by hand and reconciled. Most nurses don't understand the concept: if you get an order on June 25th, you have to write it on the June log as well as the July log. If a resident is admitted after the 20th, you need to write out their current month's log as well as the following month's log. Night shift is assigned certain charts to reconcile. I kept up with it. Doomsday explained for days that I alone was responsible for the night shift assignment. When I was off, the nurse who worked touched nothing. On Monday night, I told her that I had one left for a resident admitted on Friday that needed to be written out by hand. I told her that I was off Tuesday night and asked if I should stay and write it, or if the nurse on that night could do it. She went on and on about how it was my responsibility and that I can't put it onto other people. So I stayed and wrote out the entire July mess. I punched out 2.5 hours late (that's how long it takes to reconcile the new log with the old log, the hospital records, all by hand, rewriting the same diagnoses, allergies, etc on over 20 pages). She came flying after me after I punched out. She said that she never told me to stay and do the July logs, nobody is to get overtime, I am not the exception to the rule, and the nurse on Tuesday could have done it. I attempted to remind her that I specifically asked her if I should stay and do it and she said yes. She said that it's not my responsibility to do it, so I should have left it undone, and she is not authorizing my overtime.

I felt tricked; I have other things to do with my time besides handwriting repetitive forms for free. If the place would just become computerized like the everywhere else, there would be no need for this time-consuming monthly fiasco. I need the overtime pay. I would gladly never work overtime again, but I don't feel that it's possible to finish everything before 7 a.m. And Doomsday does "require" me to do work that other nurses don't do, such as pulling signed orders from charts to return to the pharmacy, flipping the lab book, hypnotic summaries, etc. Being the stupid person I am, I thought that if I did everything she asked, I would be okay. Instead, each additional piece of work opens me up to more criticism.

I have to leave. It's only a matter of time until something very serious happens to a resident and I'm pegged as the fall guy. I see this now. I can't say anything to Doomsday about anything and I can't let her know that the scapegoat is trying to escape herself.

For the record, certain other nurses for the evening shift get overtime every day, never leaving before 1 a.m.

Thursday, May 13, 2010

A little time off is great

I had a few days off from work. It was wonderful. I rested, slept, rested some more.

I tackled several items on my to-do list, but it really is never-ending.

I used three vacation days. I think I've earned 15 days, but nobody has a formal declaration of paid time off or time already taken.

And when I return, my treat is that Doomsday supervisor starts her vacation. (Her vacation is why I could not have more time off.)

Friday, May 7, 2010

Return to the ordinary- no differential

Pay Day.

My reason for working. Oops- I mean that I love taking care of sick people. Especially when they whine and lie in a fruitless effort to secure more percocet. I just love it when they claim to have not received the four tabs I signed out overnight, as if someone is going to say, "Oops! Here's the four pills you missed." As if there may not be serious consequences for a nurse accused of diverting the percocet.

I digress.

Last paycheck, I received a "differential" of unknown origin. No such bonus in this check. I won't ask about it anymore in case it was a mistake and they take back the money.

Wednesday, May 5, 2010

Falling into sleep

There is a resident who has been with us about three weeks. He broke his finger in a fall at home, was hospitalized, and then sent for rehab. Since arriving, he has fallen twice that we know of. I suspect that he has fallen more, but managed to pick himself up before anyone noticed.

He is very forgetful and foolhardy. He is awake all night, except for a few periods of literally falling asleep. I think he has restless leg syndrome and is not being treated. I give him Tylenol at the start of the shift and apply menthol cream to his aching legs. He still can't stay still.

In the morning, he's calmer from exhaustion. This morning, he remarked that the golden years are not golden for him, "They suck." He wants to go home and probably will. He has some understanding of his propensity for falling, stating, "I guess I'm going to have to pad my entire house."

I find it sad when someone is just starting downhill, so they still have some intact faculties to realize what is happening to them. They have periods of confusion and lucidity and remember the confused state.

Thursday, April 29, 2010

Limit the workload

Two related new(ish) items caught my attention today. I don't catch anything brand new anymore because I'm so darn tired- and behind on everything else.

Over at brazencareerist, webcasts are finally becoming available through archives. I'm usually asleep when they are live, so I haven't been able to view one, until today. The webcast was about fulfillment. As it turns out, personal relationships and not your career will give you fulfillment, so your choice of a job should consider three factors. I don't remember two of them, but one was "control over workload." I was thinking about how I don't have any control over the workload and it usually veers out of control pretty early in a shift. Then Penelope Trunk (the speaker of the webcast and the overall power behind the site) specifically mentioned nurses and that it's not a job she recommends for lots of reason, none specified.

I don't find nursing to be fulfilling. It's reliable employment at a rate better than most average jobs. And yes, no control over most facets of the job.

On a related tangent, today on one of my other favorite sites, medscape, was an article about the impact of California's law mandating nurse to patient ratios. New Jersey and Pennsylvania were included in the study because they do not have a nurse to patient ratio law. (New Jersey has pending bills in the house and senate. Nursing homes, however, are not targeted by the mandated ratios.) As one might have predicted, patients have better outcomes and nurses have fewer gripes in California than in New Jersey and Pennsylvania.

My interpretation is that nurses have so little control over their workload that legislation must be passed to attempt to lighten it. Definitely not a fulfilling career. Especially not in the nursing home setting. Doesn't anyone think that 60 patients per nurse is too much?

(I hope that the links work. I've tried this before without success and really feel that a blog should have working links. And pictures. But mine just won't insert.)

Tuesday, April 27, 2010

Two g-tube tales

Yesterday, around 7:45 a.m., an aide came into the hallway shouting for help, that a resident had removed her own g-tube. The day shift nurses were already in and had taken over the unit. I was present, but doing my charting and documenting for the night. I don't mind helping in an emergency. This was a manageable, yet urgent situation that the day nurses could easily cover. But: an evil nurse was working- the nurse that wrote bad things about me (never do that to another nurse) for a wound on another resident.

My fear was: how am I going to convince administration that the tube was intact at the end of my shift?

So I hurried to the room and found a nurse already inserting a tube to keep the opening patent. The aide was distracting the resident from tearing out the new tube. I knew the g-tube was in place when I flushed it after the feeding ended at 6:30 a.m. I hid the g-tube from the resident under two pillows. She is confused and picks and pulls at anything she finds, so her plan of treatment involves burying the g-tube and feeding line so she can't find it and remove it. I asked the aid if she knew how the tube came out. The aid answered, "I was washing her and she just reached down and pulled it all the way out before I could stop her."

I was relieved- they couldn't blame me. But they would try, just for the hell of it. So I returned to the nursing station, grabbed her chart, and documented for the night that the g-tube feeding was well tolerated and the tube was in the correct position. My last time entry was for 7:15 a.m., so a future entry of "Received resident with tube removed" will look suspicious. It still may happen.

The other g-tube story is that the resident for this morning has a g-tube in her, but eats entirely by mouth. Each shift is supposed to flush the tube and does indeed sign for it. Day shift is supposed to clean the g-tube site daily and signs for it. Night shift replaces the flush kit. I know that the day and evening shifts aren't flushing the tube because the previous night's new flush is always in the sealed package, untouched. I took care of this resident three nights ago. I assessed her g-tube and the site and found a slight bloody drainage. I cleansed the area and applied a dressing because she was going out for an appointment and I didn't want her to leak or bleed through her clothing. This morning, which is three days later, I had the resident again and of course, my dressing is still on the site. It was filthy. I removed it and don't know how I did not dry heave in that room. That means that it was really bad because, as a nurse, I have pretty much lost most of the ability to feel disgusted, or even gag at anything. I think that I did not reveal my disgust to the resident. Never do that. It is entirely not her fault that this area of her body has turned so yucky. The nurses were supposed to maintain the site and they failed.

The nurse who relieved me was a per diem floater, so I did not mention the situation to her. I will tell the regular day and evening nurses. They should receive the information well. Other nurses would not like to hear such a thing, especially from me, but I'm not doing it to feel superior. I'm doing it so that the resident receives better care. Each aid who took care of her should have seen the (glaring) date on the dressing and told the nurse. Each nurse should have assessed the area on their own accord and found the dressing and removed it. What is truly sad about this particular resident is that she has already lost a leg while living at the nursing home because she developed a foot wound (from not being positioned and turned properly), the wound went unnoticed and then was not treated regularly, became infected, not noticed, until an amputation was necessary. That's not the end. Same process played out on her sacrum, though you can't amputate somebody's butt.

Sunday, April 25, 2010

Differential

I got a little (very little) bonus in my paycheck. $146 of "differential." I don't know what it's for. It could be for working nights, working weekends, working the sub-acute floor; maybe even having a BSN? I've asked around and nobody else got it.

I wonder if I'll ever see it again.

I'm not bashful about asking and telling about pay. It's the only way that people, not just nurses, can make informed decisions about where to work and if they are being taken advantage of.

Friday, April 23, 2010

Nursing school- instructor shortage?

I understand that television warps reality and then broadcasts it.

Still, I want Days of our Lives to understand that doctors don't teach nursing school; nurses teach nursing school. Nathan Horton, MD, should not keep running into Melanie Layton Kiriakis, nursing student, because he is her teacher. But then they would have to find another way for them to be constantly tempted to romantically hook up.

Maybe like the rest of the country, Days faced a shortage of instructors to teach- no nurses with MSNs floating around Salem.

New planet

I've moved and feel very out of place. It doesn't help that I've been off from work only two nights since moving. I was off last night. I fell asleep for a recharging nap around noon yesterday and ended up sleeping until 4 a.m. this morning. I was really tired.

Happy Earth Day.

I recycle at work. Nobody else does. There are no recycling bins, so this is solely an individual effort. I found it silly to recycle at home, while throwing out cans and boxes at work. Some people understand the concept, but don't recycle; most don't understand and throw out my box of cans. Comments have included:

"Why do you recycle garbage?"
"How much do they pay you?"
"What do you mean, recycle? I've never heard of it."
"You can't recycle that paper bag. It has a tear in it."

They aren't seeking information to become educated and better the planet. They are seeking to highlight the differences between them and me, as if their ignorance is the proper way. It's quite tiresome.

Saturday, April 17, 2010

Moved

I have moved. It's peaceful sleeping during the day. I have worked every night since the move, so I'm exhausted and little has been done to organize the place.

I've been on the short term floor because the regular nurse for that floor is still on vacation. Some of the new admissions are very time-consuming.

More to come when I get cable installed at the house.

Sunday, April 11, 2010

Baby nurse

I'm catching up on my dvr recordings. I just watched Accidentally on Purpose, featuring a "baby nurse," played by Olivia Munn. I started watching the show because I think Jenna Elfman is funny- I really liked her quirky character in Dharma and Greg.

The sitcom is all about funnies, of course, so I watched to see how the nurse was portrayed. We were supposed to take it as normal that a baby nurse would be needed for a seemingly healthy couple with a presumably healthy baby on the way. As revealed in the ridiculous interview, at least the baby nurse was really a nurse and not a babysitter.

And like many other television nurses, the baby nurse was all about sex. The fantasy about assisting with feeding the baby was sexual. The nurse ends up fired for attempting an interlude with two other characters.

Someday this image of nurses as sex-starved, preying on patients, doctors, and families, will change?

Weekend to move

I'm off this weekend. I usually work anyway, but I said no to this weekend so that I could move. Things usually fall through for me, so I waited until I actually got into the house and got the keys before officially saying, "I'm moving!"

I'm making frequent car trips for the smaller stuff. As I arrive with each carload, I put the stuff where it's supposed to go. I learned that from nursing- do what you can when you can throughout your shift, so that you are not left with a heap of work at the end, and so that a snafu/emergency does not hopelessly strand you hours behind.

Saturday, April 10, 2010

Financial threats

The podiatrist comes in early in the day, when people are still in bed, because that's the set up conducive to toenail trimming. If the night was busy, I'm usually still there when he arrives.

He told me that the field is no longer lucrative and he suffers a salary reduction every year. He is seriously considering adding another career, teaching, for extra money and as a segue to leaving medicine. He said that several of his colleagues have also done the "alternate route" to teaching and are now teaching science or math, subjects more secure than arts and music. He said he would do his nursing home visits evenings and weekends to earn money while attending school during the day; then teach during the day and still work weekends for supplement until the teaching pays more.

Can you imagine? He's not the first doctor to tell me that the practice of medicine is not worth it financially. I feel pretty confident in my position and salary as a nurse- it's why I went into nursing. But maybe there is a chance of salary or hour reductions. At least for now, my state requires that medications in a nursing home be administered by nurses only and not medication aides, so I feel safe. In spite of cautions against polypharmacy, every resident's medication list grows each month. I used to have to give meds to about 20 residents for 6:00 a.m.; now it's about 50.

One of the aides told me that she is considering a program to become a "dialysis technician," designed to replace expensive registered nurses with lower-paid techs. For the price of tuition ($16,000), she could become a nurse through a county college, and I told her so. That does seem to be the trend, though, as medicine becomes more sophisticated- having less educated workers perform the work formerly done by registered nurses.

Thursday, April 8, 2010

Who's pain is it?

Doomsday Supervisor gave me off Friday night. It's my weekend off. So I should be able to pack up and get going to the new place this weekend. The van will come on Tuesday for the big stuff. The thing is that I don't need my housemate finding out until the last possible minute because she'll do bad stuff.

At work last night, I saw a family member. She came in really early. Like most family members, she had a complaint: Her father does not like his bed. There are two problems with this issue: 1- she raises it every day with each new bed and 2- his pain is caused by cancer that has metastasized everywhere and not by a bad bed. That didn't stop her from going on and on, as if she doesn't have this same performance every day. She doesn't want her father to receive pain medication "because it can make him sleepy," but she wants his cancer to not be painful. I gave her the name and number of the administrator and she pretended she had not spoken to her already. Let the higher-ups deal with this repetitive ignorance.

The other question is: why are we listening to the daughter when we decide whether or not to administer pain medication?

Wednesday, April 7, 2010

Moving along

I signed a lease and should be moving next week.

I asked for time off again, and was told that it's now impossible because the only other part-timer has to leave the country because of a death in his family. As I've written before, this should not be my problem.

I was off last night. They called me all day to come in.

Tuesday, April 6, 2010

Trudging along

Last night was busy, but manageable until the final hour. Someone went into respiratory distress and someone else died. The death was anticipated and the resident was on hospice. The other resident had been in distress earlier in the day, sent out, and quickly returned with instructions to not treat. (Read: no orders for DNR/DNH, so I have to hope I don't run into trouble. But I did.) I actually got her stabilized.

The problem with these problems arising at 6 a.m. is that I'm in the middle of the 6 a.m. med pass. The pass ceases and I attend to the residents. No other nurse helps me. By 7:30 a.m., I was still attending to these two issues, with only a quarter of the meds given. My three replacements were gathered at the nursing desk, eating and chatting. They could have helped. But they don't because the unspoken rule is that problems arising on a prior shift are the sole responsibility of that shift and must be remedied and not endorsed, no matter how long or involved. I was finally able to return to the med pass around 8:00. The three nurses were annoyed that I was now holding up their 9:00 med pass. They have plenty of other work they could have done instead of standing around, doing nothing.

To top it off, a private duty aide showed up and wanted to ask questions. For some reason, she decided that I was the only "go to" person and backed off when she saw me running with oxygen and other supplies. She waited in a chair for over an hour, even after the day shift arrived. I don't understand why she thought that she had to speak to the only person who was busy and didn't dare ask the three nurses standing around. She let me know how mad she was that she waited for me while I attended to my patients. So I made her madder by asking her what her questions were, listening, and then calmly referring her to the nurses at the desk.

Sunday, April 4, 2010

Is the grass greener in the next county?

I tried to sleep, but my housemate and her boyfriend for this weekend woke me up. Another reason why I must move. "You're still sleeping?" was the response. I fell asleep at 10 a.m. They woke me up at 12:30 p.m. They don't sleep a mere two hours each night, yet they can't fathom that I would need so much sleep.

I'm exhausted but can't fall back asleep. It's sunny and warm outside. I want to be running around outdoors, not sleeping until nightfall.

I did manage to apply to a job. It's a county job and administrative. I have this fantasy that government employment would be great for the time off, benefits, security, etc. This particular job is at a place where several of my coworkers already work. These nurses work full-time at the county job and then full-time at the nursing home. They walk around like zombies. I don't plan on doing that. I mentioned the job to the night per diem supervisor. She was familiar with the position and the person doing the hiring and said that she would mention me.

I worked for a different county as a nurse at a nursing home. I lasted five months. The job itself was horrible for lots of reasons. As for the perks, I didn't get my insurance cards until my last week, so I never got to use the insurance. I called out sick once (I was supposed to get 15 sick days per year) and was written up for "unauthorized leave of unpaid absence" and not paid. I finally handed in my two weeks' notice when the director of nursing met with me to tell me that a senile resident recalled that at an unknown time in the past, someone who matches my description attempted to strangle him; after an "investigation," they determined that I was the person, and she wanted to know why I would do that.

The two weeks was a courtesy in the employment industry, but that wasn't good enough for them. The following week, the assistant director of nursing told me that I had to leave because "Your name appeared on a paper of people who can't work here anymore." She showed me a printout of an email about people who were missing documentation. My name was not on it. She said, "I didn't say that your name was on this particular piece of paper. I'm using this paper as an example. The names were in an email, and you know that I don't know how to work email." I didn't know how to respond. She said that I just needed to show my immigration papers. I said that I don't have immigration papers. She was horrified and exclaimed, "Everyone needs immigration papers." I calmly said, "Only people who immigrated need immigration papers." She wasn't following. The shift was just starting, and I had already received endorsement from the outgoing shift. I had the assignment sheets, new orders to transcribe, keys, everything- in my arms so I could get the shift into motion. I asked her what she wanted me to do. She said, "You have to leave." I smiled, said, "Okay, the unit is yours," and placed everything into her arms as her mouth dropped open and her eyes widened. I shouted to the CNAs, "Ladies, Ms [assistant director of nursing] is going to be the unit nurse tonight, so bring your concerns to her." I grabbed my purse and ran out the door.

Yet I still hold out hope that a government job in a different location would be good.

No time off

As I predicted, Doomsday supervisor denied me any time off for the new schedule. She said it's not possible because two people are on vacation and "they come ahead of you." I realized early on that everyone comes ahead of me.

I became full-time from per diem about a year ago. In exchange for a pay cut, I was to receive health insurance, dental insurance, and paid time off. So far, the insurance has paid nothing because they are both HMOs with no participating doctors anywhere near here. I have put in for days off, but have yet to receive any. When a holiday falls on my regular day to work, I'm supposed to get another day off. That has yet to happen. I'm starting to think that this paid time off deal is really no deal for me, especially if I'll be leaving and forfeiting all of the time.

Saturday, April 3, 2010

Plans to move

I may have finally found a new place to live. It's not far from where I currently live and it's not far from the job. At least it can be considered "not far" when you are travelling at night and don't hit traffic. During the day, the commute would involve lots of traffic in trying to maneuver past lots of shopping centers and a major mall. Plus, the area, though not my particular home, is prone to flooding, closing major roads.

With this in mind, I'm looking at applying to the nursing homes and hospitals in the area. As you have been reading, I am not happy where I am, so I might as well move on, and it might as well be to a place with a short commute.

I hope I can get time off to move. I have plenty saved up because it's hard to schedule the time. I am one of two full-timers. The other one is on a two week vacation now. Most of the per diems have very limited availability, such as every other Friday. Every now and then Doomsday supervisor asks why I don't take off, but when I put in for the days, she says she can't swing it. I usually work my weekend off. Last week, when she "gave" me an extra day off (I had just worked the extra weekend), they called me all day to come in because they were short. I ignored it.

Friday, April 2, 2010

Lower your expectations

"Lower your expectations." Doomsday supervisor told me this last night. I have heard this from different people in various situations my entire life. In my professional and personal life, I feel that I have always operated in a manner so as to learn and grow, bettering myself. I realize that most people don't want to learn or grow. I just don't understand how they could desire to stagnate.

It's ironic that Doomsday would tell me to lower my expectations. One of the reasons why I work exclusively night shift at this time is because of her. Unlike the supervisors on the other shifts, she is on top of her game. She expects things to get done in a certain manner. She takes on a lot of responsibilities that really belong to other people.

By hearing, "Lower your expectations," I hear, "Stop caring." I don't think that I could ever stop caring about my job performance. In addition, because I am not one of the favored children, I could very quickly be singled out and fired when there is a failure. Maybe it's the entire set up, that one nurse (and I don't even consider myself to be very experienced) is responsible for sixty frail and sick people, with three "unlicensed assisted personnel" to help. Other nurses have expressed their opinions that the CNAs are not educated or paid enough to perform well. I agree about the training and pay, but the second part of this proposition is that the nurse, who is educated and paid well, has to pick up the slack. I don't see other nurses jumping in to fix omissions made by the CNAs. And I also don't see them getting in trouble for doing nothing.

Monday, March 29, 2010

Can't see or hear- and that's just the staff

It's pretty much the same old at the old age home.

Last night I worked with the aide that I "harassed." All night, she ignored call bells and bed alarms. I stood my ground and told her to answer them. She rolled her eyes, sighed, cursed me. In the end, the safety of the patients had to prevail and I ended up answering most of the bells and alarms while she sat there glaring at me. Amazingly, nobody fell. Nobody ever does fall with her. I do not want someone to fall or get hurt, but I am waiting for the night when one of the patients on her assignment does fall and I get to write on the incident report, "Bed alarm sounding. Aide sitting outside room. Nurse responded to alarm and found resident on floor." I have never written an incident report so as to assign blame to an individual, but this is what administration wants. This particular aide has advised administration and the night supervisor that she has no intention of performing the duties required of her job, yet they keep her.

One particular bed alarm highlights the issue. I went to another floor to obtain forms. (Only one floor has a system to keep papers in order. One out of three is not too bad, I guess. No, computers are not used at all. Every record is handwritten on paper. I have to use my own laptop to file death certificates, which now can only be done online in my state. But that's another story.) That floor had a urine specimen for the fridge to await pick up. The fridge is located in the beauty parlor (which disgusts the beautician, but that's another story), which is inconveniently wedged on the floor I was working- in between the oxygen closet (you guessed it- I don't have a key) and the air vents. I brought the specimen down with me to place in the fridge. As I opened the door to my floor, I heard a bed alarm sounding. The aide was seated in an arm chair, looking quite bored. I said, "Can you go see who that is?" (I wanted to scream, "What the hell is wrong with you? Answer the damn bed alarm before somebody is on the floor, you stupid bitch." But I restrained myself.) Her eyes rolled. Sighed. Arms fell to the sides as her entire body collapsed into the chair more. Head shook back and forth. The fill-in supervisor was nearby. She looked for her keys, then for the key to the door of the beauty parlor, then we went in, found the light, placed the specimen in the fridge, turned off the light, locked the door. I washed my hands. I heard the alarm still ringing and saw the aide meandering through the hall, casually looking at (not even into) each room, as if she was window shopping on a too-long lunch break. I went down the hall towards the sound of the alarm, quickly bypassing her. The resident had not fallen. She made it from her bed to the bathroom. This particular resident is slower than molasses pouring out of a fridge, as another resident described her. She finishes breakfast as lunch arrives, finishes lunch as supper arrives, and is still eating supper when night shift arrives at 11 p.m. Yet it took her less time to get out of her bed and walk ten feet to the bathroom than it did the aide to walk the forty feet to her room.

Although this aide is the extreme version, most of the other aides are similar in nature. They do some work, ignore the rest, and go berserk if they are told to complete their assignment. I can't work like this. This isn't team work. It's me taking care of sixty frail, elderly people with three employees actively rebelling against me. The response from administration: The nurse is responsible for the actions, or inaction, of the aides, but has no authority over them.

Tuesday, March 23, 2010

Who's in charge?

The aide who complained of my "harassment" was written up by the Director of Nursing himself for lying about the incident and disrupting work while she ran all over the facility trying to drum up support for herself.

I don't consider this a victory. If she is really viewed as a poor worker and a risk to the facility, she would have been fired and not merely written up again.

I saw that she rides in a car with three other aides. One of them acted up last night, hollering at me, "Don't start so early" when I directed her to care for a resident. I reported her to the supervisor. I added that I was tired of being screamed at by the aides when I gave them the tasks of the shift, as if they were in charge instead of the nurse. I said that administration was well aware of the situation, that certain aides act as if they are supposed to tell the nurses what to do, and most nurses go along with it. I told her that it's unprofessional and a risk to the residents and my license, and that I can't continue like this. She agreed and said she doesn't see what she can do about it, other than leaving the company.

That's a shame.

Tuesday, March 16, 2010

Roughing it

Because of recent heavy rains, we had no electricity in the facility for three days. The generator gave us lights in the hallways and power with a few electrical outlets in the halls. That's it. All the food spoiled. I won't speculate about the refrigerated meds.

The residents handled the situation pretty well. Anyone with an electric bed couldn't adjust it. The power cords and few outlets were reserved for the trachs, the specialty air mattresses, and the feeding tube pumps. Somehow, the call bell system worked. No televisions. Thank goodness I had enough flashlights to give each CNA one so that they could halfway see the people they were changing. No elevators. The stairwells are alarmed and I was afraid that they would shut down, rendering the doors stuck shut, but that never happened.

The arrangement was nicely prioritized. The supervisor supported me in not rearranging the electrical supply to accommodate individual demands for electrical supply for bed adjustments, cell phone charges, and lamp lightings.

Friday, March 12, 2010

Job duties optional

More problems with a particular aide.

She doesn't take care of the residents well. Leaves siderails down, bed sky high, diapers on the floor, call bells looped onto the wall, etc. Denies everything, rolls her eyes, sighs, disappears. States she doesn't have to listen to me, I can do it myself, stop checking on her.

I had written her up last month. The behaviors continued. Doomsday supervisor told me that I couldn't write her up again because she would call it harassment; furthermore, it was pointless because they fired her a few years ago, she fought it, and won.

Last night, she kept hiding the call bells. Again, denied it, even when showed her work. A resident must never be left without the call bell because they can't seek help if they have a problem. They may try to get up by themselves and fall, or will report it in the morning to administration. I told Doomsday. The aide blew up when Doomsday spoke to her. Doomsday told me to write it up.

Later, at home, Doomsday called me and said that the aide was still in facility, bawling her eyes out, that we are harassing her, and that she has already filed complaints with the facility and the union.

What amazes me is that she is so damn brazen. She does a terrible job. I don't think that anyone would say otherwise. Yet she pursues this formally, as if she does a great job.

I don't know how this is going to go. I didn't "stay under the radar," as Doomsday tells me each night. According to her, corporate doesn't like me and she's the only reason why I'm not fired. I don't know if this is true. I do know that the Director of Nursing doesn't know me well, only speaks to me when there's a problem, and considers issues to be "cat fights" caused by female jealousy.

I guess it's a rite of passage to have to fight for a write-up, but administration has never had my back.

Tuesday, March 9, 2010

Things that go bump in the night

We are troubled overnight by three residents. One gets in and out of bed constantly. When she's lying in bed, she moans, "Help me out. Why won't you let me get up?" and then tries to get out of bed herself. As soon as you help her into the wheelchair to prevent her from falling as she does it herself, she says, "I'm so tired. Why won't you let me go to bed?" This goes on all night. Come morning, she tells the incoming shift that she was removed from the bed, not allowed to return all night, and physically abused, usually by being thrown across the room. This is followed up with, "So will my daughter take me home now?" Social services interviews her daily and documents that she is oriented in all spheres. So the implication is that she is telling the truth. A lot of time is spent on writing her daily incident report where the staff claims that she is not telling the truth.

The other one awakes at any moment and screams for attention. As the staff enters the room, she pretends to faint. She wants to be carried to the bathroom, moved in the bed, dressed in a different outfit, etc. If touched, she screams, "The pain! The pain!" and pretends to bawl. If you leave the room, she won't stop ringing the call bell, which is extremely loud at night and wakes others. The roommate will also get involved and start calling people on her phone. This can go on for hours. In the morning, she tells the incoming staff that the night shift stole things from her. Nevermind that she never had a diamond ring or a million dollars with her. Statements must be written daily.

The third one sleeps all night. She barely wakes up to take her 6 a.m. pills and immediately succumbs into sleep. She is forgetful. Around 7:30 a.m., she wakes up enough to telephone her daughter to state that she asked for help all night and was ignored. The daughter phones the supervisor, the director, the floor, etc., to start the accusations and suspicions all over again, as if the previous day's performance just didn't do it for these people. Again, more daily statements about how we paid attention to her all night.

This is a total, utter waste of time by three people who love to manipulate others. Instead of caring for the other 57 patients, some of whom are very sick, I have to spend most of my time documenting what each of these residents is doing every fifteen minutes. And at the end of the shift, it doesn't even matter because their families and administration believe them and not us. Yet if their families were so concerned, they should have pulled them out of the facility. And administration could come in before 9 a.m. to see what's going on. But they don't.

Monday, March 8, 2010

What to do next?

I haven't been posting in a while. I'm job hunting and house hunting, which are both time-consuming and tiring.

The good thing about nursing is that I could probably find work in any geographic location. So in a way, I don't want to commit myself to a long lease or even a purchase because that would limit where I would want to work next. I don't have warm and fuzzy feelings about my current job (as you probably inferred from this blog). Yet I've gone elsewhere twice and have returned both times. The grass was not greener on the side I went to, but I still think that the grass must be greener somewhere.

Monday, March 1, 2010

The last stop for everyone

A resident finally told me more of her story.

She's a strange bird. She sits up most of the night in her wheelchair at the nursing desk. She nods off every few hours. She refuses to go to bed, stating that she is homeless and has only her wheelchair to live in. Supposedly she is wealthy, has no children, but has a few nephews and nieces who can't wait for her to die so that they inherit what's left of her money. They visit her on special days, such as major holidays and her birthday, but that's it.

She told me that her younger sister accidentally killed their baby sister by burning her to death while playing with matches. The mother was never the same. Then the father was killed in a car accident. The mother eventually died and the resident came home one day to find herself locked out of the house with a note posted that she was not to enter or to remove anything. She blamed the sister for the lock out.

I don't know if the lock out was the fault of the sister or of creditors seeking to collect on the estate, but it does show why she carries the "homeless" feeling to this day. She married, but continued working throughout the marriage. I don't know if this was by choice or because they needed the money.

The overall theme is that every resident of the nursing home came from a different background, yet they all end up in the exact same place.

Thursday, February 25, 2010

That 24 hour chart check

I'm growing increasingly tired of the antics of other nurses.

This morning, one of the LPNs who has yet to write a correct order, once again went off on me for flagging her orders. Her usual errors include: omitting the route of administration ("everyone knows it's oral unless you write something else"); writing one frequency on the order sheet and another on the medication administration record; writing the order on the wrong patient's chart; writing blanket discontinue orders and then specifically carrying them out on the medication administration order ("you know what I meant.")

She said, "You must have nothing better to do than go through all of the charts and find mistakes."

I told her she was exactly correct. It's called the 24 hour chart check and is performed at night by the night nurse, i.e., me. I asked her how she wanted me to handle the errors in the future.

She replied, "Just leave them there and the next nurse can sign off on them."

I told her that it didn't work that way, that I was responsible for the orders on the particular day that I worked, and that I could not ignore erroneous orders, nor could I sign off on them.

She still didn't get it.

But in a way, she's right. She has never been spoken to by administration about these daily errors, so it looks as if I am the only one with a problem.

I can't just sign off on all of these errors. If a patient suffers a medication error, I can also be blamed because I checked the order and signed that it was correct. If I orally inform the nurse of the error with her written order and she does not correct it, I have no proof that I caught the error; rather, it looks as if I didn't do the chart check, and that the error could have been prevented had I bothered to do chart check.

The director of nursing considers this to be womanly cattiness, so approaching him is useless.

Another nurse discontinued a few orders that never existed in the first place. I can't sign off on their being carried out correctly because they are, by definition, impossible to carry out. On the 24 hour report, I asked for clarifications. She said, "That's the most important thing of your shift? You're kidding, right? I'm not clarifying anything. Who cares? You make mistakes, too."

I told her that she can do as she wishes with the orders, as my name is not associated with them, hers is.

She said, "You don't support your coworkers."

I told her that I let her know that orders she wrote are incorrect so that she may correct them, but I cannot guess what she meant and do it myself, if that's what she means by "support."

She declined elaborate on how she expected me to handle such phantom orders.

I also documented that certain patients refused medications. She replied, "So? Why would other people care that you can't handle a med pass?"

I think that she lost sight of the resident and instead focused on slamming me. The result is that we now have several residents with current orders that maybe should have been discontinued; and we have several that are not taking their meds and their doctors will not be told. Perhaps she is content, though, thinking that she proved, at least to herself, that I am the jerk for raising such issues.

Sunday, February 21, 2010

Stop making trouble

I found a fresh scab on a resident. Put it in the nursing notes and did a brief incident report.

Told the incoming day shift nurse about it. She retorted, "That's been there. It's clearly documented upon admission."

Well, the scab was not documented at any time since the resident was admitted three weeks ago. I checked before writing the incident report. There is really no need for the day nurse to be concerned; it's not as if she would be blamed. I usually write one or two incident reports per shift. The Director of Nursing wants it that way.

The next day, I checked the resident's chart, and sure enough, the nurse had scribbled in "scab" on the diagram of the body at admission. Another nurse did the admission, but it didn't even faze her to attempt to conform to his handwriting. The scab is not mentioned in the admitting nursing note, but she didn't scribble in "scab on left trunk" in a little gap.

And yes, she will get away with it. Nobody will even tell her to not alter the medical records. The thing that really gets me is that there was absolutely no need for her to go back and doctor the record. It's as if she just likes to prove that I go around making trouble where none exists.

When the Director of Nursing hears of this, which the night supervisor will tell him, he'll call it a "cat fight." He will see no problem with altering the record, but he will see a problem with my trying to create trouble for others by pretending that an old wound was new. As if I have time to write fake incident reports.

Tuesday, February 16, 2010

Evil nightshift

Same thing again, but with a different resident.

"I can't breathe." Vitals normal, can talk, walk, etc.

Had to have her taken away to the emergency department.

Then someone fell. Didn't get hurt, but it's still more paperwork.

We're doing "bowel and bladder" training on a resident with recent-onset incontinence. I hesitate to report accidents in continent people because the unit manager says the same thing- "She's only incontinent at night because night shift doesn't help her to the bathroom." I confirmed with the main nurses on the day and evening shifts that the resident is incontinent on their shifts also. Amazingly, night shift completed their information for the last week. The other shifts did not, which is not unusual. But this gave the unit manager the opportunity to fill in her version of the resident's ability to hold onto her urine during the day and evening shifts. I watched her fill in "continent" for every day and evening shift for the last week, with only the night shift reporting incontinence. It's as if she just wants to persecute the night shift, rather than figure out why the resident is losing control of her bodily functions.

Monday, February 15, 2010

Comedy of errors

Same unit. I become faster with the med pass with each consecutive day.

Before the 6 a.m. med pass, we had to deal with the usual. Heel pads not on the same residents. No protective sleeves on the same resident with the same aide not putting on the shirt I provided, pleading ignorance. Resident at high risk for falls- still with no chair alarm. The day nurse showed it to me. The aide had thrown the bed alarm in the corner and put the chair alarm on the bed; hence, still no alarm on the chair. Comedy of errors.

Around 4 a.m., a resident said she couldn't breathe. She could breathe, talk, drink water, and issue commands. I sent her to the hospital. In general, we are not to use the town's volunteer ambulance squad/911. I called our customary ambulance provider and was told that they did not have an available ambulance. So I activated the 911 system.

The responders criticized me for: 1- there is nothing wrong with the resident; 2- I called a private ambulance first.

I just can't seem to win.

They took her anyway because, as I explained, if she started to crash, I had nothing but oxygen to give her, which was not helping her anyway.

Sunday, February 14, 2010

Must be nice having no responsibilities

I've been considering trying to get hired to work in a hospital. I shy away from hospitals because I'm more comfortable in a nursing home setting because I worked in one for years before becoming a nurse. Around here, nursing homes pay more than hospitals. But hospitals seem to have more reliable ways to increase one's salary, such as annual pay raises; extra for working evenings, nights, weekends; increases for having a degree; increases for becoming certified in a specialty, etc. With my current nursing home employer, I can basically expect to be earning the same hourly rate for years to come.

I view hospitals as stricter. You have to be on time, you have to give the medication within a certain time frame, you have to carry out orders when given. Yet I am strict with myself in the nursing home setting, while others are not, and that is a big part of the tension I feel there. I arrive on time, usually early. The outgoing nurses don't realize how early I am and get upset if I tour the floor first. Sometimes they throw the keys at me and go to leave, realize that their shift is not over, and then sit down and read or chat on their cell phone, with their undone work sitting there, endorsed to me. I don't think that this happens often in a hospital. I'm sure that other bad things go on in hospitals. I hope that I would not be jumping from the frying pan into the fire.

Last night I toured the floor and found two residents with their heel pads on shelves instead of on their feet. This is the usual finding. The nurse on each shift signs for the heel pads, yet when confronted, acts as if they have nothing to do with ensuring that the aide places the heel pads on the feet. I told the evening nurse that the heel pads needed to be placed on the two residents. She repeatedly slammed her hand on the counter while shouting, "You heard the woman. She said she wants the heel pads on now." I calmly stated, "Actually, I want them on when the resident is put to bed and not four hours later." She didn't get it.

One resident got heel pads; the other one did not. I had placed the heel pads on top of the bed, over the resident's feet. I told the night aide for that resident to put the heel pads on her. On the next round, I saw that the resident had been changed, but the heel pads remained on the bed. I asked the aide why she had not placed the heel pads on the resident. She said, "I didn't think that I had to do that." I asked her which part of my instructions of "Place the heel pads on Ms. Smith" made her think that she was not supposed to place the heel pads on Ms. Smith. She said, "I thought that the evening shift was supposed to do that." I answered that they were, but they didn't, so we needed to ensure that the heel pads were in place by placing them. She replied, "If the evening shift didn't do it, why does night shift have to do it?" Please keep in mind that this aide, like most of the aides, works every shift, yet still cannot connect the dots and realize that an omission by one shift must be corrected on the next shift.

Another resident was missing her protective arm coverings. The evening nurse for that wing was unaware (of course) and had no idea where they might be. The alternative is to dress the resident in long sleeves. I found a pajama top with long sleeves and gave it to her aide to put on her when she woke her up for hygiene care. Later, I checked on the resident and sure enough found the pajama top lying on a table. I confronted the aide. The aide said that the resident refused and because of "resident rights," she didn't put the top on her. I told the aide that the resident is confused and cannot appreciate the need for the long sleeves; furthermore, when she is unable to complete an assigned task, she needs to inform me immediately. The aide stated that she had no idea that the resident was confused and that she was supposed to tell me if she didn't do something. She chose to follow the senseless ramblings of a person in the final stages of Alzheimer's but not the directives of the nurse. I guess the resident's shouts of, "And get the are up sometime over yes," and "Geeeeee!" were not enough for her to suspect impairment.

This is what I have to work with. A bunch of people who rather use energy to come up with lame excuses for not carrying out simple tasks instead of just doing the work.

Wednesday, February 10, 2010

Tired

I've been very tired lately. It's very hard to work nights. Sleeping during the day is not as restful as sleeping during the night. When the rest of the neighborhood is calming down, succumbing to their sleepiness into warm, dark beds, you have to inspire yourself to be energized, dressed in scrubs, and driving in the cold to work under fluorescent lights, met immediately by never ending demands from patients who seem to have no idea that midnight is the opportune time to sleep.

The only patients who do seem to be deeply asleep at midnight are the ones who are supposed to get medication at midnight. It is next to impossible to get someone to swallow a pill when they are sleepy. It's also very difficult to wake up anyone over the age of 85. My favorite is when the outgoing evening nurse tells me, "I just gave Ms. Smith her sleeping pill, so don't wake her up." This implies that I cruelly go around the unit waking people up for no reason other than to be mean. When I tell her that I have to wake up the patient because she has medication due, the nurse usually says, "Oh. Can't you just wait until morning?" Well, no. The midnight meds fall on the "every six hours" schedule. I can't hold a 12 a.m. med until 6 a.m. because then I would be doubling the dose. I also can't hold the medication and write, "Held because sleeping." If I can't wake someone up, it looks like they are in a coma or dying, and I'm supposed to take vitals, call the MD, transfer to the hospital, etc. Except for antibiotics, most other 12 a.m. meds do not need to be scheduled at 12 a.m. Yet when I endorse to the day shift to contact the doctor for a readjustment in the schedule to facilitate the patient's sleep, the response is the same: "Night shift is so lazy. They think it's terrible if they have to give out a few pills when they get here." So I continue having to wake up patients.

Thursday, February 4, 2010

Huh? What?

The last several nights have been the same thing: sleeping aides who don't hear call lights, bed alarms, or requests for assistance. Then they actually get mad when I wake them up. And mad when I ask them seven times to do the same thing.
Doomsday supervisor stands behind them. "It's snowing outside," "She didn't realize," "She worked a double. She's tired," are the excuses she has for them. Nobody fell, thank goodness. If somebody had fallen, I could not have written in the explanation box, "Resident fell because the aide was too tired (and self-righteous) to get up and help the resident to the bathroom."
She finally yelled at two aides, "Get up! If that resident is on the floor, both of you are in serious trouble." A bed alarm was sounding in a high-risk room and both aides remained seated. I doubt that anything would have happened, though, if the resident had fallen. Doomsday would have turned it around on me, saying that as the nurse, I was aware that the aides were not answering bed alarms, so it became my responsibility to do their job for them.
It's becoming increasing frustrating and dangerous to work here.

Saturday, January 30, 2010

Money is free, right?

This past week more CT scans, MRIs, dopplers, etc., were done on a patient with a fractured hip because she has- are your ready- mild to moderate pain in the upper leg. She should be grateful that she never had severe pain. She was ambulating from the day I received her and never complains at night, which is when the achy/can't sleep issues arise for others similarly situated.

This is where a lot of those healthcare dollars are going. I really think that someone should stop the use of the pointless, expensive tests.

Thursday, January 28, 2010

Remember to provide nursing care between naps

One the 24 hour report from the unit manager: "11-7 change the patient's diaper overnight."

This is really bad. It's unprofessional. It says that the night shift ignores the resident to the resident's detriment. It underscores the common notion that the night shift does nothing.
There is no accompanying claim that the resident is found wet or soiled every morning. It's a flag to anyone reading the report that the resident is unattended all night. This is not true.

It's similar if I were to write: "7-3 provide food to patient." Which I would never do.

Tuesday, January 26, 2010

iPhone app for medications

I recently got an iPhone. I wasn't sure about my capabilities with the thousands of offerings because the last electronic invention that I mastered was the VCR. I have yet to master a standard cell phone. But I took the plunge and ordered the iPhone. I figured that I could stay in touch with people more. The current night schedule wreaks havoc on the personal schedule and offers little down time to make a quick phone call. Even if I did have a break, not many people are up at 3:00 a.m., receptive to a social chat.
The work-related reason that I wanted an iPhone was for access to information about medications. Today I found an app for Medscape and it seems to offer what I need- drug information, contraindications, and side effects. And it was free! I previously mentioned Medscape.com for the continuing ed. Let's hope that their iPhone app proves to be quite useful also.

Monday, January 25, 2010

Compassion?

A family member stayed overnight, sitting vigil next to her mother as she lay dying.
I administered the morphine as needed, every two hours. As a result, she remained calm and comfortable overnight.
When the next shift arrived, I gave report on her changes overnight, so as to perhaps predict when the resident might finally pass. The death process can follow predictable stages.
I told them that another daughter was flying in and expected at 11 p.m. tonight.
The unit manager quipped, "Well, it will be too late. You suppressed her breathing with so much morphine, so she'll be dead any minute."
She was not in the final stages of dying. There was no reason to suspect that she was drawing her last breaths as we spoke. Throughout the night, I suppressed her thrashing and panting while relieving the painful torture of slowly suffocating to death. Her emphysema and heart failure had suppressed her breathing for years and was finally doing her in. I don't feel that withholding the morphine would result in a longer life. Withholding the morphine would definitely result in prolonged suffering.
When I am upon my death bed, wracked in pain, fighting for each insufficient breath, please ease my suffering with morphine.

Until you came along

The facility is under immense stress because it is due for its annual state survey. It's a surprise visit, but certain dates can be ruled out while others are likely for the visit.
Today was such a date because the particular survey team finished with another facility on Thursday. They would write their reports on Friday and then visit the next facility on Monday. They vary their targets; for example, they don't hit facilities in the same town consecutively and they don't visit facilities owned by the same company back-to-back.
To prepare for this expected visit, everybody was in the facility by 7:00 a.m., running around, "fixing" things to comply with state regulations that they have not even read.
The unit manager of the short term unit rammed me before 7:00. She went off on me for writing an order for heel lifters for a resident. The handwriting did not even resemble mine and I told her so. She said, "I know you didn't write it. But you must have. You worked the 24th and this was written on the 23rd." I pointed out that it was signed off on for the entire month, starting on the first. She replied, "I know that. Somebody just filled it in." I said that I didn't do that. She replied again, "I know that. We fixed it." So then I had to ask, "So what exactly is it that I did wrong?" She said, "You wrote '7-3.' She is not in bed on the 7-3 shift, so that is why it was left off, but you wrote it in. We fix things certain ways for certain reasons, and then you come along and mess it up." I asked, "What shift is it now?" She replied, "7-3." I asked, "And where is this resident right now?" She replied, "In bed." I replied, "So why is it so bad that 7-3 signs that she has heel lifters in bed, not that I wrote it." She said, "Well, it's not. It's just that you had no business adding 7-3." I reiterated that I added nothing to the order. I pointed out that "7-3" was not squeezed in, but rather given plenty of space in between "11-7" and "3-11." She gave up. But she'll be back.
She wants a perfect unit, but knows on some level that she can't have it. She needs people to blame, and I'm one of the chosen scapegoats. I don't know how to fix this. If I found something wrong and was convinced that I had the culprit, but the person denied it, I would not continue insisting that the person was the real culprit. I would continue with the explanation of what was wrong, but rephrase it such as, "If you see this . . ." or "If you are in the same situation in the future, please don't write the order like this. This way is better." But I don't seem to do much right, so this can't be the correct approach.
I would also like to point out that it is ridiculous that the unit manager feels that 7-3 should be exempt from signing off on the "when in bed" orders. The residents are in bed on 7-3; it is that shift that gets them out of bed. The 11-7 shift has to sign off on "when out of bed" orders, even though most residents are not out of bed overnight. If I check off that the order was not met and explain "not out of bed tonight," it's a big deal. Yet every now and then they like to come after me for signing off on a "when out of bed order." I'm damned if I do, damned if I don't.

Saturday, January 23, 2010

The shift always ends

I worked the last two nights on the heavy short-term floor.
The first night took two hours past the shift end time to finish. Probably because Doomsday supervisor worked and went on and on about how this was horribly wrong, that was egregiously disastrous, and the state was about to descend upon the place and we will all lose our licenses.
The second night was a despondent fill-in supervisor. Any problems brought to her attention were met with, "I'm sure you can handle it." I hurried through the night and was finished with almost everything when the next shift arrived. That included an incident report.
On one hand, I like being done when the next shift arrives because I think it makes me seem more together, as if I handled everything well. On the other hand, being done before 7 a.m. further convinces a lot of nurses that night shift does next to nothing.
In the opposite scenario, not being done when 7 a.m. comes around does not seem to convince anyone that night shift has a ton of work. Instead, they seem to think that the nurse overslept on her already extended break and didn't get the med pass started on time.

Wednesday, January 20, 2010

Director a.k.a. RN

I just saved a bundle by switching to Geico!
I'm not advertising for Geico. I mention it here because "registered nurse" was not a career option. They had LPN and LVN, but no RN. I chose "director" because I direct the unit (though most people do whatever the hell they please).
I will now pay less than 1/3 of what I was paying. I'm afraid that it's less service- BUT- I received no service from my other insurance company. I did call my current company first and after a 45 minute hold, they would not even discuss ways to lower the premium.
And because I have (crappy) medical insurance, I was able to opt for the less expensive PIP option.

More hostility

More problems from the CNAs.
None of the three night shift aides were present at the start of the shift. One evening shift aide stays until one night shift aide arrives. The one who stayed last night was working overnight on another floor, thus selected because her staying and waiting would not cause overtime.
I hopped right into the report from the evening nurses. A bed alarm sounded. The aide remained standing at the desk, staring at me. I asked her to attend to the resident. She replied, "I'm not on this floor."
I went to the resident, fussed with her, and got her back into the bed. As soon as I was back at the desk to continue the report, the alarm sounded again. I glanced at the assignment sheet and saw that the aide still standing at the desk was indeed the evening aide who stayed behind. I told her such and told her that she needed to attend to the alarm. She said that she wasn't going to go into a room because if something happened, she would be responsible. I told her that the entire point of her staying was to attend to residents, not just stand at the desk. She said she had to go to her other floor and was unable to perform any work.
I stopped report and attended to the resident until one of the night shift aides finally arrived.
The lagging aide remained on the floor, seated, for another half an hour, before going to another unit.
I told the supervisor when she arrived. I phrased it as, "All three aides were late tonight. CNA [So and So] stayed behind to cover. I just wanted to clarify the role she plays when she stays behind. I thought that she was supposed to attend to residents, but she refused to do so earlier, telling me that she is just supposed to sit here. In fact, she sat on the unit for half an hour after the night shift aides arrived, before going to her next assigned unit." The supervisor said that she needed to address this immediately. She didn't mention it again.
I also told her about the double diapering and denial. She said, "That's an automatic write up." She said that this aide has done this before. I still think that I'll be blamed for upsetting the aide.
They are not unique. There are so many aides that are downright contemptuous of everyone else. They don't do their job, which jeopardizes the residents. When I approach them about an issue, they yell and accuse, and get their buddies worked up. The next night someone else pulls the same nonsense, thinking that I'm a nurse that does not have to be listened to. That's why the aide just stood at the desk, ignoring alarms. They seem to think that they can be excused from their duties by saying that the nurse disrespected them. I hope that administration doesn't see it that way.
I told both aides at the time that I would be discussing the problem with the supervisor so that I could clarify the issues. The strategy that I think that I'm following is that I carry through on my threats and beat them in the race to the complaint department.

Tuesday, January 19, 2010

Who is in charge?

Patients are not allowed to be "double diapered," meaning with two diapers.
Around 2:00 a.m. I found two residents double diapered and told the aide that she had to change the residents and provide one diaper each. She denied that they were double diapered. I couldn't believe it. I counted the diapers to her: "One, two." She looked me in the face and insisted that there was only one diaper. I told her I was writing her up for double diapering as well as refusal to follow instructions.
She then said that she was not the one who double diapered them. I told her that she was making it worse for herself because she was supposed to change them at the beginning of the shift at 12:00 a.m., and she was admitting that she did not change them; furthermore, if she found them double diapered, she needed to report this to me immediately, which she did not.
She couldn't follow the conversation. She asked, "Why am I supposed to listen to you?" I told her, "Because I'm the nurse and I am in charge of the care of the residents." She moped around the unit, muttering, "Nurse? Who does she think she is? She's not allowed to tell me what to do."
The really sad thing is that she will get away with it and administration will tell me to back off before she goes to the union claiming harassment.

Sunday, January 17, 2010

Extra extra extra

I was off last night, which was great. I'm supposed to be off tonight, but was just called into work. I hope that I get paid extra for the overtime as well as the holiday time and a half plus paid an extra day off. I don't mean to sound greedy, but I have bills to pay and I'd rather be sleeping in a warm bed in the dark than working and getting blamed for everything.

Friday, January 15, 2010

Haitian earth quake impacts the facility

More news of death in Haiti- the families of most of the aides. They have lost children, spouses, parents, siblings; the phone calls keep coming on their cell phones and on the facility phones. We are keeping the lines open and allowing them to keep their phones on because phone service is fleeting in Haiti and at any moment someone might be able to get through with more news, usually bad.

Thursday, January 14, 2010

Pass the blame

A nurse's latest stunt highlights the problems with the behavior/psych floor.
For two weeks, on the day shift this nurse has been documenting that a particular resident is a "chronic complainer." Food, people, temperature, feeling sick- she complains about it all. The nurse does not include any interventions she tried, such as providing different food, redirecting the resident, notifying the physician and performing a physical evaluation, etc. Instead, the nurse called the psychiatrist and got an order for xanax 0.25 mg twice a day. The resident is calm and cooperative on the evening and night shifts. This nurse should not have pushed for an order for xanax as the first attempt at treating the chronic complaints.
Second, twice a day means 9 a.m. and 5 p.m. or 9 p.m. The nurse scheduled the medication for 6:00 a.m. and 9 p.m. This way, if there is any fallout from giving xanax, she should escape blame because she won't be giving the medication herself on the day shift. She expects me to wake up the resident and medicate her for anxiety and agitation not present at 6:00 a.m. If I mention this to the nurse, she will bully me and say that the doctor ordered it for 6:00 a.m. That's not true; only on the behavior/psych floor do the nurses insist that doctors specified times of administration and each time was for the night and evening shift, never the day shift.
The next time I am floated to that floor, I want to withhold the xanax and call the physician to notify him. It's within my nursing judgment. But Doomsday supervisor won't like that because I won't be staying "below the radar." The nurse will tell the unit manager who will bring it to administration with "who the hell does she think she is?"
Speaking of reporting me to the higher ups, I was delayed getting out of work today (too many patients) and saw the arrival of the director of nursing and a corporate person- regional director of who knows what. I spoke to both of them. They both insisted that nobody had ever made a complaint about me.
Now somebody is lying. Doomsday tells me nightly that these higher-ups are very upset with me and seeing my name on complaints and hearing my name involved with every problem. She showed me a blurb in the supervisor's communication book written by the assistant director of nursing to the director of nursing that the unit manager had a serious issue with me. I guess that's the only evidence that I ever saw.
I told Doomsday that I was not going to try to fix anything anymore. The facility is due for the state survey any day. In my naivety, I thought that others would be appreciative that I uncovered and fixed an error instead of the state finding it and citing the facility. Apparently, this is not the case. Let the state descend upon them and find these errors. Maybe if they hear it from someone else, they will make the changes.
Doomsday tried to do a heel pad audit overnight. The problem was that what was ordered does not match what was on her list and nothing matches the instructions on the residents' closets and what each resident has on his/her feet is a completely different story. She gave up. I reverted to my help mode, making lists of the orders versus the reality. When the unit manager arrived, I started to mention the situation to her. She cut me off and launched into a diatribe of indications for use of heel pads that nobody is following, different treatments that nobody bothers to do, etc. I replied, "Thank you. You answered the questions I had about heel pads," and I tore up the *helpful* lists I had written. They would not have fixed any of the inconsistencies; rather, they would have gotten mad that I was annoying them with a non-problem that I should have "fixed" [with my magic wand]. The caveat to "fixing" heel pads is that their use is part of the care plan; I can't just order or discontinue them without altering the care plan, and I don't have access to those. One of the unit manager's primary responsibilities, though, is maintaining the care plans.

Wednesday, January 13, 2010

Not understanding

A lot of the aides are from Haiti and have family there. They are very upset over the earthquake.
There was fallout from my changing of the times of administration of two meds on the behavior/psych floor. Doomsday supervisor told me that the complaint appeared in the supervisor's communication book, which is read by corporate, and they will be very upset. She acknowledged that my changes were correct, but that she now has to write a report defending me and what I did. I asked where the report and complaint were when the two nurses changed the medications in the first place to incorrect times. She said that there is no such complaint and never will be, that I do not understand that I'm the one with a target on me. I said that I do not understand why they are complaining that I corrected two mistakes; I'm there to care for the resident, not just hand out pills without thinking, and that I have my own license that requires me to act correctly, not just blindly follow what someone else has set up in error. I also said that I do not understand why any of these people have not been fired with the daily errors that I find. Whenever I work on that floor, I'm in trouble for something that either never happened or that I handled correctly. I told Doomsday that they are bullies and I'm sick of corporate letting them get away with it. She responded, "They treat you that way because you let them." I think she means that if I meekly signed off on everything and said nothing to them, then they would stop filing complaints about me. That's not true. I've tried that and it doesn't work. I go through the proper channels to report problems, and nothing is done. If I document that a bed alarm is broken, they go off on me. If I don't document it, I'm written up for not documenting it. They aren't written up either way.
I told Doomsday that I'm not there to give out pills and go home. I'll be critically looking at each resident and the record. I'll address problems as I see them and refer bigger problems upward. To support the bullies' stance that I give out pills and go home, to get off their unit without causing them angst, supports the widespread opinion of night shift that night shift does nothing but wait for the day shift to arrive, and that the day shift nurses are the real workers, that night shift is some kind of a babysitter that the state, for some crazy reason, requires to be present in the nursing home overnight.
The nurse that worked up there last night told me that he discovered another med error. They took an order to discontinue potassium supplements on a resident whose potassium was too high. That was two weeks ago, at the end of December. They did not transcribe the order to the January record and have still been giving the potassium. (The bullies never carry an order to the following month. Most night nurses don't pick it up. I always do because it's part of the check. Yet for that, I'm targeted.) The resulting electrolyte imbalance can cause cardiac problems, including death. Now if that had been me, I would have been reported to the highest levels. But because the bullies are at fault, nothing will happen. They might even continue giving the potassium just to prove that they think that their prior acts were correct.

Monday, January 11, 2010

Tough customers

The night was fine. I was on the psych/behavior unit. I had not been there since last month. The residents don't call for anything, and that is the problem. You must constantly monitor them because they will attempt to get out of bed or have some other difficulty and the resident and the roommate will never activate the call bell to request help. The aides are upset because the Director of Nursing made a new rule that the floor must be toured every hour. They told me this as if I would say, "Forget that. Just sit there and sleep." I did say, "Forget the hour rule. The floor should be toured every fifteen minutes." As you can imagine, they rarely toured the floor. I have read several studies that conclude that frequent touring of the floor reduces falls and increases customer satisfaction. I have prevented falls myself with tours by finding residents getting out of bed.
One resident screamed and yelled about back pain. I believe her. She has severe osteoarthritis. She calmed down when I took her vitals are positioned her better in the bed.
There was a new resident, described as "alert and oriented x 3." She was much sharper than the average resident, but with early dementia, which resulted in repeated requests for a sleeping pill. I can't page a doctor in the middle of the night for a non-emergent matter, and contrary to popular thought, the inability to fall asleep quickly is not an emergency.
I changed the times of administration for meds on two residents. The day nurses had a fit. I was not going to do anything, but then I decided to go ahead and make the changes because I am correct, I have more authority than they do because of my education and license, and they can just deal with it. I'm tired of their bullying. Rarely do I work on any floor without making changes that others have overlooked. I'm now going to make appropriate changes on this floor as well.

Sunday, January 10, 2010

Ditsy gets out on time, but doesn't get the job done

The night went smoothly, in spite of the forces against it.
I took report from a ditsy nurse. She's ditsy about everything except putting work onto others. Her interesting statements included:

"I signed for her lantus, but I don't remember giving it. So if her blood sugar is really high in the morning, you'll know why." Giggle.

"There was a bottle of phenergan with codeine around here somewhere, but now I just can't find it. Here, sign for the narcotics."

"The bed alarms were not connected? Gee, I never even look at those."

"There was no lactulose in this cart. None. So I didn't give anybody their lactulose."

"These meds are completely out. I was going to request refills, but I can't find the sheet, so oh well."

"These two people were supposed to get antibiotics, but I see that they have allergies, so to be on the safe side, I didn't give them the dose due on my shift."

I had no responses to the above observations.

I did attempt some conversation concerning the floor.
Ditsy: "Mr. Smith had no complaints."
Me: "Why is that on the report?"
Ditsy: "How would I know?"
Ditsy: "Ms. Miller is back from the emergency room. She's okay."
Me: "Why was she sent to the emergency room?"
Ditsy: "I guess she was sick. Or hurt. I don't know."

The three aides were not the best. I woke up one of them every time a call bell was activated. One lied about checking the bed alarms. I showed her several disconnected alarms and asked exactly what she was checking for. One got a resident ready for dialysis, except that she did not have dialysis. The translator explained to me that when I said, "Ms. Smith had dialysis today and is fine," the aide thought that I meant "has dialysis." I reiterated back, "So she does not understand the difference between something that happened and something that did not happen." They all agreed.

Saturday, January 9, 2010

Lack of experience

More on the ankle wound.
Turns out it was a mixed venous/arterial ulcer. This is a fast-developing wound caused by inadequate blood flow and occurs in the distal part of a lower extremity, i.e. the ankle.
Most people at the nursing home have a tendency to label any break in the skin integrity as a "pressure ulcer." Pressure ulcers are considered bad and irrefutable evidence of neglect. I do not believe this, as the skin is an organ and breaks down just as the heart, kidneys, and lungs do. Becoming upset and blaming people because the skin is decaying is like blaming people for pancreatitis.
When I first saw the wound, I thought about venous and arterial ulcers and thought that could be the cause. Unfortunately, I do not have much experience in properly identifying wounds; extremely unfortunately, most of the other nurses at the home also have little experience in properly identifying wounds. I merely described it; I did not give it a name, which is the correct nursing technique. Nurses do not diagnose. Everyone else ran with the pressure sore theory and started a witch hunt for someone to blame: Did it happen on the night shift? Didn't the aide who showered him three days earlier notice the wound? Who changed his socks that evening- didn't they see the wound? And so on. The man walks and turns himself in the bed, which was our first clue that he probably didn't develop a stage IV pressure wound in a matter of hours.
I feel like I have plateaued in my nursing abilities and skills at the home. I originally sought employment in a nursing home because I enjoy working with the elderly and forming long-term relationships with my patients. I have either mastered or become good at everything I need to do. I'm not saying that I'm an expert and that there is nothing left to learn. It's just that I don't get to see or do a lot of highly skilled activities, such as properly assessing patients. Had I been more experienced and knowledgeable, I feel that I could have properly recognized the wound and guided the administration in properly handling the issue.
I spoke to a man whom I knew growing up. He's now in nursing administration in a hospital. He said that the field is tight for relatively inexperienced nurses such as myself, but that I am not considered a brand-new graduate because nursing home nurses have excellent time management and medication administration skills. He encouraged me to apply at the hospital. I think I will.

Pain

Last night was okay. Nobody was hurt, sick, or injured, which is always good. The outgoing evening shift complained that the day shift complained that the usual night nurse did not give out enough pain medication. So I administered pain meds to lots of patients for the 6 a.m. pass. When the day shift came in, I told them to look up the last administration time before giving more percocet. The residents have a tendency to forget accurate time.
I have two scenarios on the lack of pain meds: 1- a resident is asked about pain and denies pain, so the nurse goes on to the next patient. The patient now has the idea of pain in her head, and when the day nurse arrives and starts rounds, the patient tells her that she has pain and has been waiting for the medication. 2- At 6:00 or 7:00 a.m. as I arrive to give the scheduled med, a resident will ask for "the pain pill for rehab." I have no problem giving them a pain pill, but the pill will wear off before they go for rehab at 9:00 a.m., and they can't have another pill until 10:00 or 11. The alert residents realize this and decide to not take a pill at 6 a.m. That is not the story that they tell the incoming day shift nurse, however. They state that they have been waiting for their pain pill for rehab, when what they have been waiting for is the passage of time so that the pill is most effective for rehab.
A resident started screaming at about 5:30 a.m. that she was in agony and needed a pill. I was nearby, but helping another resident take her pain pill, so she had to wait three minutes. When I got to her room, she was snoring. Usually, if someone is in agony, they are unable to sleep. I awoke her to take the pill. She stated, "I've been up all night begging for a pain pill." This is not true. Yet that is the story that her family and administration will believe.

Friday, January 8, 2010

Likability

I'm suddenly seeing a lot on "how to make yourself more likable." I've read the suggestions and was trying to apply them to nursing. I'm finding it easier to come up with the negative, "how to make yourself less likable."

1. Show up late for every shift.
The nurses for the shift before you won't be able to leave until you show up. Or they will have to endorse to your supervisor, making her mad as well.
2. Write incomplete orders and don't carry them out.
The next nurse will have to call the doctor to verify the order, which will also make him mad.
3. Don't fill out any form in its entirety.
You will have people from many different departments coming back to you.
4. Don't do any extra documentation, such as monthly psych reviews or hypnotic summaries.
5. Don't tour your floor and make adjustments or corrections. When someone else brings problems to your attention, reply, "How would I know that?" and keep sitting there, reading.
6. Respond to any issues raised by residents or families with, "You'll have to call social services with that in the morning."
7. Tell the aides to do everything except giving out the meds.
8. Don't answer the phone, unless it's your cell phone.
9. Don't learn anyone's name.
10. Don't give report to the next nurse and refuse report from the previous nurse. Instead reply, "Can't you read?" and "I can read" to each one, respectively. (And I don't mean with respect.)
11. If someone questions you, state, "That's the way I've always done it." Don't be flexible or open.

I learned these traits from my fellow coworkers, some of the most unlikeable people around.

Patient ratio

I just calculated a new statistic.
I earn around $30 per hour to take care of 60 patients. That's like each of them paying 50 cents an hour for a nurse.
The aides earn around $10 per hour to take care of 20 patients. That's also the same nurse rate of 50 cents per hour.
I have long had the minute ratio broken down: 60 patients, 60 minutes in a hour: that's one minute per hour per patient, or not even seven minutes per patient per shift, factoring in my break time (which I rarely get). That includes minutes spent on paperwork, such as verifying new orders and charting. Sometimes the paperwork aspect takes more than seven minutes for one patient. The rest of the paperwork time as well as the bedside care has to be taken away from another patient. When a resident says to me, "This only takes a few minutes," they don't understand that I can only ration seven minutes per person, and they may have already consumed their allotted seven minutes with paperwork. I don't have time to take someone to the bathroom for ten minutes. They just don't understand this. "You're always in a hurry" is a common observation. Well, you'd move quickly too if you had to take care of sixty people.

Scrubs

One of the greatest things about being a nurse is that I get to wear scrubs. I'm not good at selecting outfits to wear. Scrubs are sold in sets or separates that go great together. My place of work allows scrubs of any color or print. When I first started, I only wore white pants with a solid color top. I gradually introduced prints, especially for holidays. One day, after growing weary of the staining and ruining of the white pants, I ventured into the world of wearing colored pant scrubs. Some people only wear white, and that's fine for them, but I tend to get coated in something by the end of my shift.
I don't wear the scrub jackets. They are too stiff and uncomfortable for me, though they do look good on other people, especially when they match the scrub outfit. I prefer cotton scrubs because they are so soft, comfortable, and flexible. I'm wearing a lot of Butter Soft scrubs from Uniform Advantage right now.
The aides also get to wear whatever color or print they choose. The result is a colorful assortment of scrubs running around the place, with residents and families unable to distinguish between nurses and aides. Most people already think that any female in a health care setting is a "nurse," but that's another topic. And some of the aides I work with do not correct people who call them "nurse," and even refer to themselves as "nurse." I have been in other facilities that require aides to wear a specific color, which may help. But the fact still remains that a resident can ask an aide for percocet or to suction their trach, but the aide will never do this because only a nurse can do this.
Doomsday supervisor says that it's best to wear all white so that you are taken seriously. I've seen studies in which people state which uniform, if any, people like to see nurses wear. Some prefer white; some don't care about the color or print of the uniform; while others prefer regular, professional outfits seen in other sectors. I do wish that the facility would consider having the staff of the dementia unit wear street clothes. I've read that people with dementia can be fearful of people who look like medical workers, especially if they have had a long history of treatment for medical or psychiatric issues. In addition, the residents with Alzheimer's are not of this present time and do not understand why a bunch of medical personnel are running around their house. One of the problems with instituting this approach in my current facility is that the staff can't be trusted to choose appropriate clothing and staff is floated too much, requiring that everyone have a scrub outfit and a regular outfit to go to work, which most of the staff could not handle.

Thursday, January 7, 2010

Long night

I left work at 11 a.m., three and a half hours late.
There was a fall. The resident was not hurt, thank goodness. She fell "because I have but one good side." She's paralyzed on one side because of a stroke. Somehow, she still manages to stand and walk using a special walker. She has not fallen in over a year.
I had to write the incident report concerning the fall. I wrote that I was notified of the fall by the roommate. This is true. I was at the desk doing paperwork when I saw her walking down the hall. I've seen her do this maybe once a week, so I was not concerned. She'll usually ask for a pain pill or something to eat or drink. She didn't quite reach the desk when she calmly stated, "My roommate fell, and she can't get up." An aide and I ran down to the room. When Doomsday supervisor read that the resident walked down the hall and told me about the fall, she was not pleased. I said that I did not hear the resident fall, nobody was hollering for help, nobody rang the call bell, and I did not find her on rounds. Doomsday supervisor said that it was okay that a resident notified the staff of a problem; however, this resident is alert and oriented and will tell people that we were sleeping. This is ridiculous. As soon as she stated the problem, we were up and running. Doomsday said that my head was down over papers, but the resident may decide that I was actually sleeping; in addition, administration may ask the residents why they did not ring the bell for help and they might reply that it's useless because nobody answers bells at night. Also, it looks bad that I let the resident almost reach the desk instead of immediately going up to her as she walked. I said that she often walks to the desk for a routine request so I was not thinking that anything was wrong. I felt that Doomsday was grasping for ways people will turn this incident around. They will make it out to be all my fault, regardless of what I write. No matter how many call bells I answer, come morning, someone will complain that their call bell was not answered for twelve hours and administration will believe the, even though the shift is only eight hours.
The second delay issue was the changing of the tubings. Not many on this unit, but still time-consuming and tedious.
The third delay issue was rewriting the ankle incident report of New Year's Eve. They did not want me to write about all of the wounds, just the black wound on the ankle bone. To include the other wounds "would make it seem like his foot was decaying." His foot was decaying. Once the condition was discovered, it was halted with wound care and antibiotics.
The fourth delay issue was once again reconciling the December medication records with January. This should have been finished by now, but was not. There were lots of nuisance errors- nothing missing that was vital.