Saturday, January 2, 2010

Incidents of nonsense

Long night. I stayed three hours late. Nothing really happened. Doomsday supervisor worked. She's long winded, so that adds to the amount of time I'm stuck on any one task.
Several marks were discovered on the bodies. Doomsday decided that only one qualified for an incident report. I labeled it a bruise. I don't usually label the mark. I just call it a "purple mark" or "maroon discoloration" because some nurses will argue with me about the label, as if that makes the situation go away. Some people don't like incident reports. I look at them as an extra hour of overtime per incident, kind of like a $50 bonus for each mark discovered. One of the aides said that they should get a cut of the profit for finding these marks. I'll think about it.
The facility is not computerized. The pharmacy is computerized. They print our monthly medication records. This task is done around the 20th of each month; therefore, any changes for the last third of the month are not reflected on the printed records. They must be handwritten onto the records. Sounds tedious but simple, I think. Yet most other nurses are wholly incapable of writing orders correctly, can't transcribe them accurately, and can't be bothered to write them on two months of records. I discovered many errors overnight stemming from this conversion problem, so I had to stay and fix them.
On some level, administration is impressed that I find so many of these problems and correct them. But on another level, there is now a paper trail of the error for a state inspector to see. Administration is torn between letting stuff go, hoping that an inspector won't notice, and finding and fixing these problems before the inspectors arrive and find the problems. Because I am the nurse finding the most errors, I tend to get the blame for making the errors obvious. Yet the cause of the errors is never addressed. Thus the same errors happen month to month. I'm good at finding the mistakes because I know just where to look because there are patterns; also, certain nurses make certain mistakes in spite of being told repeatedly about their error pattern.
I relieved two new LPNs. They had been aides and attended a nine month course to become LPNs. They felt that being a nurse would be better because nurses do less for more money. They quickly realized that a nurse, unlike an aide, cannot leave until all of her responsibilities have been satisfied and that a nurse, unlike an aide, is responsible for everyone and everything on the unit and faces loss of license, lawsuits, and possibly criminal action for failing in her duties. They still do not fully grasp a lot of concepts. One of them placed fentanyl patches on two patients as scheduled for her shift. She must have missed the day in nursing school when they told you that you must remove the old patch first before placing the new patch. So I inherited people receiving double their narcotic doses. The other LPN did not check that the fentanyl patches were actually in place on her patients. Keep in mind that she signs that they were located. I could not find the patch on one resident. I asked her where it was, but she had no idea that she was supposed to check for it, even though she signed that she did so in the medication record. I am particularly concerned about this resident because her family does not want her to receive pain medication and has threatened to remove her fentanyl patch. Fentanyl is a controlled substance. The facility should have contacted the police when the family first started removing the patch because they were interfering with the care of a resident, which is abuse; they stole something, the patch, which belongs to another; and they were in possession of a narcotic without a prescription. But the facility refuses to take a stand against them, so the family continues to run amok in the facility and when they can't physically make it in to harass people, they call on the phone.
Another resident, who is in the facility because she is senile, decided that she waited too long for her clean diaper to be replaced and called her daughter with her senseless complaint. I was in the room with the resident assessing the situation when the daughter called the desk for me. Well, I can't be in two places at once, so I missed the call. That angered the daughter further, which makes no sense. She can't have it both ways. I'm either at the bedside delivering care to the resident, which is what they claim they want, or I'm sitting at the desk to answer their ridiculous and pointless phone calls.
Once home, the many house guests of my housemate were leaving, finally, thank goodness. Now I can get some sleep. The housemate wasn't home, of course, but she does not understand why she should be home to receive visitors. I dread who she'll find next to stay at the house.

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