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.

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