Wednesday, January 6, 2010

Work every minute but still don't do enough

I started out on the dreaded psych/behavior floor. I don't mind the clientele. What I mind are the aides who walk slower than most of the residents and the in-your-face nurses of the other shifts. Each floor is like a different facility.
I toured one side of the floor, finding bed alarms missing, not turned on, broken, etc. I told the outgoing nurse. She acted surprised, even though we have this same exact conversation every time I relieve her on this particular floor. One of the aides explained that the residents received electric beds today and the bed alarms and sheets were not put back on the beds by the people who installed the new beds. Of course not. The aides needed to reassemble the alarms and the bed sheets. So they were going to wait for one nurse for the night shift to add back all of the alarms?
Another nurse appeared. He said that he was on the floor and his name was on the assignment sheet. It sure was. I told him that I saw my name when I arrived to the floor. He said that the evening supervisor must have just changed it. That sounds just like her. Change my assignment while I'm down the hall and not even tell me.
I was reassigned to the mixed short term/long term floor. Yet another nurse was also assigned. I was able to get rid of a ton of discontinued medications. I was going to write overdue monthly hypnotic summaries, but then Doomsday supervisor told us that she could not justify having two nurses unless we did extra work (what they heck does she think I was doing), so I needed to change all of the oxygen tubing.
Usually, night shift on the other units changes the oxygen tubing on a Wednesday-Thursday night. On the mixed unit, the evening shift does it on Wednesday. You do not need a nurse to do it, but the facility seems to prefer paying a registered nurse overtime rather than hiring a unit clerk for $10 an hour. Taking work from another shift really doesn't make sense. Catching up on our own past-due night shift work does make sense. Also, she waited until right before my heavy 6:00 a.m. shift to tell me about this extra assignment, so I ended up staying overtime for one hour to complete the task.
I also had to write an incident report regarding the black foot wound found on my shift one week ago. I don't know who they are going to blame. The regular evening nurse, who supposedly signs for that resident's weekly body check, told me that he noted the wound upon admission. No, he did not. I checked when I found the wound. I don't know if this is intentional or not, but the facility uses an admission form with a small drawing of a blank body. Wounds or marks discovered after admission can simply be drawn onto the form, as if the wound was present upon admission. The problem with that is any wound, mark, or remarkable physical findings must also be detailed in the admitting nursing notes. For this resident, no note in writing was made stating that he had a wound on his foot where I found a wound on his foot.

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