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.

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