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.