Thursday, April 29, 2010

Limit the workload

Two related new(ish) items caught my attention today. I don't catch anything brand new anymore because I'm so darn tired- and behind on everything else.

Over at brazencareerist, webcasts are finally becoming available through archives. I'm usually asleep when they are live, so I haven't been able to view one, until today. The webcast was about fulfillment. As it turns out, personal relationships and not your career will give you fulfillment, so your choice of a job should consider three factors. I don't remember two of them, but one was "control over workload." I was thinking about how I don't have any control over the workload and it usually veers out of control pretty early in a shift. Then Penelope Trunk (the speaker of the webcast and the overall power behind the site) specifically mentioned nurses and that it's not a job she recommends for lots of reason, none specified.

I don't find nursing to be fulfilling. It's reliable employment at a rate better than most average jobs. And yes, no control over most facets of the job.

On a related tangent, today on one of my other favorite sites, medscape, was an article about the impact of California's law mandating nurse to patient ratios. New Jersey and Pennsylvania were included in the study because they do not have a nurse to patient ratio law. (New Jersey has pending bills in the house and senate. Nursing homes, however, are not targeted by the mandated ratios.) As one might have predicted, patients have better outcomes and nurses have fewer gripes in California than in New Jersey and Pennsylvania.

My interpretation is that nurses have so little control over their workload that legislation must be passed to attempt to lighten it. Definitely not a fulfilling career. Especially not in the nursing home setting. Doesn't anyone think that 60 patients per nurse is too much?

(I hope that the links work. I've tried this before without success and really feel that a blog should have working links. And pictures. But mine just won't insert.)

Tuesday, April 27, 2010

Two g-tube tales

Yesterday, around 7:45 a.m., an aide came into the hallway shouting for help, that a resident had removed her own g-tube. The day shift nurses were already in and had taken over the unit. I was present, but doing my charting and documenting for the night. I don't mind helping in an emergency. This was a manageable, yet urgent situation that the day nurses could easily cover. But: an evil nurse was working- the nurse that wrote bad things about me (never do that to another nurse) for a wound on another resident.

My fear was: how am I going to convince administration that the tube was intact at the end of my shift?

So I hurried to the room and found a nurse already inserting a tube to keep the opening patent. The aide was distracting the resident from tearing out the new tube. I knew the g-tube was in place when I flushed it after the feeding ended at 6:30 a.m. I hid the g-tube from the resident under two pillows. She is confused and picks and pulls at anything she finds, so her plan of treatment involves burying the g-tube and feeding line so she can't find it and remove it. I asked the aid if she knew how the tube came out. The aid answered, "I was washing her and she just reached down and pulled it all the way out before I could stop her."

I was relieved- they couldn't blame me. But they would try, just for the hell of it. So I returned to the nursing station, grabbed her chart, and documented for the night that the g-tube feeding was well tolerated and the tube was in the correct position. My last time entry was for 7:15 a.m., so a future entry of "Received resident with tube removed" will look suspicious. It still may happen.

The other g-tube story is that the resident for this morning has a g-tube in her, but eats entirely by mouth. Each shift is supposed to flush the tube and does indeed sign for it. Day shift is supposed to clean the g-tube site daily and signs for it. Night shift replaces the flush kit. I know that the day and evening shifts aren't flushing the tube because the previous night's new flush is always in the sealed package, untouched. I took care of this resident three nights ago. I assessed her g-tube and the site and found a slight bloody drainage. I cleansed the area and applied a dressing because she was going out for an appointment and I didn't want her to leak or bleed through her clothing. This morning, which is three days later, I had the resident again and of course, my dressing is still on the site. It was filthy. I removed it and don't know how I did not dry heave in that room. That means that it was really bad because, as a nurse, I have pretty much lost most of the ability to feel disgusted, or even gag at anything. I think that I did not reveal my disgust to the resident. Never do that. It is entirely not her fault that this area of her body has turned so yucky. The nurses were supposed to maintain the site and they failed.

The nurse who relieved me was a per diem floater, so I did not mention the situation to her. I will tell the regular day and evening nurses. They should receive the information well. Other nurses would not like to hear such a thing, especially from me, but I'm not doing it to feel superior. I'm doing it so that the resident receives better care. Each aid who took care of her should have seen the (glaring) date on the dressing and told the nurse. Each nurse should have assessed the area on their own accord and found the dressing and removed it. What is truly sad about this particular resident is that she has already lost a leg while living at the nursing home because she developed a foot wound (from not being positioned and turned properly), the wound went unnoticed and then was not treated regularly, became infected, not noticed, until an amputation was necessary. That's not the end. Same process played out on her sacrum, though you can't amputate somebody's butt.

Sunday, April 25, 2010

Differential

I got a little (very little) bonus in my paycheck. $146 of "differential." I don't know what it's for. It could be for working nights, working weekends, working the sub-acute floor; maybe even having a BSN? I've asked around and nobody else got it.

I wonder if I'll ever see it again.

I'm not bashful about asking and telling about pay. It's the only way that people, not just nurses, can make informed decisions about where to work and if they are being taken advantage of.

Friday, April 23, 2010

Nursing school- instructor shortage?

I understand that television warps reality and then broadcasts it.

Still, I want Days of our Lives to understand that doctors don't teach nursing school; nurses teach nursing school. Nathan Horton, MD, should not keep running into Melanie Layton Kiriakis, nursing student, because he is her teacher. But then they would have to find another way for them to be constantly tempted to romantically hook up.

Maybe like the rest of the country, Days faced a shortage of instructors to teach- no nurses with MSNs floating around Salem.

New planet

I've moved and feel very out of place. It doesn't help that I've been off from work only two nights since moving. I was off last night. I fell asleep for a recharging nap around noon yesterday and ended up sleeping until 4 a.m. this morning. I was really tired.

Happy Earth Day.

I recycle at work. Nobody else does. There are no recycling bins, so this is solely an individual effort. I found it silly to recycle at home, while throwing out cans and boxes at work. Some people understand the concept, but don't recycle; most don't understand and throw out my box of cans. Comments have included:

"Why do you recycle garbage?"
"How much do they pay you?"
"What do you mean, recycle? I've never heard of it."
"You can't recycle that paper bag. It has a tear in it."

They aren't seeking information to become educated and better the planet. They are seeking to highlight the differences between them and me, as if their ignorance is the proper way. It's quite tiresome.

Saturday, April 17, 2010

Moved

I have moved. It's peaceful sleeping during the day. I have worked every night since the move, so I'm exhausted and little has been done to organize the place.

I've been on the short term floor because the regular nurse for that floor is still on vacation. Some of the new admissions are very time-consuming.

More to come when I get cable installed at the house.

Sunday, April 11, 2010

Baby nurse

I'm catching up on my dvr recordings. I just watched Accidentally on Purpose, featuring a "baby nurse," played by Olivia Munn. I started watching the show because I think Jenna Elfman is funny- I really liked her quirky character in Dharma and Greg.

The sitcom is all about funnies, of course, so I watched to see how the nurse was portrayed. We were supposed to take it as normal that a baby nurse would be needed for a seemingly healthy couple with a presumably healthy baby on the way. As revealed in the ridiculous interview, at least the baby nurse was really a nurse and not a babysitter.

And like many other television nurses, the baby nurse was all about sex. The fantasy about assisting with feeding the baby was sexual. The nurse ends up fired for attempting an interlude with two other characters.

Someday this image of nurses as sex-starved, preying on patients, doctors, and families, will change?

Weekend to move

I'm off this weekend. I usually work anyway, but I said no to this weekend so that I could move. Things usually fall through for me, so I waited until I actually got into the house and got the keys before officially saying, "I'm moving!"

I'm making frequent car trips for the smaller stuff. As I arrive with each carload, I put the stuff where it's supposed to go. I learned that from nursing- do what you can when you can throughout your shift, so that you are not left with a heap of work at the end, and so that a snafu/emergency does not hopelessly strand you hours behind.

Saturday, April 10, 2010

Financial threats

The podiatrist comes in early in the day, when people are still in bed, because that's the set up conducive to toenail trimming. If the night was busy, I'm usually still there when he arrives.

He told me that the field is no longer lucrative and he suffers a salary reduction every year. He is seriously considering adding another career, teaching, for extra money and as a segue to leaving medicine. He said that several of his colleagues have also done the "alternate route" to teaching and are now teaching science or math, subjects more secure than arts and music. He said he would do his nursing home visits evenings and weekends to earn money while attending school during the day; then teach during the day and still work weekends for supplement until the teaching pays more.

Can you imagine? He's not the first doctor to tell me that the practice of medicine is not worth it financially. I feel pretty confident in my position and salary as a nurse- it's why I went into nursing. But maybe there is a chance of salary or hour reductions. At least for now, my state requires that medications in a nursing home be administered by nurses only and not medication aides, so I feel safe. In spite of cautions against polypharmacy, every resident's medication list grows each month. I used to have to give meds to about 20 residents for 6:00 a.m.; now it's about 50.

One of the aides told me that she is considering a program to become a "dialysis technician," designed to replace expensive registered nurses with lower-paid techs. For the price of tuition ($16,000), she could become a nurse through a county college, and I told her so. That does seem to be the trend, though, as medicine becomes more sophisticated- having less educated workers perform the work formerly done by registered nurses.

Thursday, April 8, 2010

Who's pain is it?

Doomsday Supervisor gave me off Friday night. It's my weekend off. So I should be able to pack up and get going to the new place this weekend. The van will come on Tuesday for the big stuff. The thing is that I don't need my housemate finding out until the last possible minute because she'll do bad stuff.

At work last night, I saw a family member. She came in really early. Like most family members, she had a complaint: Her father does not like his bed. There are two problems with this issue: 1- she raises it every day with each new bed and 2- his pain is caused by cancer that has metastasized everywhere and not by a bad bed. That didn't stop her from going on and on, as if she doesn't have this same performance every day. She doesn't want her father to receive pain medication "because it can make him sleepy," but she wants his cancer to not be painful. I gave her the name and number of the administrator and she pretended she had not spoken to her already. Let the higher-ups deal with this repetitive ignorance.

The other question is: why are we listening to the daughter when we decide whether or not to administer pain medication?

Wednesday, April 7, 2010

Moving along

I signed a lease and should be moving next week.

I asked for time off again, and was told that it's now impossible because the only other part-timer has to leave the country because of a death in his family. As I've written before, this should not be my problem.

I was off last night. They called me all day to come in.

Tuesday, April 6, 2010

Trudging along

Last night was busy, but manageable until the final hour. Someone went into respiratory distress and someone else died. The death was anticipated and the resident was on hospice. The other resident had been in distress earlier in the day, sent out, and quickly returned with instructions to not treat. (Read: no orders for DNR/DNH, so I have to hope I don't run into trouble. But I did.) I actually got her stabilized.

The problem with these problems arising at 6 a.m. is that I'm in the middle of the 6 a.m. med pass. The pass ceases and I attend to the residents. No other nurse helps me. By 7:30 a.m., I was still attending to these two issues, with only a quarter of the meds given. My three replacements were gathered at the nursing desk, eating and chatting. They could have helped. But they don't because the unspoken rule is that problems arising on a prior shift are the sole responsibility of that shift and must be remedied and not endorsed, no matter how long or involved. I was finally able to return to the med pass around 8:00. The three nurses were annoyed that I was now holding up their 9:00 med pass. They have plenty of other work they could have done instead of standing around, doing nothing.

To top it off, a private duty aide showed up and wanted to ask questions. For some reason, she decided that I was the only "go to" person and backed off when she saw me running with oxygen and other supplies. She waited in a chair for over an hour, even after the day shift arrived. I don't understand why she thought that she had to speak to the only person who was busy and didn't dare ask the three nurses standing around. She let me know how mad she was that she waited for me while I attended to my patients. So I made her madder by asking her what her questions were, listening, and then calmly referring her to the nurses at the desk.

Sunday, April 4, 2010

Is the grass greener in the next county?

I tried to sleep, but my housemate and her boyfriend for this weekend woke me up. Another reason why I must move. "You're still sleeping?" was the response. I fell asleep at 10 a.m. They woke me up at 12:30 p.m. They don't sleep a mere two hours each night, yet they can't fathom that I would need so much sleep.

I'm exhausted but can't fall back asleep. It's sunny and warm outside. I want to be running around outdoors, not sleeping until nightfall.

I did manage to apply to a job. It's a county job and administrative. I have this fantasy that government employment would be great for the time off, benefits, security, etc. This particular job is at a place where several of my coworkers already work. These nurses work full-time at the county job and then full-time at the nursing home. They walk around like zombies. I don't plan on doing that. I mentioned the job to the night per diem supervisor. She was familiar with the position and the person doing the hiring and said that she would mention me.

I worked for a different county as a nurse at a nursing home. I lasted five months. The job itself was horrible for lots of reasons. As for the perks, I didn't get my insurance cards until my last week, so I never got to use the insurance. I called out sick once (I was supposed to get 15 sick days per year) and was written up for "unauthorized leave of unpaid absence" and not paid. I finally handed in my two weeks' notice when the director of nursing met with me to tell me that a senile resident recalled that at an unknown time in the past, someone who matches my description attempted to strangle him; after an "investigation," they determined that I was the person, and she wanted to know why I would do that.

The two weeks was a courtesy in the employment industry, but that wasn't good enough for them. The following week, the assistant director of nursing told me that I had to leave because "Your name appeared on a paper of people who can't work here anymore." She showed me a printout of an email about people who were missing documentation. My name was not on it. She said, "I didn't say that your name was on this particular piece of paper. I'm using this paper as an example. The names were in an email, and you know that I don't know how to work email." I didn't know how to respond. She said that I just needed to show my immigration papers. I said that I don't have immigration papers. She was horrified and exclaimed, "Everyone needs immigration papers." I calmly said, "Only people who immigrated need immigration papers." She wasn't following. The shift was just starting, and I had already received endorsement from the outgoing shift. I had the assignment sheets, new orders to transcribe, keys, everything- in my arms so I could get the shift into motion. I asked her what she wanted me to do. She said, "You have to leave." I smiled, said, "Okay, the unit is yours," and placed everything into her arms as her mouth dropped open and her eyes widened. I shouted to the CNAs, "Ladies, Ms [assistant director of nursing] is going to be the unit nurse tonight, so bring your concerns to her." I grabbed my purse and ran out the door.

Yet I still hold out hope that a government job in a different location would be good.

No time off

As I predicted, Doomsday supervisor denied me any time off for the new schedule. She said it's not possible because two people are on vacation and "they come ahead of you." I realized early on that everyone comes ahead of me.

I became full-time from per diem about a year ago. In exchange for a pay cut, I was to receive health insurance, dental insurance, and paid time off. So far, the insurance has paid nothing because they are both HMOs with no participating doctors anywhere near here. I have put in for days off, but have yet to receive any. When a holiday falls on my regular day to work, I'm supposed to get another day off. That has yet to happen. I'm starting to think that this paid time off deal is really no deal for me, especially if I'll be leaving and forfeiting all of the time.

Saturday, April 3, 2010

Plans to move

I may have finally found a new place to live. It's not far from where I currently live and it's not far from the job. At least it can be considered "not far" when you are travelling at night and don't hit traffic. During the day, the commute would involve lots of traffic in trying to maneuver past lots of shopping centers and a major mall. Plus, the area, though not my particular home, is prone to flooding, closing major roads.

With this in mind, I'm looking at applying to the nursing homes and hospitals in the area. As you have been reading, I am not happy where I am, so I might as well move on, and it might as well be to a place with a short commute.

I hope I can get time off to move. I have plenty saved up because it's hard to schedule the time. I am one of two full-timers. The other one is on a two week vacation now. Most of the per diems have very limited availability, such as every other Friday. Every now and then Doomsday supervisor asks why I don't take off, but when I put in for the days, she says she can't swing it. I usually work my weekend off. Last week, when she "gave" me an extra day off (I had just worked the extra weekend), they called me all day to come in because they were short. I ignored it.

Friday, April 2, 2010

Lower your expectations

"Lower your expectations." Doomsday supervisor told me this last night. I have heard this from different people in various situations my entire life. In my professional and personal life, I feel that I have always operated in a manner so as to learn and grow, bettering myself. I realize that most people don't want to learn or grow. I just don't understand how they could desire to stagnate.

It's ironic that Doomsday would tell me to lower my expectations. One of the reasons why I work exclusively night shift at this time is because of her. Unlike the supervisors on the other shifts, she is on top of her game. She expects things to get done in a certain manner. She takes on a lot of responsibilities that really belong to other people.

By hearing, "Lower your expectations," I hear, "Stop caring." I don't think that I could ever stop caring about my job performance. In addition, because I am not one of the favored children, I could very quickly be singled out and fired when there is a failure. Maybe it's the entire set up, that one nurse (and I don't even consider myself to be very experienced) is responsible for sixty frail and sick people, with three "unlicensed assisted personnel" to help. Other nurses have expressed their opinions that the CNAs are not educated or paid enough to perform well. I agree about the training and pay, but the second part of this proposition is that the nurse, who is educated and paid well, has to pick up the slack. I don't see other nurses jumping in to fix omissions made by the CNAs. And I also don't see them getting in trouble for doing nothing.