Saturday, December 22, 2012

Pill Queries Solved

The CVS app has a new feature:  a pill identifier.  This has worked very well with some of my doubtful patients.  They love helping me select the pill's criteria:  markings, color, and shape, and then seeing a pictures of the pill in their hand pop up on the screen.


Depakote ER
One of the popular medications for mood disorders.
Requires monitoring level of drug through blood work, which does not always go well-
depending on the mood.



Friday, December 21, 2012

It's Not What You Know

It's not what you know, it's who you know.

This is how jobs are attained where I work.  By some miracle, enough nurses liked me to get me in.

The problem for me in achieving employment is that I don't know people, or at least I do not know people who can get me into an awesome job.

I don't get along with most people, so I stay away from them.  The few people I do get along with aren't in my fields and can't find great jobs themselves, nevermind for me.  I also can't purposely associate myself with someone in hopes that they will give good returns on the relationship.  It just seems wrong to me.  I become friends with someone because she is nice to me, not because she is a great recruiter.  (Note that I did not use the pronoun "he."  This is because I cannot be friends with a man.  I thought I could.  But I can't because men only want sex from me, not friendship.  This took a painfully long while to realize.)

I continue applying for an additional or another job.  Imagine my chagrin when one company openly declared the "It's who you know" rule.


Of course I know nobody at this company.  In my case, this is a good thing, because most people don't like me.  But for the average likable person, knowing someone is good.  It gets good results in the employment field (and probably other fields also).

The button leads to the sign-in page at Facebook.  No way am I giving a (highly unlikely) prospective employer access to my Facebook.  Unless I am applying for sainthood or to be in the FBI, I don't see how it is an employer's business what is on my Facebook page.  And there is nothing bad there.  No party shots.  No naked pics or references to crimes.  Just your run-of-the-mill family gatherings and the occasional dinner with friends.  And still none of anyone else's business.

Wednesday, December 19, 2012

Growing Older inside the Revolving Door



"I'm superman," the patient told me.  "Do you know how I got to be Superman?"

"No," I slowly shook my head.

"I had sex with Superwoman," he explained.  "Do you want to have sex with me so you can be Superwoman?"

"Sir," I replied, "I am your nurse.  It is not appropriate for you to make sexual offers to the staff."

"You know you want it," he smirked, and then began removing his shirt to reveal a Superman "S" tattooed on his chest.  An attendant stopped him from removing more clothing.

This Superman grandiose delusion is not fleeting.  This is a very sick individual who will probably become clearer on Clozaril.  He is in his early 20s and this is his first admission to the adult psych hospital.  When I meet patients in his situation, I flash to my future at this hospital and see us aging together as they get repeatedly admitted and discharged, each time returning worse and worse.

This patient will return again because he will stop taking Clozaril when he is discharged.  How do I know this?  Pharmacists cannot dispense more than a seven-day supply without blood work results because Clozaril can drastically decrease the absolute neutrophil count, a type of white blood cell.  This patient will leave with seven days of Clozaril pills, may or may not take them, will not go in for blood work, and within two months will be picked up by the police for assault or a botched theft, and be transferred to a local hospital emergency room for psych eval.  Then he will return to me.

Other staff members tell me about the older patients and recall their first admission decades earlier, recounting their fading looks, deteriorating health, the death of their parents, the illnesses and eventual disappearance of their siblings, and other tragedies of life, witnessed by the staff through the years.

Tuesday, December 18, 2012

Money, Money, Money



I have not posted in a while because my laptop crashed.  Literally.  I dropped it.  Not hard.  Everything was intact and still worked.  When I went to use it later, it would not boot.  I took it to Staples.  $70 to assess.  Three days later:  can rebuild for $500; all files lost.  So I bought a new laptop for $600 and am mourning the loss of my files.  Not a complete loss.  I downloaded to an external drive in September.  Everything done since then:  LOST.  I feel like an idiot for losing my files and for costing myself so much money.

I know.  Money isn't everything.  But it is the thing required to pay my bills.  And I don't like to be hungry or without a roof over my head.

I also don't like change.  I have been toying with the idea that I am a bit autistic.  I thought that my only saving grace was that I was great at reading other people and their emotions.  In light of my miscalculations about my coworkers, I no longer think that I have any insight at all whatsoever into other people, in spite of my growing experience at the psych hospital; hence, I am indeed at least slightly autistic.  I prefer to be alone.  I feel no emotional connection to others.  I have my routines and am upset and lost when they are disrupted.

But I digress.

A guy at my gym (he's great but happily married, so let's just be happy that there are some good people in my life) does computer repair as a business because he can't find work.  Note to the chronically unemployed:  Create your own business, even if you earn nothing, so it looks good on your resume.  His verdict:  no files found.

How is this possible?

Anyway, I need money.  I was narrowly scraping by with the one job and no overtime.  I am not a favorite child, so I am not given overtime.  Just one or two shifts a week would save me.  As long as nothing happened, I was okay.  But we know that something always happens.  I have to pay for the charge card in January.  And my car insurance is due.  It's really high now because someone hit me in a snowstorm last year and it was deemed my fault.  She even stated that she didn't see me and was trying to beat the light, yet my insurance company conducted an "investigation" and decided it was my fault.

But I digress.

I am fervently applying for per diem nursing jobs, or full-time if it's right.  So far, all the full-time positions offer the same pay I am currently making, but not as many days off.  One of the main complaints at my job by the nurses is that they make less money than other places.  I have not found this to be true.  In light of the light work-load, my current pay is great compared to other jobs.  Not so great in comparison to my rent, car note, and student loan payments.

So I re-applied at the nursing home where I used to work.  But first I left a message for the human resources woman, asking if I was still active and could just return.  She never called me back.  In the past, I would not bother with her because she was never around and never returned messages.  If I actually found her, she would chastise me for interrupting her and snap, "I can't help you right now.  The world doesn't revolve around you."  In the past, I gave up, fearful that she would report me for harassing her.  I lost a lot of paid time off at that job because of this situation because I simply did not know what days I had earned.  No, it was not printed on my paycheck and there was no employee handbook describing the days off.  If I return to work at this place, I will go over this woman's head and report her as high up as I can for being unresponsive.  Remember the new approach!

Both evening supervisors from the nursing home work with me at the psych hospital.  I told both that I was re-applying and would like to work 3-11 every other weekend.  They said that there is a need and I was welcome back.

I have heard nothing and my messages to the Director of Nursing have gone unreturned.

I do not want to return there.  I would rather spend my free weekends writing and socializing.  But I also want to not be evicted.  I want to pay off my loans (eventually).

I also applied to an agency.  They sent a ridiculous postcard to me and probably all other nurses in the state to entice me to apply online.  (People with nursing licenses as well as their addresses are publicly available in my state.  This is great for marketers and patients looking to kill me.)  The postcard featured stock photos of cash, a woman getting a message, and a beach, with "money" typed on both sides in large bright fonts.  I want money.  I want to get massages.  So I applied.  And someone answered me!!!  So far, I was just sent ridiculous tests to complete online and paperwork to complete and return digitally.  Another nurse at the psych hospital happened to mention that agencies now do not even interview in person; everything is done through email or phone.  Sounds great for me.  I must be terrible at interviews because I rarely get the job offer.

I need more money coming in and will keep you posted.  Thanks for reading and thank you everyone who has sent me messages of support.  I will focus on being grateful that I have the credentials to pick up extra shifts for decent money.

Friday, November 30, 2012

Mind Your Own Business and Do Your Job



This is how my coworkers approach the day.

An attendant went berserk on me for not doing what she told me to do:  Call this department, call that department, order this, go look for that.  "You better stop disrespecting me right now.  I am sick of this."

I float.  I am not a regular or head nurse on any ward.  Most of these problems are ongoing issues that I am declining to jump in and try to fix.  I have tried in the past.  It blows up in my face.  I am busy enough with the normal workflow of the day, increased for me because I have to play catch-up because I average a week or two between working on the same ward twice.

So back to the berserk attendant:  she was angry.  Livid.  She lost it.  This had been brewing since my start at this hospital.  Aggressive stuff- telling me to my face, "I don't like you;" walking around the ward, telling staff and patients that she didn't like me.  As if this is relevant.  As if this is what you are supposed to be doing at work.  At a hospital.

So I wrote her up.  This angered her more.  Oh well.  I am also angry, upset, and unable to fully perform my duties because this attendant focuses her energy on undermining me and being openly hostile to me.

My immediate supervisor's response:  The attendant's behavior is okay because she thought that patients were in jeopardy.

This is not okay.  No patient was in jeopardy.  If she thought that, it was illogical and irrational, and does not entitle her to yell at me.  When there is a Code, staff is not permitted to take time away from patient care to yell at one another.  Plus, her complaint was not that patients were going to get hurt.  Her complaint was that SHE was disrespected.

So I went to the next level of management.  I was told that this attendant has been written up before and this was the third, so she is eligible to be fired.  I didn't believe for a second that they would actually fire her, but she will fight hard to remove the write-up.

The next level of management was not pleased.  They called in the Union themselves.  (This is a union job.  I have not mentioned that, have I?)  "They are sick of your complaints," the union rep told me.

"I am sick of being treated this way every day while management sanctions it and encourages it.  So if I am miserable, I am going to make a bunch of other people miserable also.  I'm just getting started."

"Misery loves company?" he asked.

"I'm hoping that everyone hates it."

Thursday, November 29, 2012

Your Opinion


This is the approach I am trying to take.

I find it easy to disregard negativity from patients.  They are, after all, certified insane.

The staff, for the most part, are a terrible lot.  They are selfish and lazy.  A negative, nasty culture permeates the entire building.  I just hope that it has not taken permanent hold of me.

Tuesday, November 27, 2012

Get Out Now



"You can't do this another eight years!" my friends tell me.

This is in response to why I am staying at this snake pit of a job.  "Eight more years and I will be vested in the pension."

"You won't make it."

So I am applying for other nursing jobs and non-nursing jobs.  I must say, this brings me glimmers of hope to think that I can work in a nicer place and maybe even earn more money.  The snake pit may not be a life sentence.

Monday, November 26, 2012

Too Juicy for Some

Crazy night nurse ran after me as I passed through her unit to get to the office for my assignment.

"I have to tell you something very important!" she gasped as I quickened my pace.

I ignored her.

"This patient over there.  I gave her two juices.  Two.  She has had enough.  Don't give her anymore," crazy admonished me.

"Excuse me," I replied calmly with almost a smile, "I have to get to the office for my assignment.  I continued walking.

I thought that went well.  My new assertive stance is working sometimes.

I was floated to a few different floors, which is not unusual, because the supervisor is simply not capable of making a daily assignment.  And yes, she gets paid more than I do.  I ended up back on the floor with the over-juiced patient.

One of the attendants flagged me down as I arrived.  "The night nurse, she said to not give that lady any more juice.  She had two."

I stared at her.  Is this kindergarten?  Preschool?

"I don't take orders from an attendant from a nurse," I calmly replied and waited.  Go ahead.  Push my buttons.

And she did.  "No, the nurse said you are not allowed to give her anymore juice."  She was staring at me as if I was a bad child.  As if she was the nurse and I was the attendant.

"I will give my patients whatever I deem necessary," I replied.  "If the night nurse did not want her to have so much juice, then she should not have given her so much juice."

The attendant capitulated!  "Yeah, I guess you are right about that," she said and sauntered away.

The main sub-theme in the Order Me Around theme is that I am supposed to fix somebody else's error.  In this situation, the night nurse thought that she had given too much juice to a patient.  The patient was not diabetic or on fluid restrictions, so this did not matter.  So I was being ordered around first by the night nurse and then by an attendant because of some irrational idea of the crazy night nurse.  No.  I am not going to kowtow to this anymore.

Sunday, November 25, 2012

Patience has Evaporated



My patience left a few weeks ago.  A few days ago my tolerance also disappeared.  I'm still not on the offense.  I am strictly defense.  When someone tells me what to do, I fire back.  I did not realize that so many people tell me what they think I ought to be doing.  I don't tell other people what to do.  I gave up telling the unlicensed assistive personnel what to do a long time ago.  They won't do it anyway.  So they have some nerve telling me what I should be doing.

I let things slide for a long time because I was new and did not think that I knew enough.  That has changed. If I am not sure of the institutional way of doing something, I plow ahead anyway and do it my way.  The organized, logical way.  If someone objects, I tell them that their way is asinine.  Which it is.

No, I am not making friends this way, but I wasn't making any friends the old way.  Now I feel better because I am voicing my opinion.  Standing up for myself.  Scaring away the vultures.

The attendants no longer have to take vital signs measurements.  A while back, I was written up because I took blood pressure readings myself after noticing that attendants handed in wild numbers not possible in living, conscious patients.  I was "disrespecting" the attendants by not relying upon these ridiculous numbers.  Other nurses complained about the numbers (not my treatment) and now the attendants are not permitted to take blood pressure readings.  Am I given any credit for heralding this change?  No.  Anyway, one of the nurses, who is very lazy, yelled at some attendants to take a blood pressure reading.  The attendants refused, naturally.  Arguments ensued.  The attendants made the mistake of asking me, in my new attitude mode, if it was proper for a nurse to ask an attendant to do such a thing.

"No, absolutely not," I replied.  "I would never rely on a single piece of information that any of you give to me.  You approach patient care as a joke, not caring that your passive-aggressive shenanigans could cost a patient her life."

From the looks on their faces, this was not the answer they were expecting.  Good.  Now leave me alone.

Friday, November 9, 2012

Missing the Drama from the Baby Mama


One person called me from work during my vacation.

We'll call him Steve.  He is an attendant.

I don't know what Steve wants.  He wants sex, right?  All men do.  He asked me out for drinks a few times. I had the sense to decline.  He seems nice, but I don't trust him, and you have to trust your instincts.

For the past month or so, he has delivered coffee to me on whatever ward I was working.  One of these deliveries attracted the attention of another nurse.

"What is going on with THAT?" she inquired of me.

"Nothing.  He just brought me coffee because I didn't have any."

She told me what I was already feeling- Don't trust him.  She said that he used to date an attendant and she had his baby about four years ago.  She still works there.

This bothered me.  I don't know Steve's story with this woman, and I really don't care.  Yet I feel odd that he openly shows me niceness in this snake pit where most other people are openly hostile towards me, and all the while his former lover and Baby Mama is either seeing it for herself or hearing about it through the grapevine.  She has said nothing to me.

I am waiting for her to do something.

Steve is from the same tribe as the supervisors and he hangs out in the offices a lot.  I feel like he is acting like a double agent, trying to befriend me in order to report back to them.  Paranoid?  He has never asked me anything about the job or asked me to give him special treatment.

I am suspicious because he is being nice.  That is what this place has done to me.

Thursday, November 8, 2012

One for me, None for you


I have been on vacation.  I didn't go anywhere special.  It was nice to get away from the hospital and the nasty employees.

The next schedule was not posted before I left on vacation.  Finding a schedule is difficult enough when I am in the building, never mind calling around by phone and hoping that the person on the other end tells you the correct information.

On Monday, I kept getting bounced back to a particular supervisor.  She told me that my next scheduled day to work is Wednesday.  I offered to come in on Tuesday, as horrible weather conditions were predicted and I can walk to work.  (Dream come true for some.  Ultra convenient when the car doesn't start or there is a snowstorm.)  She says, "I'll note that you are available for Tuesday.  Are you already on the schedule to work on Tuesday?"

Me:  "You just told me I was not on the schedule again until Wednesday.  I don't know if I'm scheduled to work Tuesday.  I don't have the schedule.  That is why I am calling."

She didn't catch on.

I called back on the night shift when the roads were covered in ice compounded by some combination of snow and freezing rain that was not snow, just terribly cold and dangerous.  Same supervisor answered the phone.  She told me that I am not scheduled to work on Tuesday and that I can't come in because no overtime is allowed.

I told her it's not overtime because I did not work two days in the week already.  She wouldn't budge.

Keep in mind that this supervisor was on overtime herself at this point.  She gives out overtime every day- to her favorite children.

It's not that I like being there.  I really hate it.  I need more money each month to pay the bills.  The student loans are as much as my rent, which is not cheap.  And I don't live in a luxury apartment.  I don't want per diem shifts at the nursing home.  The patient load is unmanageable and my license would be at risk as I was slammed with very sick people and no time to manage all of them.  I would be floated to the busiest floor and the aides would do whatever they wanted because I would be too busy trying to figure out the medications and wound care.  Then a guilt-ridden daughter would descend upon me, demanding that I drop everything and search the building for her mother's missing green pants or she will call the police to report a theft.

So I am looking for a part-time gig.  Preferably not in nursing, but nothing else seems to pay as well.

Monday, October 29, 2012

Big, Bigger, Biggest


Remember the nurse who works two full-time jobs?  The one I wrote the recommendation for?  She was horrible to me the other morning.  Let's finally give her a name:  Marie.

It started when I walked through her floor to the nursing office around 7 am.  I have to walk through that particular floor because it is the only access to the office so early in the morning.  [You would think that people should be in the office already with the day shift assignment figured out, but that is not how it works at this place.]  I have to wait in the office for a supervisor to show up, analyze the assignments, and send me to work somewhere.  This is a very confusing task to most of the supervisors, so it takes a while.  Plus, they are late and have to take off their jackets, set down their bags, get coffee first- you get the idea.

As I was walking to the office, Marie started.  "Thank goodness you are here!  Let me give you the report.  Wait!  Where are you going?  I am talking to you.  You are supposed to take report.  Who does she think she is?  An adult is speaking to her, and she just keeps walking, like she is too good to even look at me."

I kept walking to the office without speaking to her.  Why?  I have tried many times in the past to explain to her that I am not showing up to relieve her, but to walk through to the office.  She does not listen to a word I am saying and continues talking about the report, or telling me what tasks she thinks I ought to accomplish during my shift.  Other nurses and staff have intervened on my behalf with no success.  Marie remains hell-bent on giving me report as I walk through the unit.

This particular morning, she recruited an attendant into this false belief that I was supposed to be relieving her and instead I disappeared.  As I continued walking to the office, I heard the attendant shouting, "Now hold on here!  Are you telling me that this little priss thinks she can walk in here, ignore you, and then go hang out in the back like some sort of princess?  I've heard things about her, but now I'm seeing it with my own eyes."

I arrived at the office to find Meemah struggling with the assignment.  She blurted, "I just got here!  I walk in the door, pick up the assignment, and you pounce on me, wanting your assignment, like you are my first priority!"  I had said nothing.

"I'll just be waiting over here," I answered as flatly as possible.  The office was filled with night shift supervisors.  I guess this a sort of victim mentality, but I believe that they will act as "witnesses" to assure administration that I spoke nastily to any day shift supervisor.

Around 7:20 am and after the corridor had filled with more day shift workers looking for an assignment, Meemah emerged with my assignment:  the same ward I passed through to get into the office, where Marie was acting very hurt and angry.

I hoped that some of the regular nurses had come in and relieved her.  Nope.  Marie was sitting there, fuming, with no day nurse on the floor.  "I'm assigned to this floor.  Let's count narcs," I said, trying to sound factual.

"You make me wait twenty minutes for your break?  I have a family.  A FAMILY.  You have nothing.  You come and go and you don't care.  You are a teenager.  At a party.  Like this is a party.  You go here and you laugh and then you go there . . ."

I cut her off.  "Marie, can we count narcotics so I can start the early medications?  The patients are waiting."

I somehow got through the count, in spite of her anger and her inability to count, intermingled with her references to my wild and reckless teenage ways.  [Note to readers:  I am not a teenager.  It's been years since someone has even mistaken me for being in my 20s.]  When she left the medication room to get something, I shut the door so she couldn't get back in.  I started the medication line.  It was useless to try to explain anything to her.

Around 7:40 am two nurses who are regulars on the floor showed up.  Late.  We start at 7:00 am.  Did Marie blast them for being late and holding her up from her FAMILY?  No.  Hugs and kisses, followed by even wilder tales of how I alone was the sole cause of her delay in relief.  Then the long, fake nails tapping on the glass panel of the medication room door.  "Why were you late?" one of them was admonishing me.  I didn't answer.

Now Marie was no longer in a hurry to get home to her family.  She sat outside the medication room door, whining about how I was too "young" and "bratty" to work at a hospital.  Patients heard her.  Staff heard her.  At one point, a male attendant came along and fed into her drama by saying, "Did you know that they are replacing all of the hospital attendants with RNs?  That is not right.  We will not have any money, while these nurses will have even more money!"

That was all that Marie needed to keep her going.  "Did you hear that?  The RNs are getting all of the money, while the attendants, they will starve.  Did you hear that, you teenager?  You have so much money.  You live with your parents.  You have a big, big house.  But that is not good enough for you.  You want more money.  You want a bigger house.  You say, 'Oh, Daddy, give me the money!  I want more money!'  And he give you the money.  [Her accent and grammar were worsening by this time.]  And she say, 'I want all the money.  No money for the other people.  I work all the job and take all the money.'  More money, she want all money.  She no care about other people.  This poor man, he lose his job, and we say to this greedy woman, 'Please, nice lady, please help us.  You give up your job so this man, he can feed his family.'  And you know what she say?  She say, 'No!  I want all the money for me!  None for you!  You starve and I get big, big, big house!  I want mansion!'  She terrible.  She terrible person, firing all the attendants so she gets their job."

This twisted story further morphed into:  I was getting a particular attendant fired.  She told this to anyone she saw.  While sitting outside the medication room while I gave medication to the patients.  The people who had been working on the floor were ignoring her rants, but the people who were passing through paid attention to her and then looked at me in the medication room.  It is not safe to go around telling people that I am causing someone to get fired.  I work with some very bizarre and hateful people who will believe that I got someone fired because I am greedy.  They will not stop and think that this makes no sense.  They will act on it.

Marie finally left at 9 am.  I understand that her behavior is caused by a combination of fatigue, psychosis, and personality disorders, but her antics make my day miserable and she influences other people against me.

What am I to do about her?  Going to a supervisor is never an option.

Friday, October 26, 2012

Life Skills from Nursing: Organization

One of the life skills that I have acquired through nursing is organization.  I would not call myself completely organized and caught up, but I have reached the point where I anticipate potential problems and take the necessary steps to avoid a blow-up.

While working at the nursing home, I had crappy health insurance.  Ironic, isn't it?  I ended up needing surgery (nothing major) and a trip to the emergency room (nothing major).  When you receive services in this fashion, multiple providers bill you.  The insurance company paid a few, but not others.  The insurance company is not online, so I could not access my claims to check for payment or denial.  It's a "self-funded plan," supposedly exempt from state insurance rules because it's not really an insurance company.  As far as I am concerned, if it acts like an insurance company, looks like an insurance company, then it's an insurance company.  I wrote letters every few weeks, but received nothing.  The unpaid claims went into collection and my credit tanked.  Not that I was looking to acquire a mortgage any time soon- people with crushing student loan debt don't qualify to become homeowners.

I kept copies of all of my letters and the bills.  I filed complaints with the department within my state government that receives insurance complaints as well as United States Department of Labor.  It feels great to have all of this information handy when a bill collector calls.  No claims were paid yet, but I am on top of the situation.  All because of my organizational skills gained from my nursing career.

In addition, I took tips from the bill collectors.  They recommended contacting the providers to obtain copies of any correspondence from the insurance company.  This was very helpful in countering the insurance company's claims that their requests for information went unanswered.

Thursday, October 25, 2012

Do as I tell you


One of the attendants from yesterday's fire paper confronted me.

"You were a real bitch yesterday," she told me.  She's older and has worked there too long.  There are patients with more sense.

A younger attendant was nearby.  He is sassy and doesn't invest much emotion into the job.  We get along.  He sees the world from a completely different vantage point.  So I turned to him and asked what I could say.

"I am a bitch.  You're lucky I'm not worse than that every day, because I can be," he offered.

"I like it!" I responded and turned to the surprised female attendant.

"No!" she tried.  "You're a very nice girl.  I don't know what was wrong with you yesterday.  You think that because you have a fancy degree that means you can tell people what to do."

"What was wrong was that you keep pushing me and when I say that I've had enough, that you have overstepped a line, you call me a 'bitch' to try to put me back in my place of serving you."  This felt good to say this, but she was not following.  I continued.  "You can try to cling to your seniority, but younger and younger people will start working here, and they will have degrees whether you like it or not, and in health care, the person with the license and the degree is in charge of the people without licenses and degrees."

She huffed off, mumbling, "I don't know what's gotten into her."

Wednesday, October 24, 2012

Putting out Fires

Several times a week, we have to do a "fire watch."  It is just what it is called.  You watch for fires.  The fire detection system is turned off for servicing.  A form is utilized on every ward with lines for the time and a signature that no fire was found.  Every half hour, concurrent with the face check, someone needs to sign the form.

I know that this makes no sense.  Why aren't we progressive enough to use the built-in fire detection system?  It's not one of those old, scary asylum mansions.  It's a modern building with electricity and internet hookups.

Anyway, an attendant came to me late in the morning with the form completed for the entire day, even though we had five more hours left.  She told me, "Nurse, you have to fix this.  Someone wrote the time as every fifteen minutes.  Isn't it supposed to be every half hour?"

I looked at the form.  I asked, "Why did you sign that there was no fire at 2 pm when it is only 10:30 in the morning?"

She replied, "I'm not asking about that.  I am showing you that someone did it every fifteen minutes and it's supposed to be every thirty minutes."

"You signed it," I replied.

"I signed it, but I didn't write the times.  Someone else wrote the times, and they are wrong.  You have to fix it."  She stood there, staring at me.

"Actually," I proceeded carefully, "You can fix it."  Her eyes widened.  I continued, "You have discovered the errors and have time to get a new form and fill it out correctly."  She stood there, frozen.

Another attendant was nearby, listening, and now felt the need to jump in.  "Hold on!  When we tell you that something is wrong, you fix it.  That is what you always do."

She is correct.  I usually fix everything that everyone else messes up.  I do this out of fear that I will be blamed for the entire mistake.  I am tired of catching everyone's mistakes and then feeling as if the responsibility of fixing them falls on me.  I don't mention the mistakes to anyone.  I just fix them and move on.  But this angers people that I find mistakes.

I looked at both of them.  I spoke as professionally as possible.  "Ladies, I have counseled you on an error and provided you with the necessary guidance to remedy the error.  If you choose to not follow my directions, that is on you, not me."  I walked away.

They managed to find another form and fill it out correctly.

Tuesday, October 23, 2012

Little Person from Above

Another nurse told me that Meemah talks down to me and is outright nasty to me.

I had not asked.  She volunteered the information.

I was happy because I was thinking that maybe I was being too critical of Meemah, that maybe the attitude I was perceiving from Meemah was merely in response to my bad attitude.

I am also unhappy.  Why is Meemah behaving like this towards me?  And how can I protect myself?  She is a supervisor.

Thursday, October 18, 2012

Not enough hours in the day



Remember the nurse who asked me to write a recommendation for her for another job?

She still works at the hospital, at night.  Full-time.

I asked about the other job.

"Oh, I got it!" she squealed.

"So why are you still here?" I asked.  "How are you still here?"

"It's just a day job, I thought you knew that!" she answered.

"So you work there after you finish the night shift here?" I ventured, hoping this woman was not living, functioning as a nurse, on a mere four hours of sleep each evening.

"Sure I do!" she quipped again.  I finish here by 7:30, but I don't have to be at the next job until 8:30.  They finish at 3:30, so I have time to pick up my children.  It's great."

"When do you sleep?" I asked.

"After the kids are in bed, about 9 or 10."  She looked content with that answer.

"But don't you have to get ready to come back to work for the night shift at that time?"  This was not adding up.

"Yes.  Then I come here."  She seemed to be done with the discussion.

On the weekends, I noticed that she works the day shift after the night shift, a total of 16 hours Saturday and Sunday.  She must work about 100 hours a week.  That is too much.  She probably falls asleep at work.  As a former night shift nurse, I hate to say that she sleeps on the job overnight, but I don't see any other explanation for her consciousness.  She is not a go-getter.  She makes many sloppy mistakes, indicative of fatigue or mental inability, likely both in her case.  Unlike my work at the nursing home, night shift at this hospital does not give out medications.  They check the meds for the day and perform the 24 hour chart check.  That's it.  This particular nurse is known for missing med omissions and transcription errors, as if she doesn't check at all.  She probably doesn't check.

So I helped her get an additional job, not a different job.

Wednesday, October 17, 2012

Nursing Humor

You're pretty uppity for someone who doesn't have a job.
For all my patients who complain about the accommodations at the Hotel.  I mean Hospital.

Tuesday, October 16, 2012

Nursing Humor


Silence is Golden.
There should be a pill for that.

We kind of have such pills already.

"What's this pill for?" a patient will ask me.

"Anxiety.  To help you feel calmer," I will explain.

"It doesn't help me," the patient will counter, trying to find a reason to not take medication.

"It helps the rest of us when you take this pill," I will explain further.

Monday, October 15, 2012

Give Me, Give Me, Give Me

For the first time, I "worked with" Meemah, the name I'll give to the new nurse manager.  Notice the quotes- I worked and she got in my way.  I looked for specific things to identify, behaviors she exhibited- not my mere feelings or opinions.  She exhibited these reportable behaviors immediately.

She arrived in the office with her purse and proceeded to push said purse into my chest as she ordered, "Lock this up."  I didn't stop documenting in the chart in front of me, even though the ink from my pen had been jaggedly pushed across the page.

"You don't have a car?" I queried.

She looked confused and annoyed.  "Of course I have a car."  Shook her head.  As if that was the dumbest thing she ever heard.

"So lock you purse in your trunk," I answered, and kept writing.  We are told over and over to not bring purses into work because they will get stolen and there are items dangerous to patients inside every purse.

"No," she continued, "I want you to lock it up in here."  Now she was really annoyed.

"I can't lock up anything.  You never gave me keys."  I had stopped writing and was looking at her.

"This is unbelievable!" she roared and flounced off with her purse.

She returned in a short while without the purse.  She marched with determination back into the office.  "Give me that pen!" she ordered.

I glanced at the desk.  There were no pens lying about.  There never are.  If you put your own pen down, it's gone in a flash.  We aren't allowed to leave pens, pencils, scissors, and other common office supplies within the reach of patients.  I looked at her.  Her outstretched arm was reaching towards my chest, towards the pen in my chest pocket.  "There are no pens," I answered.

"Yes, there is one pen, right there!" she exclaimed, lunging at my chest.

I quickly jumped away from her lurch.  She wasn't seriously treating my pen, firmly clasped to my bosom, as a common pen for her to grab, if only I was not in her way?  Was she?  Yes, she was.

"Give me that pen!" she ordered again, giving only half a move towards my chest this time.

"Do you need to borrow my pen?" I slowly, firmly asked.

"Whatever.  Just give it to me so I can write!" she angrily spit out.

I handed her the pen.  She didn't say thank you.  She didn't say anything.  This was a test.  I knew that much.  A test of how far she could push me.  I felt like I was failing.  How do you tell your boss that her manners are despicable?

Her next order was for the phone number of a particular floor.  There are lists of phone numbers conveniently placed on the wall in front of us, next to the telephones, in this particular office.  "I don't know that floor's phone number off the top of my head," I answered, flatly I hoped.

"You don't have all the numbers memorized?" she retorted, sneeringly, but seriously, not sarcastically, as if this was a necessary skill.

"No, I do not need to memorize phone numbers.  They are all listed on these papers on the wall."  I kept on writing.

She stood there silently, staring at me, until she couldn't be quiet any longer.  "So what is the phone number?" she angrily blurted.

"Whatever number is listed on the wall," I answered, trying not to sound nasty, while thinking to myself that maybe if I were nasty, she would leave me alone.  Or write me up for insubordination.  It's a fine line to walk.

"So you expect me to look on the wall when I want a number?"  She was again staring at me while I continued writing.

"That is where the numbers are kept," I answered as I got up and left the room.  I couldn't take her anymore.  I quickly realized that I could flee to a patient care area.  I theorized that she would not go near patients.  I was right.  I didn't see her the rest of the day.

Now how am I to handle her in the future?

And how do I get my good pen back?

Wednesday, October 3, 2012

Keep Doing What You're Doing

Love this picture.

You are as old as you think.

I have taken care of many elderly people as well as young people stricken with horrible, deadly diseases.  Sometimes you do everything right- exercise, eat well, avoid smoking- and yet you develop cancer or a degenerative disease.  Sometimes the 100+ crowd pontificates about their poor lifestyle choices over the years and wonders how they are still alive while much younger people succumb.

I have no answer.

Sunday, September 30, 2012

How People Treat You

People only treat you one way . . .
The way you allow them.

I hear this so often.  I do not know how to go about this.

Friday, September 28, 2012

Patient Muse

Bugs reside at the hospital alongside the humans.  They aren't the kind that migrate towards dirt or food.  We see mostly stink bugs, bed bugs, cockroaches, and the occasional winged creature that flies in from the porch.  When a new colony is discovered, my skin crawls.  I shake out my clothes and bag before leaving to try to rid myself of carrying the creatures to my home, where I have my own brand of creepy crawly.  I am not sure what they are.  They look like a cross between a spider, a frog, and a hairy caterpillar.  When I worked at the nursing home, they were all over the walls and floors.  I stepped on a very large one when I walked into a dark room on rounds one night.  That sound of crunch and squish stayed with me.  They must have followed me home and taken up residence and I don't want to repeat this situation with the critters at the hospital.


Cousin of my pests

We exchange bug stories and theorize about their sources and exterminations.  One of the more colorful patients decided to show off in front of a group of nursing students who had just arrived for clinical.  I was showing the students around the unit when this patient told them what she thought about me.  "This one is such a whore, if she can't find a man, she lets those hairy caterpillars climb up her vagina."  The students turned red, but I laughed.

"That great!" I told the patient.  "I'm writing that one down."

Thursday, September 27, 2012

Other People Have Needs?

One of the social workers is an older lady who seems uncaring.  I think she's rough around the edges and has been around long enough to see the problems with the system she has to work within to help people, who often do everything in their power to sabotage themselves.

I was able to see her in action in a patient planning meeting.  Because I float, I miss the day-to-day happenings.  This particular patient had been really annoying me that day with non-stop requests for random objects as well as reports about other patients and staff members who were causing her distress.  At the meeting, this social worker told her that she was being discharged next week.  The patient objected.

The social worker asked for reasons why the discharge should not proceed.  The patient hesitated a bit, but then let her inner self show:  She does not like her family because they are poor.  They were rich in the country where they used to live, but they are poor now, so she would rather live in the hospital.  They don't serve her the meals that she specifies.  They want her to get out of the house everyday to attend adult daycare or work at a job.  They won't let her go shopping.

The social worker went at her:  You don't work.  Whose money were you planning on spending when you shop?  Why shouldn't you go to work?  You look down on your family because they are poor, but they work for what they have, unlike you, who refuses to work and expects other people to pay for her wishes.  If you want a hot meal of your choosing, cook it yourself!  If you were so rich and respected in your previous country, then go back there.

The social worker was saying this in a confrontational, but enlightening manner.  The patient understood that the arguments and reasons she gave were inconsistent, but there was no great enlightenment.

The end of the meeting was the patient declaring that if the hospital wanted her to get out, they could call the police and drag her out.

In the meanwhile, princess continues to occupy a bed that a sick person needs.

Wednesday, September 26, 2012

Coffee Klatch: Miracle of Conception



One of my fellow nurses is widely disliked for her stupidity.  We'll call her "Sola."  I find this fascinating because she is not the dimmest bulb in the chandelier.  I think she is so unfavored because she works constantly and it's a struggle for her and the end result is still disastrous.  Sort of like a special ed student, but at this stage of the game, adulthood has made her bitter.  The corporate culture vehemently roots out and punishes hard work.  That is one of the reasons I am not liked.  My own work is more efficient and I alone can accomplish more than several nurses put together.  My shortfall is when I have to direct others.  They don't listen and do as they please, dedicating the bulk of their workday to being missing, talking on their cell phones, and eating in the break room.

Anyway, the topic of sex came up in a coffee chat.  Sola chimed in and confirmed a theory I've had for a while about my coworkers:  They are dysfunctional in all areas of their lives, not just work.  "It's amazing I ever got pregnant!" she laughed as she continued rifling through papers.  "I still don't know how I got pregnant.  He would come at me with that thing, I was so scared, I would scream and keep my legs together.  We were married five years before I had my first baby."  This silenced my other coworkers until someone brought up a different subject.

And yes, this same woman also provides sex education to the patients.

Monday, September 24, 2012

The Absentee Guardian Angel

Often a patient will need one-on-one supervision.  Someone always needs to be within arm's reach of the patient because the patient is at risk of harming herself, others, or is at risk of falling or choking.  Although taken lightly by the staff, this is a serious situation: if harm befalls the patient while being watched, this could be interpreted as a lack of proper care.  At least I take it seriously.  I try to implore the staff to stay with the patient, comparing their role to that of a guardian angel.  I'm not convincing enough.  So many times I've found the patient alone.  When I advised the staff that the patient must be next to them always, the answer is usually along the lines of, "He's fine!  Nothing's going to happen.  Stop harassing me!"  But if work has to be done, "I'm on one-to-one" is the excuse given for not assisting.

Sunday, September 9, 2012

Round Two



A new nurse executive has joined "the team."  Not my team.  She plays for the opposition- management.  She is younger than I am, has less education and nursing experience than I do, and was hired from the outside.  Is it time to say that I have been officially passed over?

Not so fast.  She is supposed to be revamping some institutional services and structures.  I don't know and she probably doesn't either.  Anyway, she asked me to train in one of the departments that she will oversee.  She explained that the nurses currently in the department are "getting old."

I was so good.  I didn't open my mouth to verbalize that she might be stepping into the realm of age discrimination.  Let the legal department try to fix the wreckage of this train wreck in progress.

And here is the real kicker:  a clerk will be added to the department.  "Aimee."  I get to be Aimee's immediate supervisor.  I have to figure out a battle plan to contain her drama and ensure that she does not become the hospital's main source of nasty trash talk about your dear writer nurse.

Monday, August 27, 2012

Those Less Fortunate

In psych, most of our patients are homeless.  They were removed from the street for overly bizarre behavior, criminal behavior, or for medical reasons- unresponsive, bleeding, vomiting, and the like.  When they arrive, they are filthy, usually have some external parasites, and a bunch of abrasions and infections in the wounds and on other surfaces.  We won't even mention the internal problems in this posting.

They have only the clothes on their backs.  Literally.  They have a few shirts, usually two coats, ill-fitting pants with holes, no socks, no underwear, and shoes with holes in the soles.  These garments are filthy because the homeless do not have access to washers and dryers.

Taking the last item that a person owns in this world is a very difficult thing to do.  They will battle you to keep their coats, even though it is summertime.  They need their coats for the cold weather.  The streets are below freezing most nights in the winter here, with temperatures sometimes in the single digits.

So most of the staff gives up and doesn't offer them new clothes.  We have new clothes.  They are not beautiful or stylish, but they are clean and functional.  I think we get the irregulars from low-end manufacturers who can't unload the stuff anywhere and "donate" it to the facility for a tax write-off.

A lot of the staff is deeply religious, which strikes me as rather odd, given their behavior.  A lot carry around bibles and read them on the floor (along with their phones).

I tried to use a passage from the Bible to explain why they should help these patients.  This is Matthew 25:34-40 from The Sheep and the Goats.


34 Then the King will say to those on his right, “Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.”

37 Then the righteous will answer him, “Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?”

40 The King will reply, “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.”

I read this passage to them from one of their own Bibles. I explained that when you clothe, feed, and care for a patient in need, you are doing this for God. The patients were sent to us so that we may demonstrate how we would care for the Lord.

There were oohs and aahs. Has their behavior changed? No.

Saturday, August 25, 2012

Psych Hospital Tidbit: Plastic Utensils Only


And I carry my own real fork with me.

Only plastic utensils are permitted on the ward- and they must be accounted for after the meal is over!  Like counting instruments in the Operating Room before closing up the patient, yes?

Friday, August 24, 2012

Empty Black Hole Instead of a Brain


The striking features of most of my patients is their lack of impulse control and their overwhelming sense of entitlement.  "I want juice.  Give me juice.  Oh my God.  I just asked her for some juice and she is still sitting there, when she should have been getting my juice."

Because of the incessant demands, we are not permitted to give patients anything outside their schedule:  pills, meals, afternoon and evening snacks.  No extra food.  No pens, books, notebooks, music, hair pins, combs, lotion, towels, and on and on.  They don't stop with a laundry list of demands.  If you give in and give them what they have been repeatedly asking for, they are satisfied at most for five seconds.  Then they start the barrage of demands for the next random item on their list.  "Can I use the phone?  I want to call my mother.  I don't know her number.  Can you look it up?  Is it in my chart?  Can you just call my sister instead and tell her to bring me Burger King to eat.  No.  Make that McDonald's.  And tell her that I want my X Box here.  I can have that here.  My doctor at the other hospital said that you would let me play X Box, but so far, you have not given me an X Box, so you have to call my sister to get me one."  They then follow me around, demanding to know why I have not called the sister yet.

It doesn't stop.  They don't sleep.  They might cat-nap every now and then.  They bounce off the walls, draining the energy from everyone around them and using it for themselves to keep going and going.

People who don't work with these non-stop demands all day will flag me down with the same fervor as the ignored patient to say, "He just wants his mother's phone number from the chart.  That's not hard."

That's not the point.  Most of the desired tasks are easy.  The point is that I am not their Fairy Godmother, here to grant their minute-by-minute whims.  I have work to do.  One of their reasons that their lives are such a mess is that they don't stop harassing the life out of everyone.  Family members often don't pick up their phones when the hospitalized member calls because they are enjoying the peace and quiet while their Energizer Bunny is away.

An attendant who knows better kept coming to me with a patient's requests for juice, cups, napkins, paper, information, and so forth.  Each time I turned her down.  Finally she pointed out to me that the patient was becoming upset because he want HIS NURSE [read: Fairy Godmother] to be doing all of this for him.  [Do I get to stroll into a business and bark out one demand after another and choose an employee who has to do it all?  NO.]

I told the attendant that the patient was a "bottomless pit of need."  She nodded her head, as if she understood.  She did not.

"So you want to throw him in a pit?" was her reply, half scared, half confused.

"No.  He is LIKE a bottomless pit."  She couldn't be that stupid, or could she?

"He is already in the pit?  He is not," she tried to respond.

"How much can you put into a bottomless pit?" I proceeded, trying to make something click in her dense head.

"Everything," she answered, as if she knew something.

"The patient is LIKE a bottomless pit because no matter how much you give him, he always wants more."  I waited for the wheels to turn.  They didn't.

"So that is why you want to put him in a pit?" she continued again.

She didn't get it.  Nobody I work with gets it.  They understand very little of what I say and the rest they interpret as an insult or threat.

Thursday, August 23, 2012

A Reminder to Me


My coworkers do not get this.

"So you should remind him sooner?" was one of the hesitant questions asked.

This highlights to me that they do not get me.  The expressions of speech.  References to pop culture, current event, past events.  They have no clue.

Not only do they not understand, they conclude that what I said was negative.

I can't say much around them.

Wednesday, August 22, 2012

Interruptions

I was trying to write a simple nursing note on a patient.

Quality Assurance Manager walks in.  He is not a nurse.

Asks me for a chart on a specific patient.

The desired chart is sitting on a shelf in front of his face.  With all of the other charts.

His interruption causes me to write the wrong word.

"The chart is somewhere on the shelf.  Go ahead and look," I say calmly and return to my writing.

He stands there silently and then says, "I don't see it."

I start to write the wrong word.  Again.  This is in ink.  I have to cross off, date and initial.

"Keep looking," I try to sound encouraging yet firm.  He is 100% capable of locating a chart all by himself and I am the nurse, not the file retrieval girl.

He finds it.  He opens it and starts talking again.  "I'm investigating an error," he says, as if this is enticing information that will draw me in.  Little does he know that I cover up more errors in a day than he'll see in a year.  He also does not know that his constant interruptions have caused me to err in writing a third time.

In the background are ringing phones that nobody else can answer because they didn't go to nursing school.  (You answer phones and don't have a nursing degree?  You are quite talented!)  Patients screaming, "Nurse!"  Alarms beeping.

"You want to know the number one cause of all of those errors you examine?" I ask him.  He looks intrigued.  "Interruptions.  You interrupt the nurse and she loses focus on what she was doing."  He didn't seem to understand.  I pointed to the paper I was writing my note upon.  "You see these three cross-outs?"  He nodded his head.  "They were the three times that you interrupted me."  Recognition flashed into his eyes.  "Nursing requires focus and concentration to deliver quality care.  You cannot pay attention and properly complete a task when you are incessantly interrupted, which is the norm around here."

"I didn't realize this," he stammered.

"Now you just saw how your seemingly innocent interruptions caused errors in documentation.  Keep that in mind as you look for the causes of omissions and errors."

I walked away.  Idiot.

Tuesday, August 21, 2012

Psych Hospital Tidbit

Glass is forbidden in psychiatric hospitals.  The mirrors are shiny metal.
You cannot see details in the reflection.
Patients who have been there for a very long time do not know what they really look like or that their face has aged.

Monday, August 20, 2012

Mirror Mirror


New patient spent the entire shift staring at his reflection in a glass window.

Waved.

Smiled.

Giggled.

Better than harassing me or the patients.

Friday, August 17, 2012

Passive Aggressive


I think I may have a better grasp of passive aggressive behavior.

I ask the attendants which lunch they would like.  Some have a preference; others do not.

One attendant stated, "I don't care.  Whatever you give me as fine."

I scheduled everyone's activities and breaks and put out the sheet for the day.  The same attendant who did not care suddenly did care.

"You gave me the first lunch?  No!  Who gives the first lunch?  Nobody!  That's who!"

I tried reminding the attendant that she had said that she did not care which lunch slot she received.

"That doesn't mean I wanted first lunch!  Everyone knows that means second lunch!" came the shouted reply.

I did not revamp the assignments because of her.

The passive part:  Stating that she did not have a preference.

The aggressive part:  Exploding when her actual preference was not met.

Friday, August 10, 2012

Must this be such a weighty issue?


Excessive water intake is a common problem among my patients.  This results in fluid and electrolyte imbalance, which can be deadly.  A quick and painless assessment is to measure the patient's weight daily.  A difference in more than a few pounds from day to day can indicate excessive water intake.

I worked with an attendant I don't usually work with.  I don't know why it is that I work with certain people all the time, even when we are all floated to strange and unknowing wards, yet I hardly ever see other people.  Anyway, this woman is stupid and nasty about it.  She loves to challenge me and then ask someone who is not a nurse to support her position.  She starts with, "We never had to do this in all these years.  Now all of a sudden, you show up today, and it's supposed to be done a different way.  Have you ever even heard of this?"

It's different this time round because I'm different:  I know exactly what she's going to say it and the way she's going to say it.  I asked her to weigh a patient.

Her brows furrowed and a look of mixed shock and disgust flooded her her face, as if she were twelve years old and her mother just asked her to remove her socks from the living room coffee table.  "He doesn't get weighed.  We never weigh him.  You don't work here.  You don't know anything.  All of a sudden, you walk in the door, and this patient needs to be weighed?  NO."

"I need the patient weighed before breakfast."  I stood my ground.  Next would be her appeal to an irrelevant party.

"So now he not only has to be weighed, but you get to decide that it's before breakfast?  Did you ever hear about this in all your time here?" she asked the clerk.  Clerk shook her head no, as if the clerk knows more about monitoring input and output than the nurse does.  "Go do something else and I'll weigh only the people who need to be weighed and not all these people that you're just making up."

"Ms Smith," I remained firm, "The doctor is on his way over here to review the labs from last evening in light of the weight you are about to report to me.  Are you telling me that you know how to handle polydipsia and the resulting hyponatremia better than the doctor?"

"I don't even know what you're talking about," she quipped back, as if that was supposed to be an insult to me.

"I wouldn't expect you to, Ms Smith, as you have no medical training.  Your role here is quite narrow; simply weigh the patient.  We are waiting."  I stood there, not budging.  Not nice.  Condescending?  Perhaps.  She did the same to me.  Nice doesn't work with her.

She huffed off with the patient.  This particular patient is ambulatory and cooperative (though he doesn't cooperative with refraining from drinking gallons of water).  The scale is digital.  This was not a laborious task.  They were gone a long time.  Finally Ms Smith emerged from the treatment room, looking purposely past me.  "John," she called to an attendant down the hall, "How do you work this scale?"

She couldn't even perform the simple task.  How has she been getting by all these years?  Arguing with nurses until they backed down?  The nerve!  Yelled at me in front of others, like I was an idiot for wanting a weight on a patient, when all along she was trying to cover up that she was the idiot because she couldn't work the scale.

A nearby patient volunteered to show the attendant how to work the scale.  Most patients know how to weigh themselves:  Step on; read weight; step off.

Now if I could just train the staff on how to use the scale.

It is so ironic that so many smart, diligent people can't find work while a person like this nit-wit, who cannot perform simple tasks and is nasty about it, has a full-time job with benefits.


Thursday, August 9, 2012

Defense Tactic


People are talking about the strangling incident.

"The best way to keep the patients from attacking you," explained one of the older attendants, "Is to make them think that you are just a little bit crazier than they are.  Then they are afraid to mess with you.  Look at this counter," he commanded and pointed to cracks and missing pieces in the hard plastic.  "That could have been my head, but I made the patient think I was crazy, so he attacked the counter top and not me."

Wednesday, August 8, 2012

Patient Attacked Staff

Physical altercations are commonplace where I work.  Most are mild incidents with no long-term damage, but still make for an unstable and hostile work environment.  This week, I was present for a bad fight when a patient attacked a staff member and strangled him into unconsciousness.

This particular patient is too dangerous.  His attacks have been escalating.  There are facilities for long-term treatment of very dangerous psych patients.  The problem is that they are at capacity.  All over the country, psychiatric care facilities are closing.  The milder cases are pushed to the street while the worst fill the beds.  The facility where I work was not designed and is not equipped to handle very dangerous people, but with no beds available at a more appropriate facility, the truly dangerous now call this low-security psych treatment facility "home."  They call the staff whatever they wish and they punch whomever they want.  The response from management is to transfer the staff member's assignment to a different area of the building, as if this was a peculiar personal conflict that won't repeat.

I don't foresee more funding and additional facilities appearing by tomorrow, so the next best step may be for the facility to change some policies and allow more aggressive medication and restraint of these dangerous patients.

Tuesday, August 7, 2012

Is anyone in charge?


This cartoon gave me a chuckle.

We cannot medicate crazy against their will.  That is the policy where I work.

One of the hallmarks of schizophrenia is medication non-compliance, which results in relapses that worsen with each occurrence.

Nevermind that crazy is not logical or reasonable and that appropriate medication will help the person become less anxious and paranoid and help the thought process become clearer.

Patients can refuse medication and not be forced and must be left alone to be as manic, psychotic, and paranoid as they possibly can be- even if the refusal is based on paranoia, such as being poisoned, or based on an illogical thought, such as women should only take pink pills.  This is their "right."  As if someone would want to spend life barricaded in their room using tin foil to shield themselves from the beams that the FBI is aiming at them to zap thoughts into their brain.  Yet this is what some of the patients are back to doing.  I say "back" because this is the behavior that got them brought to a hospital in the first place.  I also say "back" because this is how people had to live before drugs like Lithium were invented.

"Just reason with them," is the response from management.  Now if people were so reasonable during a psychotic break, we would not need hospitals in the first place.

This is getting really out of control.

Monday, August 6, 2012

Red did not do well in these disasters


Highly recommended crazy night nurse worked with me on the day shift once.

We had five codes that day, which was a record, for the record.

Crazy wore red high heel shoes.  Highly inappropriate for so many reasons, yet not unusual in this place.  By the third code, she threw the shoes and got down to work.  When the action had cleared, she went looking for her shoes and could not find them!  One of the patients must have swiped them!

She walked around in her stocking feet for the rest of the shift.  She literally slid into the fourth code and fell.  She sat out the fifth code.

Let's find her a new job.


Sunday, August 5, 2012

I highly recommend . . .


A night nurse asked me for a letter of recommendation for a job she's applying for.

Problem is, she's not very good.

On second thought, why is this a problem for me?  If she wants to quit, or in other words, get out of my hair, I should be happy that I have a legitimate way to help her [get] out.

Unbeknownst to me, she asked another nurse for a recommendation as well.  I happened to see the letter on a desk.  I was quite impressed that this other nurse had found some good, though non-specific things, to write.  I scanned through it for some ideas.

The other nurse saw me.  I complemented the letter.  "Well, I had to leave out some things, you know, like about how crazy she is," the other nurse explained.

How true.  There are patients who are more stable than this nurse.

I can write this letter.