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.