Thursday, May 31, 2012

I am allergic to anything that is not a narcotic

Patient:  "I need some Percocet."
Nurese:  "The doctor ordered Tylenol.  You can have that."
Patient:  "I am allergic to Tylenol.  I have to take Percocet instead."
Nurse:  "Percocet contains Tylenol."
Patient:  "It does?  That's okay.  The Percocet cancels out the Tylenol part, so I can take it."

Wednesday, May 30, 2012

How Can I Float Like a Butterfly but Sting like a Bee?

She did it again, but worse this time.  As I previously wrote, I have to pass through a certain unit to get to the nursing office every morning for my assignment.  The night nurse on the floor jumps up as she sees me, trying to tell me the report and count narcotics as I continue walking past her to the office.  Well, today I was assigned to her unit.  But first, I waited in the nursing office for twenty minutes until the day shift supervisor showed up and decided the assignments.  I returned to the unit at 7:20 am, hoping the dense night nurse was gone.  She wasn't.  No other nurse had shown up yet.  She started carrying on:  "Why did you make me wait twenty minutes?  I am waiting here for relief and you disappear in the back.  What is wrong with you?  You have no consideration for anybody else."

I replied, "I float.  I have to wait for my assignment from the supervisor and she is always late.  Take it up with her if you disapprove of her tardiness."

She didn't get it.

At 7:30 am, after we had counted and gone over the report, in walked two other nurses who were supposed to be there by 7:00 am.  What did night nurse say to them for holding her up?  Nothing.  It's my sole fault because I am the first to finally arrive.

The rest of the day had this basic theme:  I was wrong, wrong, wrong.  They two other nurses talked on their phones all day, disappeared from the floor for extended periods, and ignored the desk phone.  I don't know how to handle this.  They criticize me for little things that don't make any difference, such as the angle of a binder in the medication room.  (Not kidding.)  I am a detailed-oriented person, but with so much work that needs to get done, you need to know which details need attention and which do not.  Disagreeing or protesting results in replies such as, "It's not your floor, so you don't know these things, but they matter very much."  I understand that everyone else has been employed at this facility longer than I have, but at this point, I think I can perform the job a lot better than most of them.  They are so focused on what I am doing and how they can pick on me that they let more important details, such as an accurate census count and renewing med orders, slip by.  They blame me for this, too, as you may have guessed.  The problem with multiple nurses on the floor is that only one has a specific assignment- giving medication (usually me).  Everything else is the responsibility of all of the nurses.  So I am not only on the hook for giving medication and carrying out all new orders, but I am also subject to blame for not completing any other task on the unit with a simple, "She was supposed to handle that" from another nurse.

Floors like this one make me glad that I float.

Tuesday, May 29, 2012

Holiday


At the facility where I work, the custom for major holidays is that the 3-11 shift calls out, thereby leaving the 7-3 shift stuck on a double, missing the outside social aspects of the day.  There is no additional pay for working a holiday.  You can use a sick day or personal day to call out with no repercussions.  The heaviest hit holidays are Thanksgiving, Christmas, and New Year's Eve.  There is not such thing as rotating holiday coverage.
I was fortunate to be off on Thanksgiving.  I was about three hours away in another state when the shift supervisor called me at 1 pm, "desperate."  I told her no and stated where I was.  The response, "So you can be here by 3?"  I realized that she had no idea where this other state was and I might as well have said, "I'm just sitting at home, two minutes away, watching reruns on television."  The unit manager let me have off on Thanksgiving because, as she explained, "The real holiday is Friday when we get up early to shop."  She wasn't kidding.  Most of my coworkers have very little experience with American culture.  This does not stop them from trying to educate me, though.

Monday, May 28, 2012

So Simple



They are training another new nursing supervisor.  To show him how to inspect the medication room, they chose my busiest time when I was giving out medication.  All vials must be labeled with an expiration date by the nurse opening the vial.  Who does this?  Me.  I always label when I open.  When I float unit to unit, the bossy nurses like to order me to "Check the vials!"  I would usually find unlabeled vials and dutifully label them because who would get in trouble if there was an inspection?  Me.  Why?  Because I was in charge of the medication room at the time and I should have inspected all vials myself for compliance.  I grew tired of cleaning up after other nurses.  Checking the vials takes time, and they would not give me time; instead, they yelled that I was holding up the medication pass if I did check vials.

So the new supervisor found an unlabeled vial.  They all acted shocked and then quite annoyed that I was not paying attention to their hissy fit.  "This has to be labeled!" he shouted.

"Just leave it on the counter and I'll take care of it," I calmly replied and continued my work.

They left, only to return with a higher up to ask me why I had not labeled the vial.  Nevermind that I was busy with patients.  "I did not open the vial," was my short reply.

"That does not matter," he explained, exasperated.  "You have to check them before you start.  You don't seem to understand."

"You do not seem to understand that I start with a tour of the unit, followed by a narcotic count, then the report, and by that time, I have a long line of patients and a phone that never stops ringing with no time to check vials that the nurse who worked yesterday evening could not be bothered to label."  I was careful to not raise my voice, but anyone observing this would recognize immediately that I run around like crazy while these supervisors sit at a desk, calling the unit, wondering why I am not sitting on top of the phone to answer questions such as, "How old is such-and-such a patient?"  Answer:  An hour older than he was when you called and asked me that one hour ago.  (These are real questions urgently asked on the phone.)  There is a great disparity in the workload that should translate into:  Leave me alone.

"I just was wondering why you haven't labeled the vial yet," this man continued.

"Because the labels are kept in a locked box in a locked cabinet in a locked room that is nowhere near the vials themselves, so I will retrieve them as soon as I finish my patients and figure out which three keys on this ring of 100 keys will grant me access to the labels."

He continued, "Why don't you just keep the labels in here, next to the vials?"  Critical.  Like I have any influence over the flow of logic in this place.

"I tried that," I realized I was starting to sound nasty.  "According to these nurses here, it's a crime against humanity."  He looked puzzled and shocked.  "I left the labels out one day for ease of access and was informed that it is not allowed because someone will steal them."  He stood silent.  The other nurses were watching.  I grew braver.  "Actually, this entire time that we've been talking and I have also been serving patients, the other nurses have had time to stand and listen.  One of them should be able to take five minutes to retrieve a label."

Everyone walked away.  Nobody went to retrieve a label.  Neither did I.

Sunday, May 27, 2012

Quotes





Today's best quote:

"All these voices in my head are going to drive me crazy."

Saturday, May 26, 2012

Sleep


Working the night shift for a few years has jumbled my internal sleep clock.  If I did not have to work and had no real schedule, I would probably sleep 12-14 hours and then be up for an entire day/24 hours.  I might sleep during the day, evening, or night.  I seem to have lost a natural time of day when my body wants to shut down and sleep.  I sometimes have bursts of energy that keep me awake all night, and then I pay for the nocturnal productivity by dragging myself through the day.

I purchased a beautiful, comfortable bed with gorgeous sheets, pillows, and comforters in anticipation of sleeping at night, in the dark- a luxury that eluded me when I worked the night shift.  Now that I switched to days, I can't establish a sleeping routine.

Provigil (modafinil) is a drug that is marketed to health care workers for Shift Work Sleep Disorder.  I am not big on taking medications, maybe because I give out so many pills to my patients, or maybe because I'll miss a nap waiting to be seen in the doctor's office.  I also keep thinking that if I put myself on a proper time schedule and then stick to it, I can fix this problem myself without medication.  Provigil is also controlled, meaning that I will have to visit the doctor for a written prescription every month, present same to the pharmacy, wait for refill, do this in a timely fashion to not miss a dose:  and it seems like too much hassle.  Or maybe I don't have the energy to do this right now, but I will have the energy and willpower after taking the medication for a while.

Proper sleep provides plenty of restorative benefits to your body that you may not immediately recognize, such as lower blood pressure and decreased risk of heart attack and stroke.  When I have not had enough sleep, I am slow, forgetful, irritable, and hungry.  When I feel rested, I am calmer and better able to cope with the daily challenges of being a Nurse.

What will I do?  I am not sure.  Coffee with a caffeine kick does nothing for me.  Maybe I will try to be in bed by midnight every night, no matter what, so that I can arise at 5 a.m.

Friday, May 25, 2012

Orientation of a New Nurse Hire


I oriented a new hire today.  She was great.  She is many years my senior and has been working in the ICU (Intensive Care Unit) for the last 15 years.  She was hired part-time (no full-time nurse has been hired since I was last year) and she will see how she likes psychiatry in contemplation of leaving the ICU.  She said that the ICU is very demanding and she would like to take it easy.  I assured her that psychiatric nursing is not physically demanding, but some nurses are put off by the clientele and the fighting.  She was very professional and thanked me genuinely for my insight.  I didn't overburden her with rote facts, figuring that she won't remember an onslaught of information.  I didn't lecture her on basics of nursing, which nurses (and non-nurses) love to do to me.  I made her aware of what I call "pitfalls" unique to the facility, such as patients getting back into the medication line and insisting that you did not give them medication, while you frantically try to recall which other patient received the wrong medication.

Another nurse told me a while back that I would enjoy the ICU.  I told her that it seemed like too much work and too much responsibility.  She said that I would excel because the amount of skill and knowledge required to stay in the ICU means that I would not be working with nurses who ask me gems such as, "What are electrolytes and why do you pick on patients who haven't balanced them?"

I hope that they hire more professionally-minded nurses (and weed out the others).

Thursday, May 24, 2012

Hairy Situation

One of hospital attendants seems to have enough time every morning to do her hair in the unit's bathroom.  She does not clean up after herself.

Wednesday, May 23, 2012

Sodium

The typical American diet contains more sodium than needed.  Sodium causes fluid retention as the body attempts to dilute the sodium level.  This can lead to high blood pressure, heart disease, kidney disease, and other complications such as stroke.
A coworker was complaining about her stuffy ears and a "cold" of two weeks.  I advised her to avoid sodium to reduce the pressure in her ears.  She asked, "What's that?"
I replied, "Salt."
"Oh, I never eat salt," was her quick answer.
I explained that salt is found in processed foods.  I had only seen her eat lunch that she ordered from local eateries, filled with fat and sodium.  She continued to insist that she never eats processed foods.
At lunchtime, she asked me to go to Burger King for her and pick up two whoppers.  [Burger King lists the nutritional content of its choices on its website.  Check it out.]  I explained to her that such food is filled with sodium and fat.  Her response:  "I know that.  That's why I want two double whoppers instead of one triple."  I did not give further comment and I did not retrieve her lunch from Burger King.  She ordered Chinese delivery instead.
She also smokes, but that's another story.
The maximum recommended intake of sodium per day is 2300 milligrams.  According to the Burger King website, a double whopper contains 1050.  A triple whopper contains 1110 milligrams.

Tuesday, May 22, 2012

Designer Duds on a Budget?

One of the health care attendants wears designer jewelry, sunglasses, sneakers, and clothes to work.  My apparel, in contrast, is usually $20 scrubs.  Her favorite is a Cartier watch like the one in the picture.  I know this because she tells me and shows me many times a day, pointing out each diamond with her manicured nails, and adds that others are so jealous of her.  How does she have the money?  She also wears sneakers by Coach.  I didn't know that they made anything other than purses, but they do.  She wears Coach on her feet, even though we sometimes step in some nasty substances.  I never know exactly what this attendant is going to say.  I can only predict that she takes any situation, no matter how far removed from herself personally, and makes it into a display of jealousy by others against her.  She has not turned on me, at least not to my face, but I don't trust her.

Monday, May 21, 2012

Postponing Retirement

I work with a lot of people who are in their 60s and 70s who could retire but do not.  After working for the company 25 years and attaining at least 55 years of age, a worker can retire with a pension.  Yet they don't leave.  One woman explained to me that the pension is not enough for her to survive.

"You could get another job and still collect the pension," I ventured.  "You would probably be taking in more money that way than you do now."

"No," she replied, "There's no way I could find another job where I do nothing."

That sums it up, folks.


If you continue working, you slightly increase your pension by a small percentage for each year of continued employment.  The problem is that you could be collecting that pension money for not working at all.  By not retiring, employees increase the yearly pension by a thousand, maybe, but they lose $25-$50,000 each year.  When they finally do retire and start collecting a pension, they need to live a certain number of years before the delayed benefit "breaks even."  See this link by Schwab for an explanation of this calculation using Social Security benefits.

I don't know if I will last 24 more years at this place and what my situation will be at that time, if I can make it.

Sunday, May 20, 2012

Wedding Invitation


I was invited to the wedding of another nurse!

Not everyone hates me.  This is good.  Actually, great.

Saturday, May 19, 2012

Funeral Money

Another practice at this facility is collecting money for funerals.  Spouses, mothers, fathers, children- at least one family member dies each week.  An obituary is posted by the time clock, which is my warning to be especially elusive.  In the beginning, I contributed $20.  This quickly added up.  I was trying to fit in, to get them to like me.  What happened was that they took my money and then bad-mouthed me behind my back.  I no longer contribute.  I usually don't know the person.  I also figure that no such collection would be made on my behalf if a member of my family died.  I don't even plan on telling them when I have a death in the family.  I will just call out sick for a week and have a doctor write a note.

Friday, May 18, 2012

Late

Another aspect that strikes me about the current workplace is lateness.  I was cautioned about lateness during orientation.  Must be punched in before 7:00 a.m.  Any punches from 7:01 a.m. are considered late and will be written up.  Like the stupendous worker that I am, I am always on time and report to the unit before 7 a.m.  My coworkers seem to be late.  Rarely arriving to the floor before 7:15.  Why do they not get in trouble?  I found out.  They punch in before 7:00 and leave.  They get coffee or return to their cars or sit down and talk on their phones- but they do not scurry off to the floor as I do.  And the supervisor?  Why is she not on top of this?  Because she is doing the same exact thing.  I watch her do it several times a week.  (Somehow my schedule lines up exactly with the schedule of the Supervisor from Hell.  More on her in future posts.)

The result is that I receive report and count from the night shift.  I can't do both at the same time, which leaves one night nurse huffing and puffing that I am holding her up, preventing her from seeing her children before they leave for school, and otherwise destroying her bucolic life.  No mention of the other nurse or nurses who are SUPPOSED to be on the floor, relieving her.  I am solely blamed for the night shift leaving late.

In addition, the late day shift nurses spend the rest of the day blaming me for oversights, explaining that I did not give them the report.  I finally told one that she misses the report because she is late.  I thought she wouldn't be able to wriggle out of this true claim, but she did.  She responded, "I'm not late.  You are early."

Thursday, May 17, 2012

Gossip


The corporate culture in my current workplace is very different from my previous jobs in many ways.  One of the most obnoxious operations among the employees is gossip.  They don't sit around and gossip.  They do sit around, but talking or communicating with others is not usually seen.  I don't actually see or hear others gossiping.  What strikes me is that different people come up to me and inform me of rumors about me, as if this is acceptable behavior.  At this place, it seems to be.  The informants are not concerned that there are rumors or about the content of the rumors.  They initially claim interest in confirming the rumors.  Gossip is known (at least to the outside world) for its inaccuracy.  At first, I denied the rumors, only to be met with "Well, that's not what so-and-so said," as if a person I've never heard of would know more about me than I would.  The rumors have become bolder and in poorer taste, so I disregard the inquirer or state, "Don't worry about my business."  A popular response is "I'm just trying to help you," when I know that they are not.

One of the popular rumors is that I am sleeping with -insert male name here-.  "Concerned" individuals told me that they "know" the rumor is "true" because they saw me "talking" to him.  "I can't talk to people who aren't out to get me?" was my thought, which I soon realized was true.  The rumor mongers do not want me talking to and befriending anyone who is not their ally in their plot to get rid of me, or at least make my time miserable.

Nobody’s Friend
My name is Gossip.

I have no respect for justice.

I maim without killing.

I break hearts and ruin lives.

I am cunning and malicious and gather strength with age.

The more I am quoted the more I am believed.

My victims are helpless. They cannot protect themselves against me because I have no name and no face.

To track me down is impossible. The harder you try, the more elusive I become.

I am nobody’s friend.

Once I tarnish a reputation, it is never the same.

I topple governments and wreck marriages.

I ruin careers and cause sleepless nights, heartaches and indigestion. I make innocent people cry in their pillows.

Even my name hisses. I am called Gossip.

I make headlines and headaches.

Before you repeat a story, ask yourself:
Is it true?
Is it harmless?
Is it necessary?
If it isn’t, don’t repeat it.

~ Author Unknown

Wednesday, May 16, 2012

Paperwork

Lots of paperwork.  I spend more time with papers than people.  Every interaction with a patient has to be kept as brief as possible in anticipation of all the paperwork created by even the slightest encounter.

They have invented another form.  Like most other new forms, this form is IN ADDITION TO and not IN REPLACEMENT OF other forms.  This new form also requires an additional signature- that of the Medical Director- who is not on the grounds 24/7 and is not readily findable when his car is in his parking spot.  [Can you tell that I am already sharpening my medical director locator skills?]  What is the new procedure?  We must get his signature for all narcotic refills "to keep track of where these drugs are going," my supervisor explained to me.  For those of you who are not medication nurses, let me clarify for you:  every narcotic is already signed for by the nurse removing the pill; the date, time, and patient are also recorded on this existing form.  So there is already an uncriticized system in place for tracking the dispension of lorazepam, zolpidem, and assorted other controlled goodies.  Now I have to get coverage for my patients and leave the floor every day to track down the medical director so he can sign that I am reordering the medications just as I always have been.

Tuesday, May 15, 2012

Thank You

A visitor to the unit told me sincerely, "Thank you for taking care of every single person."

She meant not just the patients, but their family and friends as well as my coworkers.  That is what I do.

Isn't that nice?

Monday, May 14, 2012

Support Staff: The Ward Clerk

This facility has unit secretaries or ward clerks, depending on how a particular one likes to be called.  I'm not comfortable telling people what to do, even though, as the nurse, I am the one in charge.  As I have been writing, I don't have any backing in this place, so if I annoy a clerk and she takes it up with administration, I'm the one in the wrong.  The clerks don't seem to be skilled in the areas of organization or efficiency.  Am I being too kind?  Could I dare say that they could all be let go tomorrow, saving the company lots of money, and none would be missed?  If one does happen to answer the phone, the next words after "Hello" are, "Hold on, I'll get the nurse for you."  No matter who is calling and what they want.  You can't tell them that you can't make it to the phone or to help the caller themselves.  They sit wherever they are, hollering, "Nurse!  Nurse!  Oh my God, why isn't she coming to the phone?  Who does she think she is, keeping people waiting?"  Never mind if I am trying to finally grab a bite to eat, or in the bathroom, or even with a patient.

I gave up asking them where certain forms are.  Their usual response is, "Why are you asking me?  YOU'RE the NURSE!"  Or, "Why are you asking me?  I don't carry this stuff around in my pocket."  Not a single one uses a computer.  The company is slowly computerizing everything, so any clerical job that is now computerized becomes the nurse's job.

I think that they have everyone so well-trained that the clerks can feel confident that their job description is to eventually show up, drink coffee, sit around, disappear, and return by 3 pm to punch out for the day.  Am I being too critical or too kind?  I could not get away with this behavior at this facility.  Why are they such a protected class?  Secretaries can be the backbone of an office.  Not in this place.

Sunday, May 13, 2012

You stay on your side of the unit . . .

Today went well.  This doesn't mean that I am on someone's good side.  This means that I did not feel so powerless.  I am still trying to fit in at the new job, even though it has been a year.  I worked with another nurse today.  She is older than I am, from a different country, and has been a nurse longer than I have been alive, or so she tells me.  I had worked with her two times in the past.  The first time was horrible.  She criticized everything I did, even though I felt that I was doing nothing wrong.  If I asked for clarification in an attempt to be professional and work through our issues, she retorted that I was "disrespecting" her and calling her a "liar."  That experience was not unique at this facility.  Most of the other nurses are very critical of me.  I tend to be non-confrontational in all aspects of my life, so I kept to myself and hoped that they would stop.  They didn't.  The second time I worked with her, my strategy was to stay away from her, which worked most of the day.  When she did criticize me, I kept my response brief, yet challenging, I felt, by saying that I am required to do [insert action here] by the supervisor and that she should call her to see if we could do it differently.  For some reason, she did not call the supervisor on me.  Why don't I go to the supervisor?  Because she is not on my side.  Other nurses are quick to complain to her about me, and her response is usually along the lines of "why is it that you can't get along with anybody?" and never reaches the substance of the complaint.  It's why I float instead of having a permanent assignment.

Perhaps today went better because I stood up to this nurse previously.  For the record, I have been pushed too far by other nurses and have fired back- and it blew up in my face and their aggression has worsened.  Maybe she is one of those people that pick on others because she can.  If I fight her on every negative word and act, maybe she'll find it too much of a bother to continue going after me.  She won't like me, but I don't see us becoming friends anyway.

I have considered that I must be horrible if most of my coworkers think that I am.  But the care of the patients tells a different story.  Three patients were waiting for me to float to the floor all week so that I could help them with different issues.  All of the problems were created by errors from nurses on the day shift and missed by the nurses on the night shift on chart check.  I was taught that you cover for other nurses.  I have done so my entire career.  Said courtesy is never applied to me at this facility, as you may have guessed.  I have to dot my I's and cross my T's because if I get caught with an error, administration will go after me.  Always quick to jump to the conclusion that I am up to no good, the supervisor noticed my frequent absences from the floor as I secured missing medications from the pharmacy.  I responded, "You are right.  Be sure to let Nurse So-and-So know that when she mixes up orders, it creates a lot of work for me."  Not only am I expected to cover their mistakes, but I am expected to be speedy about it without any fuss.  I will assure you that the supervisor's limited understanding of English, combined with her desire to sabotage, ensures that the words I uttered will be twisted and conveyed to others interested in getting rid of me.

Yet today was one of the better days.

Saturday, May 12, 2012

The Start of the Shift

I have to pass through a certain floor to get to the supervisor's office in the morning for my assignment.  I float.  A particular nurse on this floor does the same routine every morning.

"Great!  You're here.  Let's count," she exclaims.

I'm done explaining to her on a daily basis that I am passing through to get my assignment and not taking the floor from her.  As I walk on, the nurse jumps on the phone and calls the supervisor.  As I arrive in the office, the night supervisor is on the phone listening to the above nurse complain that I walked past her, ignoring her, and refusing to count with her.  The supervisor then nastily says to me, "Why are you always so rude to her?"

I don't know how to handle this anymore.  The nurse wants me to relieve her.  This I cannot do.  I cannot walk onto a floor and take the assignment without authorization from the supervisor.  Both she and the supervisor know this.  Yet anything short of relieving her will be met with accusations of rudeness.

Sometimes I am assigned to her floor and have to relieve her.  When I return to the floor and tell her that I am her relief, she carries on about how I ignored her, held her up, prevented her from getting home to her children in time to serve breakfast, and on and on.

This is how my day starts.

Friday, May 11, 2012

New Job

Hello All.
It has been a while.  I work at a different facility now.  I'll leave out the specifics so I can share the juicy details.
After three and a half years, I left long term care/nursing home setting and the night shift.  I work days at a facility that has a much better staff to patient ratio.  I have been at this new place about a year.  I have learned so much and encountered some colorful characters.
Although I find it very difficult to awake at 5 am to arrive by 7 am, I am more rested because I can sleep at night.  Trying to sleep when the sun is brightly shining is not easy.
The pay is slightly less, but I have better health insurance, a pension plan, and a lot of paid time off- which the staff takes.  I try to focus on the positive each day, but I will divulge the negative here as well because so much of it is unbelievable.