Saturday, June 30, 2012

I did what?


Something happened a few days ago and it pleased me as well as bothered me.  A lot.

I went out for drinks a few times with some coworkers.  They initiated each time.  I was trying to be social and not appear stuck up, which is a common complaint about me.  The problem is if I say nothing, I am "stuck up" and "too good" to talk to anybody.  If I say something, it is construed as nasty or condescending.  So when they first asked me to join them, I faced a tough decision:  Say "no" and be called "too good" to join them, or say "yes," have a miserable waste of time, and still be bad-mouthed.  As you may have concluded based on the readings here, I am not good at politics in the workplace.

Having someone at work who doesn't hate me would be nice.

I survived three outings.  I was so good, or at least I thought I was.  Most people love to talk about themselves, so I gently steered their talk to topics and let the pontifications take over the evening.  My responses were limited to, "I see," and "Tell me more."  No judgments.  Nothing of substance from me except about the weather:  "The weather today was beautiful."  None of these people were perfect, and neither am I, and it was only drinks after work.  Nothing to stress about, right?  Wrong as usual.

Last week, a coworker who was unable to join us asked me who else had gone.  I told him.  According to a woman we'll call "Aimee," I ommitted her name from the list.  Aimee confronted me a few days ago, accused me of the ommission, and asked over and over, "I just want to know why."

I vaguely recalled the brief exchange with the other coworker.  "If I didn't mention your name, it was not on purpose."  I could tell by her tone as well as her raising the subject that nothing was going to satisfy her.

"IF?" she snorted.  "So now he's lying?" 

See how they twist my words?

"I didn't say anyone was lying," I proceeded cautiously.  "How can I fix this?"

"You can't!" she screamed back, loud enough for anyone and everyone to witness that I was making yet another person very unhappy.  "I am so offended.  And all the people I told, they are also so offended for me."

Great.  She had told a bunch of other people and was now reaching others live through her screaming.  I had to contain this.  "Do you want me to tell the other person that I accidentally did not mention your name and that you were indeed present?"

"He knows I was there.  I had already told him I was there.  That's why he and I were both so offended when you didn't say that I was there."  She stood there staring/glaring at me, brows furrowed, shaking her head in disbelief.

Why don't I get to be the offended party?  Her complaint was ridiculous.  If the coworker was already told who was there, why did he ask me?

I wasn't going to win or even spin this into quietness.  I had to leave the area.  "Thank you for letting me know this," I said as flatly as possible.  "I have to get back to my floor."  I smiled after I turned away.  A big smile; I couldn't help it.  I could hear Aimee screaming about me as I walked, but I was happy and thankful.  Why?  Because I can see the situation more clearly now.  None of my coworkers likes me.  Nobody.  Most are outright rude, so I know that they are dangerous.  The confusing area for me is the murkiness of the others who either appear neutral or even friendly.  I must now hold all of them at a distance.  I don't have to attempt to socialize, appear nice, try to be a "team player."  They not only won't think better of me, they will despise me even more.  Aimee may have had mild feelings of dislike for me, but my attempts to socialize with her turned her dislike into hatred.

Was I forewarned?  In a way, yes.  Based on the stories that Aimee told me, she enjoyed drama in her otherwise vacant life.  That is why I was so cautious with her.  I don't feel that the errant listing was the real cause of her strife.  She wanted an excuse to go off on me and create the drama she craves.  Her explosion not only helps me see other coworkers for who they are, but also relieved me of another conflict I was having.  Aimee has several life events planned for the rest of the year, which probably contribute to her stress:  she is having a baby and getting married and buying a house.  This does not excuse her bad behavior.  I was concerned that I had to give her [expensive] gifts for all of these events, lest I be considered unfriendly.  Her severence of our fragile tie means that I don't have to give her anything.  This was another reason why I was happy.

I am bothered by her explosion because I don't know how far she will take this perceived slight.  If she tells her story of great offense just as she told it to me, she will sound ridiculous to a normal person.  But we don't work with normal people.  They don't need the facts; they just need the hurt feelings to run around and destroy me more.

Thank you for reading this rather long post.  It's not that I thought Aimee would be my new best friend.  She just caught me off-guard when I thought I was guarding myself well.

Wednesday, June 27, 2012

Running Interference

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I was working when a patient had a medical crisis, the details of which are not important here.  The supervisor responded to the Code.  To observe her behavior, you wouldn't know she was a nurse.  You wouldn't know she was a human being.  She ran around the entire time, telling everyone she could find a long list of errors she was observing and asking if they would like to register a complaint with her.  People were looking at her strangely.  She got a hold of a few patients and tried to convince them to approach me about their lunch selections, as if I was their waitress, it was anywhere near lunchtime, and I was not busy trying to save a patient's life.  When the patients advised her that I seemed busy, she responded, "So are you telling me that you wanted this nurse to help you with a simple task and she refused?"

As the floor quieted down, I was able to approach the desk to start to put the pieces together.  The supervisor was answering the phonelines.  "So you called and called and the nurse never answered?  No, there is no problem on the floor to explain why she was ignoring her phonecalls.  I will speak to her about this."  (Remember that the clerk does not have to answer the phone, even in an emergency.)  I walked over to the supervisor and said, "Are you talking about me?"  She wouldn't even look at me and kept repeating, "I will not discuss this with you.  I told you.  I will not discuss this with you."

I think that I'm ready to call this Workplace Bullying.  This is coming directly from my supervisor.  She is more interested in harrassing me than providing for patients.  In this situation, her behavior directly interefered with patient care.

Sunday, June 24, 2012

Gone like a Dream

I worked a "double."  Two eight hour shifts.  For the second shift, I was assigned to a light unit and was the only nurse- at first.  I have to hand write two types of forms:  the signature log sheet/patient accounting and the assignment sheets.  All of the attendants and I signed the log sheet.  I wrote out the assignments and the attendants signed those forms.  I then completed the first round of due medications.

About two hours into the second shift, another nurse walked in.  Her outfit resembled a prom dress gone wrong:  ruffles, sequins, high heels.  Some poofy feather thing sticking out from the back of her head.  Not kidding.  No scrubs for this woman.  She was the walking dead.  She works two full-time jobs.  And she isn't nice and doesn't like me.  She tore up the log sheet and assignment sheets and rewrote them.  She had the attendants sign new sheets and then hid them.  I didn't realize that she had done this until the supervisor (nasty man) came for them and I caught a glimpse.  I am not sure what the repercussions are for my signature missing from these forms.

A patient vomited just before supper.  (Again, what is sexy about this job?)  I attended to the patient while the other nurse slept at the desk.  Yes, she was asleep.  Head on her folded arms at the desk with the patients whispering, "Shhh!  The nurse is sleeping."  I documented the sick episode, including the color, quantity, and consistency of the vomit.  Later, the supervisor returned and they quietly conferred at the computer.  At her request, he erased what I typed on the computerized report.  She does not know how to use the delete or backspace buttons.  If she doesn't like what she has typed, she hits the Enter button until the undesirable characters are at the bottom of the page.  I watched them erase my entry.  The nurse then called over an attendant and asked her to describe the vomit.  The attendant kept looking at me while she spoke.

This is the type of hostility I deal with regularly.  This particular nurse was very quiet about it, while others shout and complain the entire night if I touch the computer or leave my mark anywhere.  Given this nurse's lack of computer skills and penchant for sleeping instead of working, you can guess that patients prefer me to her.  I can't complain to the shift supervisor- he was the one who helped her erase my documentation from the report, as if I had no right to document.

Thursday, June 21, 2012

No Phone = Peace

The day went well.  I worked with a per diem nurse.  He knows how to duck out of everything, but not like the others.  The others come across, to me at least, as just plain lazy and sly.  This guy does his part of the work and the rest is "I don't know" as he retreats.  He tells me every time we work together to stop working so hard.  Others have told me this, but when they do, it feels like they are saying, "Stop doing so much work because you make me look bad."  When this guy tells me to stop working so hard, it feels like, "Stop doing so much because it doesn't matter."

The clerk showed up in the morning and was missing most of the day.  I asked her for something and she replied, "Now just because the head nurse isn't here doesn't mean you get to give me work."  Her tasks on the unit consisted of drinking coffee and talking on her cell phone.  I took her lead.  I didn't answer the phone.  She's not an island.  Her work, or lack thereof, affects the rest of the unit.  Her work, such as answering the phone, naturally falls on me.  This day, I decided that just because she chooses to not do her job does not mean that I have to.  Plus, most phonecalls are ridiculous and don't require a nurse, nevermind me specifically.  I did accidentally answer the phone- someone was on the other line when I picked up the phone to dial.  It was a clerk from within the hospital who wanted to know how to spell a doctor's name.  "I don't know," was my reply.  She persisted, "Can't you look it up in a chart?"  "No," I answered, "We don't keep names of doctors in charts.  Names of doctors are in the directory.  Perhaps one of the clerks could help you."  "I am a clerk!" she snapped.  "Well, there you go," I answered flatly, "I have to get back to patient care," and hung up.  The phonecalls are simply someone wanting to shove their work onto me, so my day went more smoothly when I let the phone ring and ring.

Only two people bothered to come to the unit when their calls went unanswered.  One was from medical records, looking for charts.  "I don't know where they keep charts for discharged patients.  Maybe medical records could help you with that," was my reply.  "I am from medical records!" was the response.  She actually expected me to rummage through piles of unfiled papers [job of the unit clerk] while she stood there staring at me.  The other visitor was the shift supervisor.  "You don't answer the phone?"  "No," I replied, "The clerk answers the phone."  "She's not answering my calls!" was the nasty response, implying that I should be doing her job.  "Speak to her, then," was my reply as I strutted off down the hall.  Most supervisor will not go down a hallway, so it's a sort of safe zone for me to hide.

Wednesday, June 20, 2012

Is it the blood or the vomit?


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Could someone please explain how nursing is sexy?  Does the blood and vomit just sound glamorous to an outsider?

Tuesday, June 19, 2012

Queen Bee's Husband


Queen Bee's Husband husband was no prize. As I previously wrote, she was the secretary on the Unit from Hell and he was a shift supervisor, which was a necessary arrangement to protect against the disrespect of people like me.

Anyway, Husband ignored patients. Walked right past them. He was overly friendly with the employees that he liked/was related to. Hugs, kisses, laughing. For everyone else, he screamed. About nothing. In front of other employees, patients, visitors. I did try to complain to Administration. "Put it in writing." I did. He became worse. "I go to Nursing Board and lie on you. You lose license. You no mess with me." I complained to union. "He's still doing that? We wanted him to attend anger management, but he yelled so much that we backed down."


Monday, June 18, 2012

Unit from Hell: Drone

The other nurse on the Unit from Hell could be nice.  Maybe if we worked together somewhere other than the Unit from Hell, things would have been different.  The problem was that I was the outsider and unless she wanted to incur the wrath of the rest of the unit, she had to side with them and go against me.

The job was very challenging to her.  It took her about an hour to hand write a note in a chart- without interruptions.  When computers were introduced to the facility, she was completely overwhelmed.  I wasn't allowed to access the computer.  "We can do it.  You don't have to show off on the computer also," was the explanation from the Princess Nurses.  In practice, they couldn't work a computer, so they didn't; plus, keeping information away from me was a tactic to maintain their power.  So Drone Nurse was usually assigned the task of the computer work.  Drone preferred that I do the computer work (and all the other work), but she couldn't get caught speaking civilly to me.

She would need my help in locating S on the keyboard, turning on printer, finding the clicker (mouse), getting rid of the screen saver, etc.  She didn't seem to pick up any computer skills and she grew more frustrated daily.  Eventually she started asking me to type entries, which I did in minutes.  Silently.  Without comment.  Instead of solidifying us, she grew resentful of me and would remark, "It's so easy for you.  You just love showing off your fancy degree, like you're better than the rest of us."  She viewed my assistance as insulting.  So I stopped helping.  I avoided her when possible.  When she did manage to corner me and ask for help, I would refuse, citing that I was busy with another task.  So she started involving the shift supervisor for my refusal of TEAM work.  I couldn't win.  One day, I was admonished for not helping others on the computer and that I should be "grateful that you had a privileged upbringing with computers" while they did not.  (Never mind that I was not privileged or brought up on computers.)  The next day, I would be admonished for "assuming that others have no education and were raised without computers."

Even the drone had to be a Queen over someone.

Sunday, June 17, 2012

Happy Father's Day


Father's Day at the psych facility is somber.  The male patients fall into two paternal categories.

In the first category, they have children, but are alienated from them.  They often created families in their 20s or 30s during brief periods of stability.  The schizophrenia was relentless, causing them to be institutionalized while the children were young.  The children did not bond with their fathers.  Time passed.  The father remembers the children as youngsters, even though they matured into adults.  In their adult form, the children are not recognizable to their fathers.  This is very sad to watch an adult child attempt to assert the parent-child relation with a father who can't quite place the stranger claiming to be the five year old child playing in the father's memory.

The other category is comprised of men who never created families because they were institutionalized or too unstable to form relationships.  As time passed, their parents died.  They usually have siblings or cousins who remember them and some still visit.  There are nieces and nephews, but no bond to these new members of the family.  As children, the nieces and nephews did not visit the scary asylum, and if they did, they were too terrified to return or want to establish any relationship to their uncle.  The nieces and nephews grow up, but have no relationship with their aging uncle, so they do not visit.  The newer generations may never have met this secluded family member, leaving him essentially without a family.

Saturday, June 16, 2012

Unit from Hell: The Queen Bee

On the Unit from Hell, the Queen Bee was not the unit manager.  The Queen Bee was the unit secretary.  This might seem strange to an outsider.  Actually, the entire scenario is incredulous.

The unit secretary was married to one of the shift supervisors.  I was the only one who thought that this might be an unfair arrangement.  To others, this arrangement solidified Queen Bee's position as Queen Bee, in spite of the outward appearance of having an employment position of low power.  When I was new on the unit, I did things like ask the unit secretary where stuff was, which was considered highly disrespectful.  I was told that I was not supposed to speak to her unless she spoke to me first AND wanted a response from me.  I didn't get it at first.  I tried to explain that I was the nurse and in charge of the unit, which included the unit secretary, and that I needed her to answer the phone and maintain some kind of organizational system on the unit.

Because she was not the Queen Bee, the Unit Manager had to maintain a subservient role to the unit secretary.  So the unit was under the hand of someone who not only was not a nurse, but had no interest in nursing, patient care, or customer service.  She was only interested in asserting her power.

The unit spiraled out of control often.  Queen Bee would suddenly appear and call the nursing office, not for help, but to report me for not doing work, as evidenced by too many people screaming for service.  Her husband or a different shift supervisor would appear and make a beeline to me, no matter what I was doing, and then start lecturing me on how poorly I was managing the unit.  "The phone keeps ringing and nobody answers.  No attendants are on the floor.  The patients were supposed to be taken to activities ten minutes ago and they are still waiting."  Never mind that Queen Bee was supposed to be answering the phone.  Never mind that the other nurses were missing.  Never mind that the attendants who were supposed to be on the floor and transporting patients were also missing.  This was ALL MY FAULT for not managing the floor properly.  Never mind that nobody listened to me and that if I did tell anyone to carry out the above tasks, I would be reported formally and through the grapevine for disrespect.

Friday, June 15, 2012

Unit from Hell: Princess



The Unit from Hell was staffed by competing queens and one princess.

Princess was cute and stylishly dressed.  You would never know, based on appearance alone, that she was reporting to work as a nurse.  Tight blouses, cleavage front and center, glitter in the hair, makeup more apropos on a stage than a hospital ward, pants so tight it was a wonder she could breathe, and high heels to add four inches to her short stature, complete with perfectly polished toenails peaking out.  Long, vibrant nails on fingers decorated with gorgeous gems.  Dangling bracelets and earrings.  Thick gold chain necklaces with various baubles hanging from some of the strands.

The start of the day was Princess driving her brand new Lexus SUV, music blaring, into the fire lane next the hospital entrance.  With the motor still running, she would precariously jump out and solidly land on those high heels with only one hand to help balance herself, as the other held the cell phone to her ear.  She would wave and smile at some as she sprinted to the time clock.  Lines didn't faze her.  She ran up to the clock, punched in, oblivious to any shouts or groans from others, and turned and sauntered back to her vehicle.

About half an hour later, she would appear on the unit, cell phone still glued to her ear.  "Did you set up the report?" I would eventually hear her bark.  It was hard for me to distinguish when she was talking to me instead of talking to someone on the phone.  One of my many disrespectful acts against her, as far as she was concerned.

I resented setting up the entire unit and then have her stroll in late with everything ready for her.  Any problems discovered later were then blamed on me because she wasn't there.

Princess was related to many in Administration, or at least she had far closer relations with them than I did.  There were conversations about parties, celebrations, births, trips taken together.

Princess timed my breaks.  If she felt I was late returning from break, she had someone from Administration waiting for me when I returned to the unit, ready to lecture me on lateness and making Princess handle the unit by herself.  Princess, on the other hand, disappeared from the unit several times during the shift, but "That didn't count because it wasn't my scheduled break."

Her signature mark was perhaps not doing any work and then going to lunch around 12:30 or 1:00.  Around 2:30, she would call the unit and tell me, "I'm not coming back because I didn't really get a break today, so I'm adding it onto my lunch, which puts me past 3:00, so it wouldn't make any sense for me to return.  So-and-So said it's okay."

She also sabotaged me.  If I had a organized stacks of files, she would toss them about.  I thought I was going crazy until I saw her doing it one day.  I asked her why she would do that and she replied, "If you choose to get upset about a bunch of papers, that's on you."

If I scheduled a day off, she would go to the office and request the same day off and bump me.  She would proudly teeter up to me and sneer, "I'm just giving you the courtesy of letting you know that I also needed the same day off, so you can't have it because I have seniority."

She essentially became a decoration.  She had everyone trained- patients, doctors, hospital attendants, other nurses- to go to me instead of her because "That's not my job, it's hers."  On my day off, another nurse would be floated to the unit to cover, and would complain to me the next day that everything fell on them because Princess did nothing and then disappeared.  Anything that could wait until I got back waited until I got back.

People complained that I was letting Princess "get away with it."  What was I to do?  Administration was on her side.  Whenever she felt pressure to do any work, she called one of her buddies to come down on me that I wasn't doing enough.

That unit was hell.

Thursday, June 14, 2012

Wednesday, June 13, 2012

Another new nurse!

Another new nurse surfaced at the facility.  She was quiet and withdrawn at first.  She used her iPhone a lot; she even had the earplugs in when she was on the floor.  Gutsy?  Not to me.  Turns me off.  She needs to be very careful on orientation, unless she has friends in high places to bail her out if someone complains.  She said that this is her first job in psych.  This is strange to me because I hear over and over that only people with psych experience can be hired.  On a related note, I will say that every area of nursing, whether it be the Emergency Department, Operating Room, Labor and Delivery, treats patients with psychiatric illnesses.  No matter where a nurse works, it is impossible for her to not have patients with mental illness.

I like that new people are coming in.  So far, I think that all the new nurses and attendants like me.  As you read the blog posts here, you come away with the idea that a lot of my coworkers not only do not like me, they openly sabotage me to the detriment of patients.  I hope that the hiring continues and I can form a more stable network of coworkers who share my goal of great care for patients.

Tuesday, June 12, 2012

Hell


I remarked to a friend that I have to carry water bottles filled with ice to work so that I may have cold water to drink.  She seemed puzzled.  "They don't have an ice machine?"

"No, they not only don't have an ice machine, they do not even have freezers.  They have tiny cubicle refrigerators that don't seal properly and are warm anyway," I explained.  This is the first facility where there is no ice machine or even a freezer.

"Why don't you just let the water run and drink that when it gets really cold?" she asked.

"Even the tap water is warm.  You can let it run and run, but it never turns cold," I explained.

"No ice?  No cold water?  What is this place, Hell?" she asked.

I thought about it a moment.  Yes, it is.

Monday, June 11, 2012



A coworker is pursuing her MSN (Master of Science in Nursing) degree, concentration in Nursing Education, online through Phoenix.  She said that is costs $13,000 and takes 18 months.  She is one month into the program.  She said that it is very challenging and requires daily reading, writing, posting, and exchange of ideas.  The program sets her back financially, limits her time with her family, and increases her overall stress and anxiety.  Her days off are scheduled around tests.  On a different note, she is a nice person and a caring nurse, and I would like to see her in a teaching position because she will convey these qualities to Student Nurses.

I'm not advocating any particular program or school, I'm just putting this information out there for you.  I myself have been wondering how much the MSN costs.  I am great at writing a lot (see this blog?), so I don't think the daily writing and posting would be as problematic for me.  In my state, you need at least an MSN degree to teach any level Registered Nurse course or clinical.

Now here's my personal opinion:  where I work- the facility as well as the geographical area- there is no difference in pay or duties among Registered Nurses with a diploma, Associate's Degree, or Bachelor's of Science in Nursing.  Whether or not you are hired for a job is dependent upon one main, heavy consideration:  WHO YOU KNOW.  The nurse in the Phoenix program:  she will not get a teaching job around here unless she meets and maintains contact with the people who hire in the local universities.  Good luck with that.  In universities around here, only published PhDs and spouses of local politicians hold teaching positions.  This is not my coworker's lot in life.

If you wish to go into research, teaching, and/or advanced practice, then you need to pursue a doctorate level degree in nursing, such as the PhD or DNP.  Yes, there are Masters courses in various nursing disciplines, and if your state allows you to practice with just a Masters, then go for it.  Earning an advanced degree costs you time and money.  This is an individual decision, as some of us have more available time and money than others.  An advanced degree will not just set you back financially for the tuition and fees, but the time commitment will prevent you from working overtime and earning what may be a very nice salary as a Registered Nurse.  An advanced degree is not a guarantee to a prestigious, high-paying position.  There are lots of jobs for Registered Nurses, but very few for Advanced Practice Nurses.  Once you have an advanced degree, you may not find a job that requires the degree and you may shut yourself out of positions for Registered Nurses.

So if you do return to school, don't just learn the book stuff and practice new skills in the clinicals.  NETWORK, NETWORK, NETWORK.  Your peers, teachers, and proctors at the clinical sites hold the keys to your next position.  You can be very smart and able to insert and IV line into the most dehydrated 90 year old out there, but these are not the qualities that will land you a job, unfortunately.  You need to connect to people who hire.

Good luck to you and thank you for reading my opinion on higher education and jobs.

Sunday, June 10, 2012

I'm forever blowing bubbles


"Nurse, there's bubbles coming out of the floor," one of my patients told me early one morning.

"Pretty!" I replied and kept going.  Schizophrenia can cause patients to see things that are not there, termed visual hallucinations in medical jargon.

I was in the medication room getting ready to start the morning medications when there was the never-ending visitor at the door.  (For the record, nobody but nurses belong in the medication room.  I am in there to perform a necessary function and should not be interrupted.  There is a desk nurse whose job is to supposedly handle such interruptions.)

He was from maintenance and was there to "fix the bubbles in the floor."

I was perplexed.  Then he showed me how the linoleum sheet that is our floor was coming up in pockets, or bubbles.  I had tripped over these bubbles many times.

"Sure," I replied.  "Come back around 9:30.  I should be finished then," and returned to my prep.

"No, I have to fix it NOW," was his annoyed response.  Never mind that the floor has been like this for as long as I can recall.

"I need to be in here now for the morning medications," was my calm response.

"I didn't say you couldn't be in here.  I am going to fix the floor now.  We won't be in YOUR way," he replied.  As if the room was not six feet wide by six feet.  As if the carts I needed for the medications did not take up any space.  As if I was in this room for no reason other than a personal reason.

I shut the door.  Only I have a key, so they could not re-enter.  I called the supervisor from my cell phone and she said she would look into it.  I began the medications.  About ten minutes later, the supervisor arrived with some maintenance guys in tow.  (Please be aware that maintenance is in the building 24/7 and can fix this floor at any time.)  I heard the desk nurse in the background, "I don't know why she has to give everyone such a hard time.  You're only doing your job."

"Nurse, there is no other time that they can fix the floor.  They won't get in your way.  Remember, you need to get along with everyone.  Nursing is a team effort," the supervisor admonished.  I guess I am the one who always has to take a fall for the team.

They filed in with all of their supplies.  They just needed to remove the medications carts so they could work.  Answer:  No.  I need the medication carts to do my work, and you said you would not interfere.  Plus, we cannot leave medication carts unattended in the hall.  I cannot.  I was the only one who would get in trouble for unattended medications.  Not maintenance.

For two hours, they carved up the floor, placed new floor, sutured the pieces, gabbed on their phones, played music.  I could barely hear my patients as they lined up for their medications.  I moved about furiously, tripping over them, their tools, spilling liquids and dropping pills all over the room.  They were quite annoyed, but continued until the job was complete.  The floor looked horrible, all cut up, with the new, shiny pieces sharply contrasting with the old, worn pieces.  The edges were already coming up so I could trip over them instead of the bubbles.

As they were vacating the room with their supplies, I made a point of grabbing my bag and turning off the light as I followed them out.  "You're done?" one of them asked.

"Yes," I replied.  "I'm only in there about two hours in the morning, and then the room is free until noon, when we have to do lunchtime fingersticks and insulin."

A few of them stood there, trying to process this information.  "Maybe we should have just waited until this time," one of them ventured.

I said nothing.

Saturday, June 9, 2012

Other Relations

He noticed the wedding ring on her finger.  It excluded him:  it was a closed circle.  It bound her life, the wedding ring, it stood for her life in which he could have no part.  -- The Rainbow by D. H. Lawrence


Not where I work.

Friday, June 8, 2012

Unit from Hell: Introduction


When I first started working at this new facility, I rotated a bit and then was assigned to the Unit from Hell.  That wasn't just my opinion.  This unit scored worse in everything:  patient fights, complaints from patients/staff/doctors/visitors, missing medications, medication errors, missing charts, missing documentation, no supplies, inaccurate census shift after shift, bug infestations, broken equipment, botched drills; and so on.

The unit manager had been out on disability for months and nobody was assigned to replace her.  The attendants used the lack of leadership and revolving door of nurses to do whatever they wanted.  I would see them hanging out on other units, smoking in the parking lot, wandering around the building- nobody could make them stay on their assignment.  If the unit was short on nurses or attendants, other staff would refuse to float to the unit because it was so bad, so the unit worked short quite often.

So administration jostled around some staff members and off I went to the Unit from Hell.  The new unit manager was a relative of a person in administration.  (One of those jobs where nobody knows what he does.)  She was hired before I was, but was a pretty junior nurse in the facility's heirarchy.  Her appointment as the unit manager upset other nurses who had more seniority, so they refused to float to the unit when we were short as a show of solidarity in the Rule of Seniority.  She was clueless about substantive issues in nursing, such as 127 being a critically low sodium level.  (Sometimes psych patients overindulge in water consumption, which lowers or dilutes the sodium level in the blood, which is dangerous because it can cause heart problems quickly.)  Her time was spent in a back room on her cell phone.  "When you become a mother, you'll understand," was her response to me if I went to retrieve her for an issue.  She would not come onto the unit or help in anyway, so I gave up on her within the first week.  She was always late, but "when you have children, you will understand why you can't get out of the house on time."

I tried.  I really did.  I lasted five months.  More to come . . .

Thursday, June 7, 2012

Knock, knock. Knock, knock, knock, knock, knock . . .

Work is an extremely busy and chaotic environment.  One of the more annoying aspects of my coworkers is that they interrupt and expect you to drop everything and do whatever they just told you to do.  I was drawing up medication from a vial into a syringe in the locked medication room when an attendant decided to tell me, as opposed to the nurse at the desk, that he was leaving the floor to go to his car.  In other words, not an urgent matter.  He banged on the door.  I kept my back turned and continued focusing on the medication.  He banged again but this time didn't stop.  This is very distracting.  If I draw up too much or too little medication, or the wrong medication, there could be serious consequences for the patient and I would be blamed- not the attendant.  When I finished drawing up the medication, I went to the door, syringe in hand.  "What's the emergency?" I asked.

"Didn't you hear me knocking?" he quipped, annoyed.

"Didn't you see me drawing up medication?" I retorted.  "Don't interrupt me when I am measuring medications."

"All you had to do was come to the door," he answered back.

"I can't concentrate on medications and answer the door at the same time," I tried explaining, but I knew it was useless.  The prevailing behavior at this facility, as well as all the prior ones where I have worked, is to interrupt the nurse incessantly while she is giving medication.  And it is the nurse's fault for not stopping the medication pass to deal with whatever non-urgent matter that does not need to be addressed by a nurse, yet someone else has decided to dump in the nurse's lap.  Examples:  clogged toilets, getting coffee on the breakfast tray when tea was specifically ordered, needing a menu of the new Chinese place that opened around the corner to plan for a lunch that is four hours away, and so forth.  It seems to be a crime against humanity if I delay someone for a nanosecond, yet it is perfectly okay for people to ignore me or keep me from doing a task.

"If you can't do two things at once, then you shouldn't be a nurse," was the reply.  This is my support staff talking.

"When you become a nurse, you can do two things at once and we'll see how quickly you lose your license.  What do you need?"

"I'm just letting you know that I'm going to my car to get something, since you think you're in charge," was the reply.  He turned to leave.

"No.  I AM in charge and you are not leaving the unit.  That was a non-urgent matter that did not justify interrupting me and risking a patient's safety.  I need you to assist with the patient so I can administer this injection."

"You can't tell me that I can't leave!" he roared and stormed out of the unit.

I have to go to my car is a code for I am leaving the unit to socialize on other units and will return when I feel like it.  This particular attendant comes and goes as he pleases, so his "asking" to leave was designed merely to interrupt and bother me.  The supervisor's position is that no patient harm results from his behavior, so I need to stop bothering him and let him do his job.  My point is that he does not do his job, regardless of what I do or don't say.  When no attendants are on the floor, I can't perform my specific nursing duties.  I have to cover for the absent attendants while my charting waits, orders aren't carried out, and phone calls are not made.  In the meantime, more work comes in and piles up until an attendant saunters back to the unit, defiantly observing that it was okay that he was missing because nothing happened.

Although I never thought that his particular attendant was a hard worker, he became so nasty towards me about six weeks ago when I was running the unit.  The usual nurses were out and I ended up becoming  a permanent weekend fixture because of a maternity leave.  He innocently asked, "Who's the charge nurse today?" and when I replied, "I am," he started disappearing.  When I approached him about his absences, he denied it, and then screamed for all to hear, "You're not in charge.  Let's get that straight right now.  I don't care what anyone else says.  I do not take orders from you, so you better leave me the hell alone, woman."  This uproar was met with praises from some of the other staff, such as "You go!  Who does she think she is, telling us we can't leave when we want?  She can't tell us what to do."  He was gone for most of the shift, except for brief appearances when he could be heard shouting similar sentiments to nobody in particular.  I knew I had no recourse with the shift supervisor of the day, so that Monday I tried my luck with the unit manager.

"You're in charge.  You are not supposed to LET them talk to you that way.  He doesn't say things like that to me, so obviously you are the problem."

I can't wait for that nurse on maternity leave to return so I can go to a different unit on the weekends.  This post turned into more of a complaint than I meant it to be.  It's just that certain other employees make my day so miserable because of their nastiness as well as their non-performance.  They interrupt and challenge me to an altercation all day instead of caring for the patients.  This is so draining, distracting, and results in poor patient care.  The patients recognize what is going on.  They are quite observant.  They offer me support, but it is supposed to be the other way around.

Wednesday, June 6, 2012

Paperwork Calculation

Paperwork.  I’m good at it, but it keeps increasing.  In nursing, if you identify a problem, you then must implement an intervention, assess for efficacy, and keep trying until the problem is resolved.  And you have to document all of this.  Checklists for fall risk, pressure ulcer risk, involuntary movement scale, pain assessments, and so forth.  I spend more time documenting about the patient than I do with the actual patient.  This system supposedly ensures that there is a record of proper care.  But doesn’t the sheer volume of the record tell the reader that the nurse spent more time writing and typing than she did delivering care for the patient at the bedside?

We hold nursing education groups.  A list of attendees is no longer enough.  We have to document attendance, participation, and demonstrated learning on a flow sheet in the chart and in the nursing notes of each patient, in addition to completing a separate form for the entire group and sending this form to seven different administrative people.  Patients who refuse the group also need this documented in their charts (along with what the nurse did to try to encourage the patient) as well as on a separate refusal flow sheet, which needs to be sent to the physicians in addition to the seven administrative people.  The refusal lists triggers a flurry of phonecalls because where else would I be, if not at the desk next to the phone?  The 45 minute group is now cut back to 10 minutes to allow me to complete all of the documentation for the session.  The time had to come from somewhere, and the actual education time was the most apparent.  Administration seems more concerned about documenting that patients were educated than actually educating patients.

I have no doubt that if the nurse could spend more time with the patients and less time with paperwork, there would be less need for pain medication, sedatives, and fewer falls and injuries.

I consider myself a rather efficient and productive person.  This seems to be a set of skills that management does not possess.  They generate new mandatory forms every week, but do not take away any other required forms.  “We have to show that we are caring for the patients.”  All we can show is that we spent a lot of time writing.  The number of incidents and the overall dissatisfaction demonstrate that staff members do not spend a lot of time with the patients.

Tuesday, June 5, 2012

Music Therapy


This morning went well.  We played dance music on the stereo system the entire time.  We encouraged patients to dance and they did.  Even the ones who did not want to dance still tapped their feet.  It made the mood easy-going and friendly for everyone.  When a patient started to get anxious, we were able to redirect by getting them to respond to the music.

Monday, June 4, 2012

Team Nurse

The health care TEAM, as it is called, is a multi-disciplinary collection of professionals, such as the psychiatrist, psychologist, social worker, activity therapist, and nurse, gathered to promote the patient's health, welfare, and goals.  Where I work, some teams work well together, and some do not.

Nurses are also supposed to work as a team with other nurses as well as the hospital attendants.  I have the most miserable days when there is no teamwork, even if nothing seriously wrong happens.

When I am immersed in the heavy morning medication pass, I make a list of needed doctors and orders.  Most doctors tour in the morning while I am otherwise distracted and do not check in with me.  When I mention to the other nurse on the unit that Dr. So-and-so is needed to renew an order, and she replies, "Medications are your problem," this is not teamwork.  After I finish the medication pass, I have to call the doctor myself.  If the doctor has already checked in on the unit and left, I am usually met with an observation such as, "I asked Nurse So-and-so and she said there were no issues.  Don't you communicate with each other?"  I have now reached the point where I reply, "No, doctor, Nurse So-and-so and I do not communicate well."  I have demonstrated extreme competence in attention to detail in many areas, so I think that the doctors now see that I am a thorough nurse and some other nurses are . . . not as thorough.  They seek me out instead of certain other nurses because they know a task will be completed quickly and correctly.

I have also worked with a handful of nurses who work efficiently.  I love these days, no matter the workload.  While I am working, the other nurse is working.  If I ask if she has gotten to a task, the reply is not a snappy, "I am too busy" or "That's your job!"  Instead, if the answer is "yes," my reply is, "So what else needs attention?"  If the reply is "no," then I get to work on the task.  That is teamwork.

Sunday, June 3, 2012

Pain?



Patient:  "I need my Percocet."
Nurse:  "Where is your pain?"
Patient:  "Pain?  I don't have any pain."
Nurse:  "Percocet is for pain."
Patient:  "I did not know this.  I have pain from childhood?  Is that good enough to get Percocet?"

Saturday, June 2, 2012

Nurse Bullying


Do my stories about other nurses and aides depict bullying?  I think so.

Management is aware of the acts and ensures that they will continue by always siding with the other person.  Perhaps they view me as the bully- I by telling others what to do, I am being mean to them, upsetting them.  Never mind that they upset me, they are not performing their jobs, and I am the one in charge.  When someone complains about me, it doesn't seem relevant that they person readily admits to not performing a job duty; rather, the focus is on how I upset so-and-so.

Management is in position to intervene and stop the bullying in the workplace.  Where I work, management is week.  The supervisors bully personally and the reinforce the bullying of nurses and aides.  I am the outsider and they are creating a hostile and intimidating work environment to make me leave.

Friday, June 1, 2012

These Boots are not Made for Walking, But They will Walk all over Me

These boots look great, don't they?  One of the patient care technicians thought so.  She wore them today.  (PCTs do not have to wear scrubs.  They do have to wear sensible shoes.)  She walked around confidently, smiling ear to ear, taking notice of everyone looking at her.  We were hit with a sudden heat wave and maintenance can't seem to coordinate the air conditioning service with the actual weather, so the temperature inside the building was roughly the same 90 degrees it was outside the building.  If her feet were saturated with sweat, she didn't let on.  By noon, the flirtatious trips around the unit gave way to sitting in a corner.  I asked her to escort a patient to another department for a test.  "I can't," was her soft reply, along with her smile that wins everyone else over.  Not me.

"Why not?" I asked.

"Because my feet are killing me in these boots," she replied, leaning forward and stroking the soft black suede.  She gave me a knowing, softer smile, as if she were seeking mutual female understanding of painful fashion.

"Please put on appropriate foot wear and take the patient" was my reply.  She's at work in a health care facility, not a fashion show or nightclub.

She shot me a look of death.  Her feet were suddenly able to move enough to carry her off the unit, without the patient, and without telling me where she was going.

A short time later, she returned with the nursing supervisor of the day.

"Nurse, I think we've had this talk before," the supervisor started.  "You need to get along with the staff."  She stood there staring at me, looking defeated.

"I do.  They're great," I replied.  "While you're here, could you clarify an issue for me and the PCT who came in behind you?"  They both looked a bit surprised.  "She has informed me that her high heels have caused her so much pain that she is unable to carry out her assigned duties.  Should she change into sneakers or should I call the physician on call to examine her for a work-related injury?"

The end result:  The entire situation was MY FAULT because I LET her wear the high heels for half the shift instead of sending her at the beginning of the shift to the nursing office for wearing inappropriate footwear.  In the future, I need to show consideration for my fellow staff members and show them that I care.  (But I don't care that she wore highly inappropriate footwear and was in pain.)  There is no doubt that if I had told this PCT when she arrived [25 minutes late] to report to the supervisor for wearing high heels, I would have been met within the minute by the supervisor and criticized for harassing the PCT.  (The supervisor's response time is not as swift when there is a code.)

Thus established, the PCT spent the rest of the shift in an armchair, feet up in those high heels, talking on her phone.  She also left 20 minutes early so she could get to the time clock on time because she "can't walk fast in these boots."

Other staff members who were working grew angry with me for "letting" her do nothing for the rest of the shift.  I tried to explain that this edict came from the supervisor and that it was only fair, considering that I failed to guide her in podiatric safety.  They were not understanding.