Monday, December 16, 2013

The Writing is on the Wall



One of the patients had to come off one of his meds for bipolar disorder because of vomiting.  The gastrointestinal problems resolved within a few days and his mood swung upwards- where it remained for weeks.  The weeks were filled with endless, misdirected energy that wore out everyone around him.

One particular morning, after staying up all night creating a book of drawings, he started physically fighting several other patients.  We had to contain him as the instigator in a seclusion room under watch.  No, there is no padding on the walls.  Only a bed is in the room.  I checked before the patient went in.  I went on a break.  When I returned, I checked on the patient again.  He was giggling to himself as he was drawing on the wall.  The walls, door, ceiling, floor- all covered in graffiti drawn with colored pencils, crayons, and markers.  Not little "I was here marks."  Colorful, big, bubbly tags and sharper death threats against rivals.  Only twenty minutes.

I can't fault the patient.  I turned to the attendant who was watching him.  "How did this happen?" I inquired, even though the man was clearly on his cell phone in the middle of a conversation.

The attendant rolled his eyes and held up his cell phone to me, as if to emphasize to me that I was the rude one for interrupting his phone call.  "Well," the attendant shrugged his shoulders, "What did you want me to do?  Tell him to stop?"

"Yes!" I exclaimed.  "That is exactly what I wanted you to do!  That is why you are watching him."

The supervisor's response:  I should have chosen an attendant who would have actually watched the patient to watch the patient.  Also, administration will be very unhappy because this is destruction of hospital property.

So this man is excused from having to do any work at work.  They don't take into consideration that I had no attendants to choose from who would actually watch the patient.

At least the patient only hurt the walls, door, ceiling, and floor and not himself or someone else.  But the supervisor was right on one point:  Administration will come to the ward to investigate destruction of physical property, but never an injury to a patient or an employee.


Sunday, December 15, 2013

Suddenly caring about medication errors?

Medication errors are common where I work at every possible step.  Wrong chart, indecipherable handwriting, order written wrong in the first place, transcribed wrong, filled incorrectly by the pharmacy, and so on.  I pick up a lot of errors because I'm detailed and I like to do things correctly.  This is not the sentiment shared by most of my coworkers.  The only time they get excited about a medication error is when it can be blamed, rightfully or not, on someone they don't like.

So I'm working my usual floor, trying to discharge a patient home with his mother.  The facility provides a month of medication to take home, along with an appointment within the week with whatever doctor or outpatient clinic is going to follow the patient after discharge.  As usual, medications were missing because the doctor left off some medications on the order form and the pharmacy did not send half the medications that were actually ordered.  Nothing unusual.  And nobody checked the orders when made or received, so here I was, left holding the mostly empty bag.

I've learned to let it go.  The mistakes were made by many, not me, and are so commonplace that it's not worth raising my blood pressure.  I called the doctor to fix his orders and then called the pharmacy to deliver the remaining medications to the patient's home.  I don't know if this will happen, but the doctor and pharmacy tech seemed placated.

Evil Supervisor appeared at change of shift, which seems to be her favorite time to surface.  She started trying to lecture me on mistakes and that they cost the hospital time and money.  What?  Since when does the hospital care about wasting time and money, other than conserving money by not giving the staff a pay raise?  In the past, I have raised issues about mistakes, only to be told that I was being mean and that I was the only one who cared about such little details.

Saturday, December 14, 2013

Sanism prevents medical services

A patient has been trying to obtain copies of certain tests that were done at another hospital.  I didn't see the results in the paperwork that she came in with.  (I find that I establish a better rapport with patients by telling them about the results of their tests and giving them copies if they want.  It makes them less suspicious.)  I contacted medical records and they claimed they don't have anything that I don't have, which I doubt, but so be it.  I should be grateful that they even answered the phone.  I had the patient sign a release and faxed it to the other hospital.  Numerous phone calls, faxes, and weeks later- still no results.

The patient provided me some insight into her situation.  She said that she can't send a written request to the hospital after she is discharged because she is homeless and the hospital requires a permanent address to mail the copies.  She can't physically show up at the hospital because she is labeled as a "psych patient" and she will be locked up, even if she is behaving normally and denies complaints.  She said she has gone to every hospital in the area when she was in need of medical attention and now has nowhere left to go if she gets sick or injured because every hospital has her branded.  Regardless of her physical complaint, once the hospital finds out that she has an inpatient psych history, she is surrounded by staff and forced into the psych holding area and is detained until she is sent to the psych floor, where she is locked in anywhere from a few months to a few years.

"You don't understand!" she exclaimed.  I had not understood, but now I have a better understanding of this predicament that any person faces with a history of psychiatric care.  I hope you have a better understanding now, too.

I mentioned this to a social worker.  She had a similar story.  She said she was working at a hospital and called in to do an intake assessment on a frequent flyer on the psych floor.  He had presented himself to the emergency room and the report was that he was "evasive" with "slurred speech."  Upon seeing the social worker, the patient started crying and showed her his bulging face- he had a massive tooth infection and waited before seeking treatment, fearful of being locked up on the psych ward, still in pain- which is exactly the situation he was in.

Wednesday, December 11, 2013

Applying for extra per diem job

I applied for a per diem job.  The weekend rates at the place are good.  For some strange reason they are published online as part of the union contract.  We'll see if I get a call and if they don't try to shaft me with a lower rate.  A few of my current coworker nurses work there.  One of them left her purse out with the paystub sticking out.  She was getting that coveted high rate.  I hope that I don't end up in a snake pit identical to the one I'm in.

Ironically, the person who tipped me off about this high-paying gig was Jess, though she didn't mean to.  She referred to the high rates and asked why I didn't work there instead.  She was probably trying to get rid of me.

Jess could become a sudden, volatile problem.  She explodes whenever I work with her, which has not been often, thank goodness.  She was taken sick to the emergency room last month and was out for only a week, but rumor has it that she claims that she was poisoned.  The weekend she returned, she kept driving her car around the parking lot when my shift was over.  I took out my phone and activated the video feature.  I love these smart phones.  She pulled into the spot next to my car as I got closer.  I stopped and chatted with someone.  Jess leaned on her horn for a while.  Eventually she left.  I scooted to my car, quickly got in, locked the doors, and zoomed away.

I rarely take the elevators- they get stuck often.  Last week, I had to take an elevator with a doctor.  Jess was the only person on the elevator with us.  She froze when she saw me and looked as if she was about to cry.  Then she started to hyperventilate.  The doctor I was with paid her no mind because he was so engrossed in his own soliloquy about some miracle surgery in which he was the sole shining star.

I don't trust her to not do something to me.  She could be setting the stage as I type.

If I got a higher paying per diem position, I would feel better about the money situation.  When I eliminate the student loan debt, one paycheck will cover my living expenses and reasonable desires.  I wouldn't have to beg for overtime from the current place.  By doing overtime in the same place every week, I am burning out faster and exposing myself to extremely hostile coworkers on their turf while I float to cover.

Monday, November 25, 2013

A Nurse's Role: Medical Records Perspective

I was bounced around the hospital one day and passed by a room where a bunch of people were having a little party for a man who was leaving his position.

I started dreaming of an opportunity to transfer to an office job.

The man ducked out right after the toast.  I followed him to his office.  You have to stalk people for jobs nowadays.

He oversees the (chaotic) medical records department and was leaving because it is too, well, chaotic.  He had some fancy letters after his name, that looked like a certification, but not a degree.  So I asked.

He couldn't recall what each letter stood for.  He seemed confused as to why I would possibly inquire about such a position.

"You have to have a degree to do my job," he scolded me, miffed.

Now I was annoyed.  "I have a degree, a BSN," I retorted.

"A BSN?  What is that?  I have never heard of it."  He shook his head, as if I was spinning fantasy.

"A Bachelor's of Science in Nursing," I explained.

"There is no such degree," he continued, still not convinced.  "Nursing school doesn't give degrees.  You have to go to a college to get a degree."

Now I was the one who couldn't believe my ears.  "You read medical records and have never seen the letters after a nurse's name?  BSN, RN."

"I don't read nurse's notes," he huffed, as if doing such a thing was an insult.  "Regardless, a nurse could not possibly do my job because you need training in how to read a medical record, as well as training in health care and a degree in a medically-related field."

"What do you think nursing is?" I asked him.

He walked away.

I forget this.  Perhaps most nurses do.  Unless you are a nurse, you don't know what nurses do.  Here is a man who is employed in a hospital, reading records created and maintained by nurses, who has deleted the nurse's role from his mind.  I didn't ask what he thought nurses did at the hospital.


Sunday, November 24, 2013

Is your boyfriend good enough for you?

I have a patient who is bat-shit crazy.  Violent.  Sudden mood swings.  Talks to herself non-stop.  Long history of hospitalizations.  Resistant to taking most medications.  Currently on a monthly injectable.  Alienated her children.  She's so unrealistic and violent that most of the other patients know to stay away from her.

The strange thing is that she has a lovely male friend who faithfully visits her every weekend.  He seems learning disabled.  He is kind, polite, and patient.  He takes a few buses to get to the hospital.  He brings her goodies to eat and personal grooming products.  She was nice and happy when he was around.  She had reality-based, pleasant conversations with the staff.

A few weeks ago, she became more sexually preoccupied than usual, with some remarks directed at me, that I wanted her boyfriend and was to stay away from him or she would kill me.  I reported this change to her psychiatrist.  For my own understanding, I asked him why she was involving me in her sexual preoccupation.  I did not think that I was attracted to her boyfriend and figured that she was misinterpreting my politeness towards him as sexually charged.

The psychiatrist provided me with great insight into the patient's behavior as well as other women who have made similar claims.  The patient thinks that her boyfriend is a loser and she needs to prove to herself that he is not.

How did we get here?  The steps:

1.  Girlfriend is with boyfriend.
2.  Girlfriend thinks boyfriend is a loser.  Beneath her.  Not worthy of her.  She does not want this to be true.
3.  Girlfriend accuses another female of perceived higher status of being attracted to her boyfriend.  Promulgates this delusion by yelling at other female to stay away from him.
4.  Girlfriend now thinks that boyfriend is worthy of her because another female who is better than both of them wants the boyfriend.

The patient sees me as a far more desirable romantic interest than herself, so if I find her boyfriend desirable, then he is good enough for her.

This explanation has helped me so much.  It often takes a patient's raw, intensified emotions and behavior to clarify such patterns in non-institutionalized people.



Saturday, November 23, 2013

Secure no more

I arrived at work and the overnight security guy was leaving, early as usual.  His performance illustrates what I have been telling you:  people obsess over me when I hadn't even noticed them.

The guy came close, but not too close, just enough for him to justify using a loud voice in the echoing lobby.  "I have to talk to you," he said, all serious.  We have never talked before.  He's either running out the door or watching television when I see him.  He's an older guy.

I suddenly remembered why he would verbalize his interest.  The prior day, in his rush to flee, he tore out of his parking spot, which was in a fire lane in a walking area, and had to slam on his brakes to avoid hitting me as I walked towards the building.  Reckless driving is not unusual in this place and the blame is always on the person walking, not the driver.  By his tone, I knew he wasn't about to apologize, so I kept walking.

His rant began for all to hear:  "You made me late to my next job.  I had to stop to allow you to walk.  I didn't even know where you were going.  I'm trying to drive, and all of a sudden, you are in my way, walking towards the building.  I mean, how would anyone even know that you were there?  And what were you doing, walking in front of my car?"

I walked close enough to him to speak in a quiet voice to lessen the number of people able to hear.  "You almost killed me.  You were speeding on a sidewalk, doing 50 miles per hour when the speed limit in the parking lot is 5, nevermind the sidewalk.  And you have the gall to act like this is my fault because you didn't know where I was going?  Where do you think I going at ten minutes to shift change?  There is no other option other than the front door of this hospital."

I walked away.  He glared at me.

I really don't want enemies in security.  But this was a test.  I was either going to capitulate and accept his ridiculous blame or I was going to show him that I don't go down easy.  I think that I made him more convinced that I am evil and he is not the least bit put off about going after me again.

And now there are witnesses to attest that I harassed the overnight security guy.

Friday, November 22, 2013

Leave the rest behind



Take with you what you want and leave the rest behind.  ~~Sylvia Browne, rest in peace.


Why can't I just leave?  Things are not going to get better.

Thursday, November 21, 2013

Student Loans

This was my plan
I went to nursing school because I couldn't afford to pay the student loans from the first round of school.  I picked up nursing school loans and combined them with the old loans.  Ironically, I can't leave nursing because I need the $$$ to pay back the student loans.  I won't go back to school for anything else because I can't afford more debt.  When the loans are paid off, then I can leave nursing in favor of a lower-paying job that will hopefully be more enjoyable and not as violent.

Wednesday, November 20, 2013

Laziness training


Every now and then a job opening is posted.  I advertise it to my group in failed hopes of stocking the place with my allies.

Sometimes people are fearful that they do not meet the skills requirement of the position.  I forward this blip to them.

Tuesday, November 19, 2013

Your Majesty, your mop awaits

There is an attendant at the hospital that you would have to see to believe.

Someone else punches his time card.  Sometimes he does it himself, marches right back out the front door, gets into his car parked in the fire lane, and leaves.

Inside, when he actually makes an appearance on the ward, he does no work.  Nothing.  He sits in the break room, eating, reading the paper, talking on the phone.  If he does go onto the floor, he talks on his phone or reads the newspaper.

When I was new, I told him to do work.  At first, he smirked and kept reading.  When the supervisor made rounds, I attempted to discuss the situation with her.  I was the wrong one.  Someone pulled me aside and explained that this attendant was a KING in his village back home and that the supervisor is married to one of his cousins.  As the king and as a male, she must listen to him.  It is irrelevant that she is a supervisor and he is an attendant.

"So?" was my response.  The coworker was serious.

I tried informing my coworkers that the hospital is not this man's kingdom and that he needs to perform work to collect his paycheck and that if he didn't like this treatment, he could go back home to his loyal subjects.  Useless.

His reign is also the excuse given as to why he is always on the phone:  he is ruling his kingdom from afar.

One weekend, I was working with a very pregnant nurse from his kingdom.  Her c-section was scheduled in two days and she wanted to work until the end.  She was sitting in a rolling chair when The King came up behind her and grabbed the chair out from under her.  She fell directly on her butt and rolled over, unable to breathe.  I called for help and ran to her.  The King stood over us, laughing, not the least bit worried or sorry.  With the help of another nurse, we got her breathing again.  She wasn't bleeding.  As soon as she could talk, she said, "I'm fine.  It's no big deal."  The other nurse lashed into The King that he could have killed the baby.  He shrugged and walked off.  The pregnant nurse explained, "It's my last baby.  He's just upset because all my children are my husband's.  I'm not having a baby with him and he's just a little mad."  These are the people I work with.  Are they messed up or what?

Fast forward a few years later.  His Royal Highness still does not work.  I have managed to develop an effective mannerism where I tell him to do work and he gets very pissed off very quickly and storms out.  I'd rather have him gone the entire day than look at his lazy ass and smirking face getting paid to sit there and do nothing.  I can't stand to have him near me.  If he would attack his own pregnant countrywoman, imagine what he would do to me.




Monday, November 18, 2013

Mistakes

Every now and then I get bumped from a floor and sent to work in an administrative office.  It's clerical work, but usually done by a nurse.  The facility does not believe in hiring competent clerical staff.  The good nurses should do the nursing part as well as the clerical part because "everything is the job of the nurse."  So why do non-nurses receive a paycheck?  Cut the non-workers loose and give the nurses raises.

Working in one of the offices is not the start of a new career path.  It's a way to make sure that all of the errors in those offices, of which there are many mistakes, can be traced back to my one day worked in any particular office.  It's comical, really.  Except that my job becomes more and more jeopardized daily.

One of the perks of being in an office is that I get to read the facility-wide notices and email.  No, nurses and the wards do not get email, internet, or computer services.  And no, we are not in the middle of nowhere.  And no, the facility maintains that requiring medical records to be electronic does not apply to them.

The new director seemed hopeful a few months ago.  Now every email starts off with, "How could this possibly happen AGAIN?"  A few people respond, blaming someone else.  Nobody sees the same person as the problem.  Nobody sees the entire system as flawed.  My favorite response is the trendy, "My private response is in a sealed envelope under your door."




Sunday, November 17, 2013

Paranoid

Overtime has been scarce lately (for me).  I was fortunate enough to grab an evening shift one weekend.  The night nurse who relieved me said that they are very short on nights and can't find anyone to work.

I thought about it a quick second.  I really need the money at this point and night shift is a lot less work than what I usually endure.

The night nurse told me to call the office and ask if there were any spots for me.  So I did.

"Hello, this is Nurse ---.  Did anyone call out for the night shift?" I queried to the person who answered the phone in the office.

This set off an attendant nearby.  "Sheila!" he started screaming, even though it was night, lights were out, and the patients were trying to sleep.  "Sheila!  She's trying to get you in trouble for being late!"

Unbelievable.  I had not done a thing to either of them and here we go again . . .

"I know that Sheila is here.  I am trying to get another shift," I tried to explain to him.  He wouldn't listen.  He continued screaming, convincing Sheila that I had just reported her for being late when she was here the entire time.  Then Sheila started in on me.

I left without another word.  I couldn't even hear what the person on the other end of the phone was saying.

I chastised myself:
---I should have made the call in private, locked in the bathroom, to avoid anyone overhearing the wrong thing.
---I should have used different words, such as, "Could I have an overnight spot?" instead of, "Did anyone call out?"

In another vein, I am not to blame.  I said nothing bad about anyone.  The attendant took it the wrong, bad way and then dragged in another person.

Who is paranoid here?  I am paranoid that someone is going to go berserk on me for something I didn't do, so I am guarded and cautious.  But this really does happen.  The attendant is paranoid- listened in on my phone call and then twisted innocent words into a perceived attack.  I attempted a defense and then retreated while he kept attacking.

I do not know how to handle this anymore.


Friday, November 15, 2013

Of course it was good for you, too

An essential feature of my work culture is the casual hooking-up of coworkers.  I see it as another sign of their pervasive dysfunction and immaturity.

I have been propositioned by many of my coworkers, male and female.

Just the other day a male attendant tried (again).  This time he was more specific.  He wanted to travel the Khyber Pass.  No thank you.  He persisted.  I half listened, if only to prove to myself what I already knew:  he was selfish and dense.  He used the old standby, "You won't know if you like it until you've tried it."  As if I were born yesterday and this would be my first encounter with the activity.  As if I'm not a grown adult and can predict with relative certainty that any activity with him would be all about him.  His view is:  if he enjoys it, then the other party enjoys it.

If it starts out All About Him, don't anticipate that your needs will ever enter his radar.

This narrow, one-sided view can be seen at work:  he has nothing to do, so how could I have so much work?

Thursday, November 14, 2013

Do not disturb

Night shift is supposed to wake all patients up before day shift arrives and have them all lined up, cleaned and dressed.

Does not happen.

Some patients are natural risers and willingly perform hygiene.  Others are flying high in an episode and haven't slept or stayed put for days.

The rest have little motivation to begin with and are so doped up on pills that they aren't budging.  Add in their violent tendencies and the result is very few patients ready to go well into the day shift, as nobody wants to wake the homicidal maniacs.  (You can close all the psych facilities you want.  The worst of the worst still must go somewhere.  It's the least violent ones that get pushed onto the street.)

This has been an ongoing issue.  As the first day shift nurse on the scene, all subsequent arrivals- attendants, other nurses, supervisors- enjoyed blaming me for the hibernating patients.  "You ACCEPTED the floor like this!" was everyone's unsolicited complaint as well as defense for not doing anything themselves for the rest of the shift.

Now this is the strange part.  One particularly crazy and nasty day shift nurse has stopped blaming me and is instead blaming a particular night shift nurse, whether she was on duty or not.  They have a War of Writing back and forth on the Ward Daily Report.  They quote policy that each just invented to bolster their individual positions.  The day shift nurse spends most of the shift verbally kvetching about it or writing her new policy quotes.

Almost funny to watch.  I gave up getting any work out of her a while ago.

Wednesday, November 13, 2013

Lazy, part one


My coworkers are not only rude, they are downright lazy.  Using an unopened doorstop is something they would do- if we were allowed to order supplies and could get new stuff.

Tuesday, November 12, 2013

Anyone can make a positive difference

If you want to make a positive difference in people's lives, you can do that anywhere.  Not just in nursing.  You might make a difference in nursing.  As a nurse, you will probably deal more with paperwork and administrators than you will patients.

Still, the opportunity to touch people's lives is not restricted to nursing.  Whatever you do, you can make a difference.  Before I was a nurse, I held a variety of jobs in a variety of settings.  I remember that every day one particular elderly gentlemen used to come into the store where I was a cashier.  He enjoyed seeing people and it clearly made him quite happy to be greeted by name in a familiar manner by the workers.

One day, he came to the store, quite somber.  Although my line was particularly long at that time, he declined to have someone else ring him up.  When it was finally his turn, he was crying.  He had just come from the veterinarian's office, where he had put his aged dog to sleep.  He was so grateful for my kind words and a hug.

No matter your profession, your words and actions have an effect on those you come across.  You can make or break someone's day, no nursing license required.  You do not need to become a nurse to make a difference.  You can start right now in any setting.

Monday, November 11, 2013

Blessed Cursing

Or you could come work where I do.
My job is like the Twilight Zone.  The number of employees who curse out superiors is simply staggering.  Perhaps more surprising is that nothing happens to them!

I'm no fan of most supervisors, but I dance inside when one comes on the floor and is handed her ass by one of the attendants.  I love watching them resigned to retreat.  They slink away, trying to hold their head high, trying to catch my eye.  As I I'd help.  I'm not fooled.  The cursed-out supervisor is like a killdeer.  If I swooped in to help, she'd flutter up just fine and turn the situation around to my detriment.

Thursday, November 7, 2013

Mandatory Overtime

In lieu of a bright, attentive person maintaining a staffing schedule, or hiring more nurses, the hospital continues to resort to mandatory overtime.  Find the day shift short at 7:05 am?  No problem.  See who is around from the night shift and "mandate" them to stay.  Ditto for any shortness on the evening and night shifts.  If a nurse says she/he will leave anyway, threaten them with being fired and reported to the Board of Nursing for abandoning patients in order to revoke their license.

As you may have guessed, administration's favorite children have never been mandated.

I was mandated once so far, along with another nurse I was working with.  This is nonsense, especially because:

1- I have worked a floor by myself and this was not considered "short" by administration, so why can't relief be adequate when only one nurse shows up?

2- When my floor is relieved by at least two nurses, how can I be MANDATED to report to a different floor to work another shift?  I didn't abandon my patients- they were properly turned over to other nurses.  I then have to assume a different set of patients for another shift, providing relief to a nurse who could otherwise be charged with patient abandonment.

I need the overtime pay, but when I'm available to work.  I have other things scheduled after work.  Getting stuck at the job until midnight precludes me from getting to anything else and leaves me completely fatigued for days.  Splitting the shift so I could leave after twelve hours would be more palatable, but this is laughed at as a compromise.

Over the years, I have met [and worked with] several nurses who work Two Full-Time Jobs.  Over eighty hours a week.  They are zombies.  Inaccurate.  Short-tempered.

A natural consequence of mandated overtime is that the offended nurses call out the next day, thus forcing another round of mandatory overtime to cover the openings.  On popular call out days, the call outs worsen.  Day shift nurses can't risk getting stuck on the evening shift if they have something personal they really wish to attend to.  Evening shift nurses with something planned the next morning have to call out to avoid getting stuck overnight and missing the event the following morning.

Tuesday, November 5, 2013

Three versus One


I've been floating a lot more lately.  When I am floated to a ward, I do a quick assessment of the staff:  how many are Evil and how many are Unknown.  It's not safe to put anybody in the category of On My Side or Neutral.

On this particular day, I had three Evil and a wavering bunch of Unknown.  The other variable was that one particular Evil, "Jess," was downright destructive when a particular senior attendant was not there to keep her in check.  Today, that attendant was, of course, out.

We had "Dina," who is on a rampage against other women because they are after her boyfriend.

And we have idiot "Jean."  I thought I could do away with her by sending her on a long escort off the ward.  I realized something was wrong when she got all dolled up, grabbed her jacket and purse, and quickly left.  A while later, I realized that the patient she was supposed to be escorting was still waiting for her on the ward.  Then the flurry of phone calls started because the absent patient was holding up the schedule in the other department.

At that point, my acceptance of the situation told me that there was nothing I could do.  Another attendant would not accept Jean's assignment to escort the patient.  The patient would just miss the testing.  There was nothing I could do about it.  Many times I've brought up Jean's disappearances, but I was blamed as the cause.

A bitch in the supervisor's office paged Jean overhead, hospital-wide.  That was the red flag that this was going to get bad.  This particular bitch hates me, loves Jean, and will do nothing to help me.  Her paging set off Jess.  Jess lost it.  She went berserk, right out there in the middle of the ward, screaming "She is so racist,"  "She is nothing but trouble," "I fucking hate her and am going straight to the top this time . . ."

Jess's rant set off Dina.  She started screaming that I was a "slut," "whore," and "Stay the fuck away from my boyfriend."

I called the nursing supervisor and told her that she needed to come to the ward.  NOW.

Somebody must have reached Jean on her cell phone.  Jean appeared as the supervisor arrived.  Jean, still wearing her jacket and carrying her purse, insisted that she was on the ward the entire time and I never told her to escort the patient anywhere.  Dina and Jess stood there, shaking their heads in agreement, and added that I was lying when I said that I told Jean to escort the patient.

I pointed out to the supervisor that Jean walked onto the ward with the supervisor, so how was Jean on the ward the entire time?  Jean's explanation:  I became confused when I saw the supervisor walking in and thought that Jean was also walking in, but she wasn't.

I told the supervisor that I needed Jess and Dina to stop ranting about their nonsense on the floor or, better yet, get me off that ward.  The supervisor said, "I have to hear their side."  They were in a back room for hours.  Screaming, cursing, crying.

Eventually I went back in and spoke with the supervisor.  Her response:  "Clearly, this is a personal issue that you have with these people, so it has nothing to do with me or this hospital.  I recommend that you don't bring your issues to work with you."

"Oh no," I objected.  "I have no personal relation with any of these people outside of this job.  This is a hostile environment they created for me and you are sanctifying it."

"All I can tell you," she said as she got up to leave, "Is to put it in writing.  If it's not in writing, I can't do anything about it."  She left.

Dina spent the rest of the day calling me "whore" and related names.  When I was on the phone, she would walk by and yell, "She's on the phone again, trying to find a guy to fuck her tonight because my boyfriend won't do it."

Jess disappeared for most of the rest of the shift.  At one point when she was back on the ward, she was intently writing on a piece of paper.  Another attendant near her stopped me to ask me something.  When she heard my voice, she startled and screamed, "She's spying on me!  What the fuck is wrong with you!" and ran off the ward.

Jean eventually took the patient off the ward for his appointment.  She later returned him and left without returning to the ward to finish her shift.  Several people who work in the department where she escorted the patient called me and asked what happened on the ward.  I told them, "the usual."  They said that they had to have her removed because she would not stop screaming, cursing, and bad mouthing me that I am jealous of her because she is sleeping with someone that I want to sleep with.

This was a very bad day.  It was not the worst day ever at this hospital because I knew to expect this behavior from the involved parties.

Monday, November 4, 2013

Silence the Mouth


I worked the evening shift recently.  Overtime pay is good.  The workload is a lot less, with no doctors running around writing orders and no other disciplines bursting through the ward doors every two minutes, making a bee line for the nurse.

The two problems with evening shift are:
1- the other nurse
2- the supervisor

I lucked out.  The other nurse was an older man that I always got along with.  The supervisor is the most evil of them all, but he stayed away, thanks to the decades of battle that he and the older nurse have already played out, night after night.

The older nurse told me that in his country, foreigners are treated with respect and people go out of their way to be nice and helpful.  He was shocked when he arrived in the United States.  Not only did people not help him, but they went out of their way to make his day more difficult.  He studied English in his native country, but had to learn the swears and curses here.  This behavior was not only exhibited by Americans.  Immigrants from other countries also opposed him.

All of this atrocious behavior was magnified in the nurse work setting.  While the racism was usually subtle in his neighborhood or on the street, it was up-front, in-your-face, completely unveiled in the hospital.  The attendants working under him screamed at him and the supervisors backed the attendants, while adding in their own angry opinions.

He said that he has handled this situation all these years by standing firm in his professional training and skills.  He is a nurse; the attendants are not.  As such, the attendants will take direction from him, or they will be written up.  If no action is taken against them, so be it, but he has his paper trail.  As for the supervisors, he has more nursing experience in more settings than they do and he can outmaneuver them in any dispute over clinical care.  He worked as a nurse in the military in his home country; he has trauma, emergency, operating, and labor/delivery experience.  In this country, he worked in multiple areas of hospitals before finally settling in the psych hospital as his final nursing job.

Most of the supervisors have little nursing experience outside the psych hospital.  They are woefully inadequate to handle the simplest clinical matters.  This does not stop them from correcting other nurses that they don't like.

The older nurse told me that he does not respond to any protests by the attendants or supervisor as they occur.  He is silent.  There is no point in arguing with them.  They can't understand him, they can't respond rationally, and they will find three witnesses who heard him say terrible things.

Instead, he writes a letter and sends copies to the people involved, the Director of Nursing, the director of the hospital, and the union.  He doesn't go through the union; he copies them on the letter.  Every time one of his letters starts circulating, everyone is shocked.  They don't see the pattern.  They thought that it was just another day of bullying somebody who went away, but then a letter appears.

The older nurse said he's been called into administration several times, always to defend his letter.  In spite of his letter, he is always blamed.  According to him, he is always able to dance his way out because he writes damning information about the role everybody played in the event.  "The pen is mightier than the mouth," he added.

But all of these people still work here.  They are never fired.

Sunday, November 3, 2013

Efficiency

I am efficient.  That seems to be a part of my personality.  I may be rather slow the first time I do a new task, but every attempt afterwards becomes speedier and more accurate.  I then tweak the process itself to make it more efficient.

On the average nursing shift, maximum efficiency doesn't mean that I have hours to spare at the end of the shift.  Rather, efficient means that most of the major goals of the shift were met and no fires are currently burning.

One of the nursing homes I left was one that floated me to the floor with an incoming admission- every time I worked.  "But you're so good at it!" and "You love work!" were comments frequently thrown my way.  No, the work was boring, rote, the same thing- I had merely streamlined it so it took less time.  Admissions still were extremely time-consuming and resulted in hours of overtime and requiring me to basically ignore the rest of my patients while I prepared for the admission and then admitted the person.  The inevitable arguments with the assistants that they did not have to care for the new admission because the patient was not present at the beginning of their shift.  The useless nursing supervisor, standing around, telling families, "I don't know why she hasn't helped you with that yet," instead of helping because she knows I am tied up admitting a new patient.

I always wanted a job were I was noticed and rewarded for boosting efficiency and saving costs.  In the nursing setting, the people who notice are not in administration and respond by dumping more work on me and then observing that tasks are not completed in a timely manner.

Wednesday, October 30, 2013

Choking on her own words

I was in a back room of the ward.  Nobody was in the vicinity except the clerk, who was ranting while eating some greasy fast food.  "These stupid nurses think they are something.  Well, they are not.  They are stupid.  I could do their job easy.  Running around, acting like they know stuff.  They don't . . ."

Suddenly she stopped.  She was choking.

When my mind recognizes that an emergency is actually happening, the body races:  heartbeat and breathing zoom.  But my body didn't jump into action.  Karma?

She choked up the food herself.  "Oh my God!  I almost choked to death!" she observed to herself, a bit shocked.

I ducked my head into the doorway.  "Be careful, sweetie, there's no one here to help you if you choke on your nasty words."

She grew a little smile and said, "Oh, I see how you did that.  Said it all quietly so nobody else would hear you.  I got your number.  You would let me choke."

I walked away.

Monday, October 28, 2013

Irony

One of the night nurses was very happy one morning.

"I was just reading in a chart, I am not sure why I was doing that, but I was.  I see something with your name signed on it.  It's like a story almost.  About a patient.  What they ate, what they were wearing, that they were quiet and then noisy.  Very good stuff," she complimented me.

"It's a nursing progress note," I answered, wondering how she could be a nurse for so many decades without ever reading or writing a note on a patient.  Then I remember where we are, and it does not seem so surprising anymore.

"Well, I was thinking, 'This girl is so good with the details.  I have an interesting life.  Maybe she could write my life story.  I should ask her.'  So what do you think?" she stood there, beaming.

Two thoughts flashed through my mind.
1-  Yes, I could write pages of nurse's notes for your stay in the psych ward as a patient.  You're crazier than most of the patients.
2-  Ironically, I do write about your life, or at least one aspect of it.

Sunday, October 27, 2013

Feelings over facts

Some friends were discussing their jobs and the people they manage.  One said that whenever someone goes over his head to his supervisor, the supervisor bounces them right back down and does not entertain the squabble.

At my place of work, my support staff frequently runs to the supervisor, who then drops everything and runs to me, expecting me to stop working.  She then chastises me for "hurting people's feelings" and "not being a team player."

By not being a team member, she means that I did not immediately capitulate to a subordinate's demands.

As observed earlier this year, this place is about people's feelings and not real events.


Saturday, October 26, 2013

Telepathic influence


The attendant who plans to retire after putting in a year is "learning computer for my next job, in case they want it."  I must commend her for attempting to learn a skill and for being so forward-thinking.  The hospital is not computerized, but most wards have an outdated, slow, clunky desktop computer.  Someone (not the clerk) typed excel spreadsheets for assignments, rotated by day of the week.  To select a particular day, you need to select the sheet at the bottom of the window.



One morning, she was screaming that the printer broke, as evidenced by the printer printing sheets for Monday when she wanted it to print sheets for Wednesday.  I showed her the sheet selection at the bottom and told her that she needed to click on the desired sheet.  "I DID," was her nasty, self-righteous response, naturally followed by, "You did something to this computer again, didn't you?  You just can't stop messing with people."

A dialog box was open, requesting attention about sending a problem to Microsoft.  I pointed this out to her and told her that she can't do anything else on the computer until she gets rid of the box.  She looked quite unsure, but clicked on "okay" and got rid of the box.  Then she was able to click and select Wednesday and print those sheets.

"All I know," she remarked, "Is that you need to stop messing with this computer and making it hard for me to click on what I want."

"One more thing, dear," I added in a sweet voice, "Today is Thursday, not Wednesday."


Friday, October 25, 2013

Retired/Working Same Difference

One of the nurses is blissful.  Always floating around, beaming ear to ear.  "Blessed" is what she calls it.

Her chronic lateness, inertia at completing the simplest task, and inability to ever be located do not faze her in the least.  I am bothered because I pick up her slack.

On one trying day, she observed into the wind, "I love this job.  It's like I'm already retired.  Nobody cares if you are late, or if you just sit here sipping tea all day.  I love it."

"I care that you are late and do nothing but sip your tea."  I just had to say something.  She looked at me, blinking her eyes, absorbing none of it.

She went on lunch and returned two hours later.  "Now you can go," she told me.  "I'll cover the floor."

So I went on my lunch and returned in an hour an a half.  Her smile was gone.  "You have been missing for over an hour."

I smiled.  "You're right.  I didn't take the full two hours like you did.  Next time we work together I'll add half an hour more to my break."

She just doesn't get it.  The length of her lunch break has nothing to do with the length of my lunch break.  Her 45 minute lateness does not stop her from commenting on my whereabouts.

Thursday, October 24, 2013

Leave of Absence

One of the attendants has been on and off Leave of Absence in my time at the Psych Hospital.  I am very happy when I see "LOA" next to her name on the schedule.  She is nasty, suspicious, does no work, and then gets loudly upset over some perceived injustice committed against her.

Some say that the only difference between her and the patients is that she has keys to come and go.

She has been at the hospital so long that she qualifies for retirement under their old pension system, which is now defunct, but she is grandfathered in.  She ranted for weeks about how she put in for retirement and the people who handle the pension said she was short one year of service because of all of her Leaves of Absence.  She took another Leave, explaining, "I'll show them.  I'll finish out my remaining year on Leave."  After a three month absence, she is back, angrier and nastier than ever.  Someone clued her in that going back on Leave does not satisfy the deficient year of service.

It's more like a punishment to those who have to deal with her every day.

Wednesday, October 23, 2013

Growing a trove of evidence


Based on the comments in an earlier post, I have been using my phone to snap pictures of errors of others.  (Such wonderful technology!)  I pass select information of medication errors on to the pharmacy consultant.  Administration doesn't seem emotionally vested in his observations.  I'm not sure if Administration is going to do anything with the information, but I am trying.  I feel a bit better with a trove of photographic evidence for possible use later.

Tuesday, October 22, 2013

Your presence is felt in your absence, Part two


The clerk came to me and apologized for her prior performance when she pretended to be a victim of my computer sabotage.

Hell did not freeze over:  it was a fake apology.

"I have to apologize for my behavior the other day.  I didn't realize that you talked to other people and they told you what I said.  So I apologize."

Interpretation:  She is only "apologizing" because she was caught.

Next was the retraction:  the apology followed by "but."

"But messing with my computer is something that you would do.  And I know that one of these days, you are going to do it."

Why can't she just be fired?  She brings nothing but chaos and negativity to the environment.


Monday, October 21, 2013

Your presence is felt in your absence, Part one



Upon returning to work after a day off, I heard from numerous people that a clerk had thrown a temper tantrum on the ward in front of staff, visitors, people from other services, and patients.  The clerk's defense was that I made her do it:  I sabotaged her computer.

And for clarification, what she calls "her computer" is the only computer on the ward- an outdated, bulky desktop that she uses to type personal letters or create cards and banners for personal events in her life.

One of the nurses told me that the clerk was so angry and so upset and could not be redirected, that the nurse called the woman who handles the computers for the hospital and asked her for help in fixing the computer.  As it turns out, the computers are linked on a local hospital network that was down for a few hours for maintenance.  Not Sabotage by yours truly.

Later in the day, the clerk was able to use the computer and find whatever she claimed had been destroyed by me- still without me having been in the building.

This is what I have been writing about.  Nothing bad happened, yet a coworker gave an emotional performance in front of many people about the evil act I committed against her.  Whether true or not, people come away from the clerk with the impression that I am a horrible person to others and that I destroy hospital property because I have a personal issue with someone who is only trying to do her job.


Saturday, October 19, 2013

Story prompts


Each of these events from hell will later make a great story.  Try it.

Friday, October 18, 2013

You can't make me

Woes of the 30 minute patient census persist.

An attendant, usually the first to arrive, takes the first census of each shift.  Others follow suit as assigned (or not).  One day, an attendant assigned to the 8 am census complained to me that he had to "fix" the census from 7 and 7:30.

I looked at the list.  Outdated.  The first attendant had assigned everyone as in bed, asleep.  At least ten patients marked as sleeping in beds at the hospital that morning had actually been discharged weeks ago.

So now I have attendant pissed off for "doing extra work."  Nevermind that I'm not too happy myself with this recurrent situation and the added work to my already overflowing assignments.

I gave "Nellie," the attendant who erred in the earlier census, a generalization of the problem.  Her remarks were swift and included:


  • "It's the night shift's job to fix that.  Why don't you tell them to do it instead of bothering me?"
  • "Your are not perfect either, nurse.  When you are perfect, then you can tell me about something that is wrong."
  • "Everyone makes mistakes, even you, so get over it."
  • "It's the clerk's job to update the census, not mine.  I just sign it like you tell me to.  Now you're all up in my face because I did exactly what you told me to do.  Make up your mind."


I left her when the first remark hit the air.  You can't reason with someone like her.  She sounds and acts like a spoiled brat.  These assertions were so ridiculous, coming out of a grown woman who was standing in the midst of a psychiatric facility where she is employed.  The patients got locked up in the hospital for less bizarre remarks.  She has gotten to the point where she sits on her phone all day, doing no work.  If challenged, she screams, "No, I don't have to do that.  It is optional.  I can CHOOSE to work if I want to, but I don't want to and nobody can make me."

Sunday, October 13, 2013

Remembering the school days


I started this blog after I was finished with nursing school and already working as a nurse.  Had blogging been an option at that time in my life, I would have done it and shared so many funny, sad, and obnoxious stories.  As I previously wrote, nursing was not my first career or first degree.  Nursing school was different from prior schooling in one special way:  the other students were in the same situation that I was and I made good friends during school and carry those friendships with me today.

A lot of readers are currently in nursing school, trying to cope (and learn and sleep as well).  My message to you is something another student a year ahead of me said:  There is a light at the end of the tunnel.


Saturday, October 12, 2013

Wedge Politics?


"So what happens to us with this government shut down?" another nurse asked me.

I was taken aback.  Most people don't ask my opinion of anything, never mind a major, national issue.  I had to be over thinking it.  "What do you mean?" I asked.

"Well, do we stop working?" the nurse asked.

My immediate thought was, There is no difference between your working and not working.  Instead I said, "Why would you stop working?"

"Because everything has shut down," she replied,  honestly confused, but still holding onto her fantasy that she would not have to work, but probably still get paid.

I understood.  She had not recognized me as a political genius.  She was trying to garner some kind of general consensus for stopping work.

"We are not the federal government and we provide essential services, so we will carry on as usual," I answered.  Pointless.

"Well, I don't think we're supposed to work anymore," she cautiously continued, as if I was the deciding vote.

"Okay then," I responded, "I guess I'll see you when you come back to work.  Have a good day!"  I walked away.  Quickly.

Tuesday, October 8, 2013

Dreams

One of my dreams is to win the lottery and quit working.  I have plenty to do.  I know lots of people who claim to work because they have nothing else to do.  One woman said to me, "Why would I take a day off?  To sit at home?  What is there to do there?  It's bad enough I have to sit there every evening.  Imagine adding another whole day to having nothing to do?"  I do not identify with her at all.

But on a more serious note, if I did win the lottery, I would not quit working- not right away.  I would continue to show up at the hospital and irk the hell out of my coworkers who deserve it.

I currently work for the money, health insurance, and the added bonus of learning about the human mind- greatly helps with my writing.

Friday, October 4, 2013

Student loans: still paying

I owe, I owe, so it's off to work I go.

Nursing was not my first career.  I had student loans from prior education before acquiring more from nursing school.  It occurred to me recently that if I had stayed working and not gone back to school, I would be debt free now.  Instead I am looking at another twenty years of payments.

I shouldn't be too hard on myself.  One of the primary reasons for returning to school was because I could not find gainful employment.  I would be debt free today only if I had been able to pay the outlandish monthly loan payments- which I could not years ago.

Ironically, I am only able to (barely) pay all the loans today because of my nursing job, and I cannot wait to be free of the loans so that I can find other work that may pay less but be more suitable.

Thursday, October 3, 2013

Foolish and Proud

The Dunning-Kruger Effect.  This explains everything.

The more incompetent someone is, the more competent they think they are.  They are incompetent at life, which includes incompetence in accurately assessing their own skills.

This is why the attendants at the hospital continuously maintain that they work hard and well, and have no issues about telling me what to do.


Monday, September 30, 2013

Not Holding Water


A commonly expressed thought among attendants and patients at the hospital is that extra weight can be erased by "taking a water pill."  At first, I tried educating.  Useless.  The attendants are now at the point where they advise obese patients that they should take "water pills," but can't because I won't give out these wonderful remedies.  As if I dispense medication based on some illogical fantasy by someone with no medical training.  How can someone watch so much television and think that there is such a thing as a "water pill" that erases fifty pounds from your frame?  And then have the nerve to order me to give one to a patient- that is the icing on this cake.

Saturday, September 28, 2013

Who has been sleeping in my bed?


On the psych ward, a census is taken every half hour.  The assigned staff member must look at the patient long enough to confirm that the patient is alive and not in distress, and then indicate where on the ward the patient was at the time of the census.  The purpose is to quickly uncover elopements or problems.

On my psych ward, it's a source of conflict, which you should not be surprised to read at this point.

Customarily, the night shift prepares an accurate list of patients and rooms to present to the day shift to begin a new 24 hour form.  In reality, when patients were discharged, admitted, or changed rooms, this took days to be reflected on the census.  Arguments ensued.

As a remedy to the accusation of an inaccurate census, the night shift stopped preparing a new form.  The day shift now takes about an hour to try to figure out how many patients are supposed to be on the ward, their names, and their room numbers.

It's a real risk to my license, taking on a chaotic floor with an estimated number of psychotic patients and an angry mob of attendants.

I was back on my usual ward after a few days off.  In my absence, the census had grown wildly inaccurate.  I pointed out to the outgoing night shift nurse that she had signed off that the census was correct, even though at least ten of the patients listed had been discharged over a week ago.

"It's nighttime," she explained.  "The patients are sleeping.  What do you want me to do, pull back the covers to see who is really in the bed?"

"Yes, that is exactly what I expect," I answered.

"That is not how the attendance works," she persisted.  "Think of it as confirmation that someone is occupying the bed.  Who it is, you shall find out in the light of day."

As ridiculous as this sounds, she gets away with it.  Every time.


Sunday, September 22, 2013

One person's trash is another's treasure


Nasty Supervisor was on the ward when approached by a patient.  A lot of the patients are homeless and seek food and other treasures in garbage cans.  This behavior is discouraged in the hospital.  At the time of this incident, the garbage was especially enticing because lunch had just concluded.

The patient told Supervisor that she was missing something and wanted to check the garbage in case someone threw it out.  Supervisor gave the patient permission above my objection.  The patient dove into the garbage, furiously licking food off discarded cups and plates, and swallowing whole pieces of stray food.  Supervisor stood by with a disgusted look on her face, but said nothing.

The patient ended up removing a frayed magazine from the garbage, licking who-knows-what off the pages.  Supervisor finally spoke, telling her to put the magazine back into the trash.

"But it's mine!" the patient cried.  "Somebody threw it away.  I want to keep it."

Supervisor turned to me.  "Nurse, did you know that her magazine was thrown out?"

I stood there, staring at Supervisor, the patient holding a disgusting, beat-up magazine, her clothes smeared with food, a white substance dripping off her hair, the floor littered with garbage.  My thoughts centered around: This woman comes looking for trouble, and when she doesn't find any, she creates it.

I calmly stated to the patient, "Put the magazine back into the garbage can.  Go down to your room, put those clothes in the hamper, take a shower, and put on different clothes."  I walked away and passed a housekeeper who remarked, "Why did you let her dump the garbage all over the floor?"

A few days later, Supervisor proudly hands me a write-up and says, "As we discussed."  She wrote me up for disposing of a patient's personal property.

I've really had it with this woman.  (I've written this before.)  That so did not happen.  I am the only nurse who labels and locks up the patient's personal belongings such as cell phones, money, keys, identification.  Other employees will steal these items from the patients upon arrival.  And I am the one who gets written up for discarding personal property?  I admitted this woman, so I knew that the inventory of personal effects was complete.

I took up the issue with the Director of Nursing.  She is out a lot and does not even pretend to know what's going on, so I usually avoid her.  She had her response rehearsed.  "We looked through your nurse's notes, and nowhere did you write that the patient did not have a magazine."

"Who writes that?" I said.  "What nurse sits down and begins a note with, 'The patient does not have the following items.  Number One.  Magazine.'  There is a log of her personal property, where you can see that she came in with $5 in singles, one shirt, one pair of pants, underwear, and slippers.  Nothing about a magazine."

The Director replied, "Well, you know, if it's not documented, then it didn't happen."

"Exactly.  It is not documented that she had a magazine, so she didn't have one," I tried explaining.  Useless.  So I tried another angle, that there is no evidence that I am the person who threw out the magazine.  Futile.

"You don't have to be the actual person who threw out the magazine.  Someone on that ward, either a staff person or a patient, threw out the magazine.  As the nurse, you are responsible for others, so you get the write-up," the Director reasoned.

I went to the union.  Yes, there is a union.  Of what use, I don't know.  Salaries have been frozen for years.  "They should have been fired a long time ago," was the response from the union rep.  And yet this has not been accomplished.  What a joke of a union.

So I wrote a letter to the Director of the Hospital.  As previously mentioned, he is new to the hospital.  As it turns out, he is also new to healthcare, switching careers from building construction to running a hospital.  Of course I have not had a response from him or his office, but the whole hospital is whispering that I went to the new Director about nasty Supervisor.



Saturday, September 21, 2013

Lacking


One of the nastiest supervisors called me to a meeting with the clerk.  This particular clerk comes and goes as she pleases, talks on her phone, and eats.  I never know if she is scheduled to work or not.  I copy any needed forms myself and file in the charts as the papers come in.  The clerk answers to no one.  She screams, curses, sings, dances- just like the patients.  The only difference is that I can't medicate her.

We went into a little room.  Supervisor and the clerk sat down and told me to sit.  I declined and stood in the doorway.  You appear more authoritative if you stand.  Plus, I had an quick escape route.  The chair that the supervisor sat in held open the door.  Still seated, she twisted and grabbed the door to shut it.  She couldn't get the door to budge because she was still sitting in the chair that was preventing the door from moving.  I stood there, watching her, as she struggled, stopped and looked at the door, then tried again.  And this woman is supposed to be in charge of me.

Supervisor gave up on the door.  "We have been wanting to discuss this with you for over a month," the supervisor opened.

After a silence, supervisor prompted clerk to speak.  "I needed a file.  After I looked for it, I found it."

Silence again.  Both of them staring at me, as if I was supposed to say something.  "Thank you for sharing that with me."  I turned to leave.

"Wait!" supervisor called out.  "We are not done."

I inched a little back into the doorway.  "What is it that you want from me?"

Supervisor said, "The problem is that there is a lack of communication, and the lack is coming from you.  You do not communicate with the staff and that is why the staff cannot work as a team."

I am so sick of management throwing out buzz words and blaming me for the hospital-wide apathy.

I've read the same magazine articles, so I used some buzz words myself.  "Let me repeat back to you what I heard so I can make sure that I am receiving the correct message.  You waited two months to tell me something, and I am the one who does not communicate?"

They both rushed to gasp "Yes!" at the same time.  Such idiots.  Then Supervisor started a long speech about communication, team work, consequences, blah blah blah.  I could barely hear her because a psychiatrist walked past me into the room, stopped in front of me, and began showing me a chart and discussing medication, completely oblivious to Supervisor's ongoing soliloquy.  Supervisor is so self-absorbed that she continue talking at me, oblivious that I could barely hear her over the doctor standing in between us.

I was able to steer the doctor and myself away from the room, thereby ending the meeting.

It wasn't over, though.

Supervisor found me and presented me with a blank (and ripped) piece of paper with her signature and the clerk's.  "You need to sign this," she said as she shoved the paper at my hand, which was dialing the phone.  I messed up dialing, grabbed the paper, and tossed it.  "Excuse me, I am on the phone," I sternly asserted, and went back to dialing.  Supervisor stood there while I left a message for a social worker that a family member was on the ward, claiming to have a scheduled appointment with her.

Supervisor presented the paper again.  "I am not signing anything," I stated, and walked away.

Into my view came the clerk, in a patient care area, loudly telling some attendants and patients that I was "a stuck-up bitch who thinks she's better than everyone else."

Supervisor followed me and said, "If you don't sign, I am going to write that you refused to sign."

Now I had really had it with this woman.  "You wouldn't write that," I coolly said to her, "Because that's the truth and you only lie."  She looked perplexed, probably because I don't usually say nasty things to her and also because she didn't quite follow it.

The family member approached me again.  "Is the social worker coming?" he asked.

"I don't know," I answered.  "I left a message for her."

"Could you page her?  I have been waiting for over an hour," he whined.  He had been waiting three minutes, tops.

Supervisor jumped in.  "Nurse, this is what we were talking about, your lack of communication.  You need to communicate to the clerk that she needs to page the social worker overhead."  This does not describe a lack of communication.  Maybe a lack of delegation, but I can't delegate work to others because they will not do it.

So I communicated to Supervisor, by demonstration, what happens when I ask a staff member to do something.  I called out to the clerk and said, "Could you page the social worker to come to our ward to meet with this family?"

The clerk exploded in front of everyone- patients, visitors, Supervisor, other staff.  "Bitch, you just don't get it.  How many times to I have to fucking tell you that I don't work for you.  But you keep ordering me around, like I am some kind of servant.  I ain't nobody's God damn servant.  I am not your servant.  I am not the servant of social services.  If the social worker wants to see a family, tell them to get their lazy asses down here and see the family."  The clerk then turned directly to Supervisor and screamed, "See how she treats me?  This is exactly what I was telling you.  You tell her to stop, but she goes ahead and does it anyway right in front of you, like you don't see it."  She started to walk off the ward, screaming into the air, "I'm done with all of you.  I'm going straight to the top now."  She left.

And yes, while the clerk was putting on her loud cursing show, I picked up the phone and softly spoke as I paged overhead, allowing the clerk's rant to be heard all over the hospital.

After the clerk stormed out, Supervisor turned to me and said, "I just spoke to you about the way you treat the staff, and then you go and upset the clerk again, right in front of me."

As she started speaking, I turned and headed down a hallway, where Supervisor would never follow because she might come in contact with a patient.



Friday, September 20, 2013

Make Coffee not War

Even morning coffee is a great drama.

When I first started, I was chastised for taking a cup of coffee on the ward where I was working.  As it turns out, there is a weekly coffee club of $5 and I was not a part of it.  Nor was I invited to participate.  I understand collecting contributions for coffee and creamer, as this stuff is not free, but somebody could have clued me in and instructed me in a nicer manner.  But not where I work.  Not that it was an option given to me, but the coffee did not taste good enough to pay $5 per week.

I ended up befriending another ward's coffee club.  This caused so much ruckus when I walked onto my ward with a cup of coffee.  "She didn't pay for that!" they would scream to one another, urgently alerting others on their cell phones.  I initially would try to explain that it was not their coffee that I was drinking, but my actual words never seem to matter in the drama.  This would last anywhere from a few minutes to all damn shift until someone was finally convinced that I had indeed procured the coffee elsewhere.  And the process would repeat the next day with my coworkers growing angrier that they had not nabbed me stealing their coffee.

I eventually gave up drinking coffee at work.  The wrath it drew was so ridiculous, but unrelenting, and I just couldn't take it anymore.

I took up coffee drinking again on my recently assigned ward.  The man who made the coffee was not as horrible as most of the other employees and we worked out a situation where I brought in the creamer and he brought the coffee grinds and made the coffee.  Not only did no other worker on the ward contribute, they usually consumed all the coffee and creamer before I could get any.  Soon people were telling me off for not bringing a larger size creamer or not having a fresh pot of coffee ready for them.

I tried getting others to contribute money or bring in creamer.  The replies were mostly, "You nurses make so much money, you should be buying us coffee."
One attendant snottily told me, "I did buy creamer."
"Great.  Where is it?" I asked.
"It's at my house.  Why would I bring it here?" was her answer.

So that arrangement stopped also.  Yet people kept coming to me, demanding coffee or creamer, and then cursing me out for not giving it.
"It's actually cheaper and less of a hassle if I just stop and buy a cup of coffee on my way to work," I explained to someone.
"Great for you," was the nasty response, "But what about the rest of us?  Where's our coffee?  You don't care about anybody but yourself."




The $4 pumpkin latte from Starbucks is highly worth it, in light of my workplace atmosphere.

Saturday, September 14, 2013

A Few Nurses Short of a Hospital

Thank you everyone for sharing your kind comments and thoughts.  You help me to keep going.

A part-time attendant was finally granted full-time status by the new director.  The attendant seems like a decent guy and he does work.  The attendant told me that the director said that there are many open, full-time positions in nursing and have been for years, but never filled; and that spending in nursing was never over-budget, but rather so severely under-budget quarter after quarter that it is not possible that minimum staffing levels were met.

I'm not sure that the director should be telling this to people outside of the upper echelon, but it doesn't surprise me.  Many people quit, retired, went on leave- yet no new person was hired after I was over two years ago.

Several times a week a nurse is stuck on "Mandatory Overtime."  They called me to come in on my day off- 45 minutes into the shift.  I said no.  The next day, I heard the nurses complaining that the supervisor claimed that everyone was called, but nobody would come in.  I told a union representative that they do not call early enough to enable people to come in for the shift.  The union is not organized enough to compile such information in their fight against the mandatory overtime.


Monday, July 29, 2013

Failed Inspection


A survey team swept through for a regular inspection.  All prior inspections seemed to be conducted by surveyors who could not see or hear.

Not this time!

Multiple citations in every area from the cleanliness of the building to emergency plans to medication errors.  They were even cited for not using computers!  Management walked around the last two days of the inspection, dazed and numb.

Certifications, credentialing, new admissions:  SUSPENDED.  The hospital has to stay open for its current patients because, frankly, there is literally no where else that could accommodate them.

My main ward was inspected on the second day.  Management pulled one of their Favorite Children to supervise the ward.  The surveyors asked questions of Favorite Child.  She deflected all to me, including blame when she thought there was a problem.  The surveyors asked her repeatedly, "But don't you work here too?" and "So you don't have anything to do with patient care?"  Favorite Child could not understand why her honest response was not accepted, "Sure I work here, but my job is to tell people what to do, not do it myself."

My medication pass was beautiful.  The trick is to select your best patients and least complicated medications.  If you give liquids, you had better have a proper device to accurately measure the medication.  Such a device was not available to me, so I did not select patients who needed liquid risperdal or haldol.  Had I given the liquid meds with the substandard, though only available pipette, that would have been another citation.  Management was not grasping the concept that a lot of the citations were not based on errors made by individual workers, but rather from lack of supplies.  (For example, the building has no apparatus to guide people down the stairs who cannot walk in case of a fire.  "You know how to put someone on a bed sheet and have five people help you down the stairs," was management's response.  Nevermind that we have more patients than bed sheets, the bed sheets rip with normal use, and there are not six spare staff members to carry several people down flights of stairs when the building is on fire.)

After the surveyors finished, rumors swirled that there would be firings.  I was walking through the lobby when I was introduced to the New Director of the Hospital, after I overheard him telling security, "If Dr X comes back, he is to be treated like any other visitor."  Dr X was the Medical Director.  I had heard that another doctor was appointed.  The rumored new medical director is someone I already know, and I think he admires my work ethic.  (Though I am usually wrong at predicting outcomes.)

Amazing.  I am wondering how far down the Cleaning of the House has reached.  Nursing management to go?  We shall see . . .


Friday, July 19, 2013

Trying to learn the alphabet



Every morning I put the charts in alphabetical order.  Nobody else is on board with this method of organization.  They criticize, "I can't find charts this way," and "This will never work."

When I told someone this, she laughed.  Then she said, "Oh, you're serious?  They don't have the charts in alphabetical order?"

No, the charts are thrown about in chaos.  Based on the previous stories, you aren't surprised to read this, are you?

The ward "clerk" is the worse offender.  When and if she finally arrives on the unit, she screams and takes the charts out and randomly tosses them.  "She thinks she's so smart, putting things in ALPHABETICAL order.  Who the hell does she think she is?"


Thursday, July 18, 2013

The (Great) Outdoors




The only access to fresh air on the ward is a balcony.  It is fully fenced in from top to bottom.  The door is locked.  When I open it, I am screamed at by nurses and attendants alike that the outside air contains germs and will hurt people.  How can you hate fresh air?  How can you prefer recycled, stale, smelly, germ-filled building air to the outdoors?