Wednesday, January 9, 2013

Do It All

On one of the three days of sending out the patient, I asked a clerk in the office to photocopy the relevant documents from the chart to send the patient out.  I was the only nurse on the ward and I had three attendants each on one-to-one observations.  Translation:  seriously understaffed.  This particular clerk has been extremely nasty to me in the past and her refusal did not surprise me.  I figured I had to try so that when I went over her head, I could truthfully say that I asked her and she would not comply.

The ward that is the setting of this story shares a back door with the nursing office.  I left the ward and entered the office.  The shift supervisor was standing idle in the hallway.  "I'm sending a patient out and I need these papers copied."

"You can do that yourself," she haughtily replied.

Of course I can.  That's not the point.  I can't leave the ward.  I have an urgent situation.  Your data entry tasks can be put on hold for five minutes.

I set the papers on top of the copier, hoping they would not get eaten up.  I returned to the ward, kept processing the patient to go out, and then returned to the office to collect the copies.  None were made.  The machine was out of paper.  I opened other drawers and searched around the area- no paper.  I called for a different clerk.  She responded, "Oh, I don't think we're allowed to give nurses paper."  After more searching, I found 11 X 17 paper, put it in the drawer, and hurried back to the unit.

Back on the unit, I found a new patient waiting for me on a stretcher, along with two staff members scolding me for keeping them waiting.  New psych patients need to be carefully watched.  I had no idea if this woman was homicidal, suicidal, or what.  I marched back into the office, wondering how to handle this worsening situation.  I grabbed my papers from the machine.  At this point, several supervisors and clerks were hanging in the hallway, staring at me.  Not helping.  Staring.  I passed the nursing director's office and caught a glimpse of her hiding behind her door.  Hiding.  I opened the door, shocking her, and told her that I needed another nurse to help me with an emergency and a new admission and she was it.  She stammered and said, "The people out there would be happy to help you, if you ask."

"I did ask them," I talked loudly enough for them to all hear, trying to not spew into the land of hollering.  "And they refused to help me.  They are all just standing there."

"What did you need done?" director asked.  Like I have time for this.

"I needed copies made and they refused," I factually explained.

"What do you need copied?  Those papers in your hands?" she asked.

"No, I already made the copies," I answered.

"So then the problem is solved," she chirped.

"Never mind.  I'll handle everything all by myself," I hollered this time and returned to the ward.  I processed the outgoing patient and the incoming patient.  The phone rang, unanswered, for the rest of the day.  Documentation was a few lines at most.  The main goal was met:  all patients were alive and breathing at the end of my shift.  The rest is just a bunch of details.

Battle lines have become clearer to me once again.  It is the clerk's job to photocopy.  On the other hand, it is not my job to stop taking care of patients and to fix the house census every day because the clerk calls, saying she has messed it up on her end, and has to go through every transfer for the last week until she sees her error.  That information is not available from my memory.  I have to look it up myself.  You do not need a nurse to look up that information; you can do it yourself.  So I will not be doing that for any clerk.  If they want that information, they may come to the floor and retrieve it one by one from the records as I would have to.  I also will not stop patient care to track down attendants and ask them if they want to stay on overtime.  Clerks have been calling me and telling me to do that.  Their job is to find the coverage, not tell me to stop my job and go and find coverage.

We have the flow of work backwards at this place.  I may not be able to reverse it, but I can make it stop flowing down my end.

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