Saturday, April 20, 2013

Trust Nobody

There are no more good days.  All days are bad.

Earlier this week, I was approached by a nice older lady to train in her office.  She coordinates with insurance companies to certify payment for the stay at the hospital.  Great.  Better than working with the people I currently work with.  It's in a room away from the wards.

Over the years, there have been several people who were unworkable on the floor for various reasons.  Instead of being fired, they were moved to office jobs.  I figured this was what they were aligning for me.  Fine with me.

I work with evil people who don't do their jobs.  I am not sure what the criteria is to remain assigned to patient care versus getting transferred to a desk job.

The training went well.  We chatted and laughed.  Then she advised me that she would be out Friday, which is when I would cover her office.

Fridays are days from hell.  People who work the weekend are off.  A lot of people who are scheduled to work call out for convenience or because the day is going to be hell.

I could foresee that they were not going to let me cover her office because the hospital would be short on nurses.

So I reported to my ward early Friday.  I met a patient who came in last night.  A homeless man in his 50s who looked like he was in his 70s.  Schizophrenia, history of drug abuse.  The night shift cleaned him up pretty well and he was more coherent than I usually see with a brand new admit.  Barefoot.  Never walk around a hospital barefoot.

"You need to put on socks and shoes before coming out to the lounge," I told him.

"Ma'am," he said slowly, "I don't have any socks or shoes."

Polite.  What a pleasant change.  "We'll get you something," I replied.

Back in the lounge, two attendants were drinking coffee and watching television.  This is the patient lounge, not the employee break lounge- for clarification.  "Gentlemen, we have a new patient.  He needs some socks and shoes from the supply closet," I gently said.  Legitimate request, I thought.

They looked at me with disgust.  One of them snapped, "What do you expect us to do about it?  The night shift was supposed to help him, not us."

I expect you to stop watching television and help the man, is what I thought.  But I have no power here.

Two of the other attendants who were in the back in the employee lounge came rushing out in defense of their attacked collegue.  "You are the nurse.  You accepted this man without shoes, so if you want him to have shoes, go get them yourself.  Who do you think you are, running around here, giving people orders. . ."

I kept walking down another corridor.  I heard the barefoot patient jump to my defense, "Please don't yell at her.  She was only trying to help me.  I don't really need the shoes.  I'm okay."

I checked on another patient who has to be ready to leave the facility at 7:30 am for treatment elsewhere- three mornings a week.  This is another battle with the staff.  I finished her up and wheeled her out to the lounge.  Four attendants sitting there, fuming, with the head nurse of the ward present.  She is out most of the time.  The patient's early breakfast tray had been delivered.  I need to get her medications ready, so I asked the attendant standing next to the tray if he could set her up.

"That's not my job!" he snapped, and then muttered to himself, "Who does she think she is?"

Another patient got the tray and helped the outgoing patient eat while I got her vital signs and her medications.

The head nurse then told me, "If you can do something yourself, do it.  Don't tell other people to do work that you can do yourself.  If you want a patient to have shoes, go into the closet and get the shoes.  You have to stop pushing your work onto everyone else."

I walked away.  My work?  The attendants sit there all day.  They collect a paycheck.  They are also supposed to work.  I can do anything- I am the nurse.  But- there is a limit to how much I can squeeze into my shift.  I can't get the patients ready, take vitals, give out meds, and serve breakfast all by myself and before 9 am to get the patients out to their first groups.  That is why attendants are employed to do some of this work.

The phonecall came for me to leave the unit to cover another ward- not the insurance office.  I pointed this out to the supervisor.  "I'll check on that," she replied.  "In the meantime, go cover that ward."

Half an hour into the shift, I arrived on the ward and was met by two irate night nurses.  "You are late!  How do you expect me to get my kids to school on time when you come to work late?"

I am sick of this false accusation.  "The supervisor just figured out the assignments.  Take it up with her, not me.  I came here immediately after she told me to."

The nurse huffed through the narcotic county and then ran off the ward.

This ward is calmer than mine.  Go figure.  No regular nurses.  Just me.  I did quick rounds and found two attendants taking blood pressure readings for the patients.  The attendants on my ward refuse to do this.  The female attendant greeted me.  "I didn't know I'd be working with you today.  Oh, that reminds me, I have to leave because I am not medically clear to work on the floor."  She got up, grabbed her purse and jacket from the back, and left.  I am not kidding.  I was left with four attendants.  This is how many I usually have for my hectic ward, so I wasn't worried about that part.

I was really concerned that I could not perform the insurance certifications while stuck on this ward.  I called the supervisor.  "I checked with the Director of Nursing.  She said you can work on that ward by yourself and do the insurance certifications from there.  You have five attendants to help you, so you should not have any problems."

This was BS.  I can't work an unfamilar ward by myself and do the certifications at the same time.  If anything goes wrong, this supervisor will deny that she quoted the Director of Nursing.  "I need the charts in front of me when I call for the reviews.  The phones on the ward don't allow me to dial long-distance.  Plus, I only have four attendants."

I clarified for her that one attendant left for medical clearance.  "That is ridiculous," the supervisor said.  "Of course she can work on the floor.  You should not have let her leave."

"I couldn't physically block her.  Could you see if you could get her back here or send someone else?" I asked of the supervisor.

"No," the supervisor replied.  "It was your fault that you let her leave, so you can deal with the consequences of your mistake."  Then she hung up.

In the meantime, another attendant was intently listening to this phone conversation and became inflamed.

"You are such a bitch!  I can't believe you just picked up the phone and told the supervisor that Mona left.  What a bitch you are.  I can't work here.  I cannot work here with such a nasty, lying woman.  I am out of here."  And she stormed off the ward.

And then there were three.  One of them was Big Willie.  He has been there for decades and has a calming presence.  "Don't worry about them," he told me.  "We'll be fine.  They don't do any work anyway."

I was being set up to be majorly screwed in the event of disaster.  I called the Director of Nursing.  Her secretary answered.  "You have to make an appointment in person to speak with her," the bitch sneered.

"I can't come there in person.  I cannot leave my ward.  I need to speak with her about a current urgent situation.  I cannot wait for an appointment," I explained.

"That's your decision," she replied, and hung up.

The hospital's phone system is tricky and random.  I figured out that the phones in the office go straight to voicemail when someone is on the line.  On the wards, however, the caller will hear rings if the line is busy, but never go through to voicemail.

So I called back the Director of Nursing's line and hemmed and hawed to keep the secretary on the line while I dialed the number from my cell phone.  When I got the voicemail, I asked the secretary to wait a minute because a patient wanted something.  I left a message on the voicemail.  She never called me back.  The secretary probably found it and erased it.

My next plan of action was to call the acting president of the hospital.  He seems like a nice man, but is not.  His secretary said he was not in for the day.

I went about my nursing tasks.  Mid-morning, an attendant came up to me and said he was going to another ward for cups.  I told him that we had plenty of cups.  He started to leave.  I called after him, "I need you to stay on the ward.  You do not need to go get cups."

He screamed back, "I am not going to let you speak to me that way.  NO!  I gave you the courtesy of letting you know that I was leaving.  You don't tell me no.  You can't speak to me like that!"  He stormed out.

And then there were two.

The patients, mostly unfamilar with me, had acquired the impression that I was supposed to do anything I was told to do and if I didn't, I should be screamed and cursed at.  The ward was spinning out of control.  Two fistfights broke out.

I finally grabbed a chance to get to the bathroom.  One of the two attendants knocked on the door.  "I'm in here!" I shouted.

"I know," he said calmly.  "I'm just letting you know that I have to leave, since you think you are in charge or something, even though you get mad when people let you know when they are leaving."

"Do not leave!" I shouted through the bathroom door.  When I came out, he was gone.

It was me and Big Willie left.  Thirty wild patients and two staff.  I had not even started the insurance certifications.

The attendant who most recently left returned after half an hour.  I said nothing to him.  He came up to me and started.  "I have been here longer than you.  I know how this place works.  I can leave when I want.  You can't just walk in here and think you own the place.  Everything is fine.  You are the one who messes everything up."  I retreated around the corner.  This was a horrible day.

Big Willie called him off and counseled him softly.  Maybe they thought I kept walking down the hall.  I stayed hidden and listened.

And here was my first epiphany of the day:  Nobody is on my side.  They are actually all against me.

Big Willie told the returned attendant:  "Don't speak to her.  She is trouble.  She is out to get us.  Don't give her more ammunition by saying anything to her.  We're gonna get rid of her, but you slow things down by mouthing off like that, even if she deserves it."

Wow.  I wanted to cry.  I thought, wrongly, that Big Willie had no use himself for attendants who don't do their job.  I was wrong.  Very wrong.  Performing one's job is not relevant here.

Feeling quite useless on the floor, I decided to work on the insurance certifications in the back of the ward, away from the two remaining attendants.  I needed information on the patients, such as the content of their hallucinations and specifics about their disorganized behavior.  I couldn't risk leaving my ward unattended, so I called the ward where one of the patients was.  I asked the nurse about the patient's current status.

"Who do you think you are, calling to check up on me?  Mind you own business.  It's bad enough you find so many things wrong when you work with me, but that's not enough for you.  You are not even working with me today, but you still have to call me and tell me that I am not doing my job correctly."

I tried explaining to no avail that I need specifics for the insurance company.

I didn't bother calling other wards for information on the patients.  I decided to wing it.

The supervisor visited me.  She told me to stop harrassing other nurses.  I tried explaining that I needed information so that I could call for the insurance certifications.  "You were assigned the insurance certifications.  Stop trying to push your work onto other people," was her response.

So I called the insurance companies.  Massive failure.  They wanted to know the content of today's nurse's notes, medication compliance, behavior, and the like.  Totally predictable and legitimate questions.  And I had no answers.  Every insurance certification was dropped.

I had epiphany number two of the day:  There is no chance that I will be transferred to an office job.

The entire day was a set-up.  One of the Favorite Children can now slide right into the insurance department with the explanation that I was given a chance and I blew it.

I lived out the rest of the shift, holding back tears.  As I left the building at the end of my shift, I looked up in the lobby and saw the president of the hospital walking on an upper level.

Is the entire hospital against me?  I am just a little nurse.


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