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?

Monday, July 15, 2013

Another Medication Error

In the warped places where I have worked, there are some nurses who sign a doctor's order and then do not carry it out.  Repeatedly.  I have noticed when on night shift, during the 24 hour chart check, and on other shifts when investigating medication discrepancies, conflicting orders, or issues raised by a patient.  In all of these facilities, there is a procedure in place for reporting medication errors, which is never used.  Rather, everyone covers up for the nurse who dropped the ball, explaining, "That's how she is."

A psychiatrist ordered a narcotic for a patient.  The pharmacy sends a thirty day supply of narcotics for individual patients.  (We have no computerized medication system.)  The following day,  the psychiatrist discontinued the narcotic because the patient fainted twice.  "Lilly" signed for the order on the physician order sheet, but on the medication administration record ("MAR"), she did not indicate that the drug had been discontinued, nor did she remove the medication from the active medication cart.  So for 29 more days, the patient continued to received the narcotic from me and anyone else working, continuing to faint almost daily, with the psychiatrist shaking his head.  The error was discovered when someone submitted the narcotic to be refilled by the pharmacy and then pharmacy called to ask why, as the medication was discontinued weeks earlier.  The patient has not fainted since the drug was removed.

There is a 24 hour chart check for the night shift to do, which would have caught Lilly's failure to indicate that the drug had been discontinued on the MAR.  "Everyone knows that the night shift doesn't really check," is the general observation.

One of the supervisors met with me to "counsel" me on my "medication error," as I repeatedly gave out a controlled drug that had been discontinued.  I maintained that the checks in place to prevent this error were and continued to be blatantly disregarded with the blessing of administration.

"Lilly rarely fully carries out an order and nothing ever happens to her," I protested.

"You did not report this as a medication error," the supervisor explained, "so we can't fault Lilly.  You are the one who gave the drug."

Can't fault Lilly?  Then why is she employed there as a nurse if she doesn't have to carry out orders that she signs for?

So I located the forms and submitted the report.  Multiple copies.  The next day, I saw the guy from the pharmacy who is in charge of investigations.  I was on a different ward and asked him if he received my report.  "No," he answered.  I expected that.  They intercepted the report to protect Lilly, one of their favorite children.  I handed the pharmacy guy another copy I had with me.  He said, "I don't usually get these, even when I tell your supervisor about errors and tell her that reports are required.  I think she has only ever given me three reports this year, and they were all about you, even though I didn't see how you were associated with any of the errors."

Word must have spread.  The next day, one of Lilly's supporters started screaming at me from one end of the hall as soon as she caught site of me.  "What is your problem?  You are a back-stabber.  Nobody died.  Do a reality check.  You are overreacting.  So a patient got a little pill and nobody is hurt, but you have to blow this up like it's the end of the fucking world."  She was screaming as she raced down the hall at me, accusing me of overreacting.  In psych, we call that "projection."  And yes, this was a hall with patient rooms, complete with patients and staff present and watching.

I started training in a particular martial art with a place near my home.  I have not mentioned this, but I feel more confident around these physically aggressive coworkers.

As she approached, I walked towards her so I would not have to retreat as she approached.  She stopped.  "Move out of my way," I said firmly to her.

"No.  Not until you give me an answer.  I want to know why you . . ." she started ranting again.

I cut her off.  "Move out of my way now, or I will move you."  I stared at her dead on.

And she stepped aside!

I don't like to be physical or aggressive, but my coworkers do not seem to understand any other response.

The really unfortunate part is that when a really serious error is made and higher officials find out, they will want someone to pay, and administration will aim at me.  It's more than a risk of being fired.  I could lose my license and my ability to earn a living.

Sunday, July 14, 2013

Are you being served?

Meal time on the psych ward is regulated, as you may have guessed.  Choking is a very real hazard among the patients.  In addition, many of the patients are homeless and have to literally fight for food on the outside, a habit that they continue to practice inside the hospital.  The patients are not permitted to eat in their rooms.  They must come into the lounge area and sit at a table.

The trays are pushed onto the unit by a dietary worker.  A small piece of paper with the name of a patient protrudes from each tray.  Usually an older gentleman brings the trays.  His ability to see and read appears highly compromised.  He takes the paper with the name from a tray, brings it all the way up to his eyes, lifts his glasses, puts them back, lifts them again, and then mumbles something barely recognizable as the name of a patient.  The patients sit there, unable to recognize their own names in the garble.  With nobody claiming the tray, he then sticks the piece of paper back onto any tray and grabs the next paper that he can see to repeat the process all over.

It's a disaster every time.  I've asked him to not attempt to hand out the trays.  I was reported for being racist.

I hand out as many as I can while running circles around him to prevent him from giving out the wrong tray and causing a riot.

On one particularly obnoxious day, while I was racing around to get the trays out, I noticed two attendants in the dining area.  One was standing, absorbed in pressing buttons on his newest electronic gadget.  The other was seated next to him, staring off into the distance, as if she were at the beach on her day off.

"Can you please help us with these trays?" I asked of them.

"It's not our job," the standing attendant replied.

Really?  REALLY?  "Whose job is it?" I queried, shocked at their blatant honesty.

"I don't know," the seated attendant replied, "But it's not our job."  I stood there staring at them.  She continued, "I mean, we can help if we feel like it, but I have never felt like helping, so I don't.  If you choose to hand out trays, that's on you."

Unbelievable, but there it was.  The attendants somehow have the belief that they are not at work to perform any work.  At this point, the patients provide more services for other patients than the attendants do.  Some of the attendants are so intrusive and attention-seeking, constantly telling me to do this-and-that, that they are more time-consuming than the patients.

The Head Nurse of this ward has returned from some kind of extended leave that was tacked onto the end of her prior extended leave.  [But if I request a Friday off, all hell breaks lose.]  I mentioned to her that the attendants do not think it's their job to hand out trays.  "It's not!" she gasped.  "Dietary has to hand out the trays.  The trays come from dietary, so dietary has to hand them out."

"But the dietary aide does not know our patients and gives out the wrong trays," I tried explaining to no avail.  After all, the medications come from pharmacy, but the pharmacist does not hand them out- the nurse does.  Or rather, this nurse does.

"Then it is his responsibility to ask the staff to identify a patient, but that does not mean that the staff has to give out the trays for him," the Head Nurse explained, looking at me as if I was pure evil for wanting an attendant to get up and do something.


The patients notice that most of the staff sits there, unwilling to help them.  The patients tell me this.  But this causes the patients to come to me for everything, which is quite stressful.