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


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.