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.