Thursday, January 31, 2013

Language Problems (Again)


I have to be so careful about what I say at work.  Every word is misinterpreted negatively.

I messed up.  Again.

Another nurse was asking me about my schedule and when I am off.  Suspicious.  Why does she care?  She can look on the schedule.  She was comparing my days off to another nurse and said, "So when she is off, you are on, and the next day, she is on and you are off?"

"Yes," I replied, "I piggyback her."  Wrong wording to use, apparently.

"How could you do that to her?  You are so mean.  I can't believe you just come right out and say that!"  She shook her head in condemnation.

"Do what?" I asked, genuinely confused about what I had done wrong this time.

"You piggyback her!" the other nurse blurted, as if this was something bad.

"Piggyback means that I go after her," I explained.  Blank stare.  Stupid me, I continued to dig my hole.  "Like an IV piggyback.  When one is done, the other one automatically starts."  Wrong example to illustrate word meaning.

"A nurse like you who is so much smarter than everyone else would know all about piggyback IVs.  We know that you think you know such much more than us."  And she huffed off.

I can't win here.

Diagram of a piggyback intravenous bag set-up.

Wednesday, January 30, 2013

On a positive note . . .

I wish for you
Love
Peace
Health

I was becoming too negative, so here's an antidote.

Tuesday, January 29, 2013

Need to adjust that attitude again

Sometimes in the morning while drinking my coffee,
I think about all the people I'm going to piss off today . . .
and I smile.

I really need to get back to this outlook.  I let my coworkers upset me too much.

I am exploring other jobs.  Per diem.  Agency.  Problem is, I don't make a good first impression, either in an interview or on my first few weeks in the "getting to know you" stage.  Makes per diem assignments impossible.

A friend and I will be applying to test consumer products on ourselves.  I heard that the pay isn't bad.  Maybe I'll break out in hives and scare people away.


Monday, January 28, 2013

Tell me Everything

One of the nurses I work with is crazier than most of the patients.  And selfish.  She shows up late and then starts yelling at me for not doing her work, regardless of what I am doing or who else is present.

"You are so selfish.  All you care about is getting your assignment under way.  What about mine?  Did you ever even stop to think for a minute that you are part of a team and the team needs help?"

By "team" she means herself.  And no, I don't care more about her assignment than she does.

One day this past week, one of the other nurses who is not too bright but doesn't advertise her selfishness, gloated, "I am not here to fight, so I don't let her bother me."

"How do you achieve that?" I asked.

"Just do whatever she tells you to do," she replied.

"I can't accomplish all of the ridiculous and unnecessary tasks she hurls at me, designed to make sure that I don't get my actual assignments done."  She'll walk into the middle of wound care and start screaming, "You were supposed to make lists of what the patients want for lunch.  You didn't do this.  I tell you to do something and you ignore me, like you are better than everybody else, like you have more important things to do.  You are a member of a team, but you go off on your own."

(Actually, I could use help with the wound care, but you all refused.  You won't even do the wound care when I am not there, so if the "team" could clean and dress some of these wounds on my off days, that would really help out.  But it's not going to happen.)  I don't say this.

Dense nurse tells me something enlightening:  "Tell her everything.  She likes to know every little detail about everything."

My first thought:  Who wants to know every little detail?
My second thought:  She does complain a lot that "Nobody told me this."  I was thinking to myself that if you were not late and you stayed on the ward and got off your cell phone, you would pick up on more of these details.  Also, the flow of information is a two-way street and I have never been clued-in or tipped-off by her about anything.

When the unenlightened "team player" wandered back to the ward, she started on another rant:  "You went behind my back and ordered supplements for a patient.  You conspired with the doctor and the two of you got together when I wasn't here and put her on supplements.  Does this make any sense to you?  No, of course not, because it's ridiculous.  If you had asked me, which you never do, I would have told both of you not to do it.  Now administration is going to ask me why this patient is on supplements, and I have no idea because you won't tell me anything."

I countered with my usual:  Weight loss over the last two weeks over 10% of her body weight.  Poor intake at meals.  Anemia.  Low serum protein.

She countered:  You didn't tell me any of this.

Me:  You were not here for those two weeks.  It is documented in the chart.

She wouldn't give in- I was wrong and she was right.  Never mind that I had two doctors and a dietitian supporting my position in the chart.

So I tried this new strategy:  "Speaking of this patient, we have pending orders for her to have a podiatry consult and special shoe fitting because of her bunions.  We are just waiting for a return phonecall with the appointment time."

Almost magically, nasty nurse calmed down, like I was feeding her some sedating nectar.

So I continued.  Whatever popped into my head about any patient, no matter how irrelevant or outdated it may have been, I told her.  It was so bizarre.  She got a kind of smile on her face, but with a far-away look in her eyes.  She became calmer.  I was afraid that she was going to start arguing about how this or that was wrong, so I kept it simple and factual.  "Mr Smith visited his son yesterday.  We served cake and orange soda on the unit for Ms Miller's birthday, courtesy of the recreation department.  Yesterday's lunch was well-received by everyone."

This is an interesting exercise in human interactions and personality, but this is too much to take anymore.  I not only have to quell psychotic patients, I have to placate psychotic staff members, but without medication.

Sunday, January 27, 2013

Thank you, Nurse

Always thank your nurse.
Sometimes they're the only one between you
and a hearse.


Saturday, January 26, 2013

Feelings versus Facts



Out of all the testimony from the complaints against me, this one stands out the most.

Attendant:  Nurse told me that I come from a third world country where the water is too filthy to drink.

Investigator:  Do you remember when she said this to you, in what context, and who else was present?

Attendant.  Yes.  She said it to a patient.

Investigator:  She insulted you in front of a patient?

Attendant:  No, to the patient.  She wasn't actually talking to me.  She was talking to the patient about me.

Investigator:  And why do you think she was talking to the patient about you, with you standing right there?

Attendant:  The patient asked Nurse for a cup of water.  She came over with a cup of water and told the patient that I am filthy.

Investigator:  She used that word, "filthy?"

Attendant:  No.  She said that the water from the faucet was safe to drink.

Investigator:  And why would she say that out of the blue, with you standing there?

Attendant:  The patient asked her.  He saw Nurse get the water from the faucet and asked her if it was safe and she said yes.

Investigator:  And after she said that, is that when she made the remark about you coming from a third world country?

Attendant:  No, she didn't actually say that, but that is what she meant when she said that the water was safe from the faucet.

Investigator:  Ok.  So that is the feeling you got when you heard her speaking to others, that she thinks you come from a filthy third world country?

Attendant:  Yes.  That is how she made me feel.


WTF?

It doesn't matter what I say or do.  Certain people at my job have decided that I am to fulfill a role that they have cast for me in their twisted minds and every word I say or don't say supports their delusions.  I wasn't even talking to this attendant or about her.  Yet she heard an insult embedded in an innocent interaction between a patient and me.

WTF?

And the investigators found in favor of these f*cked up complainers.
Conclusion:  "It's not about who did say or didn't say something.  At the end of the day, it's how you make others feel, and they feel that you are being unfair to them."

Only their so-called feelings are illogical and not based on reality, which they openly admit.

What about my feelings of having to do all the work while they sit there, hating me?

I really need to get the hell out of this snakepit.

Friday, January 25, 2013

Manipulation and Lies


I came across a resourceful website in my narcissistic research.  Melanie Tonia Evans.  Check it out.  Free ebooks. 

I'm not saying that the people I work with are narcissistic.  A lot of the behavior and expressions are the same, however.  I did not even realize, at least not on a conscious level, that their behavior fell into predictable patterns designed to discredit me, shift blame off them, and blur the issues.

---Telling me that I am too loud or my voice is "squeaky."
---Interrupting me constantly with non-urgent and irrelevant demands.
---Verbally berating me and when I walk away or tell them that I will not listen to their insults, yell that I am rude for not letting them finish their verbal assault, and then continuing.  When done, instead of waiting for my input, they declare the matter settled.
---Interrupting legitimate work/patient oriented discussion to advise the group that they are upset with me and then shifting the topic from the patient to themselves and their perceived emotional injury.
---Constantly telling me that they know what I think or feel (and it's not good).
---Telling me that nobody at work likes me and "everyone wants you fired."
---Telling me that I was seen out with -insert name here- and that both of us will be fired for violating workplace rules against dating [there aren't any such rules].


Same sayings:
"I'm sorry," and then repeating the same offending behavior.
"I'm sorry, but you are not perfect either.  You do this wrong . . ."
"You are the only person in this hospital who has a problem with this."
"You made me behave inappropriately."
"That happened yesterday.  The past is the past.  You need to get over it."

Thursday, January 24, 2013

Gaslighting

During last year's investigation of me, one of the supervisors who gave me a very hard time (and still does) had this to say:

---She was never my supervisor.  She supervised the other side of the building whenever I worked.  Even when she covered the entire building, our paths never crossed.

---She never spoke to me.  I approached her on several occasions to make fun of the ethnicity and/or race of other employees.  [This is one of the reasons why the investigation took so long.  They actually called in all of the employees that the supervisor claimed that I made fun of and told these employees, most of whom I had never met, that I was making fun of them.  This explains a lot of sudden nasty behavior towards me that seemed to arise from nowhere.]

---All of the incidents, put-downs, re-assignments all over the hospital day after day- they never happened.  My documentation is fabricated.


And the investigators accepted her version.

I read all of this, shaking my head, wondering if I had made it all up.  Day after day.  In researching narcissistic personality disorder for an unrelated matter, I came across the term Gaslighting.  This is what this supervisor was doing.  Outright lies and denials to make me look like I was going crazy.  But they believed her.

I don't know if she knows that I have copies of all the transcripts.  I knew she was not a nice person, but now when I see her, I look at her, don't speak to her, and wonder how and why someone would be so nasty and deceitful.

Wednesday, January 23, 2013

Unsupport Staff


Today was simply wild and out of control.

I was the only nurse.  My support staff argued with every single thing about their assignment.

I had mentally rehearsed this, but today I had to actually do it.  The details, the paperwork, the non-essential crap that administration wants to see-- it all had to be ignored so that I could just do patient care and end the shift with safe, breathing patients.

I ignored the phone.  No chance the "support" staff would answer it.  Few ventured onto the ward to inquire about their unanswered calls.  If they did, and managed to find me, they were quickly deterred by my exasperated, "You came to help me?  Great.  Here's what I need you to do first."  A few foolish people paged overhead and then sent really foolish people to see why I wasn't answering.  With the exception of the pharmacy, the person on the other end of the phone is not calling to help me in any way, but rather is calling to deposit more work on me- work that the caller could have done herself in the time it takes to repeatedly call the ward.

Document to defend yourself.  I know.  Here's what I have also learned in this snakepit:  your documentation disappears.  If something goes wrong, administration conducts an Official Investigation, and documentation screwing over The Fall Guy magically appears.

Saturday, January 19, 2013

Go back in with a plan



I had some friends read the complaints about me.  They laughed and laughed.  The complaints are actually quite funny, if your job is not on the line because of them.

They told me to own the word in most of the complaints:  ALOOF.  They pointed out that it's too consistently used and is one of the few words used to describe my supposed unfair treatment of other people.  So I should work ALOOF into all of my verbal interactions with my coworkers, and speak in a Minnie Mouse, especially squeaky voice.

ALOOF is not a word that I can even recall hearing at work, and we have to describe the behavior of patients.  Disinterested, keeps to self, isolates self- these are words or phrases similar to ALOOF, but ALOOF I have never seen.  Makes the whole thing even more suspicious.

The thought of returning to this environment makes me sick.  So I called out.  On speakerphone, just so I had ear witnesses of my claims.

Other person:  Baboogooleeboonii.
Me:  Hello.  This is Nurse ---.  I am calling out sick for the day shift tomorrow.
Other person:  Gaagoolikonnuu.
Me:  Who am I speaking to?
Other person:  Munaalikewumuwanupi.

They burst out laughing.  "And they complained about your voice?  A drunk with his jaw wired shut is easier to understand."

Friday, January 18, 2013

Voicing Complaints



Did I mention they investigated me all of last year for treating others unfairly?  Not for lack of patient care or for errors in delivering care.  Treatment of my coworkers.  I was the alleged unfair one.  The facts:  none.

The complaints:  My voice is high pitched and I am aloof.  Also, "She looks at you, but doesn't really look at you."

The quality or lack of quality in my voice is not really the issue.  That I have the nerve to speak at all is what gets them mad.  Plus, I am the only one in the place with an American accent.  Yup.  Only one not of foreign birth.  If I were to criticize the pitch of a coworker's voice, I would be accused of racism.  The characteristics of voices I am exposed to on a daily basis include: raspy, sing-song, clicky, husky, hissy, loud, soft, flat, whispering, shouting, garbled, and many other unintelligible qualities.

The ironic part?  The hospital actually has a policy against treating people differently based upon their "voice."  Not kidding.  There is an entire section dedicated to it.  I brought up this policy during the investigation, which, in my view, made the charges moot.  The administrative gurus conducting the investigation were not aware of the policy and after reading it, declared, "You are reading into this," and continued investigating why I continue to use the voice I have when other employees have complained that it is not fair that they have to hear me.

"I use this same quality of voice everywhere, so how is anyone treated unfairly or differently when everyone in my life hears the same voice coming out of my mouth?"  This was not a line of logic that the investigators cared to pursue.  They shook their heads in disbelief when I told them this was my real voice.

Now in case you are wondering, I don't have a squealing voice that sounds like a baby or a bird.  I have been told over the years by different people in different situations that my voice is lovely, soothing, and steady.  Becoming a singer was never one of my goals, but I can honestly write that this is the first time that anyone has told me that my voice is bad and I must be intentionally faking it in order to annoy others.

So they don't like my voice.  They don't like the alternative either, that I am aloof.  If they don't like my voice, which is their evidence that I unfairly treat some people, why are they then complaining that I am aloof?  Wouldn't this spare them from my "unfair" voice?  I don't fit in with the established cliques.  I think I have posted enough stories here to demonstrate that I come to work to work and others come to hang out, collect a paycheck, and harass people as desired.  Not my kind of people.

None of the complainers alleged that in my unfair treatment, I shifted a disproportionate amount of work onto them and not myself or others.  None complained about the workload at all.  It's never about work for them.  They have no intention of doing any work, they do no work, and administration supports this.  A few attendants even stated, "I don't do any work when she is there to show her that I don't like her voice."  This sounded rational to the investigators.

I need to be emotionally detached from this snake pit in order to survive.  I would spend the day crying in the bathroom if I allowed myself to be dragged down by all the bickering and suspicions.

In case you are still wondering, there is a union for the nurses.  One of the nurses I have worked with was the representative for me.  Her voice is less than stellar, rising and falling and finally trailing off at the end.  Yet I never filed a formal complaint against her for it.  This so-called helper chimed in, "They is correct.  You voice bad.  I no understand what you say sometime."  That really bothers me because, first of all, she was supposed to be helping and not hurting me, and second, she has difficulty understanding me because she does not understand English very well, not because my voice is "bad."

She also felt the need to add that I needed more time to learn nursing skills because I am a "new nurse."

This I could challenge on a factual basis.  "I have been a nurse longer than you have and I correct errors that you make."

She sat there, confused, as if she had spoken of elephants and I was countering with couches.

I have a stack of papers detailing what coworkers said about me.  I have not been able to speak to them since I read the nasty, career-destroying garbage they said about me.

Friday, January 11, 2013

Synesthesia





I stumbled across this online.  Synesthesia.  As a nurse, I seek to expand my knowledge base constantly.  I do not have synesthesia.  Do you?  Check out the website and find out.

Synesthesia is experiencing one sensation (such as smell or sight) and associating another, unrelated sensation (such as touch or smell).

When I see the number 3, I associate the letter R.  This is apparently not synesthesia.  I wonder if this has a name.


Thursday, January 10, 2013

The Ruling Class, Almost Official










The director of the hospital has left and another administrative person is filling in.

This will bring tensions to a head because the hospital is run by a clique and he is one of this clique.

The person under the Director of the hospital, the Director of Nursing, does not exist.  The position has been vacant for years.  Nobody is running this ship- you probably aren't surprised to hear that.  There are plenty of Assistant Directors of Nursing.  All except one are from this same group, and every issue lately has been blamed on her.

It's a one-way street with this group.  They are entitled, argumentative, suspicious.  If the rumor is true, then the group will have officially taken over the hospital at every level.  I am screwed.  Perhaps others who are stronger than I am and not a member of the ruling group will become so embroiled that something gets done.



Fancy text provided by http://www.teacherfiles.com/free_word_art.htm

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.

Tuesday, January 8, 2013

Three was the Magic Number

I sent a patient to the emergency room for chest pain three days in a row until they finally uncovered the problem:  pulmonary embolism.  She would have died if not treated.  As a nurse, you need to use your training and knowledge to guide you, in spite of what other health care providers may tell you.  You then need to advocate for your patient.

Like many conditions, pulmonary embolism, or a blood clot in the lung, does not present itself with classical, obvious, textbook symptoms.  This is unfortunate because blood clots in the lungs are life-threatening.  As a result, pulmonary embolism is the second leading cause of sudden death in the United States.  Take a psych patient with a pulmonary embolism, and you are statistically predisposed to miss the diagnosis and result in the patient's death.

In the psych business, people tend to not believe people who reside at a psychiatric care facility.  (Unless it is the administration looking to screw over the least favorite employees.  Then the wild, physically impossible tales are prosecuted.)

The background:  50 year old woman, no significant medical history, slightly overweight.  Poor historian; evasive.  No family or friends listed in the chart.  Patients states, "I have no family.  I have no friends.  I am all alone."  Residing at the psych hospital since July of 2012; pending placement in a group home.  Psych diagnosis:  schizo affective disorder.  Usual behavior is calm, cooperative.  Shows little emotion.  Keeps to herself.  Compliant with medications:  Depakote, Risperdal, and Cogentin.

Day One:  Night shift reported that patient did not sleep and sought staff attention for cups of water, which was unusual for patient.  Easily redirected back to room.  By 8:00 am, patient had refused morning medications and breakfast.  When asked why, patient stated, "I have chest pain.  I don't want to move or do anything."  Vitals:  Blood pressure 120/76.  Heart rate 130.  Respirations 20.  Temp 98.0.  Pulse oxygen 95% on room air.  Patient stated that chest pain started last night and worsens upon exertion or movement; denies shortness of breath or pain when breathing.  No other complaints.  Denies radiating pain.  Nitro 0.4 sublingual given; reported some relief.  I take off her sneakers and find that her right foot is swollen and hot.  She replies, "It's been like that for years.  It doesn't bother me."  Sent to emergency room with paramedics.

Day Two:  Patient was returned to the psych hospital on the evening shift the day before with a diagnosis of "chest pain."  Night shift reported that patient stayed in bed, not sleeping, complaining of chest pain if asked. Patient ate breakfast and took due medication, stating that she felt better.  Vitals were within normal limits; heart rate was around 80.  By noon, patient would not get out of bed to eat lunch, stating, "The chest pain is worse.  I can't move."  Temperature was elevated to 102.  Right foot is still hot and swollen.  As I am examining the foot area, another nurse comments, "You are always looking for people to have something wrong with them.  Not everyone is perfect like you."  This highlights what I am up against.  I was not looking for imperfections to make me feel better about myself.  I was looking (and finding) signs of a circulatory problem to help guide me in figuring out what was causing the patient to have chest pain.  Paramedics did not want to take patient to hospital, explaining, "We did this yesterday.  She is just depressed an anxious.  You are supposed to fix that."  I explained that the complaint of pain and lack of compliance is not typical of the patient.  Paramedics took patient, explaining, "We're only taking her again because this time she has a fever."

Day Three:  Patient was returned to the psych hospital on the evening shift the day before with a diagnosis of "chest pain."  Night shift reported that the patient stayed in bed, immobile, complaining that the slightest movement caused more pain in her chest.  Upon seeing me, the patient started to cry and said, "I am dying here.  I am having a heart attack and nobody will help me."  Blood pressure 140/90.  Heart rate 120.  Respirations 12.  Temperature 99.2.  Pulse oxygen 96% on room air.  I sent her out again, telling the paramedics that we would be doing this every day that I worked until the patient's pain is treated.

The emergency room called around lunchtime:  pulmonary embolism.  Admitted to ICU.



Administration doesn't like me and most of my coworkers are nasty and against me- on a good day.  Combine the usual hostility with fighting for this patient, and I had three bad days.  When the diagnosis finally came in, did anyone applaud me or apologize for giving me such a hard time?  No.  OF COURSE NOT.  I don't do what I do for acclaim, but it would be better for all involved if my coworkers would work with me instead of harassing me and interfering at every turn.

There is a second part to this story, which I will tell in another post.

Monday, January 7, 2013

Floating in Shark Infested Waters

I was changed from float to an assigned ward.  I don't usually stay on the ward, though, because I have the least seniority, which automatically designates me as the nurse to float off the ward to work on a lesser-staffed ward.  

Instead of reporting to the nursing office in the morning, I have to bear the brunt of the night shift aggression with obnoxious complaints about how they had to do some work because I didn't do enough during the day.  It is not relevant if I worked on the ward the day before.  I am the go-to person for assigning blame.  It is also not relevant if there is an actual problem.  A fluke low blood sugar reading will be blamed on my lack of foresight in not getting an order to lower the bedtime Lantus dose; plus, I should also change the timing of the blood sugar reading to the day shift because "doing a fingerstick is too much.  We only have two or three nurses at night."  There are only two nurses on the ward during the day, but again, this is not relevant to their complaint.