Monday, November 25, 2013

A Nurse's Role: Medical Records Perspective

I was bounced around the hospital one day and passed by a room where a bunch of people were having a little party for a man who was leaving his position.

I started dreaming of an opportunity to transfer to an office job.

The man ducked out right after the toast.  I followed him to his office.  You have to stalk people for jobs nowadays.

He oversees the (chaotic) medical records department and was leaving because it is too, well, chaotic.  He had some fancy letters after his name, that looked like a certification, but not a degree.  So I asked.

He couldn't recall what each letter stood for.  He seemed confused as to why I would possibly inquire about such a position.

"You have to have a degree to do my job," he scolded me, miffed.

Now I was annoyed.  "I have a degree, a BSN," I retorted.

"A BSN?  What is that?  I have never heard of it."  He shook his head, as if I was spinning fantasy.

"A Bachelor's of Science in Nursing," I explained.

"There is no such degree," he continued, still not convinced.  "Nursing school doesn't give degrees.  You have to go to a college to get a degree."

Now I was the one who couldn't believe my ears.  "You read medical records and have never seen the letters after a nurse's name?  BSN, RN."

"I don't read nurse's notes," he huffed, as if doing such a thing was an insult.  "Regardless, a nurse could not possibly do my job because you need training in how to read a medical record, as well as training in health care and a degree in a medically-related field."

"What do you think nursing is?" I asked him.

He walked away.

I forget this.  Perhaps most nurses do.  Unless you are a nurse, you don't know what nurses do.  Here is a man who is employed in a hospital, reading records created and maintained by nurses, who has deleted the nurse's role from his mind.  I didn't ask what he thought nurses did at the hospital.


Sunday, November 24, 2013

Is your boyfriend good enough for you?

I have a patient who is bat-shit crazy.  Violent.  Sudden mood swings.  Talks to herself non-stop.  Long history of hospitalizations.  Resistant to taking most medications.  Currently on a monthly injectable.  Alienated her children.  She's so unrealistic and violent that most of the other patients know to stay away from her.

The strange thing is that she has a lovely male friend who faithfully visits her every weekend.  He seems learning disabled.  He is kind, polite, and patient.  He takes a few buses to get to the hospital.  He brings her goodies to eat and personal grooming products.  She was nice and happy when he was around.  She had reality-based, pleasant conversations with the staff.

A few weeks ago, she became more sexually preoccupied than usual, with some remarks directed at me, that I wanted her boyfriend and was to stay away from him or she would kill me.  I reported this change to her psychiatrist.  For my own understanding, I asked him why she was involving me in her sexual preoccupation.  I did not think that I was attracted to her boyfriend and figured that she was misinterpreting my politeness towards him as sexually charged.

The psychiatrist provided me with great insight into the patient's behavior as well as other women who have made similar claims.  The patient thinks that her boyfriend is a loser and she needs to prove to herself that he is not.

How did we get here?  The steps:

1.  Girlfriend is with boyfriend.
2.  Girlfriend thinks boyfriend is a loser.  Beneath her.  Not worthy of her.  She does not want this to be true.
3.  Girlfriend accuses another female of perceived higher status of being attracted to her boyfriend.  Promulgates this delusion by yelling at other female to stay away from him.
4.  Girlfriend now thinks that boyfriend is worthy of her because another female who is better than both of them wants the boyfriend.

The patient sees me as a far more desirable romantic interest than herself, so if I find her boyfriend desirable, then he is good enough for her.

This explanation has helped me so much.  It often takes a patient's raw, intensified emotions and behavior to clarify such patterns in non-institutionalized people.



Saturday, November 23, 2013

Secure no more

I arrived at work and the overnight security guy was leaving, early as usual.  His performance illustrates what I have been telling you:  people obsess over me when I hadn't even noticed them.

The guy came close, but not too close, just enough for him to justify using a loud voice in the echoing lobby.  "I have to talk to you," he said, all serious.  We have never talked before.  He's either running out the door or watching television when I see him.  He's an older guy.

I suddenly remembered why he would verbalize his interest.  The prior day, in his rush to flee, he tore out of his parking spot, which was in a fire lane in a walking area, and had to slam on his brakes to avoid hitting me as I walked towards the building.  Reckless driving is not unusual in this place and the blame is always on the person walking, not the driver.  By his tone, I knew he wasn't about to apologize, so I kept walking.

His rant began for all to hear:  "You made me late to my next job.  I had to stop to allow you to walk.  I didn't even know where you were going.  I'm trying to drive, and all of a sudden, you are in my way, walking towards the building.  I mean, how would anyone even know that you were there?  And what were you doing, walking in front of my car?"

I walked close enough to him to speak in a quiet voice to lessen the number of people able to hear.  "You almost killed me.  You were speeding on a sidewalk, doing 50 miles per hour when the speed limit in the parking lot is 5, nevermind the sidewalk.  And you have the gall to act like this is my fault because you didn't know where I was going?  Where do you think I going at ten minutes to shift change?  There is no other option other than the front door of this hospital."

I walked away.  He glared at me.

I really don't want enemies in security.  But this was a test.  I was either going to capitulate and accept his ridiculous blame or I was going to show him that I don't go down easy.  I think that I made him more convinced that I am evil and he is not the least bit put off about going after me again.

And now there are witnesses to attest that I harassed the overnight security guy.

Friday, November 22, 2013

Leave the rest behind



Take with you what you want and leave the rest behind.  ~~Sylvia Browne, rest in peace.


Why can't I just leave?  Things are not going to get better.

Thursday, November 21, 2013

Student Loans

This was my plan
I went to nursing school because I couldn't afford to pay the student loans from the first round of school.  I picked up nursing school loans and combined them with the old loans.  Ironically, I can't leave nursing because I need the $$$ to pay back the student loans.  I won't go back to school for anything else because I can't afford more debt.  When the loans are paid off, then I can leave nursing in favor of a lower-paying job that will hopefully be more enjoyable and not as violent.

Wednesday, November 20, 2013

Laziness training


Every now and then a job opening is posted.  I advertise it to my group in failed hopes of stocking the place with my allies.

Sometimes people are fearful that they do not meet the skills requirement of the position.  I forward this blip to them.

Tuesday, November 19, 2013

Your Majesty, your mop awaits

There is an attendant at the hospital that you would have to see to believe.

Someone else punches his time card.  Sometimes he does it himself, marches right back out the front door, gets into his car parked in the fire lane, and leaves.

Inside, when he actually makes an appearance on the ward, he does no work.  Nothing.  He sits in the break room, eating, reading the paper, talking on the phone.  If he does go onto the floor, he talks on his phone or reads the newspaper.

When I was new, I told him to do work.  At first, he smirked and kept reading.  When the supervisor made rounds, I attempted to discuss the situation with her.  I was the wrong one.  Someone pulled me aside and explained that this attendant was a KING in his village back home and that the supervisor is married to one of his cousins.  As the king and as a male, she must listen to him.  It is irrelevant that she is a supervisor and he is an attendant.

"So?" was my response.  The coworker was serious.

I tried informing my coworkers that the hospital is not this man's kingdom and that he needs to perform work to collect his paycheck and that if he didn't like this treatment, he could go back home to his loyal subjects.  Useless.

His reign is also the excuse given as to why he is always on the phone:  he is ruling his kingdom from afar.

One weekend, I was working with a very pregnant nurse from his kingdom.  Her c-section was scheduled in two days and she wanted to work until the end.  She was sitting in a rolling chair when The King came up behind her and grabbed the chair out from under her.  She fell directly on her butt and rolled over, unable to breathe.  I called for help and ran to her.  The King stood over us, laughing, not the least bit worried or sorry.  With the help of another nurse, we got her breathing again.  She wasn't bleeding.  As soon as she could talk, she said, "I'm fine.  It's no big deal."  The other nurse lashed into The King that he could have killed the baby.  He shrugged and walked off.  The pregnant nurse explained, "It's my last baby.  He's just upset because all my children are my husband's.  I'm not having a baby with him and he's just a little mad."  These are the people I work with.  Are they messed up or what?

Fast forward a few years later.  His Royal Highness still does not work.  I have managed to develop an effective mannerism where I tell him to do work and he gets very pissed off very quickly and storms out.  I'd rather have him gone the entire day than look at his lazy ass and smirking face getting paid to sit there and do nothing.  I can't stand to have him near me.  If he would attack his own pregnant countrywoman, imagine what he would do to me.




Monday, November 18, 2013

Mistakes

Every now and then I get bumped from a floor and sent to work in an administrative office.  It's clerical work, but usually done by a nurse.  The facility does not believe in hiring competent clerical staff.  The good nurses should do the nursing part as well as the clerical part because "everything is the job of the nurse."  So why do non-nurses receive a paycheck?  Cut the non-workers loose and give the nurses raises.

Working in one of the offices is not the start of a new career path.  It's a way to make sure that all of the errors in those offices, of which there are many mistakes, can be traced back to my one day worked in any particular office.  It's comical, really.  Except that my job becomes more and more jeopardized daily.

One of the perks of being in an office is that I get to read the facility-wide notices and email.  No, nurses and the wards do not get email, internet, or computer services.  And no, we are not in the middle of nowhere.  And no, the facility maintains that requiring medical records to be electronic does not apply to them.

The new director seemed hopeful a few months ago.  Now every email starts off with, "How could this possibly happen AGAIN?"  A few people respond, blaming someone else.  Nobody sees the same person as the problem.  Nobody sees the entire system as flawed.  My favorite response is the trendy, "My private response is in a sealed envelope under your door."




Sunday, November 17, 2013

Paranoid

Overtime has been scarce lately (for me).  I was fortunate enough to grab an evening shift one weekend.  The night nurse who relieved me said that they are very short on nights and can't find anyone to work.

I thought about it a quick second.  I really need the money at this point and night shift is a lot less work than what I usually endure.

The night nurse told me to call the office and ask if there were any spots for me.  So I did.

"Hello, this is Nurse ---.  Did anyone call out for the night shift?" I queried to the person who answered the phone in the office.

This set off an attendant nearby.  "Sheila!" he started screaming, even though it was night, lights were out, and the patients were trying to sleep.  "Sheila!  She's trying to get you in trouble for being late!"

Unbelievable.  I had not done a thing to either of them and here we go again . . .

"I know that Sheila is here.  I am trying to get another shift," I tried to explain to him.  He wouldn't listen.  He continued screaming, convincing Sheila that I had just reported her for being late when she was here the entire time.  Then Sheila started in on me.

I left without another word.  I couldn't even hear what the person on the other end of the phone was saying.

I chastised myself:
---I should have made the call in private, locked in the bathroom, to avoid anyone overhearing the wrong thing.
---I should have used different words, such as, "Could I have an overnight spot?" instead of, "Did anyone call out?"

In another vein, I am not to blame.  I said nothing bad about anyone.  The attendant took it the wrong, bad way and then dragged in another person.

Who is paranoid here?  I am paranoid that someone is going to go berserk on me for something I didn't do, so I am guarded and cautious.  But this really does happen.  The attendant is paranoid- listened in on my phone call and then twisted innocent words into a perceived attack.  I attempted a defense and then retreated while he kept attacking.

I do not know how to handle this anymore.


Friday, November 15, 2013

Of course it was good for you, too

An essential feature of my work culture is the casual hooking-up of coworkers.  I see it as another sign of their pervasive dysfunction and immaturity.

I have been propositioned by many of my coworkers, male and female.

Just the other day a male attendant tried (again).  This time he was more specific.  He wanted to travel the Khyber Pass.  No thank you.  He persisted.  I half listened, if only to prove to myself what I already knew:  he was selfish and dense.  He used the old standby, "You won't know if you like it until you've tried it."  As if I were born yesterday and this would be my first encounter with the activity.  As if I'm not a grown adult and can predict with relative certainty that any activity with him would be all about him.  His view is:  if he enjoys it, then the other party enjoys it.

If it starts out All About Him, don't anticipate that your needs will ever enter his radar.

This narrow, one-sided view can be seen at work:  he has nothing to do, so how could I have so much work?

Thursday, November 14, 2013

Do not disturb

Night shift is supposed to wake all patients up before day shift arrives and have them all lined up, cleaned and dressed.

Does not happen.

Some patients are natural risers and willingly perform hygiene.  Others are flying high in an episode and haven't slept or stayed put for days.

The rest have little motivation to begin with and are so doped up on pills that they aren't budging.  Add in their violent tendencies and the result is very few patients ready to go well into the day shift, as nobody wants to wake the homicidal maniacs.  (You can close all the psych facilities you want.  The worst of the worst still must go somewhere.  It's the least violent ones that get pushed onto the street.)

This has been an ongoing issue.  As the first day shift nurse on the scene, all subsequent arrivals- attendants, other nurses, supervisors- enjoyed blaming me for the hibernating patients.  "You ACCEPTED the floor like this!" was everyone's unsolicited complaint as well as defense for not doing anything themselves for the rest of the shift.

Now this is the strange part.  One particularly crazy and nasty day shift nurse has stopped blaming me and is instead blaming a particular night shift nurse, whether she was on duty or not.  They have a War of Writing back and forth on the Ward Daily Report.  They quote policy that each just invented to bolster their individual positions.  The day shift nurse spends most of the shift verbally kvetching about it or writing her new policy quotes.

Almost funny to watch.  I gave up getting any work out of her a while ago.

Wednesday, November 13, 2013

Lazy, part one


My coworkers are not only rude, they are downright lazy.  Using an unopened doorstop is something they would do- if we were allowed to order supplies and could get new stuff.

Tuesday, November 12, 2013

Anyone can make a positive difference

If you want to make a positive difference in people's lives, you can do that anywhere.  Not just in nursing.  You might make a difference in nursing.  As a nurse, you will probably deal more with paperwork and administrators than you will patients.

Still, the opportunity to touch people's lives is not restricted to nursing.  Whatever you do, you can make a difference.  Before I was a nurse, I held a variety of jobs in a variety of settings.  I remember that every day one particular elderly gentlemen used to come into the store where I was a cashier.  He enjoyed seeing people and it clearly made him quite happy to be greeted by name in a familiar manner by the workers.

One day, he came to the store, quite somber.  Although my line was particularly long at that time, he declined to have someone else ring him up.  When it was finally his turn, he was crying.  He had just come from the veterinarian's office, where he had put his aged dog to sleep.  He was so grateful for my kind words and a hug.

No matter your profession, your words and actions have an effect on those you come across.  You can make or break someone's day, no nursing license required.  You do not need to become a nurse to make a difference.  You can start right now in any setting.

Monday, November 11, 2013

Blessed Cursing

Or you could come work where I do.
My job is like the Twilight Zone.  The number of employees who curse out superiors is simply staggering.  Perhaps more surprising is that nothing happens to them!

I'm no fan of most supervisors, but I dance inside when one comes on the floor and is handed her ass by one of the attendants.  I love watching them resigned to retreat.  They slink away, trying to hold their head high, trying to catch my eye.  As I I'd help.  I'm not fooled.  The cursed-out supervisor is like a killdeer.  If I swooped in to help, she'd flutter up just fine and turn the situation around to my detriment.

Thursday, November 7, 2013

Mandatory Overtime

In lieu of a bright, attentive person maintaining a staffing schedule, or hiring more nurses, the hospital continues to resort to mandatory overtime.  Find the day shift short at 7:05 am?  No problem.  See who is around from the night shift and "mandate" them to stay.  Ditto for any shortness on the evening and night shifts.  If a nurse says she/he will leave anyway, threaten them with being fired and reported to the Board of Nursing for abandoning patients in order to revoke their license.

As you may have guessed, administration's favorite children have never been mandated.

I was mandated once so far, along with another nurse I was working with.  This is nonsense, especially because:

1- I have worked a floor by myself and this was not considered "short" by administration, so why can't relief be adequate when only one nurse shows up?

2- When my floor is relieved by at least two nurses, how can I be MANDATED to report to a different floor to work another shift?  I didn't abandon my patients- they were properly turned over to other nurses.  I then have to assume a different set of patients for another shift, providing relief to a nurse who could otherwise be charged with patient abandonment.

I need the overtime pay, but when I'm available to work.  I have other things scheduled after work.  Getting stuck at the job until midnight precludes me from getting to anything else and leaves me completely fatigued for days.  Splitting the shift so I could leave after twelve hours would be more palatable, but this is laughed at as a compromise.

Over the years, I have met [and worked with] several nurses who work Two Full-Time Jobs.  Over eighty hours a week.  They are zombies.  Inaccurate.  Short-tempered.

A natural consequence of mandated overtime is that the offended nurses call out the next day, thus forcing another round of mandatory overtime to cover the openings.  On popular call out days, the call outs worsen.  Day shift nurses can't risk getting stuck on the evening shift if they have something personal they really wish to attend to.  Evening shift nurses with something planned the next morning have to call out to avoid getting stuck overnight and missing the event the following morning.

Tuesday, November 5, 2013

Three versus One


I've been floating a lot more lately.  When I am floated to a ward, I do a quick assessment of the staff:  how many are Evil and how many are Unknown.  It's not safe to put anybody in the category of On My Side or Neutral.

On this particular day, I had three Evil and a wavering bunch of Unknown.  The other variable was that one particular Evil, "Jess," was downright destructive when a particular senior attendant was not there to keep her in check.  Today, that attendant was, of course, out.

We had "Dina," who is on a rampage against other women because they are after her boyfriend.

And we have idiot "Jean."  I thought I could do away with her by sending her on a long escort off the ward.  I realized something was wrong when she got all dolled up, grabbed her jacket and purse, and quickly left.  A while later, I realized that the patient she was supposed to be escorting was still waiting for her on the ward.  Then the flurry of phone calls started because the absent patient was holding up the schedule in the other department.

At that point, my acceptance of the situation told me that there was nothing I could do.  Another attendant would not accept Jean's assignment to escort the patient.  The patient would just miss the testing.  There was nothing I could do about it.  Many times I've brought up Jean's disappearances, but I was blamed as the cause.

A bitch in the supervisor's office paged Jean overhead, hospital-wide.  That was the red flag that this was going to get bad.  This particular bitch hates me, loves Jean, and will do nothing to help me.  Her paging set off Jess.  Jess lost it.  She went berserk, right out there in the middle of the ward, screaming "She is so racist,"  "She is nothing but trouble," "I fucking hate her and am going straight to the top this time . . ."

Jess's rant set off Dina.  She started screaming that I was a "slut," "whore," and "Stay the fuck away from my boyfriend."

I called the nursing supervisor and told her that she needed to come to the ward.  NOW.

Somebody must have reached Jean on her cell phone.  Jean appeared as the supervisor arrived.  Jean, still wearing her jacket and carrying her purse, insisted that she was on the ward the entire time and I never told her to escort the patient anywhere.  Dina and Jess stood there, shaking their heads in agreement, and added that I was lying when I said that I told Jean to escort the patient.

I pointed out to the supervisor that Jean walked onto the ward with the supervisor, so how was Jean on the ward the entire time?  Jean's explanation:  I became confused when I saw the supervisor walking in and thought that Jean was also walking in, but she wasn't.

I told the supervisor that I needed Jess and Dina to stop ranting about their nonsense on the floor or, better yet, get me off that ward.  The supervisor said, "I have to hear their side."  They were in a back room for hours.  Screaming, cursing, crying.

Eventually I went back in and spoke with the supervisor.  Her response:  "Clearly, this is a personal issue that you have with these people, so it has nothing to do with me or this hospital.  I recommend that you don't bring your issues to work with you."

"Oh no," I objected.  "I have no personal relation with any of these people outside of this job.  This is a hostile environment they created for me and you are sanctifying it."

"All I can tell you," she said as she got up to leave, "Is to put it in writing.  If it's not in writing, I can't do anything about it."  She left.

Dina spent the rest of the day calling me "whore" and related names.  When I was on the phone, she would walk by and yell, "She's on the phone again, trying to find a guy to fuck her tonight because my boyfriend won't do it."

Jess disappeared for most of the rest of the shift.  At one point when she was back on the ward, she was intently writing on a piece of paper.  Another attendant near her stopped me to ask me something.  When she heard my voice, she startled and screamed, "She's spying on me!  What the fuck is wrong with you!" and ran off the ward.

Jean eventually took the patient off the ward for his appointment.  She later returned him and left without returning to the ward to finish her shift.  Several people who work in the department where she escorted the patient called me and asked what happened on the ward.  I told them, "the usual."  They said that they had to have her removed because she would not stop screaming, cursing, and bad mouthing me that I am jealous of her because she is sleeping with someone that I want to sleep with.

This was a very bad day.  It was not the worst day ever at this hospital because I knew to expect this behavior from the involved parties.

Monday, November 4, 2013

Silence the Mouth


I worked the evening shift recently.  Overtime pay is good.  The workload is a lot less, with no doctors running around writing orders and no other disciplines bursting through the ward doors every two minutes, making a bee line for the nurse.

The two problems with evening shift are:
1- the other nurse
2- the supervisor

I lucked out.  The other nurse was an older man that I always got along with.  The supervisor is the most evil of them all, but he stayed away, thanks to the decades of battle that he and the older nurse have already played out, night after night.

The older nurse told me that in his country, foreigners are treated with respect and people go out of their way to be nice and helpful.  He was shocked when he arrived in the United States.  Not only did people not help him, but they went out of their way to make his day more difficult.  He studied English in his native country, but had to learn the swears and curses here.  This behavior was not only exhibited by Americans.  Immigrants from other countries also opposed him.

All of this atrocious behavior was magnified in the nurse work setting.  While the racism was usually subtle in his neighborhood or on the street, it was up-front, in-your-face, completely unveiled in the hospital.  The attendants working under him screamed at him and the supervisors backed the attendants, while adding in their own angry opinions.

He said that he has handled this situation all these years by standing firm in his professional training and skills.  He is a nurse; the attendants are not.  As such, the attendants will take direction from him, or they will be written up.  If no action is taken against them, so be it, but he has his paper trail.  As for the supervisors, he has more nursing experience in more settings than they do and he can outmaneuver them in any dispute over clinical care.  He worked as a nurse in the military in his home country; he has trauma, emergency, operating, and labor/delivery experience.  In this country, he worked in multiple areas of hospitals before finally settling in the psych hospital as his final nursing job.

Most of the supervisors have little nursing experience outside the psych hospital.  They are woefully inadequate to handle the simplest clinical matters.  This does not stop them from correcting other nurses that they don't like.

The older nurse told me that he does not respond to any protests by the attendants or supervisor as they occur.  He is silent.  There is no point in arguing with them.  They can't understand him, they can't respond rationally, and they will find three witnesses who heard him say terrible things.

Instead, he writes a letter and sends copies to the people involved, the Director of Nursing, the director of the hospital, and the union.  He doesn't go through the union; he copies them on the letter.  Every time one of his letters starts circulating, everyone is shocked.  They don't see the pattern.  They thought that it was just another day of bullying somebody who went away, but then a letter appears.

The older nurse said he's been called into administration several times, always to defend his letter.  In spite of his letter, he is always blamed.  According to him, he is always able to dance his way out because he writes damning information about the role everybody played in the event.  "The pen is mightier than the mouth," he added.

But all of these people still work here.  They are never fired.

Sunday, November 3, 2013

Efficiency

I am efficient.  That seems to be a part of my personality.  I may be rather slow the first time I do a new task, but every attempt afterwards becomes speedier and more accurate.  I then tweak the process itself to make it more efficient.

On the average nursing shift, maximum efficiency doesn't mean that I have hours to spare at the end of the shift.  Rather, efficient means that most of the major goals of the shift were met and no fires are currently burning.

One of the nursing homes I left was one that floated me to the floor with an incoming admission- every time I worked.  "But you're so good at it!" and "You love work!" were comments frequently thrown my way.  No, the work was boring, rote, the same thing- I had merely streamlined it so it took less time.  Admissions still were extremely time-consuming and resulted in hours of overtime and requiring me to basically ignore the rest of my patients while I prepared for the admission and then admitted the person.  The inevitable arguments with the assistants that they did not have to care for the new admission because the patient was not present at the beginning of their shift.  The useless nursing supervisor, standing around, telling families, "I don't know why she hasn't helped you with that yet," instead of helping because she knows I am tied up admitting a new patient.

I always wanted a job were I was noticed and rewarded for boosting efficiency and saving costs.  In the nursing setting, the people who notice are not in administration and respond by dumping more work on me and then observing that tasks are not completed in a timely manner.