Friday, January 31, 2014

Dating: Not an exact science

I have been telling the attendants to put dates on the records that they create.  At this point, what they actually have to document is minuscule, but includes the patient checks.  Every hour, on a form containing the room numbers and patient names for the entire ward, the assigned attendant checks off [not necessarily checks] that the patient is alive on the ward or is off the ward.

Me being the unreasonably picky bitch that I am, started asking the attendants to put the date on the paper.  This was met with great resistance:  cursing, telling me off, storming off the ward, and other behaviors typical of the average two year old child.

Eventually some people started writing the date sometimes.  But never the correct date.  When I pointed this out, the response was, "You were the one who wanted the date on every paper.  We write the date, but you still aren't happy."

"I wanted today's date!" I exclaimed.  How could a group of adults be so damn uncooperative?

The response:  "It's a date.  It's good enough!  You are the only one who cares about such little details."

She does have a valid point.  If I brought in a supervisor on the date issue, the supervisor would decide that the task is too difficult for the attendants and that the nurse should add it to her task roster.

Thursday, January 30, 2014

Who's in charge here? Not me.

One of the nurses is a spiteful, mousy thing.  She's a useless idiot.  Whenever I work with her, I run around, getting things done.  She sits there or disappears.  The staff, doctors, patients- everyone comes to me and disregards her, which she is usually content with.

Enter new nurse.  I feel bad for her.  New grad.  Ended up at this place.  Nobody is hiring, she told me.

I am training her.  Until Stupid Nurse intervened out of petty jealousy.  I am pissed that she did this but even more pissed that I cannot maneuver around these attacks.

I trained new nurse Monday, Tuesday, and then started to on Wednesday.  Stupid Nurse, who was out on Tuesday, met with me and one of the supervisors.  This particular supervisor loves conflict and will create it when she doesn't find it.  I avoid this supervisor and know that she will take any situation and make it far worse- on purpose.

Stupid Nurse's complaint:  I talk with the new nurse and I allow the new nurse to "shadow" me.

Me:  Exactly.

Stupid Nurse's continued complaint:  I have done no work since last Friday because I am too busy talking with the new nurse [who was not at work Friday, Saturday, or Sunday].

Me:  Are you kidding me?  You don't seriously believe that you carry this ward, do you?

Supervisor's remedy:  New nurse removed to train on another ward because "she can't get along with [Stupid Nurse]."  Stupid nurse is to be in charge of the ward and I am to accept direction from her because I have not done any work for a week.

Stupid Nurse sought clarification:  "She just comes in and does work without even asking me or telling me.  She has to ask me before she can do anything.  Tell her that."

Me:  First, your complaint was that I did not do any work.  Second, I have my own nursing judgment and can recognize when something needs to be done and I have the professional responsibility to step in and do it without consulting you.

Supervisor:  No, you need to take direction from [Stupid Nurse].

Neither of them was able to explain how work got done on the weekend when I worked without Stupid Nurse or when I stayed for the evening shift and worked by myself.

They are both so transparent and they just swoop in and destroy my mood and any cohesion on the unit that I was building.  Everyone knows that Stupid Nurse can't run the ward.  Even this supervisor knows this and kept coming to me for things she needed.  I simply answered, "I would have to refer you to the charge nurse for that."  Stupid Charge Nurse disappeared for the afternoon.  I let the work pile up; after all, I was not to initiate anything on my own as specified by both the Supervisor and the Stupid Nurse.

When Stupid Charge Nurse resurfaced close to the end of the shift, I had my exit strategy.  I repeated words she's called out to me many days as I sat swamped in new orders:  "The shift is over!  I'm going home!"

She caught sight of all the flagged orders and gasped:  "All these orders!  Why didn't you do these?"

I gave her an answer she taught me:  "Me?  Nobody told me there were orders that I had to do.  Bye!"

Wednesday, January 29, 2014

Two is better than three

After slashing staffing levels, a nurse was suddenly added back on the day shift on each ward.  I'd rather work with one incompetent nurse than two, but this is what the higher powers want.  The gift of another nurse comes with a price:  the supervisor follows some of the nurses (not her favorite children) around and calls constantly, inquiring as to what the nurse has been doing.  As if nurses have the most boring, non-eventful jobs.  This is also after supervisors have stripped any tasks that the attendants still did and hoisted them onto the nurse.  I serve breakfast and lunch to the ward because dietary is short and serving food is not in the attendant's "contract" or it is against policy, depending on who you are talking to.

One of the surprising reasons given for not needing so many nurses is that "You have all of these doctors here to help you during the day."  WTF?  Who in their right mind describes the doctor-nurse relationship as the doctors helping the nurses?  The messed up supervisors at my job, that is who.

Now, I must tell you that most of the doctors at my hospital are nice and approachable; however, I must dedicate considerable time to discussions with them, guiding them on what orders need to be written, correcting the orders, and then actually transcribing them and carrying them out.  Few orders are written on the evening shift and only emergency orders are written at night.  I think it would be quite clear that more nurses are needed during the day to enact the hundreds of orders written on the day shift.  Nope.  Two nurses per ward per shift is the new standard staffing.  Adding back the third nurse on the day shift has lasted about ten days; in actuality, the supervisors use it as an excuse to harass certain nurses.

Tuesday, January 28, 2014

Flexible Hours

One of the nurses who is usually assigned to my ward is chronically late by over an hour.  That's not all.  She charges in, one to two hours after the shift has started, and then seeks me out to start in on me for having work for her to do.  "You've been here two hours!  How could just leave all this work for me to do?"  As if my job is to come in on time and do an entire shift's work of two nurses in two hours.  She rants and carries on like a spoiled brat, gets nothing done, distracts me from my work and irritates the hell out of me.

The positive part is that she used to be only half an hour late and it has grown into an hour or two.  It's less time that I have to endure her.  And some days she fails to show up at all.

I have tried replacing her by telling the supervisor that I'm still by myself an hour into the shift and that this brat (I use her name) is not coming in.  Sometimes I am able to bump her late ass elsewhere.

One day she arrived over two hours late.  The supervisor was surprised to see her and exclaimed that I had said that she was not there.  Well, she wasn't there at the beginning of the shift when I have to report which staff are on the ward.  This set off the brat who yelled, "Why are you telling the supervisor that I'm not here at 7 when I don't start until 8?"

This was news to me and made me mad.  First, if she starts at 8, she ends at 4:00.  Many times I have stayed for free until 4:00 with her because she complained that there was work to do and we couldn't leave.  Second, if she starts at 8:00, she no longer arrives by 8:00.  It's more like 9:00.

I am no longer staying a minute past 3:00 when she works with me.  She gets paid until 4:00, so let her stay and finish work she didn't get to because she took a two hour lunch and was on her phone the rest of the day.

She continues to get away with this.  I feel so played that she changed her start time and nobody told me.  And she is still chronically late with no repercussions.

Monday, January 27, 2014

Incredible Credentials

One of the nightmare nursing supervisors posted her usual open letter to the various wards with warnings of what must be done and not be done, blah blah blah.  Rife with her usual misspellings, run-on sentences, and rambling phrases, while clearly demonstrating her lack of knowledge about psychiatric nursing and the schedules of the wards.

What was unusual this time was the extremely long chain of alphabet soup following her name.  There were nine degrees:  BSN, BS, BA, MSN, MS, MA, ASN, AS, AA.  RN was listed twice.  There were two sets of letters I had never seen before.  I won't specify them here because that could out her.  I googled the letters and only one other person in the world uses each.  The first letter of each is M, which I suppose she self-designated to mean "Member."  The rest of the letters stand for organizations that anyone, not just nurses, can "join" after paying yearly dues.  The degrees, double RN, and the memberships were randomly tossed together.

I don't think she is old enough to have amassed Associate's, Bachelor's, and Master's Degrees in art, science, and nursing.  For someone with nine degrees, three of them in nursing, she demonstrates no knowledge of nursing.

There are rules on what and how to list in credentials following a name.  In general, you list the degree first, followed by the license, followed by the certification.  The lower degrees and non-nursing items are not listed.  Nor do you list RN twice.  You would not list membership in an organization open to everyone as a credential after your name.

I know this woman is nasty and thinks highly of herself, but this chain of ridiculousness shows how messed up she really is.  How does administration not see through her and fire her dumb ass?

Tuesday, January 21, 2014

Catching a Fall

The last several days were rife with physical fights.  I have to write separate incident reports for each patient and then re-write the summary in each patient's charts.  Four hand-written copies minimum.

Physical altercations are not unusual on the psych ward.  Punches and kicks and screams.  Me hoping that no other patients join in before the staff breaks up the original fighters.

Idiot supervisor decided to also require fall incident reports, complete with fall investigation reports and new fall risk assessments and plans of care whenever a patient in a fight ends up on the floor.  Landing or hitting the floor is common in the fights I've seen and I think it's covered under the fighting incident report and is not truly reflective of a fall incident.

Idiot supervisor would not budge.  As if I have nothing else to do but write the fighting incident reports and add in the pamphlet I have to write for the "fall."  I tried arguing that it was not really a fall; rather, the patient was not able to withstand a push, punch, or kick, and went down.  Surely that is different from stumbling and falling over one's own feet or an object on the floor.

The supervisor still wanted the fall incident reports.  So she got them.  Reasons for falls:
---"Was kicked on thigh by another patient, bent at the waist, and then was pushed to floor by other patient."
---"Pushed from behind by another patient and fell forward."  (Like the use of the word "fell?"  Makes it seem more logical, right?)
---"Punched on back of head by another patient, lunged forward into the wall, punched at the other patient, missed, and swung onto floor."

It's not just a fall incident report.  It's a new risk assessment with copies for the report, the chart, and the Fall Risk (Reduction) Committee.  Plus the care plan must be re-written to include the new problem of Risk of Fall.  I put the problem as "Risk of Fall related to potential for violence."  Usually the Risk of Fall is related to decreased vision, unsteady gait, orthostatic hypotension, or decreased risk awareness.  But these falls were special, so I may have a new category here.

Monday, January 20, 2014

She can't walk a mile in her own shoes

After fixing laboratory orders for two days, I called out one of the night nurses on her alleged "chart check."  I told her that it was obvious that she merely signs the charts every night and does not check that the orders are actually carried out, nevermind correctly.

She proffered, "What if I am by myself?  Then you don't expect me to check all of these orders?"

To which I responded:  "If I can take all these orders and carry them out BY MYSELF, then surely you, BY YOURSELF, can check them, especially without the constant interruptions that I have during the day."

She answered, "Well, I am never by myself.  The other nurse usually yells at me the entire night, so I can't concentrate and check anything."

She is so full of it.  I told her, "I would not sign my name and put my license on the line that some other nurse did something without verifying it myself."

She replied, "Well, I assume that the other nurse carried out the order, and that is why that person signed off on the order.  If the other nurse did not do what she was supposed to do, that has nothing to do with me."

Is she really this stupid?  The entire point of the 24 hour chart check is to catch orders that have been missed or messed up before they are perpetuated.  This is how errors continue for weeks until caught through another net.

You really can't blame her.  She has been operating in this haphazard manner since I started working in this hospital- at least three years.  Nobody above her has ever written her up or otherwise disciplined her for not checking the charts.  There have been serious medication errors and the investigation always blames the day shift nurse- never the night shift for signing that the order was correctly carried out when it was not.

But that little story is not fully illustrative of how far gone this nurse really is.

This is the finishing touch:

She eventually left and then called the ward about half an hour later.  "Did you find any shoes?" she asked.

"Shoes for what?  A patient needed shoes?" I asked.

"No," she replied.  "I got home and am looking at my feet, and I just realized that my shoes are not on my feet.  A patient was making so much noise that he woke me up early and in my confusion I must have forgotten to put on my shoes.  Do you see them anywhere around there?"  She was serious.

I said I did not see her shoes by the desk area, but would ask the staff out on the floor if they saw her shoes.  She replied, "Why would my shoes be all the way out there?  I never go out that far."

She went home without her shoes.  Through the hospital.  Through the parking lot, wet with rain.  Drove a car without shoes, without noticing that the pedals felt different.  Then thought that it would not be bizarre to call her place of employment, looking for her shoes that she just noticed were not on her feet.

Sunday, January 19, 2014

Time Off

I took two weeks off from the hospital.  I have never had such a long hiatus from a job.  The most I've taken is about a week.  I usually take a few days here and there, return to work with a backlog of work awaiting me, and dive in.

This time, my prolonged absence highlighted that nobody else does much.  Some people became afraid.

I returned on a Saturday, which is a light day to return.  My partner nurse arrived late, as usual, and immediately laid into me.  "Let me tell you something," she started.  She was miffed that I didn't stop working to give her whining my full attention.  "You were out for several days," she tried.

"I know that," I quipped and kept going.

She tried again.  "When you were out, nobody did any work."  She looked at me for sympathy maybe.

"I know that too," I quipped, still going.

"Well, what happened is that you didn't come back and do the work, so I had to do so much work."  She looked at me with tears in her eyes, and not from missing me.

"You aren't seriously looking for sympathy from me because you had to pull your own weight around here for a few days, are you?" I shot back at her.

"I'm just saying that you should have consideration for other people and not take off so many days at once," she continued.

"Really?  This coming from a nurse who had used up all of her paid time off last year by March?"  I yelled back.  She stared at me.  "And then you took off FIVE unpaid weeks OVER THE SUMMER to tour Europe?"  She continued staring.

The rest of the day, she scrambled to cope with the onslaught of two weeks of unchecked medication errors and unfinished work that couldn't be (logically) blamed on me.  I worked on the last two weeks of laboratory tests: orders never carried out and results never relayed to doctors.

I really don't understand how these nurses get away with it.