Monday, June 30, 2014

Misery and its company

You know it's a bad day when another nurse asks, "Where's the nearest liquor store?"

At 10 in the morning.  Only three hours into the shift.

At least I'm not alone in my misery.

Tuesday, June 24, 2014

Fighting for Control

Remember Dina, the person who who behaves very badly because she insists that I am after her boyfriend, "Pete," who is an orderly?  This is a problem that she has manufactured in her head.  I had heard that Pete was on permanent float status because he had an altercation with a patient on his home ward.  He is not allowed to work on the same unit as Dina.  Yet he was never assigned to my ward, which was great.

Until now.  He had an issue with one of my patients, which is why he was never floated to my ward.  As soon as this patient was transferred, Pete has floated to my ward almost every day.

He has no work ethic and is lazy, but that seems to be the requirement at this hospital.

As a nurse, I have hundreds of tasks that I must complete in a shift.  I have to prioritize them in order of importance to maximize efficiency.  Most orderlies have no idea of the amount of work I do and are oblivious that I have a mental task list in my head of the next hundred actions I will take.  This is why they will sit there, shooting the breeze, while I run around and they comment, "I don't know why she hasn't done this yet.  It is so simple."  Or the really obnoxious, "Nurse, you are keeping this person waiting."  It would never occur to them to go ahead and do these simple tasks themselves.

On one busy morning, Pete's one task of the hour was to sign his name on the cover page of the shift report.  The nurse, in contrast, composes the entire report template on (an ancient version of) Microsoft Word.  The cover page includes the patient census and acuities, which must be recalculated at the beginning of every shift.  The patients are listed on the multiple pages of the report in alphabetical order, along with their specific acuities, patient numbers, date of birth, attending psychiatrist, etc.  As the patient census changes daily on my admission-discharge ward, I have to spend time composing the report template before printing it.  No orderly grasps why I cannot magically print up a cover page upon my arrival in the morning.  Their comments range from, "You did not print the sign sheet yet?" to, "I don't see what takes you so long to tell the machine to print one page."

On this particular morning, I had printed the necessary papers and handed the cover page to the impatient orderlies who had gathered to sign.  I am busy.  I had to quickly divert my attention to other issues.  My usual order of tasks is that after the first round of meds, I return to the report and hand write relevant info about most patients.  I start with the front sheet, signing it, and then go through the rest, patient by patient.

Pete came through late, as usual, and made a beeline to the report to sign it.  They never read it, which is actually the purpose of signing the report- you confirm that you have read the report.  I was busy in a treatment room with wound care because the night shift nurses refuse to do wound care and I can't have patients wandering the halls with open wounds in front of doctors and administrative people.  Pete brought the report into the room, pushed it into my personal space, oblivious to my bloody gloves and sterile work area, and said, "Enid, you forgot to sign the report."  His tone is friendly for the set-up.

"Please mind the treatment set-up and put the report back at the nursing desk," I told him.

Step two:  He became nasty in a flash and stated, "I was only trying to help you."

"You can help me by allowing me to finish wound care," I answered.

Step three:  He became nastier and rephrased his request as a command and informs me what my responsibilities are.  "You are supposed to sign this report.  So sign it and we can go on with the day."

I stand up for myself:  "Get out of this room.  Go back to the supervisor and get assigned to a different ward."

Pete got louder as he left the room so more people could hear his voice echoing down the halls.  "I'm not going to a different ward.  You can't tell me what to do."

Just before lunch, as the patients congregated in the dining room, some of the patients called out for me, upset that they were not allowed into the bathroom.  I stopped my charting in the back and came out to the floor to find that Pete had closed and locked the doors to the dorms.  He was standing in front of the only accessible bathroom, snipping at patients, "I told you.  I will call you one by one to use the bathroom.  You cannot go back to your room to use the bathroom in your room."

You can't jam all the patients into one room, make them wait for you to decide to let them into the bathroom, and think that there won't be a fist fight.  Paul getting punched in the face would be worth the paperwork, but with my luck, the fight would be only among patients.

It would have been useless to tell Pete to stop.  Instead I unlocked the doors to the dorms.  The patients streamed in.

Pete gave his three stage performance.  As I was walking across the floor towards the dorm entrances, he called out in an almost friendly tone, "Hey Enid."

As I approached the doors, Pete got nasty, "I got the patients out here to help you."

As I unlocked the doors, Pete shouted, "You aren't allowed to let the patients go to their rooms.  Don't unlock the doors."  As I crossed back through the floor to try to get some charting done before lunch arrived, Pete screamed, "Since you don't listen to me, I am going to tell them to not put me on this ward because you don't want my HELP."

I am pleased with myself that I can see right through him.  In the past, I would have been afraid to go against Pete because Dina would have swooped in and created a loud, emotional scene on the ward.  Now, it seems pleasurable that it is so easy to tick him (and her) off.

How to Determine if You are the Dumping Ground

My dear readers, please keep in mind that I did not set this cascade of events into motion.  Nurse Tina did.

Near the end of my shift, I was wrapping up loose ends on what had been an uneventful day.  Nurse Tina called, blabbering that she needed to trade a patient with me because her patient "Is going after another patient."  Tina said that the doctor had already written orders.

I told Tina that the doctor had not been to my ward yet, so I had no order to move the patient she named to swap.  In addition, the patient was visiting with her sister on the ward, so I could not get her packed up now.

I was surprised by Tina's selection of which patient of mine that she wanted.  The patient is a nightmare.  She insists that she is in the hospital because she is in a witness protection program and not because she has a psychiatric illness.  As she is not mentally ill, none of the rules apply to her, because she is not really a patient.  Her family smuggles in all kinds of prohibited items to her, from the more innocent candy and hair dye to the serious marijuana, knife, pet lizard, and beer.  She refuses most medication because she is not sick.  She will take Klonopin and constantly seeks Percocet, which no doctor will order for her.  She needs the Percocet because several years ago she was hit by a car or a bus driven by a rock star or a model, depending on the version, and still has pain "like everywhere," and will be getting a million dollar "reward" from suing the "President of Europe because it was his country that made the car."  She gets credit cards in the mail and orders a bunch of designer stuff from Macy's until the card is canceled.  She is plump and walks around in tight, revealing clothing, spilling out of leggings and push up bras.  She forms romantic triangles on the ward, resulting in violent fights.  She speaks very slowly because she is very busy listening to all the voices in her mind, nodding her head, discussing and issue with them before answering the actual person in front of her.  She randomly attacks staff and patients because they implanted microchips in her teeth.

For another ward to specifically request this patient in a trade, I knew that the other patient had to be a doozy.

I informed Nurse Tina that I had to speak to the doctor first and see if the patient would cooperate with a transfer.  Nurse Tina dismissed my reason for not swapping immediately and hung up.

Half an hour later, just before my shift was over, I came up from a wing on final rounds to find an orderly from Tina's ward with an unknown woman next to him.  He was hollering, "Who is going to take this patient from me?  I am not staying here."

He told me that he was told to bring the patient over to my ward, but that she was on close observation, so he couldn't just leave her.  I asked the orderly the patient's name and got the usual answer, "I don't know."  I asked the patient her name.  She didn't answer.  The orderly left.  There was no chance my orderlies would watch the patient, so she went unwatched.

I called Tina's ward many times.  I had nothing on this patient.  Finally I got Tina on the phone.  "She's very violent, out of control, running around here, hitting everyone.  What did you expect me to do?"

"I expected you to put her in seclusion and sedate her, not sneak her onto my ward.  I have violent, psychotic patients on my ward as well.  You have shown no concern for the welfare of this patient or any other patient on my ward."  If I had done that to her, the supervisor would be writing my ass up that moment.  "I don't have a chart or medication for her.  We do nurse to nurse patient transfers here.  I need report on her."

"I am too busy to drop my work to give you all these things you decide you need at the end of the shift," Tina sneered, and hung up.

The nurse for the next shift arrived.  I gave him a run down of the transfer situation.  Predictably, he roared, "I do not accept this.  You cannot tell me that you have more patients than you have beds and you do not know the name of this new patient and have no chart or anything for her.   And have you even packed up our patient who is being sent over there?"

"No," I explained.  "We can't touch her stuff without her because she is too suspicious and volatile.  She is still with her sister."

The nurse told me, "Call Tina back and get report on the patient."

I called Tina and put her on speakerphone.  I said, "Tina, I have you on speakerphone so you can give both of us report on this patient."

Tina lost it.  "You are not allowed to put people on speakerphone.  I am too busy to give you report.  She's your problem now.  Nobody likes you.  Everyone says you are so rude, and you are.  That is too bad if you don't want to do a transfer.  Who do you think you are, telling me that I have to give you report on a patient that isn't even mine when my shift has ended.  If you wanted a report on her, you should have called earlier.  Everyone on your ward tells me what a horrible person you are.  You should grow up.  This is a hospital.  You are supposed to have patients.  When someone gets around to bringing you the chart and medication, that is when you will get it.  You can't expect people to listen to you and do favors for you when you are such a bitch."  She slammed down the phone.

The evening nurse sat there with his mouth open.  "And that is why I have no report to give you on this transferred patient."  I left.

The next day, I was off.  I called Nurse Fortune to lightly tell her "my side," that the patient was sent at the end of the shift with no chart and no nurse to nurse report.

Fortune told me that Tina was irate with me and badmouthing me all over the hospital.  This I expected.  I think that Fortune realized on some level that I was not at fault.  She said, "I figured something was up when I saw that she was moved just before shift change and that the evening shift did not get the other patient moved out until bedtime."  Fortune also told me that the patient was on close observation for falling down, not for aggressive behavior, and that she is a fragile diabetic with seizure disorder.

Monday, June 23, 2014

Enforcing Boundaries

One of my fellow nurses, "Tina," shows an interest in the patients- but she is an idiot with no decorum or sense of boundaries.  She talks and talks intensely, seemingly without thinking.  I picked up on her lack of fondness for me and kept my distance from her.  Thankfully I don't work with her often.  She shows no empathy for a patient's turmoil or feelings, as if she doesn't even pick up on signals that she is being intrusive.

In one instant, a teenage patient was trying to get his bedsheets changed before anyone noticed that he had wet the bed- again.  Someone noticed and brought it to Tina's attention.  In the middle of the dayroom, in front of many other patients, Tina loudly berated the patient, "I told you this before.  If you wet the bed, you need to tell me.  You can't just hide it.  You were trying to hide it.  I told you not to.  Don't you remember that I told you this?  How do you expect to get treatment for wetting your bed if you pretend that you don't wet your bed?  Don't walk away from me when I am talking to you.  Where are you going?  I am trying to tell you something very important, and you try to walk away and not listen.  From now on, I'm going to ask you several times a day if you have wet the bed.  Do you understand?  Why aren't you answering me?  I asked you a very simple question.  Do you understand that you have to tell me every time you wet the bed because I have to call your doctors and tell them.  Everyone needs to know that this is going on."  She was oblivious to the patient's embarrassment, his facial expressions, his glances around the room at everyone listening, laughing at him.

Tina is obsessed with bed bugs and keeps insisting that she finds them on her ward.  She walks up to patients in the open and starts moving their clothing to check for bites from the supposed bed bugs.  Most people don't like this, never mind patients on a psych ward.  Someone really needs to deck her.  One day during the patient's lunch, she came up to a big guy, eating his lunch.  She pushed up his shirt sleeve as she told him that she was looking for the bed bug rash.

He sternly told her, "Don't touch me."  When a big guy who lives in prison or on the streets when he is not on a psych ward tells you to not touch him, you don't touch him.

Our Tina doesn't pick up on warnings.  She didn't stop trying to move his sleeves as she stated in an irritated manner, "I am checking for the rash because you had bugs in your belongings.  Why would you want to walk around with bugs crawling all over you?  You are not making any sense.  I am trying to help you and you are telling me that you want the bugs on you.  Well, that's not going to happen.  The bugs will not stay just on you.  You are going to give everyone in here the bugs that are crawling on you and then I will have an even bigger bug problem on this ward."

Big guy stood up in what I perceived to be the last warning.  "Bitch, you and your bugs need to get the fuck away from me."  Orderlies had to redirect both Nurse Tina and the patient.

Tina kept ranting within earshot of the patient and other patients about how she tries to help people, "But some people would rather live with parasites."

Seven Ways of Lazy

The orderly who microwaves fish every morning for breakfast approached me near the end of the shift.  As usual, I was swamped with orders, patients calling out for me, the phone ringing non-stop.

"Excuse me," he sort of sang, "I just wanted to tell you that I did seven things today.  That is too much."

I stared at him.  I wanted to beat him, but I would probably go to jail, and that is bad.

He continued.  "I am just saying, that seven things is too many.  You cannot give a person so much work.  I worked all day."

"Walk away.  Now.  Turn around and walk very quickly away from me."  I said this in a low, slow, serious voice as I glared at him.

And he shut up and went away.  What a lazy fuck.

Placing Blame where due

One of my fellow nurses is angry, loud, opinionated, judgmental, and pushy.  And she does no work, but that was a given, wasn't it?  We'll call her Fortune.  Over the weekend, she somehow came to the conclusion that she was not chosen for two open positions in the hospital, Ward Manager and Nurse who schedules Specialists.  She carried on for two whole days.

Concerning the Ward Manager position:
"I have seniority.  I'm incompetent to run this ward even though that is exactly what I have been doing for over a year now ever since that sorry excuse of a ward manager stopped coming to work.  "You are out too much," they said.  It's called AN ACCIDENT.  I did not mean to be out, but I had AN ACCIDENT.  That could happen to anybody, even a ward manager.  Even one of those people who pretend to run this hospital.  So they should not have jobs running this place because they could also be in AN ACCIDENT.  I am out sick a lot.  Yeah?  So?  I get sick like everyone else.  If I am not supposed to call out sick, then why do we have paid sick days?  Like they don't call out?  I'll file complaints against them for racism."

Then Fortune's focus shifted to me, once the racism theme popped into that scrambled brain of hers.

"And I'm filing a racism complaint against you," she snapped at me during one of her rants.

"Me?  I have nothing to do with you not getting a different position," I said, as if offering logic would help this screwball.

Fortune bickered, "I have it on good authority that last year, you went to the office and told them that I was late."

"You are late every day as far as I am aware," I answered back.  "If you punch in, then whoever reviews the punches can see that you are late.  I don't have to point this out to anyone."

Fortune then engulfed the scheduling position into her racism complaint against me.  She insisted that I was given the position of nurse scheduler and to add insult to injury, I did not tell her and was now lying that I did not know that I was given the job.  "You went ahead and applied for that position with no regard for my child.  You know I can't find anyone to watch him and so I really needed a position with no weekends.  You know that they'll give you the job over me because you are all so racist.  Now who is going to watch my child on the weekends?  You?  No, of course not, because you are too selfish and only look out for yourself."

One of the patients who listened to her all weekend pointed out one flaw in Fortune's argument.  Fortune was not thinking of her child when she applied for the Ward Manager position because she would also have to work weekends with that position.  Another pointed out that Fortune had worked at the hospital for years before she gave birth, so she knew in advance that the job required weekends.

Fortune has so much hostility for me that she readily releases it onto me when she gets herself worked up.

Thursday, June 19, 2014

How to deal with Problem People

This is a perfect example of the Trouble Maker nurse from administration who interviewed me for the in-house transfer.

She performs at change of shift, when the place is too noisy and chaotic for anyone to pay attention to her.  This is the first thing she points out in her complaint to the Director of Nursing, "When I attempted to make the nurses aware of this problem, they all ignored me and refused to discuss the matter."

She targets a patient with borderline personality disorder.  She then declares to the staff that the patient has borderline personality disorder, as if we did not notice, and presents the long list of the patient's complaints about the staff, with the typical honorable mention to the one staff member who was wonderful but fell from the pedestal for failing to do one thing of thousands for the patient.

In this situation, she chose a 30 year old man.  He does not speak- selectively mute.  He communicates his demands by writing them on a piece of paper.  He does not begin writing until he has the staff member in front of him, and then becomes upset when the staff member cannot wait for the list to be written.  He talked upon admission, but soon stopped "because the staff did something to upset him," according to Trouble Maker Administrative Nurse.  In addition, he stopped walking and uses a wheelchair provided by some unsuspecting staff.  Trouble Maker nurse wants full body scans, neuro consult, and speech and physical therapy started immediately.

I myself have observed him walking without difficulty in his room when he thought nobody was watching, which is reflected in my nurses notes.

The problem with catering to the demands of someone who behaves like this is that you can't ever satisfy him.  You can meet his every demand, and he will still be upset because he now has more demands for you to meet, but you are paying attention to someone else or you are too exhausted by him to meet the next batch of tedious and illogical "needs."

I am not sure how to handle Trouble Maker Nurse.  It seems like she craves attention, but especially needs to make trouble for other people.  She does not get loud when ignored; she stops talking and leaves.  But that's not the end of it.  She then contacts many people about the patient's horrible condition and the lack of care exhibited by the staff- and then gloats as the fallout hits.

A big, mean, nasty nurse was on coming on duty.  He is also energized by conflict and gets loud.  He screamed at Trouble Maker Nurse, "You don't know what you are talking about."  He then turned to the patient, rocking back and forth in the wheelchair, and hollered, "Tonight, you are getting out of that wheelchair for good."  He then grabbed the wheelchair while he hoisted the patient to a standing position.  He sent the wheelchair flying down the hallway while he shouted, "It's a miracle!  He can stand!"  The patient was so angry that he started yelling and cursing at the nurse.  "Another miracle!" the nurse shouted.  "The mute cripple can stand and speak!  Hallelujah!"  He then screamed at Trouble Maker, "Take that back to your bosses.  I will tell them that you wanted this capable young man to become permanently disabled."

She walked away.

The big nurse declared, "And that is how you deal with such people."

Blind Leader

I had another job interview.  Don't get too excited.  It is for a different position within the hospital.  Over the years, I have applied for many transfers, but never heard word.  This was the first ever response to my application for a move.

The position is silly, but I have filled in for it many times.  A nurse is not even necessary to perform this job.  The nurses on the unit do not arrange for tests or consults by specialists.  They send the doctor's order to this office, who then makes the arrangements and notifies the unit of when, where, and how to prep.  The people on the other end of the phone are not nurses, as your average person is capable of making an appointment without a nursing degree.  But this is the way that this hospital has decided to run things.

The interview was with the Director of Nursing ("DON"), a nurse in administration whose primary task is Making Trouble, and a shift supervisor (not the most Evil Supervisor).  The supervisor seemed to want me for the position, as I am the most organized and thorough nurse on the staff.  (I have little competition in that skill set.)

The Director of Nursing sought to prove how ignorant and stupid she is.  She asked, "What skills would you bring to this department, if you are transferred there?"

I replied, "I am highly organized and efficient."

DON said, "You need to know how to use Electronic Medical Records for this position.  Have you ever worked on a computer?"

Me:  "This hospital does not utilize Electronic Medical Records in any department and yes, I am skilled in computer use."

DON said, "Well, you need to use a computer to make appointments.  Are you saying that you think you are capable of doing that?"

Me:  "We make appointments on the phone and then hand-write the information and physically bring it to the ward where the patient is staying."

DON:  "You see, I did not know any of this.  I really don't know what you would be doing in that department."

At some point, the DON decided to add that "Knowledge of medical problems" is necessary for this position.  "How would you be able to make appointments if you have no experience taking care of sick people?"

I pointed out that the patients who need appointments for their medical problems are the same patients that I physically care for as a floor nurse.  I also worked in nursing homes for years, admitting patients straight out of the ICU, with tubes everywhere and dozens of medications by many routes- all without a doctor on the premises.

DON:  "How could they send such a sick person to a nursing home?  Why don't they keep them in the hospital?"

Me:  "Under the current reimbursement structure, people can only stay at the hospital for the number of days proscribed based on the illness.  People who still need care are transferred to nursing homes, if their insurance covers it."

DON:  "You see, I did not know any of this.  Nobody ever told me.  I thought that nursing homes were places that people went to die.  I never knew that sick people stayed in nursing homes.  I am going to have to look into this."

Trouble Maker kept going back to her phrase, "How you are perceived by the other people who work here."  For example, "How do you expect to convey information to a particular ward, given the way the staff perceives you?"

Trouble Maker herself is despised throughout the hospital and is cited as the instigator in many suspensions (quite rare nowadays, though).  She has some nerve pointing out that some people don't like me- the same people who also do not like her.

After the other two had concluded their questions, the DON returned to her original question:  "You said that the skill that you could bring to the department is that you are organized.  I am confused.  You mean you are organized on the computer?"

"Sure," I answered, wondering how someone so obviously clueless could work as the director of anything.

The DON then pointed to a blank area at the top of the paper she was writing on for the entire interview.  "You see, I have to put an answer to each of these questions for every person we interview.  The first question is still blank for you.  I need to write what skills you have that would be useful to the department."

"Organization and efficiency," I replied.

"But you need to know how to work a computer," she replied, like a little child, explaining disappointment but acceptance over not getting a desired toy.

"I do," I answered.  The fate of my employment rests in the hands of this idiot who considers computers some mystical, untenable concept.

Imagine how much could get done if the people who won't go near a computer were replaced by people who worked on computers.

"You can write that I know computers," I told the DON.

She hesitated, but wrote the word, then issued me caution.  "I'll write that you can work a computer, but if you don't know, well, I don't know.  I don't know how you will learn.  But I guess that's not my problem."

Thursday, June 12, 2014

Telephonic Job Interview

I had a phone interview for a job at an accounting firm!  The ad was for an administrative assistant and specified that a NURSE or "someone with a medical background" was preferred.

The person who interviewed me said that they do a lot of financial management for nursing homes and doctors.  They were looking for someone who had a knowledge of medical terminology.  The man explained that he would "love" to have a nurse because "nurses are smarter than your average secretary."

The salary:  $12 an hour.

I told him I couldn't work for so little.

He sounded as if this was such a great opportunity for me to learn accounting and that any money paid for learning just made the deal sweeter.

No thank you.  I told him that nurses make more money that what he was offering, so his chances of getting a nurse to work for him on that salary were almost nil.

I'm glad I was able to do the interview on the phone.  I didn't have to get dressed up and waste gas traveling.  Is my current job the best I will ever find?

Friday, June 6, 2014

Less is Best

"If it wasn't documented, it wasn't done."

This is ridiculous.  I wish people would stop promoting the notion that it is possible to record every little thing that the nurse does for all of her patients and that if something was not documented, it was not done and caused a patient's problem.  Most things that a nurse does for a patient are not documented because this is not practical, but this does not mean that the undocumented care was never performed.  If a hospital actually believes that every act can be recorded in the patient's chart, then they need to assign three scribes to every nurse.

Who documents every damn call light?
Folks, in medical settings, there are people who ring the call light NONSTOP.
This is extremely time-consuming.

I do rounds at the beginning of a shift and greet patients, adjust people and items, answer questions.  In my current setting, I usually have about 30 patients; in the nursing home, I had anywhere from 30 to 60 patients.  My shift is not designed for me to open 30-60 charts after my initial rounds and document the condition and services rendered to every patient.  That could take an hour.

Take a highly detailed, minute-by-minute account of a patient's care during a shift.  That nurse spent more time creating the shift notes than she did delivering actual care to patients.  Who was caring for the patient while the nurse was documenting the care already delivered?  Do we really want a nurse paying more attention and time to a chart than to the patient?

In every setting I have worked, I have also been told that "Less is Best."  The more details you provide, the more you open yourself up to criticism for doing something wrong.

For example, a blood pressure reading.  Desired at my places of employment:  BP 128/78.  End of story.  If you were to write a more detailed note, such as, "seated BP 128/78 via manual sphygmomanometer on upper right arm," someone could attack every element.  Had you measured the blood pressure standing up, you would have gotten a lower reading, perhaps indicating postural hypotension and the need to institute fall precautions.  The sphygmomanometer was found to be defective during an inspection the next day.  A review of the patient's medical history revealed a mastectomy of the right breast, so the right arm should not have been used to measure blood pressure.  BUT- If you simply record the blood pressure, you have wiggle room should an incident arise later.

Monday, June 2, 2014

Third Time not a Charm

The hospital that hired me for per diem worked has withdrawn the offer "because you have failed to take the required three tests before orientation."

I traveled to the hospital three times to take these tests.  I found confused people who gave me the wrong tests.  They were at fault, as far as I am concerned.  I pointed this out to the caller.

"Be that as it may, the fact still remains that you were supposed to take specific tests for medication administration and behavioral health and you did not do this.  I must inform you that you may not start orientation."

I tried to be firm:  I took three days off from work and in every instance, an employee of the hospital either did not know how to give me a test or gave me the wrong test.  I have no reason to believe that coming in a fourth time would result in administering the correct three tests.  I am willing to take the correct tests during my orientation.

No deal.  "The people in this office tried their best, so it is not their fault," she explained.

Well, that's that.  I'm back to hoping for overtime at my current place of hell.

Backing Off, Part Two

The ward was inherited at 7 a.m. with an overflowing toilet in one of the patient's rooms.  No, night shift did not notice because "we worked short."  A patient stuffed shoes and clothing into the toilet and kept flushing, flooding his room and the room below it.

I summoned Housekeeping and Maintenance.  The process: housekeeping mops the water, maintenance fixes the plumbing issue, and then housekeeping cleans again.  There was a snag with this situation, however.  Both departments claimed that they cannot go near the problem because they are not permitted to touch personal items that belong to patients.  While I was running around, busting my ass, the workers and their supervisors held a meeting in the hallway, discussing who should pry the shoes and clothing from the toilet.  Their conclusion:  The Nurse.

The gang approached me with the news of my assignment.  I told them no.  They offered reasons why this was actually my job and not theirs- while I was giving medication to patients, taking blood pressures, answering the phone, and on and on.  They stood there, telling me, "We'll wait until you are done."  I'm never done until my shift is over, darlings.

I was not going to fall into the trap of telling them, "Fine, don't do it, see what I care."  Because they would have walked away from the disaster and defended themselves by saying that the Nurse in Charge (who they never listen to anyway) "told us to not work on the flooding toilet."

I reminded myself that I have a working toilet for my use, both at work and home, so that I am not really affected by this stuffed toilet flooding problem.  I was not going to put my work on hold while I attempted to pry stuck items from pipes- while a bunch of people stood around, chit chatting.  I kept doing my work, which never stops flowing.  Eventually the floor below us complained enough that administrative people of importance got involved.  Then, like magic, housekeeping and maintenance worked on the problem and fixed it.

Backing Off, Part One

The regular garbage cans in the treatment room were replaced with biohazard containers.  Only medical waste is supposed to be placed into such receptacles.  This is a problem at the hospital because most employees don't notice where they throw garbage and because no regular trash receptacles were available.

The biohazard bags quickly filled and then overflowed onto the floor because nobody threw out the bags and replaced them.

I asked housekeeping to take care of the trash.

"I can't," was his response.  "You need to fill out a special form if you want them emptied.  But I can't take them anyway because they are filled with regular garbage, not medical waste."

This is ridiculous.  "I didn't fill out a form to have the regular trash containers replaced with medical waste containers.  Where are we supposed to put regular trash?"

"I don't know," was the response.  "I just know that I am not supposed to take out regular trash in a biohazard bag."

So the trash remains.  I no longer keep insisting that people perform work.  I end up in trouble for harassing people and my tone of voice.  I write down who I told and when.  If they choose to not perform their duties, that is on them.  When they complain that I told them to do work, I am the one who loses that battle.

How to Defend a Bad Review

Time for the annual reviews of the "support staff."

Another nurse completed one review- for the clerk.  The clerk was quite angry.

"Who the fuck are you to fuck with my money?  I don't give a fuck what you think of me.  You have no right to prevent me from getting a merit raise."

This went on all day.  As usual, she performed no work and disrupted the entire ward with her screaming.

She clearly has a fundamental misunderstanding of how one obtains a merit raise.

The raise is only a few hundred dollars, which most employees don't even attempt to earn.

Her excuse for the condition of the charts is so typical of this hospital:  "I know that the charts are falling apart.  First of all, that is not my job to fix them because I am not the one who writes in them.  Second, I thinned a chart once.  The doctor complained that I removed records that she needed and she told me to never touch the charts again.  So I am not even allowed to go into a chart to thin it or fix it.  Third, seven years ago I asked to be inserviced on how to correctly thin and repair a chart and TO DATE have yet to receive such an inservice.  So until you all sit me down and explain to me what it is you want me to do, you can't fuck with my money."

And she had to throw in:  "This is sexual harassment.  You all are racist.  You want me out of here because I am old.  You are discriminating against me because of my religion.  I'll file grievances against all of you."

It's like a scene out of a movie.  She does not realize how ridiculous she sounds.