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.

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