Sunday, July 27, 2014

Not my job

I spend a little time in my new position, scheduling appointments, but then am yanked to a desperate ward to work as a floor nurse.  The ward physically located nearest the office is the ward from hell.  I am usually pulled there.

Radiology is in a room next to the scheduling office.  This is the layout of the hospital and does not indicate that I have anything to do with them, which I do not.  The techs cannot go onto the wards after recent violent incidents.  An orderly must bring the patient to radiology.  The ward from hell has the most patients for radiology, mostly facial and hand xrays because of all the fighting.

One morning, the tech asked me to contact the ward from hell because she was getting gruff for not getting the patients processed- but the ward will not answer their phones.  I called.  No answer on any line.  So I walked over there.  The clerk was sitting next to the ringing phone, eating a doughnut and reading the Bible.  I glared at her and kept walking.  I found a nurse.  "I only do medication," she said as she dismissed me.  I found the charge nurse.  She was so involved in a heated argument with an orderly that neither noticed my presence or attempted verbal interruptions.  I called out for the patient.  An orderly appeared and said, "You just come here and don't even say, 'hi.'  I want to tell you all about my vacation.  You didn't even ask me how it was."

They are absolutely ridiculous.  "Listen," I said, "John Smith needs to go over to radiology."

"Who is that?" the orderly asked.

"It's one of your patients," I answered, and turned to walk away.

The clerk jumped up to stop me, not because she is interested in providing patient care, but because she is suspicious of me.  "I heard you say that the patient needs radio.  Where is the paper?"

"I have no idea where you keep the requisitions for radiographs.  As a courtesy to the tech, I came over here to let you know that they are waiting for your patient," I said and went to leave.

The arguing nurse became interested and called after me, "Oh no!  You can't just come here and tell me to send a patient over to radiology.  They are supposed to call first."

I turned to her.  "The tech and I called multiple times.  Nobody answered.  As I courtesy, I stopped my work to come over here to let you know that radiology is waiting on your patient."

"Nobody answered all those calls?  I don't believe it," the nurse argued.

"Believe it!" I snapped back.  "You won't get any work out of this clerk," I hollered as I pointed at the clerk, who was still standing there, trying to take in my existence.

I left the ward and told radiology that the patient was not likely to be sent.

How am I supposed to handle future requests from people that I physically walk over to the ward from hell to induce them to cooperate?

Lying to Achieve Goals

The supervisor from hell approached me two weeks ago about a medication error from eight months ago.  It was not tragic- ibuprofen given a day after the order finished.  It also wasn't my error.  She tried attributing the error to me:  "Clearly, this other nurse was helping you, so you are responsible for this error.  Consider this your formal counseling."

Fast forward to the present.  Hellish supervisor again approached me with the same error.  "If the state saw this, the hospital would be closed down immediately.  I am trying to protect this hospital as well as your nursing license.  The record must be rewritten.  Because it is your error, it is your responsibility to track down everyone else who signed on this page and have them rewrite their entries and signatures."

I told her that due to the grave nature of this situation, I would be seeking guidance from the pharmacist as well as the union.  Supervisor replied, "You can't show this to anyone!  Medical records are confidential.  If you tell anyone, I will have no choice but to report you to the nursing board for breaching patient confidentiality."

I am not sure how to handle this.  I want to crucify her for this, but it always blows up- in my face.  We don't re-write medical records.  If the error were that serious, they could have the nurse who gave the ibuprofen cross it off and write "error."  The chart itself should not be a target for state review- the patient arrived, was stabilized, and was discharged.  No complications or incidents.  The state tends to go after charts of patients who are very complicated and had major problems during hospitalization.

Supervisor put nothing in writing.  This is going to be a problem for me if I challenge her because she will deny telling me to rewrite a medical record.  She handles my annual review, which is past due.  She can reference this medication error and then misplace the supporting evidence.  She'll bring in false witnesses to testify that they were present when I was repeatedly counseled on my errors and that I refused to accept guidance.

Serious errors are made daily by her Favorite Children- about which, she does nothing.  And yes- I am copying all of them and keeping them in a safe place.  I can't charge her with failing to go after other people who make mistakes if I can't prove the mistakes and her lack of prosecution.

Monday, July 14, 2014

Clear, Hazy, Whatever

One of the psychiatrists has never written a coherent, sufficient order.  Aside from the handwriting, which is almost indecipherable, he always omits at least one necessary part of the order:  strength, route, duration, indication.  He'll discontinue a medication that was never ordered.  He'll order an existing medication in a different strength at a different time- and he either means that this new time and strength is in addition to the existing order or he means that the prior order is (silently) discontinued and that this is the new and only current order for the particular med.

I had to sit him down and review two pages of orders for a patient that were screwed up in so many ways.  I noticed the problem last week when I floated through the ward.  I called the doctor to return to fix the problems.  By the end of my shift, he had not showed, so I copied the pages and highlighted the errors to be fixed.  One week later, when I returned to the same ward, I found that the orders had not been fixed and that the pharmacy was sending medications that were discontinued weeks ago.  Three different nurses handwrote the medications onto the Medication Administration Record "because why else would the pharmacy send them?" one explained to me.

And no, there is no 24 hour chart check to review the orders.  The night nurse opens each chart, writes "24," a little circle (hour), a check mark, her initials, and then closes the chart.

The doctor's response:  "Why is it that when the pharmacy screws up or a nurse transcribes an order wrong, I am the one blamed for someone else misinterpreting what I wrote?"

The supervisor's response:  "You don't really expect a nurse to look at all the current medications that a patient is taking, now do you?  If the doctor discontinued a medication, but it was not an active order, you just go on.  Same if the doctor wrote an order for a medication that the patient is already on.  You just transcribe the order and move on.  So what if there is a duplicate order or something is not clear?  That is what the doctor ordered, so who are you to say that we should not follow the doctor's order?"

That's not what I said at all.  This is why this place is going to hell in a handbasket.

What's good for the goose . . .

I heard that a nurse was fired for posting a picture on Instagram.

I didn't pay much attention, but then a blogger posted about it, so I figured I would check it out.

I have posted pictures of my job on Facebook.  Usually ridiculous signs or food messes left behind by coworkers.  I make sure no patients or private information gets into the shot.  I am on Instagram, but only to look at other people's pictures.  I have never posted a picture on Instagram, but it has similar features and potential for public observation like Facebook.

Nurse Katie Duke was fired from New York Presbyterian Hospital.  What struck me about this situation is that Ms Duke was not some unknown nurse.  She appears in a television show called NY Med.  I had never heard of this show until today.  I was confused at first because I thought that the uproar was that the television character was fired in the show.  No.  With the consent of the hospital, Ms Duke and other healthcare providers are filmed inside the hospital performing their jobs in some kind of reality show ("documentary") for the Emergency Department.  Ms Duke is not an actress playing a nurse.  She is a nurse and she really works[ed] on location.

Ms Duke was fired for posting a picture of her job setting- the very same setting that is filmed and broadcast on television for the public to view.

What am I missing here?

Ms Duke seems to have moved on to a new nursing job, as well as new business ventures.  Good for her.

Sunday, July 13, 2014

Two minutes, two days

I'm working irregularly in the scheduling office, most unfortunately.  It was to be my lifesaver in this snake pit.  Every day I am pulled to work a ward.

Anyway, reports are required of the office about requested appointments, patients seen by which doctor, and speed of tests administered versus when requested, and so on.  The nurse who has been running things keeps daily track of these events on a spreadsheet.  The first entry is from January and as we are halfway through the year, the accumulation is rather long.  She has to submit a weekly list of the desired events to the Powers That Be.  She asked me to work on it.

The steps:  Select past week.  Copy.  Paste into new document.  Done.

She was shocked.  How had she been doing it?  Over a two day period, she would print out the entire document from the beginning of the year to present, because she does not know how to select a specific area to print.  Because she does not know how to change the paper orientation from portrait to landscape, the columns run onto a different page.  She spends considerable time matching up the unlabeled end columns with the beginning columns on different pages.  Once she has identified the week of interest, she then sits at the computer and retypes the entries for that week- using her two index fingers because she does not know how to type.


How does nobody realize that half of her work hours are spent on needless tasks directly stemming from her lack of knowledge about computers?

She's a very nice lady and she is great with the patients.  It's just that this hospital could be so much more efficient if the people who could not use computers were replaced by people who can use computers.

Saturday, July 5, 2014

Just accept the Crazy

I worked in my new role as a scheduler for a few days, and then was pulled back to my ward for a Day from Hell.

My partner nurse was Helen.  Two discharges and subsequent admissions were scheduled.  We should have had more help, but we didn't.  I discovered early on that nothing was ready for the discharges, although Helen had signed off on them.  "You do that, but you weren't here," was her reply, as if it was my fault.

Actually anyone can check if everything is in order for a discharge, especially since I was not working on the ward.

Multiple supervisors descended upon the ward, wanting to know how this happened.  I let it fly.  "Because you employ dumb ass nurses and let them get away with it."

Helen told me to work through my lunch break.  I told her no and went on my break.  When I returned, some of the orderlies in the parking lot told me that Helen went home.

I returned to the ward to find the nursing supervisor babysitting, as a nurse must always be present on the ward.  She explained, "Although you got the new position, you won't actually be working in that position.  You are needed on the ward."  WTF?

Things exploded for the rest of the shift.  As two female patients were (supposed to be) discharged, I could admit either two males or two females, because each room has two occupants.  Admissions sent one male and one female.  I called the department and explained the problem.  The idiot on the other end said, "Look, we all know that you don't want to do an admission.  That's too bad.  They are yours."

The male admission spoke a rare dialect of a rare language.  The telephone translating service claimed that they could not find anyone who knew the language.  His records stated that he was hospitalized for a broken hip and diabetes.  I have no idea why he was on the psych ward.

The female admission was a frequent flyer.  Violent.  All I could do was hope that her earlier injections of Ativan and Benadryl held on until my shift was over.

The ward erupted into a noisy free-for-all.  The phone lines rang incessantly.  Nobody bothered to answer.  I was paged overhead constantly.  People from all over the hospital kept coming up to me, wanting stuff, oblivious that there was a long line of people already waiting for me and that nobody was getting anything else out of me today.

I only realized my shift was over when the next shift sought me out to ask if a code was taking place.  "Why, is someone hurt?" I asked.

"No, it is so noisy and chaotic.  Why is there a mattress just lying in the hallway?  Is this a fort built out of the dining room tables?  Why are so many patients running around naked?  Do you know that they tore down the wallpaper in the dining room?  Where is your staff?"

The ward ended up with more patients than there were beds, not counting the mattress in the hall that seemed to have appeared out of nowhere.

All the patients, whether they belonged on the ward or not, were alive and well.  I decided that this was all that really mattered and I left.


The day after I was told that Adrienne was the new unit manager, she appeared on the ward.  "I'll be second nurse," I told her, which indicates that I give out medications while she runs the ward.

"No," she responded, "I am second nurse.  I am not running this ward for you."

I was confused, but said nothing.  The staff kept asking me why Adrienne was not in charge if she was the new manager.

Adrienne completed the medications in record time.  "Do you want me to help you with the wound care?" I asked her.

"No," she answered, "I already did everything."
No, she had not done any wound care.  She had not left the medication room since she fled into it at the start of the shift.  Oh well.  This is who they want to run the place.

I went on a lunch break.  When I returned, the hospital was abuzz.  "Hurry, there is a code on your ward!"

I entered the ward, just in time to see one of the wild patients in the main room, completely naked and oiled up, scream at a bunch of bewildered staff, "Come on, mother fuckers, come at me," as she waved her fingers at them.

Most staff will not bother.  It is difficult to subdue someone who is so slick.  Also, the male staff are extremely hesitant to grab a naked female patient.  This is exactly why a female patient who is spiraling out of control will strip and apply petroleum jelly or hair goop all over her body.

Eventually the patient was subdued.

My staff pleaded with me that Adrienne was useless and should not be the unit manager.  "She didn't know what to do.  We kept telling her to call the psychiatrist to get medication ordered, but she just stood there.  The patient kept getting worse.  Finally, we called a code to get help."

Oh well.  May your new unit manager treat you as well as you treated me.

Friday, July 4, 2014

Actions and Consequences

The Director of Nursing called me into her office (not the first time) and told me that I got the job as the Nurse who schedules Specialists!  Don't cheer yet.  She qualified her statement with, "You will transfer to the other department when we find a replacement for you on the floor."

Finding a replacement for me might never happen, as only two part-time nurses have been hired after I started, in spite of many nurses leaving.

The Director of Nursing also told me who was selected as the new Ward Manager.  We'll call her Adrienne.  I have not written about her.  I have not worked much with her.  She messes up everything and blames other people when confronted.  She hides with earbuds in her ears and either pretends or really doesn't hear people calling out to her.

If this is who management thinks is qualified to run a ward, then they truly are deranged people with no sense in their heads.

I happily told my staff that Adrienne was their new supervisor and that I was being transferred.  The look on their faces was priceless.

"She is terrible!" they blurted.  "You would have been so much better!  This ward will fall apart if you leave!"

I smiled.  Karma.  "We don't work well together.  You tell me every day.  Several of you have even walked off the job, unable to stay on the same ward as me.  You have told our supervisors, the Director of Nursing, even the director of the entire hospital, how bad I am to work with.  You have filed complaints against me through your union reps."  The staff stood there, trying to counter.  "In selecting a ward manager, administration must consider whether or not the nurse works well with the staff.  Clearly, we do not work well together, so administration could not possibly put me in charge of the ward."

"But Adrienne is an idiot!" someone blurted.

"Be that as it may," I continued, "I have to be removed and a new nurse installed as the unit manager to provide better care for the patients."

"But Adrienne won't go near a patient!  You are the only nurse who actually goes on the floor and helps patients," some people protested.

To which I replied, "If only you had told that to administration.  Instead, you told them only negative observations about me.  This is the result."

Avoiding stress at work

I no longer bother with one of the night nurses.  (The one who went home barefoot and then called the ward, looking for her shoes.)  She doesn't do what she is supposed to do and the little she does is so messed up that you end up not wanting her to touch anything.  Other people feel the same way about a lot of the employees at this hospital, which is why they end up coming to me for everything and I resent it and say nasty things.

This night nurse came to me, quite pleased with herself, because she could not understand an entire page of new orders and had concluded that the doctor must have made a mistake and she "caught it."  She explained that the doctor had rewritten the same orders multiple times.  This nurse was wrong.  She paid no attention to the doses.  The doctor had placed the patient on low doses in the morning and higher doses at bedtime, which is common with medications that can induce sleepiness.

My explanation went right over her head.  I decided to confirm what a waste of a paycheck she is by asking, "So did the nurse who took off the order correctly transcribe it onto the patient's medication administration sheet?"

Blank stare.  "How would I know?" she smiled at me, as if I am the weird one.

"Because you signed off on the 24 hour check," I countered and pointed to her signature below the signature of the transcribing nurse.

"Let me explain something to you," she said lightly, "I have been doing this a lot longer than you have, so let me share my wisdom with you."

I poised as if interested, which I was, purely for the entertainment value to share later with all of you.

"I do not check.  It is less stressful.  If you check on things, this takes up your time.  If you find that something is wrong, then you become stressed.  You might try to fix the problem, which is stressful.  So I let other people deal with that.  And see?  Here I am, smiling, happy to have worked.  Now I am going home to sleep and will come in tonight and have no stress."