Saturday, August 30, 2014

Setting Priorities in Nursing School

During the orientation to my nursing school program, one of the [many, never ending] speakers told the incoming class something that was met with criticism from a lot of students.

"Make nursing school your Number One priority."

People called out things like, "I have children!" or, "I have a life outside of school," or, "I need to earn a living to pay for school."

The speaker offered some explanations.  Like most of the faculty and staff at the School of Nursing, she was a self-enamored kind of a person, so convinced in her own rightness that any explanation of her views was unnecessary.

I remembered what she had told us because I disagreed and because I remembered the roar of protest.

As school continued, I came to agree with her statement.

Nursing school needs to be one of the top priorities in your life.  It's not wonderful and it's mostly irrelevant to the practice of nursing, but you have to devote considerable time, effort, emotions, and money to nursing school in order to earn the degree that will qualify you to sit for the licensing exam.  You may never read another EKG after nursing school, but you need to figure out how to read EKGs to get through school.  Should the need arise while you are a practicing nurse, you can learn then.  (YouTube is wonderful for this- but it did not exist when I was in school!)

To those student nurses who are also parents, this statement does not mean that you should attend a clinical instead of taking your child to the emergency room with a suspected fracture.  You have to balance your priorities.  The time you are in nursing school may not be the time you take the children hiking every weekend.  It's not fair to you or your family to make a partial investment in nursing school, only to have you flunk out after draining time and money away from the family.

People who are not fresh out of high school go into nursing school for intentional, specific reasons that their current situations do not meet, such as career fulfillment or finances.  Nursing school is intense but temporary.  Put off as much as you can so that you can graduate from nursing school.

Going off on a Rant- And not coming back

Strange day.  Nurse Fortune was only a few minutes late and she did work.  She ranted all day long, which is normal, except that the rants centered around "Somebody reported me for being late, taking a two hour lunch, and not doing any work, all of which is untrue."  I think of her as a highly confrontational person, but her behavior on this day was passive-aggressive.

My gut reaction was, "Oh no!  She thinks I reported her."  Then I realized that this is the same behavior she would display with any other nurse, just to let them know her displeasure in her own existence on the planet.

Nurse Fortune has two modes at work, which she hides from nobody:
1-  Ranting
2-  Missing

Nobody has to report her for anything.  She does not hide her lateness or her non-stop griping.  It's not all her fault.  She has gotten away with it for years.

I've been drawing boundaries with her.  She has her work and I have mine.  Unless there is a catastrophe, I don't do her work.  She has NEVER helped me.  After her two hour argument with the night nurse the other day, I gleefully vacated the ward at the end of the shift, leaving her to continue carrying on, "I have all of this work that's not done and the other nurse just leaves me."

She was quick to draw boundaries when a patient asked her about a medication.  "That's NOT MY JOB," she snapped at the patient.  "You are supposed to ask HER.  I don't know why she would not provide you with the education you requested, as if I am supposed to DO HER JOB FOR HER.  Well, she has something else coming if she thinks that I am here to serve HER.  Just wait.  Wait until she finds out that I DON'T PLAY. . ."  The patient wandered off with a bewildered look on his face.

You can't badger Honey Badger

Nurse Fortune is getting worse.  Was this possible?

One morning, she argued with the outgoing night nurse for two hours straight, in front of everyone.  This night nurse is bonkers to begin with.  The gist of the argument was one nurse who does nothing and is irrelevant accusing another irrelevant nurse of doing even less.

The highlight was when Fortune tried to set up the other nurse by walking near patient rooms, and then screaming, "You're badgering me!  Stop it!  Everyone can see that you are badgering me while I am trying to work!"

All I could think of was Honey Badger as Fortune screamed.


Kayla, the ward visitor, is not without merit.

One day, a Nurse Helen came into the charting area and launched into a diatribe that she was going to lunch and that I was to call a particular social worker about a patient, and on and on.  She was not making sense.  Plus, her speech was full of hems and haws and she lost her train of thought often.

I tried using the communication technique of repeating back what I thought I had been told.  Because Helen lacks oral comprehension skills, this technique backfired.

I think I ended up with the meaning, "Call the social worker and tell her that the patient wants $10 from her account to buy special shampoo."  I added, "That can't be correct.  It would have taken you less time to call the social worker yourself and say that than it just did for you to repeatedly try to explain that to me."

With that observation, I heard loud laughter break out in the neighboring break room.  Helen can't [pretends to not] hear, and she stumbled through some more unconnected phrases before finally leaving.

I sighed, counted to ten, and then picked up the phone and called the social worker, who said, "I know.  The other nurse just called me."  Now I was pissed.

"Why did you waste both of our time explaining that to me, only to call yourself, without telling me, 'Never mind'," I screamed after Helen as she was fleeing.

The laughing grew louder.

I peaked into the breakroom and found Kayla by herself.  She was laughing about this exchange.  "I can't believe you have to work with such an idiot!" she gasped in between laughs.

This made me feel better, that someone else gets it.

Boobs versus Brains

A woman works at the hospital.  I don't know her title or her job responsibilities.  We'll call her Kayla.  Kayla's desk is in a series of offices near my ward.

Two things immediately strike me about her:
1- She has a voluptuous bosom that she props up with some kind of super bra so that her boobs almost touch her chin, with plunging necklines that have revealed areola more than once;
2- She hangs out on my ward most of the day.

Boobage aside, I asked her how she gets her work done when she is usually on my ward.  She said that she can get her work finished in ten minutes; "thirty tops."  I asked if she feared getting in trouble for never being at her desk.  "No," she replied brazenly, "Nobody can get me in trouble because I did all of my work."

I replied, "Some days I am so busy that I don't even get a chance to pee."

"I know," Kayla answered.  "That's because you are a nurse.  I would never be a nurse.  You don't even make as much as I do."

Kayla's statement finally made things click for me.  Nurses are expected to go, go, go to the detriment of their own health.  Any deviation from this non-stop routine is met with criticism about being uncaring.  Seriously, I don't get paid enough to put up with this.

Twist (or Narrowing) of Fate

Here's some poetic justice for you.

A nurse dropped off a drug information printout on a new drug for BPH, benign prostatic hypertrophy.  I was not surprised, as a urologist had just been through the ward.  What surprised me was the name of the intended recipient- an orderly.  He was on [indefinite] break.  I said I would meet with the patient and document the education, if I could just have the patient's name.  The nurse said that the person who wanted the information was the orderly because his doctor had just prescribed the pill for difficulty urinating and difficulty achieving and maintaining an erection.  She thanked me for passing on the information and briefing him on the drug.

Music to my ears.

This was the same orderly who asked me to bear his baby- and that was at least three babies ago.  Now he was having trouble in the baby making department.  Good.

Wednesday, August 20, 2014

Keeping Calm

I was so good today.  I didn't lose it once.  Not even when Evil Supervisor sought me out to again to ask me why she has not received a rewritten medical record that I was supposed to create because of a supposed error made months ago by another nurse.

I stopped her, almost magically, by saying, "I will discuss this with you later with a union representative present."  She left and did not return.  Hmmm.

Thanks to reader comments, if the matter comes up again, I will cite the policy on how to correct an entry in a medical record.  Destroying the original and having nurses rewrite the record is not the policy.

Reminisce: Nursing School

I wish that I could have blogged during nursing school.  Blogs did not exist back then.  The internet existed, but laptops had not caught on in popularity or function.  No smartphones.

I think that now is as good a time as any to share some stories from my time in nursing school.  So I will be featuring flashbacks to those days.

If you are in nursing school, I advise you to be strong and keep your eye on the prize.

Monday, August 11, 2014

Shrinking Offensiveness

Is "Shrink" an offensive term?

For the authors of the blog and the book Shrink Rap, they may be thinking:  Now you tell me?  I'm diagnosing you already.

Being offended is worn as a badge of honor, which should not be.  If someone claims that they are offended, this means that they could not regulate their emotions and want you to do it for them.  There is also an air of seeking control and manipulating others.

I actually have not heard the word in quite some time.  I hear people refer to a psychiatrist as a:
social worker,
and head doctor.
The first three are a misunderstanding of the profession, while the last one, head doctor, is descriptive.

To me, Shrink has a bit of a negative tone that applies to the unfortunate situation that necessitated a person to see a psychiatrist.  It's a slang term, not for formal speaking or writing.  "I have an appointment with my Shrink," means that the patient is in the unenviable position of needing a psychiatrist, while the psychiatrist is attempting unsuccessfully to fix the person and the unhappy circumstance.

Psychiatrists can take ownership of Shrink to make it a positive name.  Shrink Rap is a whimsical title for writing that is creative, not clinical.  A university course would not be titled Shrink 101, but tales of a psychiatrist could use Shrink.

Saturday, August 9, 2014

Tight Schedule

Whenever I ask an orderly to do something, the refusal follows one of several common patterns.  In this post, we'll review the I Can't Do That Because In The Future I Have To . . .

Unless the next activity is a break, the activity is never performed.

For example, I asked an orderly to drop off a patient.  His response:  "I cannot, because in ten minutes, I will be going on my lunch."  Me:  "Perfect.  You'll be back in plenty of time."  Him:  "No, I do not think so.  I will go on my lunch now so I am not late to the lunch."

I asked another orderly to pick up a patient.  Her response:  "You know I would, but in fifteen minutes, I have to give the patients snacks."  Me:  "You can pick up the patient and still have spare time."  Her:  "No, I better not, in case I am late.  The patients would not like that."  Fast forward fifteen minutes and the orderly is in the back, on her phone, where she sat for the rest of her shift, never doing anything for a patient.

People telling me to "write them up" are not helpful.  Been there, done that.  Nothing happens to them.  Instead, I waste my time writing and then waste more time having a supervisor explain that I am the reason why nobody feels comfortable performing any work and that I am picking on every little thing.

Psychopath Spotter

Got them beat by miles.

I'm not just talking about the hospital.  One great thing about my job (there are some!) is that I can easily recognize psychopaths in the general population.  (Or do I just think they are everywhere?)

I was chatting with a friend after gym class.  I noticed a man cut through the parking lot, smoking.  Just a weird angle to walk, plus he walked right through some bushes.  Didn't seem to notice them.  Most people would step over them or around them.  He entered a store.  A few minutes later, we heard roaring.  He kept kicking a garbage can.  Finally he walked onward.

As soon as I saw him walking and the way he processed his surroundings, I knew he was troubled.  There was nothing that could have happened inside the store in a few minutes that would have merited such a loud, violent response.  He showed no regard for his own safety in repeatedly kicking the trash can.

Another skill to add to my resume.  Psychopath spotter.

Call Out

The past week has been so chaotic and utterly draining that I have been unable to do much of anything after work.  I called out on Friday.  The ward clerk called me mid-morning, frantic, claiming she couldn't find the paperwork for an admission I did on Thursday.

"Did you look inside the chart?" I asked.

"Oh, that's right, you file stuff.  I was looking through the piles," she replied.  Then, "Oh, here they are, right in the chart like you said."

Friday, August 8, 2014

Bloody Mess

This falls under the "If it's not documented, it wasn't done" argument.

Patient bumped his arm in his room.  He's a bleeder, so there was blood on his arm, his clothes, his bed, and his floor.

The actual skin tear wasn't large or deep.  Doctor looked at it, nurse cleaned it up and bandaged it.  Documented in chart.

Idiot supervisor wasn't satisfied.  "What about the blood on the floor of his room?  Did you notify housekeeping?"

Me:  "Yes.  Everything has been taken care of."

Supervisor:  "You know why I'm asking, right?"

Me:  [Thought:  Because you are an idiot who has no idea what to do.  But I didn't say anything.  Proud of me.]

Supervisor:  "You did not document that housekeeping cleaned the room, or that the sheets were removed, and how the floor was disinfected."

Me:  "Correct, I documented about the care rendered to the patient, not the floor or the sheets."

Supervisor:  "Well, part of the care rendered to a patient is keeping the environment clean.  I'm just looking out for you.  If somebody were to read your note, they would probably think that the blood was left in the room.  That creates an unsafe environment for every patient here."

Me:  "I have never documented that housekeeping cleaned anything.  No rational person would read a chart and conclude that the patients were staying in a garbage dump because the nurse did not provide detailed notes about efforts of the housekeeping staff."

Supervisor:  "Part of the care rendered to a patient is housekeeping, so you need to document that as well."

Me:  "No, the nurse does not have to document that housekeeping cleans.  Besides, I did not personally see that the housekeeper cleaned the blood, so I can't document that he did."

Supervisor:  "That is the other part of your problem.  You did not bother to stay in the room to make sure that housekeeping cleaned the room consistent with the policy on cleaning a blood spill."

Me:  "No, instead of staying in the room to take care of the floor, I stayed with the patient to take care of him."

Nurses and fellow healthcare workers:  Does your employer require you to document in your notes that housekeeping cleaned?  For example, in the emergency department, after a bloody trauma has been sent up to surgery, do you document that housekeeping cleaned the room?

Paging a Nurse

Someone activated the overhead page system, apparently unknowingly.  For twenty minutes, the entire hospital was treated to a conversation of three women.  I thoroughly enjoyed the broadcast, as well as the snickering of everyone passing through my area as we exchanged nods and finger pointing at the speakers on the ceiling.

The highlight was discussion of Nurse Fortune.  "She thinks she is so great.  I hate her."  "I would never work with her."  "Did anyone ever find out the father of her last baby?  Why is she keeping it such a secret?"

Nurse Fortune was absent that day.  She works approximately half of her assigned shifts.  She will have to rely on the gossip concerning what was actually said.

Tuesday, August 5, 2014

When you weren't looking

A patient was experiencing a violent manic episode, so he was placed on special observation, meaning that a staff member is assigned to watch him, and only him, at all times.

On this particular morning, the staff member who was supposed to be watching the patient started frantically calling for help from the hallway.  I arrived to find staff trying to open the shower room door with a handle that was mostly disengaged from the door.  "He is trapped inside!" the man screamed.

I went to the door and yelled for the patient to push from the other side.  No response.  This was not good.  The patient could get into trouble quickly.

I called the maintenance department.  Paged them overhead repeatedly.  Finally several large men arrived with various tools and began to dissemble the door.  The drills and hammering continued for about 15 minutes when I noticed the "trapped" patient ambling through the dining room, bumping into chairs.  I turned to the staff member and asked him how the patient was in the dining room when he was supposedly trapped in the shower room.  His reply, "This I do not know."

Another twenty minutes later, the door was removed from the frame to reveal an empty room.

This man pays more attention to his phone than to the patients.  He has no work ethic and is protected by his family in administration.

Friday, August 1, 2014

Communication Problems

As promised, Nurse Fortune has filed official complaints with the union against the hospital and me because she did not get the in-house transfers that she applied for.  I have been advised that my transfer is "on hold."  The ward continues with nobody officially in charge.

Working with Fortune is a nightmare.  She arrives late and begins her day-long rant about how I don't have everything done and how I'm mishandling everything.  Her sparse work output is now reduced to writing some of the shift report.  Whatever is missing is my omission, not hers, as far as she is concerned.  She hides in a back office on her phone for the entire shift, except when she is missing from the ward completely.

I'm trying to enforce boundaries.  Because her only work is the shift report, I don't touch it.  I give all medications and only document on medication-related issues.  Shift notes fall on her, and if she doesn't do them, oh well.  If she needs vitals for a note, she can get them herself, which she won't do because she won't touch a patient, so how she comes up with the numbers is not my concern.

A patient's brother arrived to take him out.  A pass can range from a few hours to a few days.  The psychiatrist designates the time period in an order.  This patient had a weekend pass, meaning he could stay out overnight Saturday but had to return Sunday.  Nurse Fortune was hiding when the pass needed to be written, so I wrote it and documented in the chart.  When I saw her again, I told her that I sent the patient on a weekend pass.

The next day, one of Nurse Fortune's buddies was the supervisor.  On the shift report, Fortune had written the pass as four hours instead of overnight.  In a back room, where Fortune was spending the shift, supervisor was blaming me for the error on not only the ward's shift report, but her supervisor report as well.  I grabbed the chart and pointed to my nurse's note, which correctly described the pass as overnight.

Supervisor asked me why I told Fortune the pass was for four hours.  I denied telling her that and added that anyone could find out the length of the pass by reading the doctor's order, which is better than listening to what anyone tells you.

"Fortune is very busy," the supervisor explained.  "You could help her out by doing a little work.  Why should she have to sit and read the whole chart when you knew the answer, but went out of your way to tell her the wrong thing?"

During this exchange, Fortune was scrolling through FaceBook on her phone.  I don't have time to pee, but she can browse FaceBook.

I was pissed.  Fortune does so little at this point and is so nasty towards me.  "You don't have to read the entire chart.  You read the most recent orders, which describe the length of the pass.  That is what I did before I could release the patient.  I specifically told you, Fortune, that this was a weekend pass."

Supervisor remarked, "It seems that the two of you have a communication problem.  After listening to both of you, I am finding that the problem with communication is from you, Enid, because why else would Fortune write the wrong thing, unless you told her the wrong thing."

I walked out.

Valley of the Shadow of Death

One of the orderlies has always been friendly towards me.  She's on the slow side, but would tell me about caring for her elderly mother.  She was thankful for my advice when she was making the decision to move her mother into a nursing home.  She selected a nursing home close to the hospital so she could visit her mother on her lunch break or after work.

The orderly's sister played a different role in the care of the mother.  It's a scenario that I encountered a lot in my years working at nursing homes.  One child lives near the mother and takes care of her; the other sibling lives further away, visits infrequently, yet criticizes the care provided by the sibling and hired caregivers.

The orderly's sister has filed complaints with the local police as well as The State, charging the orderly herself, other caregivers, and the nursing home with neglect and abuse, ranging from starving the mother to beating and raping her.  This is all without ever visiting the mother in the nursing home.

The orderly was telling me about the latest tall tale when she added, "My sister doesn't know how good she has it.  Many times, I was going to kill her, but I didn't.  She is lucky she's alive."

I simply nodded, thinking she did not literally mean her words.  Nope.  She did.

"One time, my sister was staying with me because she didn't have money for her own place.  She was shooting up pretty bad.  I found her out cold on my sofa one day, the needles on the floor.  I was going to put the pillow over her face and suffocate her.  I thought about it for a long time, but I ended up not doing it.  Another time, she was really getting to me, and so I picked up one of those long kitchen knives, you know, the kind you see in movies.  Right into her chest I was going to jab it.  But I didn't.  Another time, her back was to me, so I picked up the knife and was going to stab her right in her back.  So you see, my sister is lucky to be alive, but that stupid bitch doesn't even take that into account when she fucks with me.  She should be glad I found Jesus and won't kill her."

"Weren't you afraid of going to prison?" I asked.

"Of course I would have gone to jail!" she answered.  "But I would have plead insanity and been released."

"Why would you do this in a way that made you the only suspect?" I queried.

"Oh," the orderly paused, "You mean do it in a way so I wouldn't get caught in the first place?  I never thought about that."

I left her with a contemplative look on her face.  Thank goodness she has found Jesus.