Wednesday, December 31, 2014

New Year's Resolution

One doctor writes orders with multiple contingencies.  Orders one med, then discontinues it in the same order.  In illegible handwriting.


"If patient goes on grounds pass Saturday, with family, then give Ativan 1 mg oral by mouth before she leaves at 8 a.m.

If patient does not leave, but is agitated, give Haldol 10 mg oral and Benedryl 50 mg oral for one dose.

May have grounds pass Sunday care of -illegible.-

Ativan 2 mg oral now for psychosis.

Discontinue Benedryl.  Benedryl 50 mg oral daily for salivation.

Depakote 500 mg oral twice daily for bipolar.  Depakote 1000 mg oral daily for psychosis.

Discontinue previous not today Benedryl orders.

Patient is not allergic to Prolixin.  Add allergy to Penicillin."


When you seek clarification, she answers, "Why is it that whenever somebody can't read, it's my fault?"

Tuesday, December 30, 2014

Post-Holiday Comfort

I wore sweats and a t-shirt to work.  Finally.  It was the day after Christmas, so I figured nobody would notice.  Nobody did.  A white lab coat was within reach if needed, which it wasn't.  Most of administration was out.

My hair remained in its post-shower frayed bun.

The day started slow, but then an avalanche of orders started- backed up from two days, Christmas Eve and Christmas Day.  Plus, people panic on Fridays, not wanting to go into the weekend without medical intervention.

Thursday, December 25, 2014

Solving a Problem with Alcohol

People in the office area gave me stuff for Christmas.  I was completely not expecting this.  I was planning on gifting a few good pals- that was it.  I received socks, scarves, Christmas decorations, chocolates, and decorative carry-all bags.

I was at a complete loss as to what I should give in return.  My gifts for everyone ended up being bottles of wine.   I honestly think that some of these people don't drink at all.  Oh well.

A better game plan is needed for next year.  As foreshadowing, several weeks ago I saw a neighbor pull up with bags of shiny boxes.  She called them Christmas gifts for "you know, your hairdresser, the lady who does your waxing, the dogwalker, coworkers- all those people."  I was relieved that I did not have to buy such things because I lacked such people in my life.  I also mentioned my concern about her dog- the unproductive cough could be heart failure.

The neighbor dismissed my caution, saying, "It's a hairball, that's all."

That very night, the neighbor's screams woke me up.  The dog had died.

So around October or November of next year, I am going shopping for shiny stuff for coworkers- just in case.

Wednesday, December 24, 2014

Triple Cocktails, Nursing Style

The holidays are a stressful time for everyone.

That's why we have Triple Cocktails.

Know them.  Ask for them for those times when everyone needs to chill.

Monday, December 22, 2014

Protect Yourself

Nurse with Attitude violated the sanctity of my calm work area.

"There is something that I would like to clarify with you," she started.  Her eyes looked above me, not at me, as if I was too far below her on the social scale to merit direct contact.

I've seen her around.  She is new-ish.  I've heard people complain about her, but everyone complains about everyone else in this place.  I was just thankful that I was away from all of them.

"What did you mean when you said that you were ashamed of me?" she continued, exasperated, yet with a firm voice.

"I have no idea what you are talking about," I replied, as I scanned the physical layout for a chance to make a run for it.  Psycho Nurse saw this as an opening to continue.  Not clarify, just continue.

"Did you, or did you not, give a donut to Nurse ---?"  She stared at me, hands on her hips, as if the answer was a definite Yes, but I was supposed to say it.

"I did not," I replied, as if anything was going to help.

"So how did she get the donut?" Psycho continued.

"From a donut shop?" I answered, and yes, there was sarcasm.  But please- this is what my professional life is supposed to be?  Middle School Hissy Fits over Nothing?

"Then why did she say that the donut was from you and that you said I couldn't have a donut because you were ashamed of me?"  Psycho stood there, as if the story made such resounding sense that I couldn't wiggle out of it.

"You have nothing to do with me, so 'ashamed' would never be an emotion I equate with you," I respsonded, carefully.

"Exactly," she agreed.  Okay.  That's good.

"It sounds like you and this other nurse have been having problems?" I queried, when I knew it was true.

"Yes!" Psycho agreed again.

"Well," I counseled, "She should just state the problem she has with you directly instead of indirectly through someone else."  Psycho seemed to be listening.  "I don't understand the emotional involvement that some people place on others at this hospital.  We all work here because we need a paycheck.  Just come in, do your job, and go home.  I don't have the interest or energy to become emotionally invested in a coworker."

"You are right!" she answered and went away.

I dodged that bullet.  But more will come.  I am learning.



Saturday, December 20, 2014

Nursing Home Industry



I stumbled upon a blog post that captures the situation of nursing home care.

Nursing homes are businesses, often owned by large corporations.  The goal is to make a profit, not provide good care to patients.  The direct care-givers may or may not provide for the patients' best interest.  The rest of the company is so far removed from the direct care-giving component that they could just as easily be working for a company that manufactures pencils.

In addition, the people running operations have the same motivations and personality conflicts seen in the general population.  They conduct their business, and therefore the company's business, based on their own personal goals and prejudices.  Their actions trickle down to negatively impact patient care, but this is not their concern.

The blog post details someone's career as a direct care giver and then a nursing home administrator.  The author's experience is true in many states- becoming a nursing home administrator requires acceptance into a facility's administrator-in-training program, which is based on favoritism.  Some states require a college degree; others do not.  No health care experience is necessary to run a nursing home.

I myself tried many times with many companies to get into an administrator-in-training position.  At this point, I am no longer interested in running a nursing home.  I am glad that I did not get such a position.  Not that my work life is all unicorns and rainbows, but running a nursing home would have made me more miserable, especially the younger version of myself.  (I'll have to write a few posts about my failed administrator attempts.)

The ability to provide good care to a patient does not require the same skill set needed to run a profitable company.  The nursing home industry needs to create a nexus between these gaps to ensure both quality patient care and profits.

Friday, December 19, 2014

Priorities

One of the doctors is constantly ordering tests and consults for his patients.  For someone who is paranoid, it is very difficult to leave a familiar setting to have a medical procedure done.  So most tests are refused by the patients.

Imaging for one of the patients revealed a possible liver tumor.  Additional testing, including biopsy, was recommended.  Doc wrote the orders, but patient refuses.  She's delusional, convinced that we want to take her organs and sell them.  Administrative people complain about the cost to the hospital, especially when charged for No-Show appointments.  But the doctor's complaints are worse.

Doc keeps coming to me to get the biopsy done.  All I can do is make the arrangements and hope that the patient feels like complying that day.

Another nurse suggested I hold back from arranging expensive tests.  I explained to her that saving money for the hospital is not my goal.  Rather, I need this doctor to stop barging in every day, demanding to know why the biopsy was not yet done.

Although no person is an island, I have to put my needs first, just as everyone else does for themselves in this place.  Quick scheduling is desired by this doctor, so that's what he'll get so he leaves me alone.

It's about framing priorities:
Should I save money for the hospital- money that I'll never see in my paycheck;
or should I provide myself with a calmer work environment?

If the hospital really wanted to save money, I have a list of people who do nothing but collect a paycheck.  Firing them would cut costs and boost morale.


Thursday, December 18, 2014

It's okay to Retreat

My former ward had a holiday party.  It's a nice event for the patients.  The dietary department caters.  The staff brings in their own dishes as well.  A few staff members invited me to attend.  My contribution was cupcakes, which are an easier desert to serve to a large group of people- no utensils required.

Nurse Fortune was busy grabbing food for herself.  When she reached the cupcakes, glistening with red and green sprinkles, she squealed, "Ooh!  Who brought these?"

Someone nearby answered, "Enid."

"Who is that?" Nurse Fortune queried.

"Her," the person answered, and pointed at me.

Nurse Fortune turned to look.  When she saw me, her face dropped.  She slammed her plate of food onto the table, causing the rolls to bounce off.  She walked off, muttering curses about "that woman."

For those who had not witnessed this event, I pretended like nothing was wrong and then quietly slipped away.

I had no desire to attend this party.  The staff as a whole does not accept me- they never did.  At this point, I am truly an outsider.  I didn't want to fight with Nurse Fortune.  She enjoys fighting; she actually seems energized by it.  In contrast, fighting depletes me.

I returned to my quiet office area.  Much nicer.

Wednesday, December 17, 2014

Not Working on My Day Off

"We were just wondering why you didn't punch in or out last Monday," the clerk in payroll asked me on the phone.

"Because I had a PTO [paid time off] day," I answered.

"But you didn't punch," the clerk persisted.

"Because I wasn't here," I explained, again.

"Did you forget your swipe card, and that's why you didn't punch?" the clerk tried a new angle.

"No, I wasn't here at all.  I was off."

Bear in mind that I had two days off, but she was only focused on one, with no logical explanation.

Later, one of the nurses who works in my area told me that the supervisor asked her if I was here last Monday, to which she told her I was not.

I explained to the nurse that I was off two days, which should not be confusing, but for some reason, they were only concerned with one of the days.

The other nurse said that the supervisor told her, "Watch her.  She didn't punch in or out last Monday.  She may not have even been at work."

What is wrong with these people?

Keep in mind that their Favorite Children walk in, punch their time card, and then walk back out.  Or a designated person punches all of them in.


Tuesday, December 16, 2014

Disaster Planning



As the year comes to a close, someone decided that the hospital did not do enough disaster drills.  Problem fixed in one day.


The first announcement in the morning was to disregard all alarms and announcements.

The rest of the day was punctuated by announcements of doom and gloom.  This greatly confused patients and several staff members who did not understand that these were Mock Mock Codes.

The calamities that struck in one day included:


  • Fire
  • Flood
  • Blizzard
  • Hurricane
  • Hostage Situation
  • Bomb scare
  • Missing Child
  • Earthquake
  • Heat wave


Patients kept looking outside for the snow that was not falling or the hurricane that was not swaying the trees.  Visitors were confused, then scared, then really confused when nobody gave any attention to the emergency just announced overhead.



Monday, December 15, 2014

Sanctuary for the Otherwise Unemployable

The front entrance to the hospital is staffed by "security guards" who double as greeters.  I've seen this trick at nursing homes, too.  One person does two jobs, but is suited to do neither.

An older man started working at the hospital several months ago.  We exchange a nod or "hello."  Finally I talked with him at length.  Oh my goodness.

He talked about the death of his mother at a hospital and beating up "the doctor who killed her."  Then stalking the doctor for years.  The restraining order to keep him away from the offices and hospitals where he worked.  To circumvent recognition, he would find out where the doctor was giving presentations or lectures, and then show up there to try to "get that bastard."

He stopped because the doctor died of a heart attack.

How do such abnormal, dysfunctional, violent people get jobs here?

Sunday, December 14, 2014

Care Shift by Shift

One of the patients needed a procedure that required fasting overnight.  The facility wanted to know if he was diabetic.  I have worked on the ward with the patient, and I thought I recalled that he is diabetic, but I needed to make sure.

I called the ward and spoke to a certain nurse.  She denied that the patient was diabetic.

I mentioned that I thought he got fingersticks a few times daily and standing insulin at bedtime.

The nurse confirmed that he did get fingersticks and insulin.

"So he is diabetic," I tried to confirm, again.

"No, he is not.  The fingersticks and insulin are not given on this shift, so he is not diabetic on this shift."

In the past, I would have launched into an explanation that people are not diabetic only at certain hours, but rather continuously.  This person is too ignorant and indignant to listen, nevermind learn.

This is what I work with.

Saturday, December 13, 2014

And Another Writer!

One of the doctors has an office near my work area.  He's a kind man, but so hard to reach when you need him.  I see him quite often now.  He's in his office all day, except for a trip to a ward.  He is very busy typing and editing a book about his childhood!  And all this time I thought he was busy with patients when I was unable to reach him on the phone.

He prints a copy of his book daily, over 200 pages, which he then reads and edits by hand.  This is why the printer runs out of ink every week and why Central Supply accuses us of stealing paper.

I admire someone who can accomplish something amid the chaos, but he really needs to make himself more available to the wards.


Friday, December 12, 2014

Trying My Patience

My new office-like position requires firm boundaries, something I am not good at.  It seems that whenever I reinforce a boundary, I am in trouble for not helping out.

Most patients refuse to comply with tests and procedures.  One patient had refused a procedure multiple times.  The doctor insisted that it be done.  The facility to perform the procedure was getting angrier with each missed appointment.  For the last two appointments, I called the ward to see if the patient would confirm her attendance the day before.  Both times, the nurse manager said, "I have nothing to do with anything done outside the ward.  You set up this test, so you go ask her if she wants to go."

I need to reiterate that I make the appointment and tell the ward the time and date.  That's it.  I don't cruise around the hospital, looking for patients to undergo tests.  It's really a clerk-like position, but because the hospital's clerks are rude and incompetent, the job is mine.

I found the patient both times with the help of other patients.  When asked if she was going, the patient answered, "No."  So the procedure was rescheduled for this week.

The nurse manager called and said that the patient was discharged, to cancel the procedure, which I did.

On the day that would have been the procedure, the nurse manager called and said that the patient wasn't discharged and would undergo the procedure.  I told her no, it was cancelled, and the place is booked until next month.  More nurses and then the doctor called, telling me that the procedure needed to be done today because so much time has passed.  I told them I would let them know the new date.

The nurse manager's remark pushed me over the edge.  "Why can't you call them and explain that we need this done today?  You could at least try to help the patient."

"I could help the patient?" I yelled at her.  "For the last two appointments I was on the ward, talking to her, trying to get her to go.  When I asked you how to find the patient, you told me that it didn't concern you and I should ask an orderly.  You are the one who said the patient was discharged, which caused the cancellation this time."

"No," the idiot declared, "None of this is my job and most certainly not my fault.  You are supposed to be handling all of this, which you did not."

"You are the patient's nurse," I countered.  "Why is it that when I was a nurse on your ward, all of this was my job, and now that I am off the ward, it's still all my job?"

She couldn't follow the logic.  "It is all your job.  I am going to call people and find out for sure."


Thursday, December 11, 2014

Nurse by Inheritance

One of the men in housekeeping is rather obnoxious.  He constantly tells me what to do and how to do it, adding in, "I know this because my mother was a nurse," or, "I know it's tough.  My mother was a nurse, but she made sacrifices and got it all done, and that is what you need to be doing."

Basically, everyone is the nurse's boss around here.

I was working with another nurse whose mother is a nurse at this very hospital.  (Nepotism!)  Housekeeper comes by and starts in on our footwear.  "You aren't supposed to wear sneakers.  I know they're more comfortable, but you are supposed to wear special shoes for nurses.  My mom was a nurse, so I know what shoes are allowed, and those are not allowed."

The other nurse whispered to me, "I can't stand this guy."  This made me feel better.  I'm not the only one he picks on.  But I had enough.

"Our mothers were also nurses," I snapped back at him.  "And we still had to go to nursing school and then sit for a licensing exam."  He looked confused.  "So until you actually have the degree and license, don't come to me with that 'My mother was a nurse' routine."

He walked away.  He has not said anything to me since then.


Wednesday, December 10, 2014

Obsession

One of the evil nursing supervisors is constantly roaming my new work area.  She chats with a few people.  She outright ignores me, which is great.

I overheard someone commenting about this supervisor, that she never used to come to the area, but now she frequents the place several times daily.

I think she's checking up on me for some nefarious purpose.

That's not paranoia, right?

Monday, December 1, 2014

See No Evil, Hear No Evil, but Speak Evil

A doctor complained to me about the substandard staff.

Honey, what I know could fill volumes.

The nurse called the doctor around 4 o'clock in the morning to report an Unwitnessed Fall.  The doctor demanded to know how nobody saw the patient fall when the patient is supposed to have a sitter at all times because of her high fall risk.

The nurse claimed that nobody told her that a sitter was ordered.  The doctor said she wrote the order herself the prior evening.

"Nobody told me" is a popular and accepted excuse around here.  I'm using it more myself, but to get out of doing other people's work, and not for shirking my real responsibilities to patients.  The sitter should have been part of the shift-to-shift endorsement.  Even if the sitter was not mentioned, the night nurse is supposed to (hah!) check each chart and sign off on new orders, so she would have seen the order for a sitter, but only if she read what she was signing.

The doctor said that this place is a joke and wondered how she could ever get in trouble for anything with such antics accepted daily.  I wonder the same thing myself.  Yet it happens.