Sunday, May 24, 2015

Overheard

Another overtime shift!

I cringed when I received the assignment- the same ward where I had worked overtime a few weeks ago.  One of the orderlies on that ward is so nasty to me.

On that day, while hanging out in the back of the nurse's station, playing on her phone, this nasty person screamed at me, "You are the only nurse who has to tell me to do work."  She named a bunch of other nurses and added, "They don't have to tell me what to do.  I just DO IT."

"So your behavior today is something you do to me only?" I asked.

She stumbled with the concept for a moment and then blurted out, "YES."

So I took my time getting to the ward, hoping that the nasty orderly was off.

Well, she was there.  But she was taking blood pressures.  She was on the floor working, not in the back, on her phone, screaming at me.

Another nurse was in charge that day.  I told her that I was nervous returning to this ward because of the nasty orderly's behavior.  The other nurse was surprised.  "She always does work when I'm here."  But she understood.  She told me, "I have overheard so many people, not just orderlies, but other nurses as well as supervisors, stand around and criticize you.  Not your work.  They say that they can't stand your voice and that you think you are better than they are."

I shared something I heard about her.  "I stopped going to nursing meetings because at the last one I attended, discussion turned to who you were sleeping with."  The other nurse's mouth gaped open.  "I think that such gossip had no place in a formal meeting and am thoroughly disgusted with our so-called nursing leaders."

The other nurse told me to disregard such unprofessional people and remember that I am at work to serve the patients and get paid.

Saturday, May 23, 2015

Losing my Innocence

A new nurse told me:

One of the staff said, "You're not nice anymore.  You're like Enid.  She was nice and sweet and now she doesn't take shit from anyone."

I smiled.

My reflections:  So this was all an act by these spoiled "co-workers" of mine?  Temper tantrums like a toddler.  The many times I was reported to the supervisor, listened to them whine and complain like spoiled brats while the supervisor took their side- this was all a game of pretend?  They're still doing it.

And I still do take their shit.  But now I can avoid a lot of these people and hopeless situations.  And I am glad that I can inform new hires that it's not their fault.

Friday, May 22, 2015

Magic Computer

The newest generation of new schedules and reports started when the supervisor locked me out of the prior generation.  Basically, I started from scratch- again.

I took a mental health day ("sick day"), planning on sending out the required schedules and reports upon my return.

Instead, I was besieged with phonecalls and emails by employees who were mad because they either did not get a copy or the copy was riddled with errors and omissions.

Supervisor dismissed the complaints.  She had emailed or faxed an outdated schedule, one I made before I was locked out.  She determined who gets a copy and who doesn't by first calling the intended recipient.  If the person did not answer the phone or was out for the day, she did not email them the schedule.

"Why would I send an email to someone who is not here?" she explained, as if this was common sense.

She does not understand the concept that email will wait inside the Magic Computer until retrieved.

I passed the complaining phonecalls along to her.  For one of the employees, she explained to me that the person could not be calling because he was having gastric bypass surgery.  I insisted that he really was on the phone and at work.

"Did he tell you he was having surgery?" I asked.

"No," she answered, "But he is so big, I just figured that if he was out, it was to have the surgery."  She doesn't jump to conclusions, she cannon balls into them.

At one point, she told me that I don't have to give her every phonecall; instead, I should ask the caller if he/she is at the computer and can get the email right then and there.  I told her that the email does not disappear if not immediately read.  She looked at me as if I was telling a superb lie and almost had her believing.  So I gave an example that blew up in my face, of course.  "When you come in to work after being out overnight or even several days, you have email waiting for you from all that time, yes?"

This was all she needed to be convinced that I was fooling her.  "How would you know what email I have, not unless you broke into my email!" she exclaimed.  She scurried away and I could hear her calling the "computer lady" to reset her email passcode.  Again.

Tuesday, May 19, 2015

Caring



"I know you get paid to do this, but you really do care.  Thank you."

A patient said that to me.  This was so nice to hear.

Sunday, May 17, 2015

Article Review: "Secrets" of Nurses

Someone asked me to comment on an article at Politico.com, "Nurse Confessions: Don't Get Sick in July."  So here it is.

The article is written by Alexandra Robbins, a journalist and novelist, to coincide with her newly released book, "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital."

The article reiterates a theme that is still not widely accepted by the American public:  nurses, not doctors, do most of the work, including diagnosing and treating, and that nurses know more about what is going on with a patient than the doctor does.

Point 1:  Do not go to the hospital in July.
As disclaimed in the body of the text, this only applies to teaching hospitals in the United States because the new residents begin their training on July 1st.  I don't work at a teaching hospital, so I am not subjected to this.  Even if you end up hospitalized in July at a teaching hospital, you will have access to experienced doctors (and nurses).  This is not really an inside tip offered in secret by nurses; studies show that mortality increases in July.
I will add that staffing levels drop on major holidays, especially holidays attached to weekends, so if you can avoid having an accident or going into labor at these times, you will be better off.

Point 2:  Nurses are told to treat certain patients better.
This is absolutely true and it is laughable.  I have been told by administrators and other nurses to give more attention, or don't keep Ms So-and-So waiting because she is paying privately or has good insurance.  No.  My nursing time is given out based on medical needs, not bank accounts.  I prefer to not know how someone is paying for their stay, as it is an additional detail of no concern to me.  I don't get paid any extra when a patient has good insurance.

As for famous people getting private suites, well, money buys lots of things that the average person has no idea even exists.  A famous person attracts an entourage that would get in the way of delivering nursing care to any nearby patients.  Beyonce gave birth in a private wing of the hospital that cost her over a million dollars.  Nurses have told me about other famous people getting entire wings for themselves, complete with a full medical team and chef just for them.  And you can be fired for telling the press that the famous person is a patient at the hospital.  Most people are not at risk of strangers overrunning the hospital to snap pictures of them at delicate moments.  Famous people can buy privacy for these times.

Point 3:  Staff places bets on patient outcomes.
Yes, but not formally and not for money.  It's more like a human nature prediction, such as "I think he'll return from pass drunk like last time," while someone else says, "I think he's learned from last time and will be clean."  We don't hope for the worst.  It's hard to standby and watch someone self-destruct.

Point 4:  Codes and Slow Codes.
I have not seen this officially at any place as portrayed in the article.  Yes, the staff will work longer and harder to try to revive a younger person than they will an older person with terminal brain cancer.  The article hints at, but does not directly state, that this situation touches upon another misconception by the general public.  CPR (Cardiopulmonary resuscitation) is usually not successful.  It is brutal and causes physical damage to the deceased individual (that's right- CPR is performed on someone who is already dead!).  If the person comes back to life, the physical damage incurred during CPR may be too severe to overcome, and the person dies soon afterwards.  A younger person whose body is not already ravaged by disease has a better chance of being successfully resuscitated and recovering from the CPR than does an older person who succumbed to disease.

Point 5:  Nurses know secrets about the doctors.
Yes, by nature of our work.  This is true about any workplace, though.  This helps patients- nurses know which doctors overlook certain areas and which doctors know more about certain ailments or injuries.
Psychiatrists were specified in the article as avoiding patients.  Where I work, this is not true.  All of the doctors are very responsive and do not need to be told to do rounds.  They are receptive to questions and requests from the nurses and the patients.

Point 6:  People impersonate nurses.
Oh yes.  The people themselves who are mistaken for nurses rarely correct the assumption.  They even get upset when I speak up to correct the mistake.  Again, this traces back to the public's idea that men in healthcare are doctors and women are nurses.  Not only can women be doctors and men can be nurses, but most of the people who work in healthcare are neither doctors or nurses.  They are clerks, nursing assistants, patient care technicians, lab techs, housekeeping, dietary, recreation, security, and so on.  Some places color code the required scrubs so that nurses are readily distinguishable, but everywhere I have worked, there is no required difference in scrubs.
I visited a doctor's office where the medical assistant introduced herself as a nurse.  I happened to know her from a prior facility, where she was a recreation aid.  I asked her which school she attended.  She corrected herself, "Well, actually I'm a medical assistant, but it's the same thing as a nurse."  "No," I answered her, "It's not the same thing, hence the two different titles."
An instructor in nursing school warned us about this and told us to stand up for the value of the profession and always correct people who label non-nurses as nurses.

Point 7:  Use a larger needle than necessary.
I can envision this, but I have not personally done more harm on purpose.  A patient might hit you if he senses that you are inflicting more pain than necessary.  I've seen rough handling, but not consciously, but rather by caregivers not realizing how frustrated or angry they've become in the course of physically attending to an uncooperative patient.

Point 8:  Nurses lie.
More like not directly answering what was asked, because we have to for the sake of the patient and our job.
When a person asks, "What would you do if you were me?" my first thought is usually, "I would not have gotten myself into this situation."  But the patient's situation and life are not identical to mine, so what is good for me may not be good for the patient.  I respond more generally, without advocating immediate action, such as, "Let's gather all of the information and facts first.  Then we can discuss the situation with your support network and the doctors to see which course of treatment is most likely to deliver the results you hope to have."
We don't put down a doctor or a doctor's recommended treatment because that would subject us to dismissal.  Plus, we know that everyone is different and what didn't work for one person could be great for another.  We can discuss our concerns with the doctor and maybe change one of our minds.

Point 9:  DNR (Do Not Resuscitate) order may be ignored.
Yes.  DNR does not apply in some situations, such as during surgery or when dying from a sudden accident or trauma, such as choking.  Also, the medical personnel responding to your distress may not know that you are a DNR when they begin CPR.  They won't stop CPR simply because someone finds the DNR and waves it around.
Families can demand that CPR be performed regardless.  (See above for discussion of the fantasy revival.)  In the lawsuit-happy United States, the medical team may perform a light display of CPR, knowing that the person is not returning from the dead absent a miracle, hoping to make the family less inclined to stop at an attorney's office on their way to the funeral parlor.



Thursday, May 14, 2015

Happy 50th Birthday

I've noticed.
     I was invited to a party.

     I'm not going.  Not my kind of crowd.

     The party is Linette's 50th birthday party AND book party.  Linette is the unstable orderly who never shuts up (or does any work, but that's a given).  I've been waiting for a copy of the book because I think it will be enlightening to see the whirlwind of her mind printed on a page.

     Apparently the book has been (self) published and distributed.  I didn't get a copy.

     I was leaving through the lobby.  Linette was wandering around the lobby, shifting her weight from one leg to the other, bobbing her head side to side, as if her bones could no longer support all of her weight.  She has lost a lot of weight, so her current movement style is a carry-over from past days when she could not move fluidly.

     The security guard voiced concern that Linette's left foot was angled out of the clog and spilling over so that her ankle almost grazed the floor.

     Linette responded, "It's been like that since 1998.  I explained that in MY BOOK.  Didn't you read it?"  She stood there, looking quite annoyed with the security guard.

     I left.  I have to get a hold of that book.


Sunday, May 10, 2015

Happy Mother's Day

Happy Mother's Day
Did you know that 91% of nursing homes lack
adequate staff to properly care for patients?
The difference in staffing in long-term (nursing home) care versus psychiatric is remarkable to me.

Most nursing home patients require around-the-clock care, including total care (cannot do anything for themselves).  In the nursing homes where I've worked, the staffing ratio was one nurse for 30 to 60 patients, with help from 2 to 5 nursing assistants.  Nobody in their right mind could look at this set-up and deem it safe.  Do the math.  When I had 60 patients, that's one minute per patient per hour, or eight minutes per 8 hour shift, assuming I didn't get a break, which I usually didn't.  The eight minutes was not in direct patient care, as I had to extensively document every patient.

People may think that lots of documentation is great, but think about it.  The more time a nurse spends with the chart, the less time the nurse spends with the actual patient.

On the psych ward, in contrast, the staffing ratio is double than that of the nursing home.  Some say it's because of the violence potential.  Yet most of the staff lack people skills, thereby increasing the risk of a patient acting out.  Whenever a staff member complains about the work load on the psych ward, I think about the work load in a nursing home, and laugh to myself.

A lot of nursing home patients have psychiatric issues, but are not medicated for these issues because it's a "chemical restraint."  I remember a patient in the nursing home who was very violent.  His PRN "as needed" medication was 1 mg of Haldol.  ONE, and giving it meant you had to write and write to justify chemically restraining the patient, as if the dose had any effect.  On the psych ward, 20 mg of Haldol is a more common dose.  When a patient ages out of the psych ward and is transferred to a nursing home, their psych meds stop.  No wonder they become so disoriented and agitated.

Saturday, May 9, 2015

Bossy Boss

I got an overtime shift!  I'm happy for the money, but I earned it, dealing with one reticent orderly.

Overtime is on the floor- not in a cushy office.  Worse, I was charge nurse because everyone else was per diem.

The floor was short on orderlies as usual.  But let me clarify:  an orderly who does nothing but yell at other staff does not ease the shortness.  One nasty orderly came in late and then sat in the break room, talking on her phone.  I told her to join the floor and get the patients moving.

She retorted, "I don't know if I'm working here.  It makes no sense for me to start working and then have to stop."  She's such an A-hole.

Well, her work never started.  Over an hour into the shift, her loud laughing really got to me.  I told her that she needed to come onto the floor and start working.  She mouthed off to me for about ten minutes as I wrote the assignments and started the shift reports.  You see, I have no recourse.  The supervisor will side with her, not me, because I was "harassing" her by repeatedly telling her to do work when she was "going to," I was just impatient.  Others will say that I was only in charge for a day, to not worry about it.  Yet the other orderlies complained to me that they had to handle the slacker's workload and that it was my duty, as charge nurse, to insist that this nasty orderly do work or write her up; and I "let people walk all over" me.

I can't win.

At one point, in front of patients and staff, she loudly sneered, "I guess you just like being bossy."

So contemptuous.  She should have been fired long ago.

I looked at her and remarked, "No, actually, I don't like telling grown adults at work to do work."

She responded, "Well, you sure tell me what to do an awful lot for someone who doesn't like being bossy."  She didn't get it.  She makes no connection between her behavior and the behavior of others towards her.

She did NOTHING all shift.  Nothing.  She complained non-stop and disappeared from the ward for long periods of time.



Tuesday, May 5, 2015

Compartment Coping

It's a constant struggle, coping with my job.

I am trying to compartmentalize.

My employer provides me with two very important things that I need to survive in this world:  money and health insurance.

The other things I would like in life:  personal fulfillment, friendship, a sense of belonging and self-worth:  these I must obtain elsewhere.  Isn't this how everyone else lives?

It's just that the work segment of my life is so negative that it drains my energy and enthusiasm for the other segments of my life.  The constant barrage of insults and attacks depletes me for life outside of work.  I am eyed with suspicion and accused so often that I've developed an apathetic attitude on the job, which then carries over into the rest of my life.

I have to work on the skill of compartmentalization.



Sunday, May 3, 2015

No Computer for You

Finally it happened.  My supervisor in the office is showing her true colors.  When I was on my break, she called the "computer lady" to change the passcodes to the computer and voicemail.

When I returned, the supervisor was not around.  I tried logging in and checking voicemail unsuccessfully.  I knew what had happened.  Did I bring this on by waiting for it?  I attracted this to myself?

I knew the supervisor was up to something because her behavior changed.  She used to arrive late, take her time folding her jacket, getting coffee, chatting.  For the past two weeks, she has arrived before me and cleared out the fax machine, voicemail, in-house mailbox, and general office email.

There is not much on the computer- just Excel spreadsheets of appointments that I created to organize the paper deluge.  But I need those schedules for distribution and for weekly and monthly reports to the higher-ups.  I didn't have two versions of every document because that would create more work and confusion.  The Supervisor will sometimes make changes on a schedule or report, but not mention it to me.

At the end of the day, the supervisor informed me that she changed the passcodes because "You don't need them.  You have your own email."  That has nothing to do with the computer lock or the voicemail.  She has no clue about computers.

I wanted to establish if I did something egregious, or if she compromised my work out of spite.  She told me I had done nothing wrong to oust myself from accessing the office computer or voicemail.  So my conclusion is that she did this to prevent me from doing my job.

Day 2 of the lockout coincided with the end of the week and month.  She was concerned that people were requesting the weekly and monthly reports, as well as upcoming schedules.  I showed her a piece of paper where I had written Updates that she would need to make to those documents.  She wasn't following.

"You have email.  You can send the documents," was her reply.

"I can't access the documents because you changed the passcodes," I tried to explain.

Her face contorted as she tried to reconcile her desire to prevent me from accessing the documents with her desire for me to complete the documents and send them out.  "I'll call the computer lady," she decided.

The Computer Lady showed me how to access the intranet of the hospital, which was up and running that day.  She showed me where to look for uploaded documents.  The problem is that patient information is banned from being uploaded to the intranet because anyone in the hospital has access.  Only general announcements and news are found on the intranet.  Supervisor could have uploaded the documents anyway, but she didn't because she doesn't know how.

Supervisor continued to pester me about not sending out the reports.  I told her I have no access.  She firmly stated a rehearsed line designed to set me up:  "At this point, you have been instructed by the computer specialist on how to retrieve these documents, yet you are still unable to carry out this essential function of your job."

"I can't retrieve documents that you never uploaded," I replied.

"I did do that," she scrambled.  "I mean, I told the computer lady to do that, whatever it is that you are talking about.  It's done.  You are the one refusing to do your assigned tasks."

"Can you email the documents to me?" I tried.

"Me?  You have your own email.  You can email the documents.  I'm not stopping you from using your email."

I called the Computer Lady.  "All I know," she explained to me on the phone, "Is that your supervisor called me and told me to lock you out of everything except your own email.  I'm not getting into the middle of this.  If she wants you to have a particular file and she doesn't know how to send it to you, she can call me herself, which she isn't doing."

This is absolutely ridiculous that this is my job.  The job itself doesn't even require a nurse.  And I have to navigate a passive-aggressive supervisor who thinks I do Black Magic on the computer, so she has to put an end to it.  It's the year 2015 and I am at the mercy of a supervisor who is afraid of me and my abilities on a computer.

If this supervisor takes this to nursing management, I'm still screwed.  They have no idea about computers.  All this supervisor has to say is that I have email that I can access, so I have no excuse for not emailing schedules and reports.  If I try to explain, all they will hear is that I think I'm better than them because I know how to use a computer.