Malfeasance Manifest

I’m bad at updating.

Registered Nuisance — Sun, 07 Feb 2010 20:49:22 +0000

Whoops. I got a second job.
Also I have an interview for possibly my dream position Thursday this week. I might shit myself, I’m nervous.

Additional Job

Registered Nuisance — Sat, 30 Jan 2010 21:40:23 +0000

I got a part time job at a women’s clinic. It’s very interesting. Sidenote, I know a lot more about early pregnancy now than ever.

Resume

Registered Nuisance — Wed, 06 Jan 2010 08:59:30 +0000

Of course the er job is open and I haven’t got my resume on me. Of COURSE.

edit 0650; I am so smooth. I got it.

Merry Xmas – or “A punch in the right tit.”

Registered Nuisance — Fri, 25 Dec 2009 15:17:59 +0000

I had to show a doctor I work with my tits because a fucking whacko( a third, totally different whack) punched me square in the tit even thought four (4) nurses were holding the cunt down. She tore through her restraint like the fucking crackwhore Incredible Hulk.

A Summary I Posted Elsewhere

Registered Nuisance — Wed, 23 Dec 2009 09:18:08 +0000

VENT? I need to vent. I had the same wernicke-possibly-korsakoff alcoholic who grew increasingly combative over night and each night but never during the day so the doctors didn’t believe how bad it was. While covered in blood he attempted to dig his nails into my arms while I was only blocking his path and keeping him from falling over backwards. He was sober. Each night was worse. He tried to bite my aide twice in the same night (fingernail night). I had him for 36 hours out of 72 (three days) and was probably in his room for at least 20 of those hours. Probably more, he was so up and down and unsteady I had to park a mobile computer station in his room and stay there for hours at a time. He is still on the floor.

Two weeks ago a different whacked out patient (DT alcoholic + who knows what psych dx) assaulted me and another nurse with an IV pole twice. I had to cut the line to get it away from him (couldn’t get close enough to unhook it proper) and called all the shots of common sense like… remove the projectiles, get the other patient in the room OUT. There was a code strong, police involved.. and then he accused me of sexual misconduct. Apparently I forced him down on the bed and tried to rape him. He told the police this. He wasn’t even my patient that day. I was helping the primary nurse because she was scared of him. He is still on the floor. Unrestrained. He was on 1:1 for a few days until staffing ran out, until he bit somebody. Now he’s 1:1 again… but no restraints. No psych transfer.

I DON’T WORK IN PSYCH, OR EVEN ER. Med surg. I really don’t feel like my safety should be so consistently compromised. I’ve been an RN since JULY. My resume is going around other facilities, this can’t be normal.

Why I hated my job the other night.

Registered Nuisance — Wed, 23 Dec 2009 09:11:01 +0000

I just worked 3 12 hour shifts in a row with a sundowning alcoholic DT guy who may or may not have drank himself into full blown Wernicke-Korsakoff. ANYWAY.
First night, 1900. He’s not that bad, just confused and peeing a lot. Not steady on his feet at all. Can’t keep him in bed or even seated. Can’t park him at the nurses station because he can easily get out of recliners and anything. He wants to sign out AMA. I can handle that. I notify Charge, charge notifies Supervisor, Supervisor convinces him to stay. Thanks for that. Called the MD, was able to increase 0.5mg lorazepam from q4h prn to q3h prn because “q2h” was “too much ativan in a day.” ….. yeaaah, thanks. 1mg Haldol IV. Really? Useless. Fortunately he let me put in a foley because the pt was peeing every 20 minutes and dribbling a lot, never had a prostate exam, and was a significant factor in fall-risk. By 0400 or so he fell asleep. In 2 hours he put out over 1300 in urine… think it helped? Yeah. I had an extremely frustrating night but made it out without assault, battery, or a fall.
Night two. 1900. He’s a little worse, he frustrated my day-counterpart but not too badly. It seems he gets much worse after sundown. Thanks. I live in a sundown universe. Almost immediately he’s getting up a lot, forgetting about the foley bag which he carried around almost all the time during the day successfully and remembered it. Tonight he’s forgetting. I remind him a lot. He demands to use the bathroom constantly because “I have to piss.” I remind, reorient, educate, SHOW HIM HIS URINE and he keeps getting up demanding to piss. I cannot keep him in bed. Now he demands cigarettes. I make it approx 6 hours into the shift through bargaining tactics… somebody likes his soda, and I just happen to have diet caffeine free cola on hand in quantity. Bargaining works about 45 minutes at a time, giving me enough time to take care of my other patients who are fairly low maintenance. I may be tired and annoyed but getting by just fine. Later in the shift, he gets more demanding, refuses to be in bed at all and wants a cigarette. Tries to go into the hall asking people for cigarettes. Almost falls over backwards and stumbles a lot with me catching him. I’m not getting any helpful answers around, nobody knows how to keep homeboy in bed. (He’s late 60′s. and probably homeless.) I tried being super nice, bargaining, meds, nothing helped. I moved to setting limits. You have to stay in your room, and you have to stay in bed. He refuses and tries to push past me. Threatens to hit me (fist in the air, ready) grabbing my forearms as tightly as he can forcing me to twist my arms out of it which caused my arms to get red and swollen after the number of times we did it. Phoned the MD. Same MD by the way, who yells at me and asks me why this wasn’t handled on days as it is the attending md’s problem. Thanks. Obviously I’m here 24 hours a day to handle it. More haldol. Some Depakote, and one extra po 0.5mg ativan.
Nope. He falls asleep at his usual time around 0430ish, which was long, long after the meds, but pretty close to our most significant physical encounter where he became exhausted. Pass him to days counterpart.
Night three. The WORST. Literally DURING REPORT at 1900 he walked out of his foley because nobody was watching him. It ripped out, there was blood everywhere. So now I have a crazy guy covered in blood. AWESOME. Day guy refuses all responsibility saying the Dr didn’t give him anything else. But he didn’t ask, either, and he recognized that the pt got worse overnight. Here’s your trainwreck, have a good night! I had two pretty acute patients (one that shouldn’t have been in my hospital because of his acuity and specialized issue) on top of this guy, and one low maintenance pt. So pissed. Dude said it didn’t even hurt to rip that 10cc balloon through his urethra. The NP of the urology office shows up and is deeply disappointed he ever had a foley at all and announces it’s because his nurse couldn’t handle him TO ME not realizing I was his nurse. I explained my rationale and she got really quiet and looked away. Thanks. I give him some food and coke and he’s nice while the urology NP is present. He’s talking in confabulation but pleasant. Which is great, since now another prescribing professional thinks he’s just the nicest guy ever… The MD (not last night’s) comes up for another reason and I corner him and ask to up the ativan. He gives me 0.5 po q2h prn. At least it’s something. The charge on evenings claimed to have called the doc and never heard back. Based on his reaction I doubt it.
The night gets worse and worse. He is up to pee all the time. Pissing blood. Getting himself, his gown, his socks, the room and the bathroom covered in blood repeatedly. One aide remarked it looked like a CSI crime scene everytime he urinated. At first they brought him to the bathroom but each time was a horrible mess so I demanded he use a urinal. This is less of a mess and a good option but occasionally people give in and bring him to the bathroom. Way to undermine my authority… I cannot keep him in bed and he constantly gets up either to piss or for a cigarette. IN addition, he has eaten entire ketchup packets that were left behind (with packaging) salt and pepper packages, chewed on the call bell, tried to drink out of his urinal twice and thinks he’s in the ice cream store. I maintain the bargaining and when my usual night crew arrives (most people do 8′s, I do 12′s) I explain the bargaining position and not to give him stuff. It is so bad I have parked my mobile computer station in his room to do all my charting and I am unable to leave or he gets up and waivers backwards. He is more escalated tonight, yelling more, shoving more (and bloody hands, remember). The charge nurse comes in to “diffuse” and merely acquiesces to him constantly, even demanding I get him black coffee… IN THE MIDDLE OF THE NIGHT. WE DO NOT CARRY DECAF. I explain to her he likes coke and I’ve been giving him caffeine free coke since I would like him to fall asleep at some point. She demands I get it anyway. I do. It makes no difference as he either does not or cannot live up to agreements to stay in bed. Long-short, he did not sleep at all.
Around 0100 or so, I’ve been given an aide to help me with him exclusively. He’s more aggressive and demands pants and shoes… covered in blood. He has been cleaned up repeatedly but constantly pees and leaks blood everywhere. Depends are useless but present. While his hands and nails (long, sharp) are covered in blood he makes a huge scene and tries to get out of the room. I had gloves on but they end at the wrist. Aide and I block, totally nonviolent, touching as little as possible. He grabs my arm and tries to pierce my skin with his nasty, blood covered nails! He attempts to BITE MY AIDE TWICE. We were not restraining him, just preventing him from walking out of the room and keeping him from falling backwards. I was LIVID. I was not pierced but only because I have reasonably quick reflexes and got my arm away. He was squeezing hard and meant business. I immediately put on an isolation gown, the same for my aide and we back him down into bed. The charge nurse finally calls the MD (YOU THINK???) finally a new MD and gets an order for IV Ativan, 1mg. NO RESTRAINTS. NO ONE:ONE OBSERVATION. NO SEDATIVES. HE DIDN’T EVEN COME UP TO VISIT THE PATIENT. The IV ativan makes him less mean and he begins to hit on me. Fantastic. The Charge nurse left that aide in that room because at this point I was neglecting my other patients but unable to leave this guy alone. I am shaken, livid and losing it quickly. I manage to at least do the bare minimum for everyone else and get my charting and meds done…. in time for him to rip out his new IV (the PO ativan expired during the night and all I had was the q2h 1mg iv) I place another one immediately because this ativan is all that’s standing between me and additional assault. I document thoroughly on all my problems with the patient, all the meds given, and it’s nearly 0700, I give up the patient to the new day person (who never had him before) and wish them luck.

I hate my job

Registered Nuisance — Tue, 22 Dec 2009 07:16:48 +0000

I never said that until tonight.

Health Insurance

Registered Nuisance — Fri, 18 Dec 2009 16:07:38 +0000

We get it by now, right? You need health insurance. It’s not something you get on a rainy day. A significant number of people work strictly for health insurance benefits. It is important.

Well, my hospital’s insurance is with CompanyX. A major company. In fact, your health insurance is probably through them. Well, for whatever reason, they changed the name of the plans BY ONE LETTER EACH and jacked up the prices. Fine, whatever. I just want the plan I have now, jacked up is fine. Brilliant scheme, har har, ten bucks, I can suck it up. I fill out the paperwork. I put it in the drop box (at the same time as other employees!)

I get a phone call a few weeks later. They can’t find my paperwork, and did I really mean to not have insurance? I called back immediately, of course not! I need insurance! I am human! I describe in great detail how and when I handed it in. The woman backtracked and said she’d look through the paperwork again, they hadn’t made it to the end of the pile. Okay, good.

I heard nothing more. I assumed it was located, as I had dutifully done my part.

We get one last threatening email (in COLOR TEXT!) at work about handing in the paperwork by 12/18. I decide, as I had heard nothing but radio silence, to email her to just double check that she located my carefully handed in paperwork. I did this Tuesday night at work, went home Wednesday morning. I get a voicemail 10 minutes from my home (recall I work an hour away) that no they never found it and they’ll be there all day if I could just drop by sometime and fill out new paperwork, the deadline is Friday. I am not scheduled to return to work until Saturday, as I work 3x12hr shifts. I also cannot simply take a joy stroll over to the hospital for a single piece of paper.

I am livid. But moreso, terrified to lose my precious insurance!

I call in a panic, cops be damned, while driving. I explain who I am and the situation and the woman says oh right, we had several forms with no names but signatures so maybe yours is one of them, just come by and…
no, no. I took an entire shift to fill the fucking thing out. My name was there, all the appropriate boxes were checked and dates and everything. I am not so careless as to leave my NAME off of A LEGAL DOCUMENT. FOR FUCKS SAKE. I WORK WITH MONKIES.

I am appalled that a HOSPITAL whose workers know more than anybody else how VITAL health insurance is was going to simply let the deadline pass and my insurance LAPSE if I hadn’t emailed her. Insane. InFUCKINGsane.

I panic on the phone with her and ask how we can pull this one off. She asks if I have a fax. Of course I don’t have a fax line and machine, jesus. I ask her if she can simply scan the form and email me the image. She states she has not got that capability (more on this later.) I fret. She offers to mail it. I ask how it will possibly get from her to me and back in time. Then I consider the vet I worked for had a fax, and I could fill it out and fax it to her if she were sure I would receive it in time. She was certain, so that was the plan.
I wake up yesterday afternoon and find the envelope and paperwork within. It’s after business hours, so useless to do anything right then. This morning I fill it all out at 9am, and sit, unshowered, growing more and more annoyed that I have to do this. This could’ve been handled in the MONTHS since I handed the form in very easily. Goddamnit. Instead, I take iphone photos of the documents, which if my bank will accept that for a CHECK and LEGAL TENDER then they should be able to accept a clear photo for a legal document. I call and get the voicemail and leave this option and ask her to call me back.

While waiting I call the insurance company to see if I can renew with them, since it’s the same company, the same fucking plan, with one letter difference and a higher price. The airhead I get on the phone (after trying to tell the machine my number several times) brightly states my insurance is paid through 2020. What?
That is impossible. Seriously? I didn’t sign a 21 year contract, I am positive. She has no idea what she’s talking about, places me on hold for 6 minutes, then opts to give me the hospital rep. The number is the number for my hospital HR. You know, the people who lost my shit in the first place. FUCKING THANKS. I of course miss the call from my HR office being on this useless call.

Voicemail states the email idea is acceptable. I immediately fire off the images from my iphone. I call and say who I am and I sent the email images and could she confirm them. She says oh yes I have a new email right here… she almost immediately declares she cannot do it. What?

Why?

She is incapable with computers. Initially she blames me, stating my email is entirely blank. Patently not true. She states the second email with the authorization to pay worked but was tiny (the THUMBNAIL, PERHAPS?) Suddenly she goes Oh, I think I got it, places me on hold, then triumphantly returns minutes later saying she got the enrollment form printed out. Really? My blank email … wasn’t blank? Thanks!

I throw in a passive aggressive remark about how I wish I’d known sooner that my paperwork was never found and this could’ve been avoided. She is narrating what she’s doing on the computer to keep her focus and I said something like computers are fun. She states they weren’t for her, she hated them, she had enough knowledge to get by and that was it. Yeaaaah….

IT’S ALMOST 2010. THE INSURANCE COMPANY TOLD ME THAT YOU CAN IMMEDIATELY UPDATE SOMEONE’S INSURANCE PREFERENCES AND ENROLLMENT ONLINE FROM YOUR OFFICE. YOU STATED YOUR EMPLOYEES LACK THAT CAPABILITY. I BELIEVE YOU MEAN THAT SIMPLE TRAINING OF FILLING OUT A MOTHERFUCKING INTERNET QUESTIONNAIRE AND HITTING SUBMIT. WHAT. THE FUCK.

It wouldn’t matter in the first place if you had not LOST MY PAPERWORK. Fuck. I work with fucking monkies, I swear to god.

It’s Monday Night.

Registered Nuisance — Tue, 15 Dec 2009 13:42:44 +0000

It’s my first 12 hour shift.

I was assaulted by a crazed patient in the DT’s with an IV pole. When the cops showed up he accused me of raping him.

All in a Monday night…

Conflicted

Registered Nuisance — Wed, 09 Dec 2009 18:00:34 +0000

Rant: We walked in and found a patient dead >10 minutes, min.

Rave: We ran a code.

Rant: We had to run a code on a dead guy.

Rave: Codes are very exciting even on a dead guy.

Rant: Totally unexpected on a ‘stable’ guy.

Rave: I participated in a code, in fact started the breathing for it (not mouth to mouth – gross)

Rant: He shouldn’t have been coded, he didn’t want this, but never signed DNR stuff.

Rave: We got a sinus rhythm back.

Rant: On the way to ICU they lost it.

Rave: But got it back!

Rant: But lost it again.

Rave: His labwork was abysmal and there was NO chance of getting him back.

Rant: It may have been caught in time if a Dr had ordered a urinalysis.

Rant: I broke a rib during CPR when I took over compressions.

Rant: Diabetic Ketoacidosis is a BITCH. Diabetics, check your blood sugar, please.

Rant: A nurse bought him a new pair of nice shoes just two days prior. I had to collect and bag his brand new shoes.

Rave: Really good experience, if extremely conflicting in nature.

Rant: The image of him frozen in time and death is seared into my brain in a way I can’t adequately describe.