Yeah, it all happened…

The following is an explanation to much of what I had hinted at in my last post. I have copied and pasted the narrative of a experience with a patient.

This report, led to the patient being charged with Second degree manslaughter. Ten days after this incident, I resigned from this facility. There is much more that has transpired since. A lot more. But this is already long enough.

So…. Here is a start……(the names have been removed to protect, well, everyone)

I have been asked to prepare a statement regarding the events of the evening of July 30, 2013, into the beginning of July 31 2013, with patient ___________

I am preparing this informal preface to the statement so that I may explain how it came about that Mr. ______ and I were outside of the facility at the time of the conversation we had.  I feel without knowing the reason Mr. ______may have felt more comfortable speaking to me will help in understanding how it came to be that he said what he did.

I am writing this while all events are as fresh in my mind as possible, and I wish to preserve the chain of events with as much accuracy as possible.

I am completely unaware of what if any legal obligation rests with me, as to the statements made by Mr._________were quite serious, and very disturbing.

As someone considered a mandated reporter of suspected or actual abuse I am at a loss as to what is expected of me as what Mr. _____ stated as to the cause of his injuries could be considered, I imagine a number of serious crimes.

I hope that since the conversation took place as I was in good faith with him as part of my employment that the facility and/or its corporate office would assist me with any legal guidance I may need.

I reported the “majority” of what was said to me directly following this “episode” to _________ the RN supervisor immediately following the conversation, for “guidance” as to what to do; she suggested I write the statement. I was quite shaken up and knew that the drive home would provide me with clarity and I would be more effective in communicating where I was able to focus with less distraction.

Mr. _____ was admitted to the facility while I worked A wing. All I had heard was that the pt we expected was involved in a terrible vehicle accident that involved multiple vehicles and it was my understanding that three people were killed. (I do not watch much news, so I really had very little knowledge of the incident)

I was what I thought, momentarily at least “ALONE” on the unit when soon after arriving the pt was beginning to become quite angry and very insistent that he was leaving the facility. An aide called out to me for assistance when he pushed her out of the way in order to leave. I had just come from a pt that was on the complete opposite side of the hall that had been found bleeding, and I asked the aide where the nurse was for that “side”. I was told it was only me. So I approached the angry pt and asked what the problem was. He quite angrily stated he was not told this was a “Nursing home, he thought he could smoke….” He was carrying a bag of his belongings and donning a hospital gown, and blue slipper socks.
My immediate concern was the patient was standing on a leg with a cast. I had no idea what his weight bearing status was, so I wanted to calm him and get him at the very least in a wheelchair. I asked one of the aides to get a chair, the Overnight supervisor emerged from the narcotic room during the exchange and when I asked “How can we get him a wheelchair?” I was told “We can’t get him one; PT has not seen him yet.”

I stated that “This patient is in more harm standing on this leg then in a wheelchair that has not been approved.” We got one; he sat, and continued to talk to me. I assumed that the patient had injured his head and was possibly being belligerent and anxious due to a brain injury, or perhaps PTSD as a result of the gravity of the incident.

After acquiring the chair he seemed receptive to a few minutes of conversing, and it became a bit noticeable to me that mental illness was a factor as well. I helped the patient back to his room, and he started to speak a bit about the accident. But he was so “disorganized” in his speech, and saying things to me that did not connect, I really attributed his words to a brain injury, and anxiety to his surroundings. I also still had a patient bleeding down the hall, and assumed the supervisor who was now the nurse for him and way more experienced than I could handle it.

The evening of the incident of July 30-31st I had not seen him until about 1045pm had no knowledge of his whereabouts I was assigned to the other hall.  As I was prepping for change of shift, I began to hear an unfamiliar alarm sound and a yellow light above my head was lighting up, I was told it was a wanderguard signal. I knew no one left, so I was confused, as was the agency nurse that was on the other side. We were told from the other unit it was the main door. A patient’s husband had just left so we were questioning whether it could have somehow been him that caused this. Then Mr. _____ appeared through the door. He had apparently, I would find out a few minutes later, been involved in a situation that had police involved and a hospital visit.

Within minutes of arrival he began to insist he was leaving, AMA. He made phone calls, and the agency nurse called the supervisor for assistance.

Apparently the supervisor had gotten doctor approval for him to have a smoke if a staff member was willing to take him out and the issue that was causing his desire to leave would be better addressed with more staff.

I volunteered to escort him.  I told him I would make a “deal” with him, if I took him it would be to calm him to help make clearer decisions about the future of his care in the morning. My hope was that by my doing something so simple the “skeleton crew” on the overnight shift would be at least a tad safer.

He agreed. He came out with me. I had explained to the Overnight supervisor and the male LPN (whose name I am unsure of)  present that because of the situation and it being a special circumstance, I would be right out the door, where I could be heard if any actions on Mr. ____’s part were in anyway dangerous to me or to himself.

So we went out the side door by the time clock. Mr. _____and I spoke. I provided him with a cigarette and a light, I also had a cigarette, and I did not need it, but was trying to make this as “normal” and “relaxed” a few moments that I could. The Nurse and supervisor we had left inside said they would prepare his pain and anti-anxiety meds while we went out. Within a few minutes the male nurse came out. Saying nothing he just stood there. Almost as if he was protecting us. I was just answering some questions Mr. ____ had regarding whether I agreed with his family that “he had sustained a head injury in the accident” I tried to provide medical explanation to him as to why I thought it possible, and the mood was getting lighter. We stood not far off the door, and “chatted” (again I wished to both calm him and stay within earshot if help was needed.)The male nurse was suddenly gone. Within a minute or two the male nurse came out again and with an aide. The aide saw us smoking and started to point at a camera behind us and said “You gotta move. You can’t SMOKE here. That camera is gonna see you so close to the building, and they will hand you your butts tomorrow, you need to go to the ROAD, this IS a non smoking facility!” And she and the male nurse walked to the Gazebo to smoke! I was wearing a name badge, and scrubs and in a lighted area, and she was with a nurse that was AWARE of what I was doing at the time. She really had no business interfering, and she could have (should have) returned into the building and spoke to the supervisor! I was nervous now that the “chewing out” we just got was going to undo the whole point of this.
Mr. _____did start to get a bit “unwound” said “She really didn’t need to talk to you like that, doesn’t she know you work here? Let’s go and we can talk some more.” He had not finished the cigarette, and started to move the wheel chair, and started to say things that show me paranoid ideation. I simply kept the conversation light and stopped walking as he moved the wheelchair as he finished the smoke. He stopped too. He asked me for one more. I said “Ok, but then I really have to insist we go back in as soon as it is done, my husband will worry”

I should have stated earlier in this that I had previously worked for 15 years with people who were developmentally disabled as well as dually diagnosed with many mental illnesses and again only offered to do this so that Mr. ____ would remain in the safety of the facility until morning, after hearing his statement to me, I wonder if he is safe to be in the facility. If he has the ability  to construct so vividly what he told me transpired as part of his “accident” whether it is a true reflection of the real events or not, especially in a facility where the staff are ill equipped to “handle” someone with such a potential for apparent violence.

The remainder of the incident will follow as my “formal “statement as requested on a separate page.

WHAT WAS SUBMITTED TO POLICE:

July 31, 2013

On July 31, 2013, at about midnight, I escorted patient ________ outside of the ____ _____Rehabilitation and Nursing Center to just outside the side door, in an attempt to get him to stay in the facility as opposed to going AMA, and possibly endangering his health further as he had no responsible person to care for him, and did not seem capable of making a decision in the best interest of his health.

While outside Mr. _____ and I were instructed to move by a staff member apparently unaware of who I was, and what I was doing. When we had been moved Mr. _____began to make statements regarding a variety of topics. I responded in calm, short answers, in an attempt to reduce his anxiety. He quickly jumped from items about Native American spiritualism to the “voices he received through the Bose speakers” he has. When he made mention of the “voices” I calmly and as non alarmingly as I can ask,

“By voices, you mean like “spirit voices” not like voices instructing you to do things you would not do, just so I get what you are trying to say, right, I mean I don’t want you wasting what little time there is with you saying things, that I am getting wrong”

Mr. _____then directed the conversation to his recent accident.
He asked me “How good are you at reading between lines?”
Confused, yet trying to “go along” to keep a sense of calm, I said “Ok I guess.” He then stated “Well, I mean, what if I told you, my accident, it wasn’t an accident.  I got into my car, wanting to die”
I said “You wanted to die? I am confused” I really was not expecting this.

He then said “What if I told you, between the lines, that I was at ___(convenience store) ___, and I waited for cars, the first one, wasn’t right. The second one wasn’t right, then the third, or the fourth, but then the fifth there was two cars. I had two cars coming at me I wanted to die, but I didn’t.  I was flipped over and the cop came up as they were opening it up and shoves a straw in my face, and says “Here, blow into this” I mean, I was upside down! He is pushing a straw in my face! I wasn’t even out of the car!”

I was confused and incredulous as to what I had heard. I asked “So, you mean you were trying to kill yourself, by hitting the cars on purpose?”  I still maintained a calm demeanor as it is still, and remained throughout, my intention to at the very least, keep Mr. _____ from escalating in his agitated state, and had thus far, seemed to be successful.

He responded, “Well, between the lines, yeah, but I put my seatbelt on. How bad did I really wanna die if I put on my seatbelt before I picked the cars? My airbag went off and I mean, I only had a second, just a second to hit the brake. And I didn’t ”

Still in disbelief from what I was hearing, I said, “So you now feel guilty because, wait, I know that some other people died, but you feel guilty that you lived? Am I understanding this right? I mean I am just trying to get the whole picture here.” I then non-chalantly start to push the wheelchair back to the building, as I was now very scared and by doing so, controlled the actions that got us back in the building.

He replied, “Well I said a prayer for the lady, and I told my wife about it, she said ‘Well there is nothing you can do to change it now.’”

I pointed out “You sound like you have a lot going on in your head that has to be sorted out. It will take some time.” He then started to cry, and thanked me for listening. I assured him that it was all “good” as I was trying to keep him in the calm state he was in.

Signed, LPN

Just for clarity, and as you will see in subsequent posts, I returned to work for my next shift, the day after this happened. I did not get home from work this night until nearly 2 am. It took me hours to type all of this, and I had no sleep after. When I returned to work, I discovered the RN supervisor reported only the fact that the Doctor ordered the cigarette, not what happened during it.

I’m BAAAAAACK….Sort of.

I haven’t posted anything new since April. If I were to post what has happened over the seven months of “hiatus” it would be so long that I would probably crash the entire world wide web.

Its not that I have not wanted to write. I have been afraid to. Afraid that putting what has been happening into words all together somehow makes all of what has happened more “real”. It has been unreal. Sort of like a bizarre dream. Nightmare is more accurate. But I have to start somewhere, and try to get clearer thoughts. I plan to begin what I am thinking of a “purging” this week. A court date I have to attend on Friday is putting what I hope to be an end to about 75% of this nightmare, and I hope that if I sweep the cobwebs out with putting it all in words, it will help me. Help me end the mental turmoil, and toxic feelings I have been experiencing.

Hoping maybe to also help someone else if they ever come to a place in life where situations force them to make some really tough decisions, what to do with the ramifications of those decisions.

So to spark interest, be on the look out for my return to Nursing, (yeah I know), the patients “confession” that lead ME to court. Front page story (that apparently no one read) and what now?

If I did not live this crap, I would swear it was all just a lie.

I haven’t written any of it yet, but I have to. Perhaps just seeing it all in one place will clear it up for Me. Because I have to say, there has never been a period in my life, ever, that has been such a blur.

I may post a wee bit later. I procrastinated too long. But I fear a real emotional response from me, when I do get this done, so I need to ensure I am rested up for it.

Sharing the Pain (e book)

http://issuu.com/janegonzales/docs/sharing_the_pain__2_/37

This link is to a E book that is a compilation of personal interviews with sufferers of RSD. A  dear friend Ms. Jane Gonzales compiled all of the interviews so that the words of the sufferers could show the life altering effect of living with such an incredibly painful illness.

Please, take a few moments to read the words and imagine if you lived such a nightmare. Then do something to help spread awareness!

Diseases no one knows about, don’t get cured!

Thank you Jane and all the interviewees for their hard work, and sharing the intimate details of their struggle so that the world knows what life is like (as much as one can without actually living it) when pain is so prominently featured.

I am singing.

So, I am singing. I am the fat lady, so that means it is over. A nursing career, that is. After the train wreck that was job number one, I  promised myself even before the last interview, that whether I got that job or not, it was my last attempt at it. Not even going to try any more. So, in many ways, it had to work. Since I got fired today, I get to sing. The farewell aria to what I thought was the perfect fit for me. Turns out, it wasn’t. It also turns out that you can’t really wish something hard enough, and make it so. Doesn’t work.

It also turns out, that even if your patients LOVE you, because you ACTUALLY care, that doesn’t make you a Nurse worth a job. Nor, does the fact that you have on many, many occasions actually caught errors that would have caused in the very least some Harm to the patients. Doing that just gets every one to hate you.

Working hard doesn’t either. I do. But since my version of hard work doesn’t fit any “pass the meds, that are all fucked up, off orders written by complete morons, that have no idea at ALL what they are even giving the patients, in a quick, careless manner, so that you can meet some impossible time that if not done by breaking actual laws, but the laws of common sense, or we will fire your ass”, I got my ass fired.

Yep. Getting a phone call at 6:45 am that was about me staying for more hours, after my own shift, I couldn’t possibly meet the time deadline that was placed on me, and since I didn’t ask TWO of the stupidest fucking people I have ever met, for help, or figure out WHY the nurse that came in at 10 am to relieve me, only stood there rather than carry on, with the rest of what I had not finished, (I poured the meds LEGALLY and knew if I had not done one at a time as you are supposed to, no matter what the oncoming nurse would have refused to touch them) I got fired. Well, first I got screamed at. By two bitches I had already been humiliated by. Both two of the most incompetent fucks on the planet too.  The thing about this event, I tried to prevent it the night before.

I got a phone call, at my home at 12:30 in the afternoon, I had errands, so I had basically just gotten home from work. I let the machine get it. It was work. The mental defective that does scheduling (who knows I just left) calls to ask if I will either come in early, or stay late. Fuck her, I think, because WHEN DO YOU THINK I SLEEP? A nurse called in for the evening shift. The two-time DWI guy, who I don’t have a clue how he even HAS a nursing license, who started the same day as me, has fucked up more shit then 12 people, and is pursuing his RN, has said TO ME, that he wanted me gone, because he wants my hours, called in. He now got the morning nurse stuck their from 7 am to 11:30 pm. She is almost 70. (An idiot too) When I arrived I asked “Am I staying late?” Almost 70 says this big story that says NO. She was wrong. Scheduler calls the place as I am finishing up, have about an hour left, can go home. I am staying. I am wicked pissed, because HAD I KNOWN, could have spent the time I needed,as I have never done the med pass for this floor at that time slot. I just gave most of them 6 am meds, had to get a hospice patient through a crisis. (1/2 hr GONE) and still administer meds to 9 people on another floor. That one takes 10-15 mins. Nope, of course today 40 mins.

So, I do one patients meds at a time, not pour all the 8 am meds, place them on the tray with their names. Because I know I will leave the 9 am meds to the end, and hopefully still get in on the cut off.

Nope. Not even close. Relief comes in AFTER every single patient, had to be spitting what I managed to get in, out. Ever talk a dementia patient into taking the meds they are SURE you are trying to poison them with? After having done so MANY times. Having lost almost an hour researching how 3 Lpns and 2 RNs fucked up a med order so bad, til I caught it who COULD make the time. Especially, when the one med that I had left, poured and the relief says, “You give this, YOU poured it” No shit. Ironically, I am the one asshole you CAN trust won’t fuck up a med pour the patient these meds were for took LITERALLY one HOUR start to finish, with even the relief taking SOME of it off me, to try and speed it up, to TAKE them.

How is it possible? “Why didn’t I ask for help?” Who? the new RN that every time I have spoken too her, have had the worst interactions with a human I have EVER had in my life? Or maybe the Quality Assurance fucktard, who is an LPN but she trains EVERYONE, and admits residents, and according to her own words this morning, when she BITCHSLAPPED me, first in front of EVERYONE, but the SECOND I proved I wasn’t going to just stand there, and let her, takes me into an office shuts the door, and proceeds to say her! She apparently could have done it, and delivered 4 babies, all breach, and lifted cars off the limbs of crushed puppies, with both eyes closed. She is THAT good. Yeah, I doubt it, since I have seen her handy work. Admit papers on residents where EVERY SINGLE med is WRONG! Zyrtec for Depression? Hmm that’s new. Or the resident who has been there for months, BLIND IN ONE EYE not a mention on ANYTHING. Yeah, help ME please!

I had a guy DIE IN FRONT OF ME because of a Nurse making a med error. Oh yeah, I almost forgot, I also had this incident where my husband almost got killed by a Med error. That was less than 6 months ago still don’t know HOW he survived and it “ONLY LANDED HIM IN ICU!”.

So I got fired. I even said, “Well, that’s a shame. I am a good nurse. But it is what it is. Everyone in the line of this fucked up BEFORE me, I did my BEST, and I am fired in a way, I am relieved. I will now go back to selling chinese crap to tourists”

Nursing was something I thought I wanted. But I am now singing, because it is definitely over. When your best is not good enough. When CARING is something that is detrimental to a nurses JOB, I know the tune is RIGHT.

I could have done good things.  I won’t even look back.

A bagel on the “bucket list”…

Odd. I have been thinking quite a bit lately how DEATH can teach you so much about LIVING.

Not a stretch really. When someone YOUNG dies and it is the result of some tragic accident or an unforeseen circumstance, it makes you consider how fragile it all is.

Live life to the fullest, make every moment count. Those cliches that get tossed about.

You should do those things. Of course. Some moments can be spent in reflection. They have not been wasted. Not knocking items off a “bucket list” does not mean you aren’t LIVING. Sometimes you do have to stop and take it all in, assign all items to their rightful places and “clear out the clutter”. Been trying to do that.

I have done the “bucket list” items too. Twice in this lifetime I have been skydiving. I have tried out for Jeopardy. I did NOT get on, but HEY I tried. I obviously lived through the skydiving. Had I not, I would definitely be giving “ghostwriting” a more literal definition writing this post.

It was Nursing school that made me definitely form my now solid beliefs in 1. A God. 2. That DEATH should be done RIGHT. Well, when it can be any way.

First I will explain how Nursing school helped me realize the definite knowledge that there is in fact, a God. We are no accident. We (and by we I mean HUMANS) are so intrinticate in design that there had to be a “supernatural” designer, a magic implementer of that design. Yeah, I believe in evolution. Things, animals, people, and plants have to adapt to change. If they don’t, they die. How that is done may be part of that creation plan.

I don’t have ALL the facts. I do know, or at least am solid in my belief, that there is more here to climbing out of some “soup” and evolving to what we are today without some “Help” from above.

The learning of the works and how everything is dependent on everything else to function properly, and then UNDERSTANDING that, is how God being a sure thing, happened. I even went to my academic instructor and told her so. I also said “I am sure you never heard THAT before, but learning all this, thats what cleared things up for ME anyway.” She laughed, yet she saw my point.

Working with folks who are in the process of dying, well that is now shaping my attitudes, even more so, on death.

Death, is PART of LIFE. The end part, YES. But we do it so WRONG.

When the end of life and its immenence is KNOWN, why do we not make it more pleasant for the one who is dying? We can also make the experience easier for those that will be left behind.

I keep recalling overhearing a conversation when I was in Clinical during Nursing school. With the curtain between patients drawn, while working with my assigned patient, I heard a doctor tell the other patient, she had colon cancer.

He was quite cold, clinical and very “Matter of fact” about the whole thing.
“Well you have colon cancer, I won’t treat it, because the fact is, at 88 the treatment would be so intense and unpleasant it would surely kill you and in worse a manner that the cancer would. Your children however need to be informed that the type of cancer you have is quite hereditary, and they need to not only get checked more frequently, but also learn the options they have as far as preventing it.”  That is it. He was gone after that.

I felt so bad for that poor lady. Here she was all alone, in a hospital, post op.  She just got some heavy shit thrown on her. She had no support there. No shoulder to cry on. Just “Here ya go. Now I must move on.”

I did not overhear the doctor tell her, “we will do all we can to ensure that you will be comfortable in this process” Would that one sentence have REALLY taken so long to have thrown in there?

No. But doctors feel that Hospice is a defeat. They believe that if they can’t CUT IT OUT, or throw pills at it to make it, if not GO AWAY, or at least manageable, they have failed. They don’t want FAILURE on their scorecard.

Sick folks get hospice, but WAY to late.  They have shown in studies that in The United States, by the time Hospice becomes involved in a patients “End of Life” that they usually only have WEEKS left to live.

What about the time before? I have hospice patients NOW that I care for. I don’t believe that ANYONE even explained to one of the patients I care for in particular that she has medications available to have to make her more comfortable.  They have ordered morphine for her pain, and Xanax if she were to become anxious.  One night she had told me she had an issue sleeping when I went to her in the early morning to give her some meds, and I sat and explained to her that had she used the call bell, and told the aides, I would have seen to it that she NOT had that problem. Then I told her that she had these meds available. I asked if anyone had explained it to her. “No, they did not” I did not say, “Hey lady you are dying, so they got you on Hospice so NOW you can spend these last days, weeks or months of your life in a drug induced fog”  I simply said, “You know, they have ordered medicine for you that if you are in pain or your “worked up” you can have them.” It’s not MY PLACE to tell her she is expected to die.

Usually the patient knows THAT already. THEY are ok with that. THEY worry about what THAT will do to those LEFT here.

But, it is hard to discuss something when it is unpleasant. There is also that feeling of “Well, Mom has some dementia so she just won’t “get it”. Not true.

I have had some people that I have had the most lucid conversations I have ever had with someone, that were at times “WHACKED” from dementia. Yet there are periods of completely coherent thought.

I have had patients in moderate dementia that have said to me, “Hey, I am dying, I know my cancer is back. I don’t know WHY they won’t tell me. I am READY to go. I am tired, I miss my ___________ (spouse, child). Do they think I am stupid?”

No. They don’t think you are stupid, it is just UNPLEASANT.

How unpleasant is it for the patient though, KNOWING they are dying, KNOWING they are ready, WORRIED about what that is going to do to their loved ones. One more BURDEN on them? To not be able to say, “Ummm can we talk about how I am dying? There are things I want to say or do.”  It’s like ignoring the 500 lb. Gorilla in the room. Not fair.

Why not sit down, say “Hey Mom, the doc said that the chances are….” then MAKING the last days as PLEASANT as they can be. Pain control, happy reflection, “Remember when…” Find out what they REALLY want?

One of my hospice patients, I have a routine with now. Every morning I go to give her her meds, and while she does a breathing treatment, I put lotion on her legs, her feet, her hands, etc so that she gets the One on One time with someone, the feeling of hands on her that as they gently massage the lotion, CARE that she feels ok.

The other day, when I did this, she started to talk about the food. The french toast is always cold, the oatmeal is always cold. The cold cereal is always warm.

I asked her, “What would you LIKE for breakfast? One thing, if you could get one thing, you know, a choice, what would you want for breakfast?” She replied, “A bagel” “What kind do you like, plain, onion, cinamon?” “Oh just Plain” “Cream cheese?” I asked. “Oh yes!” she said.

I told her, “On my way home, I will get you some bagels, and some cream cheese. Tomorrow, you will have one for breakfast” “Oh no, I don’t want you to pay for anything yourself.” she said. “Don’t you worry” I told her.

I did get them. Brought them in. It was all of Maybe three bucks when I was done.

The look on her face the next morning when I told her they were there, that they would bring her one for breakfast, who knew that three bucks could not have been better spent?

It is NOT all about Morphine, or pain, or “unpleasant” it’s about taking the time and ASKING “What do YOU want…”.

Preheat oven to 350 degrees…

Rethinking the whole Nursing thing. Nurses DO eat their young. They eat everything and everyone in sight too. And whats funny is, when they eat ME I am old and stringy. Got way too much fat too.

One can only hope that when they DO eat me, they succumb eventually to heart disease. Yeah that is bitchy and mean but I have a philosophy on that too, FUCK em!

Here is an example of Nursing cannibalism.  I am at work the other night. Shortly after the beginning of the shift, one of the aides on the neediest of the two floors I am charged with providing care to, asked me to come look at a resident.  She wanted to show me how a resident, a former Rockette, with advanced Alzheimers, was being put to bed. Specifically in the “incontinence product” department.  The aide stated that the resident has frequently been found with her brief that has a pad placed inside as well, was being applied incorrectly.  This was causing the lady to become wet, and who knows the last time the poor woman had been checked.  She was probably put into bed at 7:30 p.m. and she is the first one checked at Midnight, after I have given the aides a report on the state of the residents, as I have just gotten it.

I saw with my own eyes that had she been a man, her set up, was perfect. Since she is indeed a female, not so much. The aide, a Graduate Practical Nurse, awaiting her board exam, as is the other Full time aide that works with her, had already instructed the “evening staff” on the proper placement, but of course, she was ignored.

I wrote a note.

The note was NOT on “company” paper, but plain. I worded the note as professionally and politely as I could, while stressing the importance of the appropriate placement. In it I ask that “Perhaps the 3-11 supervisor could instruct the aides on appropriate placement to help allow the resident to be comfortable….”.

Apparently, I had some fucking nerve.  The 6:30 a.m. Nurse we will just from here on in refer to her as Crotch, ( I would so love to use another C word here, but I am a fucking lady) Crotch came in and SHE read the note. Crotch said nothing, I now assume because she was plotting some ingenious way to do me in, because that next night, boy, was I sorry I left that fucking note.

Crotch had already set me up to have even MORE difficulty not only my first week there with the med book change, but also for the remainder of the time I will remain there. I already administer an abundance of medications on my shift, on TWO floors, but she saw to it that I had a whole lot more, Three pages more in fact, and anything she just did not FEEL like doing. But she also made it well known on the med book change night that she left the “three hardest patients for ME to do.”

See, that kills me. I have TWO floors, the two neediest in the facility to care for, and the day nurses see to it that they make everything they find annoying or inconvenient left for ME. I don’t mind working, but I would just like consideration for also having the same TITLE as them. I just chose Nights, because I chose to avoid the daytime bitch drama.

I should note that in the case of Crotch, less than a week earlier, I discovered she had made an error. It is part of my job. I have to look at the record, and look for errors, count cells on medicine “blister packs” and ensure no one fucked it up. Well, I found an issue that she had made. Not a huge one, but enough to call her and tell her what I was going to do. Since it was not an issue where a person would be harmed, I corrected it. If I had reported it, she would have been in some trouble. I was sure that having done this, her sight that she has set on running me out, as sneaky as she THINK she is being, would be LOWERED at least for a while.

I got less than six days out of that. Shame on ME.

Well the note garnered more than getting a stronger site for the rifle she had aimed at me. She switched her weapon. She would make ME suffer by making the residents and the aides working with me suffer. She would also turn the staff NOT on the shift with me against me too.

And I am the nicest motherfucker there.

She showed my note to EVERYONE. Told the aides what I am sure amounted to, “Can you believe the BALLS of this bitch? She thinks your all stupid, you know the aide put her up to this… lets teach them all a lesson.”

She apparently worked on the 3-11pm Nurse too. Also turns out she lied to the newly appointed administrator, and she made it so that EVERY single resident that has issues with incontinence, which is like 99% all were put to bed with NO products to keep them dry and comfortable. Including TWO who are dying on Hospice care.

They were all pissing their beds all night long. Ironically I was not the Nurse that night. So, part of her plan, which would have worked better for her if I had been, well, was a bust. My friend, an RN was the Nurse that night, as I occasionally do have assistance.  My friend held a position there before. She had left due to the need to work nights because of family issues, so we will be working together a few times a week.  That night I was going to offer her the easier of the two floors or we could both work both, so she became familiar with the two of them. She was,  however, instructed to take the heavier floor. I suspect because the floor is such a train wreck that they wanted a GOOD RN to see it and make changes. SHE was there that night.  She saw what they did. She had plenty to tell the administrator the next morning too.

The gentleman on hospice on that floor even asked one of the aides through the ordeal, “Why are you treating me worse than a prison inmate why are you making me go through this? This is so undignified” This is a gentleman in his 90s mentally still quite sharp, physically has what most would expect for a man his age.  He also has a very bad case of Chronic Cystitis, which is bad bladder inflammation. So much so that he frequently urinates copious amounts of blood.

I feel HORRENDOUS that he had to suffer so. All night when I saw an aide come to the first floor, or when I had a cigarette break with my friend, I was repeatedly saying “I am sooo sorry this is all my fault, I should not have written that note.” Everyone said “You’re crazy this has nothing to do with a note.”

Well they said that til morning anyway.  The aide who asked I look at the resident the night I wrote the note, asked an aide that had come in the morning, and had worked the evening shift the night before, “Why the hell did you guys leave everyone like that for last night, that was neglect of every single resident you know, it was Crotch wasn’t it?”

The answer was “NOPE, it was the note Overnight left” How fucking beautiful. Question, why would a nurse, show a note, not even intended for HER to the aides? She wanted them to get pissed. I am sure it was “See she thinks your stupid.” Then she probably did similar with the 3-11 Nurse.

I just could not believe that someone could be such a CROTCH. I would have been much less disturbed with my tires slashed. A dead animal or a pile of shit on the front seat of my car, would have been better. She not only ALLOWED but plotted and abused 16 residents to teach ME “my place”.

The administrator was pretty pissed off when she came in and saw what REALLY happened. The aide had filled her in on the note I had left the day before. She did not know about it. She was said to have apologized to the aide repeatedly. How about the RESIDENTS?

Crotch had the “day after” off. I am sure she had planned for it to be that way. She is cunning. She is a fucking idiot when it comes to writing or reading anything NURSING related, but the fact that she is taking her RN now, she will probably get over it.

Crotch did have to work YESTERDAY though.  I was on too. Her floor even. She came in with this elaborate bullshit story too. All about her getting these pissed off phone calls “On her day off, and how they must have “misunderstood”. Whatever.

The day of the note, I had also inquired about an error with an order. I asked HER because according to the fucked up system there, it appeared that someone ELSE had done the error, Bringing her error to HER, just gave her the chance to cover it up. I had also written a note to the administrator because a resident on that floor was VERY unhappy about some important issues that Crotch was supposed to have taken care of, yet hadn’t and when the resident inquired all she got in return was nasty remarks. I did not even MENTION that the resident had made the Crotch aware in my note to the administrator. I did hear from the resident, :”Thank you! I don’t know what you did, or who you know, but all that stuff I asked for is DONE! And BOY was Crotch mad at me all day! When she didn’t avoid me, she just gave me dirty looks!” That was on the night of the payback incident.  I had to go to that floor to get something and the aides were getting her up. I had mentioned that “I at least got started on her problem” when she offered me the Thanks.

I don’t know if that contributed to the “payback”. But here is the thing, WHO wouldn’t reconsider, “Why the fuck did I become a Nurse?” When you consistently run into stuff like that? Florence Nightingale, is probably spinning in her grave.

Now I am thinking of wearing Cooking instructions on my scrubs.

Nurses are hungry gals…they DO eat their young, but they also devour their coworkers, and they use their patients sometimes as side dishes.

Definitely considering going back to retail. Or maybe something safe like lion tamer. Crash Test dummy, explosives,  Nuclear waste disposal….

Up in the Air… It’s a Bird…It’s a Plane…NOPE!

I gotta do this for TWO reasons, PURGING and INFORMING, there WILL be foul language, but one has to expect that, come on its ME here. So here goes….

The Overnight Nurse, you know the one, the one everyone else ASSUMES does nothing but SLEEP when she is working, well guess what, SHE AIN’T! Here is EXACTLY what she is doing: she counts narcotics, many for people who DIED six, or seven MONTHS ago. They have been handled so often the pills are opening up, and they are sure to just get lost, leaving someone to be charged with Narcotic crimes, when it just FELL out of an open blister pack from repeated handling. After getting a SHITTY report that is “OH nothing happened today” (Hospital trips, new admissions, changes in meds they don’t count) she does that AGAIN on another MUCH needier floor. Funny how NOTHING happens all day.

Then she goes and counts and looks at 30 people who you now just disturbed by entering their room, half have now got to go to the bathroom and NOW, because they have been in bed since 6 pm. But she only has 3 aides, because one called in or went home sick, AGAIN. So Nurse will do the work of THREE.

Then she gets to get a look at the Med Book. Here is where her b/p gets DANGEROUSLY high, and even with the door closed, you can hear her say “WHAT THE FUCK IS THIS?” Is this an ORDER? Can’t BE! Looks like I shoved a pen up my ass, danced over a piece of paper! Zyrtec! For DEPRESSION? Who the fuck DID this?”

That overnight nurse, well you see, even though SHE came in YESTERDAY and FREAKED out hard when she saw that the med orders on a New admit TWO DAYS before MADE NO FUCKING SENSE, she got it ACROSS LOUDLY that she was “REAL fucking happy that I got to be left with MY LICENSE and these piece of shit “orders” got 4 four lists, not ONE matches ANYTHING here so good thing no one expected me to pass meds to him because NO WAY.”

Case notes will help, right? Gotta write one a shift for three days,should tell me SOMETHING, right? WRONG. Instead of FIVE there is ONE, and it basically said “Nice man.”  Yeah I heard that.That don’t help. Since the patient is THERE with a diagnosis of dementia,she kind of questions whether he can be a reliable historian

Well, she comes in LAST night to the SAME fucking thing and altered documentation. Also made to feel like A NON brained asshole, because she wouldn’t accommodate the fact that OTHERS didn’t like the DATE. So a PRE PRINTED sheet was made with the date already on it, SOOOOO even though it was made clear, WHY is it that everyone just assumes I get to be the asshole? I am NOT there to do everyone elses INCONVENIENT shit!

Example: ” I don’t wanna give so-and so her pills there are too many lets PAWN IT OFF to the overnight. She has DOUBLE the patients and a third of the staff we have, FUCK HER.”

Oh and Lets FUCK UP ALL THE ORDERS so that EVERY SINGLE DAY she comes in and finds something, make her have to stop take an hour to try to find what is right, but we will hide it! (Funny)

Even though there was THREE (3) Nurses for 15 patients, and the one with ONE NURSE and THIRTY patients we wont do a FUCKING THING but make sure she looks like a lying scumbag, by FALSIFYING paperwork.

Who gives a SHIT that she seems to be stopping us from KILLING someone EVERY fucking time she comes in, because that just makes more work for US!

Talk to the head of shit, NO HELP.

Already tried with the Nurse that fucked it up, she just falsified documents.

Found more errors, like the order for (depending which papers you go by) double or triple the amount of NSAIDS for a patient with a history of GI bleed from…wait for it….wait…Ding ding ding…that’s right…too many NSAIDS!

Then the Cholesterol med that she is STILL being given 6 MONTHS after the doctor said STOP!
When she asks another Nurse about it, it turns out SHE was responsible. So, what is she gonna do, that’s right, fuck YOU, she is gonna cover HER ass. No one will know anything happened. Not that it seems like anyone cares anyway.

Then down to freak on Nurse one of three from yesterday, and pass meds. Ha ha.
Nurse one of three STILL so incompetent she should not be left alone. But she sure did pretty good covering up the shit from yesterday, not bad for her first “just outta school” Nursing job.

Being Older and Wiser, Overnight gives the Youngster advice. Also points out, “think what you want, let the “day people” tell you Overnights do nothing, but guess what? Its my job to CATCH what YOU fucked up all day. And I do. You Do NOT wanna be on the phone telling a loved one that you killed their ____________, or put them in the hospital because its cool, it was a mistake, and not even my own?. I been on the end where it was “OOPS we Od’d Your husband and the father of your kids. I have also been in the room where someone died from a med error. One everyone KNEW happened, the place, the state, the family. None cared. Know what a squeaky toy sounds like when they get squeezed and they are half broken? That’s what the last bit of air sounded like coming from a REALLY old guy, he died IN FRONT of me, because of fucked up orders. They’re a funny color too, and let me tell ya, the sound and the color, they stick with ya.”

So…the family, the residents, everybody on the fucking planet can pat the Day or Evening Nurse on the back all they want….”She takes such great care of Mom, lets buy her a present!”  “Such a wonderful Nurse! I don’t know HOW she does it all?”

Think whatever the hell you want, put as much lipstick on the pig you want, but the one keeping Mom, Grandma, Great Aunt Sally, who left YOU all the money, well she is being kept alive by the chick who looks like she hasn’t slept in a month. That is only because she HASN’T!  The one over there bleary eyed writing notes wondering, “Why did I think this was a good idea?”

She wears her cape UNDER her scrubs, hidden, and she WANTS to fix her ponytail, but she has to catch up, there just isn’t time because she got behind, trying to figure some sense out of what looks like NON SENSE! But in the end, SHE is doing A LOT to make the  lives in her hands BETTER. She doesn’t want the present. Just to know that she can try to sleep with a clean conscience is its own “reward”.

Sorry if I screwed anything up. I am so tired right now, I can’t keep my eyes open. I used all my energy on making sure no one gets bad meds!

She couldn’t sing… but one hell of a nurse.

We all want to be great at something.  We all want to be that one thing that comes to mind when a word or idea comes to mind, you wanna be that picture in someones head. Many in my age range may remember picture dictionaries.  When you looked up a word, there would be a picture to help get the definition across.

We all have something that when you look up that thing in the dictionary there is a picture of US.

I want MINE to be as a Nurse. I want to stand out, for being that Nurse you remember for “She really cared, she took her time to get to know …she nursed the body and the soul”

Last night was the second worst night of my Nursing life so far.  It started with the reliving of the first worst night of my life, and then just got all “Murphys Law” on me.

The 6 days I have worked this job alone, after some horrible orienting, I have not only been completely unable to perfect my skills, I can’t even get an accurate account of how to perform one of what I consider, (as should everyone else) the most important part of my job.

Almost a year to the day after the worst night, I entered the new job having felt apprehension that I was in for more of the same.  The first worst night revolved around the “Medication Administration Record” switch, as it is the first of the month.

As a rule these records. which have ALL of the prescribed patient meds and treatments, are  checked for accuracy so as it ensure they are correct.  They are usually reviewed and signed for page by page, for each patient, by THREE separate people. They usually have check marks at the bottom of each page, along with the initials of the Nurse reviewing, so when done, there are three sets of initials per page. Per Patient.

Worst night, I was left with records NOT checked by ANYONE and was told I couldn’t legally give meds, without these checks having been done. By the time I was told I was already due to give a heart med to a patient. The night that followed was a DISASTER.

Almost the same thing happened to me last night.  I had been to the Training Coordinators office that very morning, at her request, and mentioned how unprepared I felt to do this task, and why I was feeling that way.  “Don’t worry you have an RN coming in with you tonight to help you” The very same RN that provided the useless orientation, but HEY, it will fall on HER.

Well, I still felt apprehensive going to work.  Scared. Vague creepy feeling. But even my husband who has a pretty good psychic sense, so I trusted him, said, “Don’t worry, it will not be like that last time.”

She called in sick. I almost Puked when I was told she WASN’T coming! I began to feel like I was in some Twilight Zone episode. “Thats it! I am leaving HOW HOW HOW?! I TOLD them! What the FUCK? And I stayed and it WAS hell. Then because of HOW hellish, I got behind in meds for the a.m. and the RN that came on one floor to relieve me WOULD NOT HELP ME!  I got stuck there for another hour and a half! So much for TEAMWORK! I would have done better with, “Go fuck yourself!”.

The funniest part, when I got home the day before this, I got a call requesting that I come in early the next day, and I said I would but only an hour and a half.  I knew I would have an issue with sleep, so I said the earliest I could get there was 10pm.

They told the nurse I was relieving (who was at the last second FORCED to stay) that I said 9. Fuckers. NEVER. I made myself a promise I was NEVER doing that shit. They can’t schedule correctly-not my problem, if I need money, bad enough, I will do ME a favor. Not them. When I got there early after working HELL night, PISSED as hell still, I was counting Narcotics with the nurse that got stuck, when they stuck her they PROMISED her the following day off. How could they? They had NO ONE to work it. So the phone rings while we are counting, its the scheduling gal asking to get ME to stay for the next shift!

Fuck NO! Then I realized that the nurse I was with was going to be fucked out of her day. She not only HELPED me tremendously the morning after hell night, she even went to the “bigwigs” bitching, “How could you do that….” “If she never steps foot in here again…” “She was so scared and crying when I got here…” So I said I would stay, but MADE IT CLEAR it was for HER, not the facility. They heard me through the phone, I screamed it! I said I would not be able to stay the whole day. They arranged for another nurse to come relieve me at 11 a.m.  Fine.

That shift was o.k.  Odd though, one of the aides I worked with said, “It seems like you are the only nurse here that CARES about the patients.” Wow! But while I liked the compliment it saddened me. Doesn’t every nurse CARE?

The next morning into the next shift, I asked another aide to let me know before a patient got dressed, I had a dressing to change on her leg.  The gal said something about not wanting to put her support stocking on her after I was done, they are a struggle to begin with let alone over a dressing. I just repeated the “Let me know” and walked away.

When I did the dressing I saw the stockings, so I put them on. Then her pants, then  shoes.  We began to walk the hall to bring her to breakfast. Another aide comes running at us.  “What am I doing something wrong? She needs assistance to walk right? Am I doing this WRONG?”  “No, Nurses don’t DO THAT.” “What? What don’t nurses do?” “Touch the patients.” she said.  “Really? Well I do, and if I didn’t WANT to touch my patients, I would NOT have become a nurse.” “Well, the Other Nurses would NEVER do that.” “Well, I am not breaking a rule, right? And if I am, I don’t want to work here.”

We go to the dining room. The aide assigned to the patient had been with another patient and saw that the lady was at her place for breakfast.  “How did she get dressed? How did she get down here?” The aide who told me about the other nurses, she responded, before I had a chance. “The nurse did it. She dressed her, she walked her.” The other aides face was incredulous. The aide then added, “She ain’t all UPPITY like the other nurses, she actually wants to touch them. She is cool.”

I again felt good about the compliment,but sad at the same time.

A little while later, I was done with pills, exhausted, so I began conversing with some patients. When I am working they are usually asleep.  Some I have to wake up to give them pills, but that is a ten second thing, usually. So this was nice. Talked with some gents about their navy days, and they LOOOOVED it.

One of those gents had a visit from his grand daughter. I was now PISSED because my relief was already 20 minutes late. (He would be an hour and a half late) The grand daughter stopped me.  She hadn’t seen me before. I explained “Well, I work overnight, was filling in, and was only there a week anyway.” We chatted for about ten minutes. While we spoke, she said, “You know, no one here has ever spoken to me for more than 2 minutes. They NEVER spoke to my grandfather like you did ( I had told her that her grandfather told me a funny poem about the navy just before she had arrived, he told her for the first time when she asked him about it during our chat) and I see you really CARE about the patients. I hope you stay, no one here does seem to care.”  Again, I appreciated the compliment but it  made me sad too.  Caring, well you sort of expect that in a Nurse.

We all want to be great at something, something that they can put on our tombstone. I hope mine says, “But she was one hell of a Nurse.”

What is done is done…

Will try to be short and sweet, as I have a tendency to usually be rambling and rambunctious. Last shift at work (this morning) ended with me getting “critiqued” about how I had done something. Normally, I am most appreciative for an early correction. I am SOOOO desperately trying to get started with both feet in the right positions this time out. Seems as though its about as fun as banging ones head on the wall because it feels so GREAT when you stop.

The critique was an issue only because Night ONE of orientation I had seen the RN training doing the task that I had done on my past few shifts. At that time I asked her, what was done to show the task had been done. “Don’t you initial the bottom of the page and place a check mark and then the second person reviews and does the same?” I got the look of everything that I had just said being the MOST ridiculous words ever uttered.

Really? Because even before Nursing, this was known to ME and I know MANY others as the standard for A. Assigning responsibility if something got fucked up. B. Ensuring that there were checks and balances along the way.

So, not believing that I did get an accurate response to my question I asked others. Two others. Got TWO different answers, none of which matched what I thought. So….I did what I was told.

One of the answers I got was “Oh so and so and I did that already, you did DOUBLE work.” “Of course I did, there was no way of ME knowing you did” and as I said that I thought “Wow you SUCKED hard at it because I fixed MOST of the things you two fucked up.” God how I wanted to SAY that out loud. The answerer said “Here is how you know” and shows me a paper that is made up to have the person doing each part of the task to initial certain areas as each part was done. However, it was an OLD paper, from a past I was not a part of, so what FUCKING GOOD does it do me? Answerer goes on to say, “Well, this is what we are supposed to use, but we don’t have any.” Again HOW THE FUCK does that help me NOW?

Great.  Piece of paper. Missing. Could have prevented me from double work. I am glad in this instance though because I had done what was deemed “unneccessary” but since what I am talking about is reviewing the MEDICATION RECORDS for elderly people for the next month, I am glad I did RECHECK the “done” because DONE was Deadly.

Today on another floor I am responsible for the task being executed the Nurse relieving me asked me if I had done the checks. I said “Yes, but if there were some type of system of recording this, You would know that if I weren’t here.”  She goes on to tell me that there is. “What?” I ask.

It’s the EXACT thing I had asked the RN training me on Night ONE. I now have to do TRIPLE the work tonight.

Right after this conversation, where I was PISSED and disgusted, the Training Coordinator comes to me in the office. I am desperate to get the FUCK out of the place, I have NEVER once gotten a break, and wanted to leave a half hour before due to EXHAUSTION and the fact that Mother Nature saw fit to dump a shit ton of snow in a short time, I have a husband at home with what is likely developing into pneumonia and I have a 45 mile ride home that was also a factor in my desire to leave.

Training Coordinator TELLS me, not ASKS, that tomorrow, I have to STAY after my shift. Great. WHY? She never finished her job. She has to get with all us Newbies. The other Newbies are STILL working one on one with Nurses everyday, for going on their second week, getting appropriately trained. Not that I need weeks. The three days I had would have been good, if the person TRAINING would have been any good.

Ironically, the other newbies are being trained, by nurses they will likely be replacing.

This is not the case for me, as again my Trainer or Orientor was an RN. I cannot replace an RN. I am only an LPN.

But, the titles don’t always matter….or do they?

Made it through the first night alone, and so did all of my patients…

So, I guess I officially had my first “solo” at my new job. I am the overnight nurse at an assisted living facility. I had what on paper would appear to be THREE official orientation shifts at the new job, but they weren’t really anything more than the bullshit I expected.

Night one, the RN (whose is also a case manager there) who was orienting me had to be called and woken up, 15 minutes into the start of the shift.  Uh-oh. Then she came and showed me forms, and gave me a “cheat sheet”. Cheat sheet having the stuff like, “if someone dies, call 911.” Thanks. I probably would have just stepped over the body, and what if I tripped? Good thing I have that paper! The second of what was supposed to be FOUR nights, until it was realized that to have worked the schedule I was given, on a post it note, differed from the “official”, would have had me working a couple of weeks with ONE day off. The job is supposed to be 32 hrs a week. I was called Two days prior to even orienting and asked to come in and “start orientation because two nurses quit that day” NO. Not starting that way. Even with the administrators name being tossed out as the one asking. Because I knew what the hidden message there was, “Come in save our ass, you have experience, so we will throw you in a fire, and keep our fingers crossed.” Turned out I was right. Besides, if you are that desperate, who the HELL would have been orienting me? No one. If they had someone to orient me, they wouldn’t have been calling me begging to come in, WHO is so desperate to orient someone?

Night two-she was again an hour late, but since I already had 7 hours experience, the other two nurses left me alone til she got there. The whole time I prayed. “Please NO ONE have any NEED for me!, because I don’t know where anything is and no one even showed me how to use the phone system here!” By the end of night 2 she could be found SLEEPING while I did all the work guessing along the way. Hard to teach ANYTHING when you are sleeping. Harder, I think to learn anything when the teacher is sleeping. The third night began with sort of critique on how I got “behind” the morning before, but an hour after the shift began, as she was…wait for it…LATE again!

Night three, well, I kind of consider it my first night totally on my own, because she sat at her desk, doing her case manager work, and apparently gave some PRN meds and just never mentioned it to me, (why would I need to know?).  Oh and she apparently also made changes to the charts based upon my finding some GLARINGLY dangerous errors. Yet when I mentioned those EXACT errors “oh that is no big deal.” OOOOKKKKAYY, Apparently the big deal was, that here I am a LPN day 1, 2 and 3 finding shit, She, and everyone else had missed.  She changed these things, but she found it difficult to thank me or give me any kind of credit for brains. I don’t really give a shit what she thinks, but it’s nice sometimes, when you feel in a vulnerable position to have SOME reassurance. And the thing is, she was an LPN before her RN.

Many people seem to forget, that no matter how old you are, no matter what you have on your resume, EVERYONE had their first day, their first week, their first trip over their own feet.

I pride myself on attention to detail.  When I am entrusted to do a job, I will and have always done so to the best of my ability, even sometimes beyond what is afforded me by the employer.  If it makes my job better, I will supply it myself. So, I try to see the details, especially the ones that could make me call a loved one saying, “I am so sorry, I killed your Mom, because no one noticed the fucked up, idiotic error that has been on her chart for the entire time she has been here.” I will stipulate that a new set of eyes is always a great way to catch these things. The mind see’s what it expects to. What is right, and essentially what is not deadly.  You cannot always trust your eyes.

Now watch, I will be made to look like an IDIOT when the spelling or grammatical errors, I am sure to make in this post stand out like a gangrenous thumb! They are just used for dramatic purposes and all are, of course intentional. You have no idea how much my train of thought has now slowed since I wrote that “detail” thing, I will probably cut it out as I lack a spine! Hee-hee.

But the safety or the dangers are in the details. People get hurt or can die because of a detail. I don’t want to kill someone, or their kidneys even, because of a “minor detail”. Last night, as I pre poured the meds for the patients for the morning, a complete and total no-no elsewhere, yet somehow, ok in assisted living, I noticed that the one patient had a once weekly Vitamin d3, 50000 units due this morning, so I go to retrieve it from the med cart. No one there really receives less than 10 different types of medications, so there are lots to sift through. Having ALWAYS checked and rechecked as a matter of safety, and just the way I was taught, I happened to notice that directly following the vitamin d3, was another vitamin d. Also 50000 units to take once a WEEK.  The same patients name on the pills and a months supply. The date that this script was filled was one week before. However, it was NOT the med I was looking for. (I had already removed what I needed from the previous pack.)

This was Vitamin d2 and they look totally different in shape, type, and color. But I questioned now. Why were they there? They may have made a change. No such change documented anywhere I could see. I did have the Medication Administration Records for next month next to me, as they undergo a series of checks, before they are implemented the first of the month. Since another patients were SOOOO fucked up, I had not gotten to this patients as yet, so I was sure to be in for surprises.

I was.  The March records indicated BOTH Vitamin d2 and then directly following, the vitamin d3. HELLO! Pharmacy that MAKES these! Where are YOUR checks? But that doesn’t surprise me. These things are a JOKE! The record did indicate that this was an error and the order nullified. Whew!

But WHAT THE FUCK WERE THE PILLS THERE FOR? Because I have seen Nurses so complacent and oblivious, that they just see A.M. on something, the patients name, and honestly the 2 and the 3 you have to LOOK to see the difference. But I did, EXHAUSTED and with a life long history of vision issues, I did.

Yeah, I am the nurse that takes a bit longer to get all the patients pills to them, but they WONT be on dialysis when I am done giving them.  So take THAT, bitches.

However, even though every one in my charge made it through the night, I do not know as yet that I have made it through unscathed.  For this exact patient, I may have gotten myself into a wee bit o’ trouble. Here is why,  I didn’t give her laxative this morning.  So, I may be written up and handed a med error. Ironic, no?

Yep. But I did have a reason. I think a good one. When I went to check her on the beginning of my shift, I noticed a smell, like when someone has gas. She seemed to be sleeping, not diagnosing mind you but she was snoring, and her eyes were closed, and she did not budge when I came up to the side of the bed.  Since she was asleep, I assumed as I said she had gas.

Nope. She has an issue with some watery stool. A while after I left the room, the aides found this woman with the aforementioned all up the back of her. Twice.

So, using my Nursing Judgement I “held” her morning dose of Miralax. The aide had mentioned the issue with the watery stool, (can’t call it diarrhea, that is beyond a nurse to diagnose) has been happening to her all week. Yet NO WHERE is this noted. But as I said, I, in an effort to save my patient some dignity, some future skin breakdown, and the nutritional deficiencies due to the expulsion of food not yet “done” thanks to the sped up digestive process, HELD the med.

I did it according to procedure, as far as I knew. I circled my initials and explained on the back of the med record why I hadn’t given the laxative, I documented it on the shift report, and in the patients chart. I sent the doctor a FYI as is the facility procedure.

It was also the first thing I reported to the RN who came in to relieve me.  She having been a Director of Nursing in the past, for a facility where I was previously employed (but well before my hell there) I hoped would TELL me. “Wow, idiot, you have to CALL the doctor to get a HOLD, not just DO IT.” seeing as how we are all “there for the patients, and as a team”. But I have to admit, I doubt now that she would have. In my previous employ, this would have NOT been the issue it has the potential to be here.

Here the ASSISTED means that TECHNICALLY they do NOT need 24 hr SKILLED nursing.  But…Would you call your (or your elderly mothers) doc at 4:30 a.m. on a Sunday to ask, “Hey doc, I was shitting my brains out last night, and as a matter of fact shitting water several times a day for days now, should I skip my laxative this morning?”

Doubt it. But, because I did NOT call, and withstand the sure to have been LOUD and CLEAR rebuke from a doc at ANYTIME I would have phoned on a Sunday with the same question, “How Stupid are you? Did you even GO TO NURSING SCHOOL?” (Like one would have to in that case) Because I have heard those words.

Well, they were actually, “Seriously? Did your SUPERVISOR even go to Nursing school?” after I was forced to call a doc about something far more serious, and since I KNEW and had argued the exact point the doc was making with that supervisor before being forced to call, I just couldn’t stop laughing when he said them. I followed his question at that time with, “Hey, she is my supervisor, she has the RN, so I have to assume yes, would you like to speak with her?” That shit was FUNNY.

This laxative issue, the doubts it has left, have caused me to be unable to sleep.  Having issues sleeping just back into graveyard shift, well that is NOT good!

I can SEE myself in an office in the next few days, having to explain why, and being expected to apologize. I admit to maybe I should not have taken the matter in my own hands, I should have left it to someone else to decide. But that is it. I in my mind weighed the pros, the cons, and came up with, do not give. I will not apologize.

The last time I did something I knew I had to many doubts about being right, was only a couple of weeks into my Nursing career, and that did not bode well for the patient, I offered the med, she took SOME (as it was liquid, mixed in a beverage) and when she protested mildly even, I was like “OK, she refused, but she did take SOME. She ended up in the hospital the next DAY and came back and died a few days later. And another nurse went down for writing the order from the doc that CAUSED me to try to get her to take it. That caused a shit storm, and honestly I still don’t get what happened in that whole debacle.

So, who wants to be a Nurse? Even the “cushy” job…you still have to THINK.