Monday

I need to get to bed soon, but I wanted to get some of this down on “paper” before it leached out of my brain entirely… lol

Been a long three days at work. The hours were short, but I was busy. I went in today for 6 hours or so and sat behind the computer and did lab audits on five of the nine apartments. Tomorrow, I will finish the other four.

Until I go in tomorrow afternoon, I have brought blank orders home in order to fix all of the lab orders that I just fixed five months ago that our pharmacy has totally
messed up when they print out our monthly order sheets. We make corrections every month, but I try and sit down three times a year and go through every single order and make sure that the lab draws are coordinated so we’re not sticking people needlessly and repeatedly. And, I audit and fix every single pharmacy printout screw up that the nurses don’t manage to catch and fix on a monthly basis. Honestly, Brian and I do most of the catching and fixing.

Him more so than me these last couple of months as I have had a serious attitude about nurses who do not want to do their jobs and seem to expect that someone else will come in behind them and clean up the mess.

When I went to part-time in the late spring, my patient paperwork load was cut to 4 people. Full-time nurses do paperwork for 8 people. This was in addition to all of my lab orders and audits and corrections and physician contacts and updates, etc. And, I pretty much kept that same paperwork load when I went part-time.

The full-time nurse who had the other four patients in the apartment for paperwork was assigned my four as well when I went contingent (and still had all of my lab duties to keep up with). She said that it was just too much work for her and cut her hours to part-time.

This is a night shift nurse. Trust me, I worked the night shift for years. I know exactly what there is to do on the night shift. For the first 18 months that I worked nights, I was the only nurse on grounds on Friday and Saturday nights. I still did paperwork for an entire apartment.

That would also be one of the nurses about whom I have had an attitude these last couple of months. We have nurses who have been there for over two years and act like they do not know how to phone the pharmacy for medication that has run out. Give me a fucking break!!

And people wonder why I was not interested in taking the night supervisor position.
I haven’t seen my friend Lisa, our program director, for close to a month now. She saw me typing away in the supervisor’s office and popped in. She told me she had received a letter inquiring about me. (From the VA. Brian had gotten his, too.) I ran down the details of the position to her. She said she would fill it out and put it in the mail for me tomorrow. Brian did his over the weekend. I had asked Brian if he had received a call from the VA for a reference, and he had told me about the letter. I told him, “You’re my friend. Lie dammit!” LOL

Lisa inquired as to how things were going with the guy. I filled her in. She said she said hi to the guy the other day on grounds and he looked down and wouldn’t meet her gaze. (I made sure that he knew that Lisa and I are friends when he and I first started seeing each other. She is the supervisor of his department.) She said she really wanted to pull him aside and tell him that she thinks it’s great for the two of us and not to worry about it. It obviously causes him some problems. As she said, it’s hard enough to find someone that you really “click” with, and to have it happen at our job and to have to try and keep it out of the grapevine has had to be tough.
I told her that she and the other three people who know are still the only ones. But, I was getting tired of having Helen hanging all over him all the time. If Helen knew, she wouldn’t be hanging around him like she does. So, it really isn’t fair to her. She’s trying to get somewhere with a young, attractive, intelligent, nice guy. He can’t tell her that he’s got a girlfriend because if it gets out that he has a girlfriend, it won’t take long for it to be figured out. A few people have had suspicions and have gone to my friend, Joni, with them. Joni’s response, “I guess you’ll have to follow them home some night.” Oh, I love it!!

I loved Lisa’s response to me about Helen. “She’s the African version of a blonde.” OMG! That was just so right on! Helen is very nice and very sweet. And, she would be soooooooooo blonde!

My daughter and I joke that if her dog, Mocha, were human, she would be blonde and would be a democrat but not know why. LOL

Speaking of democrats… Brian was working in the office Saturday when I went in to do some paperwork before I started work. We went out to smoke. He commented about it being so hot outside. It’s the first week of October and temperatures have been right around 90 for the last 2 weeks. Records have been broken due to the heat. I told him, “Yeah, but there’s nothing to this global climate change myth. That’s just stuff propagated by those liberal fags.” He laughed and shook his head. “That’s according to the religious reich, anyway.” He told me I was bad.

Please note, my friends Al and Genny and I have determined that bad is good. (Refer to previous blog entry. If you can find the damn thing.)

Things are going well for Lisa and her new guy. I’m so glad that I told her to go for this one rather than the one she had been dating for the last year when she asked my opinion. Any guy, who meets you when you’re out mowing the lawn, sweaty, no makeup, looking ratty, covered in grass clippings, and thinks you still look hot… Hey, he’s seen you at your worst at that point, so it can only get better from there. She and I had a good laugh over the y-chromosome defect because her fellow let that “I love you” slip when he was ending the phone conversation the other night. He tried to explain when he saw her. He felt that way about her but just wasn’t ready to say it yet… but, he had already said it… omg! Men! LOL

I’m glad Lisa’s happy. I concur with her dad who said (when she told him about meeting Scott), he would have been disappointed had she ended up with Ned. As soon as she told me that Ned had taken umbrage at her shoe collection, I knew that he was not the one for her! Hey, some girls just really like their shoes. Lisa likes her shoes. I like Lisa’s shoes, too. She has some really cool ones!

Today was my first day on grounds on a weekday in a few weeks. The weekday staff was glad to see me, asked where I have been. They are disappointed that I have gone contingent. Of course, as it always is when I go in and try to do paperwork, drama finds me. Our autistic runner sprinted from her building with the staff doing some seriously quick acrobatics in order to cut her off on her way up the sidewalk. I was impressed! I jumped up from the swing where I was talking with one of my PITA, noncompliant, irascible patients and cut off her progress up the sidewalk towards the parking lot and the street. We managed to get her to sit down on one of the benches and get her calmed down and back to the apartment after about 10 minutes.

A couple of hours more behind the computer, and I needed a smoke and was headed out back. I heard a tapping on the window from one of the apartments and turned around to go see who it was and what they needed. The staff needed help in getting a patient who had been sedated alert enough to go eat dinner. It took about 10 minutes to get him roused and me sitting at the table with him to keep him awake enough to eat. I am his favorite nurse, and he will do just about anything that I ask, including take a shower. His shower is the reason that he gets sedated. For being a little guy, he can kick the shit out of a three-person escort if they’re trying to get him to the shower. He will usually go for me with no behaviors and without sedation. My guy works in this apartment, and Jim will generally go to the shower for him, too. With Jim, it’s all about how you deal with him 100% of the time in how he will respond to you when you mention a shower.

Of course, the staff took the opportunity of having an extra person in the apartment to go take a smoke break. Tom went and then Angie. The apartment is mandatory double coverage. Two people have to be there at all times. So, if there is no extra person to come and cover, you don’t get a break. Nurses aren’t allowed to cover when we are working the floor because we could get a 911 call from another apartment at any time and have to leave immediately.

Angie had returned from smoking, and Jim had finished eating. I helped clear the remaining dishes from the table and took them over to Mark, who was loading the dishwasher. I had just grabbed my bottle of water and my cigarette when the phone rang. It was another apartment calling. Tom volunteered that I was there and could come unlock their office and retrieve the keys they had locked inside.

Off to the other apartment I went. No keys inside the office. The staff and I began searching the apartment for the keys. In several of the apartments, it is required that the staff keep the keys in their possession at all times. We have residents who will take the keys and get into the office or other locked areas and steal soda, cigarettes, snacks that belong to another resident, money, etc. This would be one of the apartments where the staff is required to have the keys in their possession. After searching for about 10 minutes, the nurse who was working the floor for this apartment came in. She had found the keys on the table where the staff had left them when going to help the occupational therapy assistant. Not seeing any staff to give them to, she had picked them up but had gotten a call from another home and had to leave before she could find a staff person to leave the keys with. Incident report avoided! Whew! Glad it was she and not one of the other nurses who would have written the incident report. I hate having to write statements! LOL

Every minute detail that goes wrong is an “incident.” More often than not, it is a serious pain to have to pick up and sign off on some of these incident reports. We have lots of scrapes and scratches and small bruises of unknown origin. Some of our people have difficulty negotiating around in their wheelchairs and bump into things. Some of our ambulatory folks bump into things. Some of our folks are very fragile. Those types of incidents can get overwhelming some days. I’ve had shifts where I have had five or six of those types of incidents. Because we deal with a vulnerable population, it is important that we record and document those minor injuries and do our best to try and determine origin. Administration is responsible for documenting and contacting all other persons and agencies with which the client had contact in the previous 24 hours. Workshop. Recreational staff. Community outings. Family. All staff assigned to work in that apartment. Doctor’s offices. When we have so much of that to deal with, in addition to the major type of incidents… falls and injuries and people being sent to the emergency room... incidents like the staff not picking up the keys when being interrupted in the middle of doing something in order to go help with a client just sort of piss you off. But, we have a few nurses who are just thrilled to be able to write up those types of incidents.

I will confess, when I first started work here several years ago, I joined up with that crowd. It took me about six months to figure out that you just can’t worry about the inconsequential incidents if you ever expect to be able to get anything done for your clients and gain the respect and trust of your staff. When my supervisor did my first yearly evaluation, it was a good one. Very fair. Her off the record comment was the best… “And you quit writing incident reports to get people in trouble.” LOL

I’m one of the nurses that people will tell things to, because they know it will go no further. The staff knows that if they come to me with concerns about a resident, I will follow up on it. I ask questions about how the residents have been doing with certain things. I will feed the residents their dinner if we are short-staffed in an apartment. I will stop in the middle of a med pass and make breakfast for a patient going out to dialysis. I will strip a bed and throw the soiled linens in to be washed. I will hang out in the homes and interact with the folks. We have a very good time, though I still have yet to make it to one of the infamous Saturday afternoon Yahtzee tournaments that take place in one apartment. Leon, who always complains about being made to get out from in front of the TV and come play, always seems to win!

By hanging out in the apartments, you get to know the staff and see how they interact with the residents and how the residents respond to them. More often than not, there is a lack of interaction. I help to remedy that. I had one of my noisy ladies folding towels one day. She didn’t do a very good job, but she wasn’t bored and yelling the whole time. In fact, we had a very nice conversation.

One of my patients from a previous job was living here when I first started work here years ago. John was in a wheelchair as he had been in a nursing home for a while due to a broken hip before coming to live with us. The guys who lived in the apartment invited me to stay for dinner one night. When John finished eating, he began to roll himself away from the table, leaving his dishes. John was autistic and did not speak. I asked him if he was going to take his dishes and put them in the dishwasher. He rolled himself back to the table, put his plate and silverware on his lap, rolled over to the dishwasher and put his dishes in and then rolled on into the living room. The staff looked at me amazed, and commented, “I didn’t know he could do that.” My response, “Have you ever asked him?”

I am often the one who jokingly reminds my patients that we are not the Hilton, and we do not provide maid service. This is your home, and you need to be responsible for getting things done. We are more than happy to assist you with the things you need assistance with, but…

Is it really such a big deal that Larry doesn’t sweep under the tables very well? Or that Calvin doesn’t wring out the mop quite enough when he does the kitchen floor and it stays wet for an extra 20 minutes or so? Or, that it takes Gerry 30 minutes to vacuum the hallways when it would only take the staff 10 minutes to do it? Or that if you have Tracey take out the garbage someone has to walk with him? Or the fact that if you have Gaylord or Allen fold the towels it will take them an hour because the towels have to be folded exactly perfectly?

I so prefer to see my folks active and productive in some way rather than being actively enabled to total dependence in every facet of their existence. I love being able to tell my folks that they have done a good job, even if it is just for remembering to use their napkin at dinner. We talk a whole lot about “role modeling” and “normalization” in our home settings - everything from remembering to use a napkin to how to answer the phone and to walk on the sidewalks and not cut through the bushes or the courtyard. That’s why I love it when my patients invite me to stay for a meal. Yes, I’m there prompting the ones who need cues to eat slower, chew well, put your fork down, take a drink right along with the staff. But, we are also interacting. We’re practicing conversation and manners. We’re sharing – how our day has gone, what sporting event is coming on TV, what flavor of ice cream is best… It’s a good time, and it should be viewed as part of the job.

Oh, I’m not even going to go there right now.

That’s one of those areas where only fools dare to tread… at 12:42am with a 6:30am wake up time pending…