It’s Been A Week

It’s odd, I figured this unemployment thing would be like a vacation.  Sit back, relax, catch up on things left unread, do some housework while slowly getting things for the imminent move together.  I figured I would not miss working, prepping for work or the actual time spent going to work.

Yeah.  Wrong on all counts.

Admittedly I’ve done a fair bit of relaxing.  There have been many days of sitting around in sweats like some somewhat thinner suburban version of Jabba the Hut, dropping whatever snacks were within reach into my maw, ordering minions to do things (at least in my head).  I’ve spent some quality time on Twitter, on some blogs, scoping out new places to ride when we move, but have done little of anything constructive.  The place looks pretty much exactly like it did the week I stopped working.  Packing?  Psshh.  Attacking the list of things I need to accomplish for the week?  Did (the easy) 50%.

Never thought I would say it, but the hardest thing is not going to work.  I see the #nocshift tag come up on Twitter for all those headed to slay the dragon of work and while I may be there in spirit, I’m really just an impostor now.  I wish them luck and go back to doing nothing of consequence.  But it’s the odd things that seem to mean the most to me.  Not buying food specifically for work.  Not staying up ’til all hours to readjust my internal clock to stay up for the next three nights.  Not having the in-person interaction with my friends as we strive towards a common goal.  It has made me slightly off-balance and I don’t like it.  Coming from a long line of Scandinavian hard working folk, the need to work is etched indelibly into my DNA.  Go too long without and I become insufferable to be around, pacing like a wild animal trapped in an enclosure but unable to do anything.

Worst though it has allowed my fear of not getting work even more real.  It has allowed that nagging voice, the one that I used to continually tell to “shut the fuck up!” a little more volume.  That little voice has been very, very talkative of late.  Doubt, the killer of initiative, has been working overtime.

All this after only a week.  I’m going to be a psychic wreck by the time I get to Arizona.  And I will have probably driven my wife insane.

At least though, things are slowly coming together.  It appears we have a place to call home lined up.  There seems to be some jobs in the area that I could pursue.  I just have to realize that things will take some time.  This isn’t going to happen overnight, no matter how hard I want it to.  The last time I was unemployed was so painful, more for factors beyond not having a job/income, that issues I thought I had dealt with long ago are bleeding into the current discussion which makes this more stressful.  I have to remember that this is not like last time.  I have experience.  I have money coming in.  I’m not running from death, disappointment and despair.  Instead I’m running to something new, exciting and different.  And you’e all along for the ride!

The First Day

Yesterday was the first day of a new adventure.

I no longer have a job and I’m OK with that.

I volunteered to be part of a “reduction in force”, business speak for “laid off”. Why? Many reasons, but mostly it was beyond time to leave. Also because I things have become clearer to me with regards to what is important in life. It’s like the axiom goes, no one lays on their death bed saying, “Boy, I wish I worked more.” Work was overwhelming my life, permeating every nook and cranny and luckily I had the clarity to realize that wasn’t what I wanted out of my life and this was the first step in doing something about that.

I woke up yesterday though with an odd feeling of freedom. Nowhere to be I just sat around in my sweats and relaxed. Then the reality set in. I had a momentary burst of panic of when I was going back to work, then realized it was never.

I then had another more sustained burst of overwhelming panic realizing that I no longer had a job.

Then came the calm realization that it was going to be OK.

Things would be OK.

…more to come…

Meetings: Not a Prioirty

To: Unit Manager

From: Wanderer, overworked charge nurse

Subject: Monday’s Meeting

I guess one of the included functions in the Managerion™ 2000 automated management toolset randomly creates meetings and requires our attendance.  This would explain relative randomness and recurring frequency of such meetings and their lack of cogent concept or agenda.  Having meetings just to have meetings about meetings is pointless and a waste of all of our time.

In the last 4 meetings we have decided absolutely nothing, but keep referring to later meetings to “work out the details”.  Would it be so hard to make a decision?  Yes, you have multiple units that these decisions will affect, but sometimes you need to throw caution to the wind and make a decision – call it an executive mandate.  There is something to that y’know?

This said, I won’t be coming to any more meetings.  I’m not going to spend an hour each way commuting in to work for a meeting that lasts 45-60minutes and decides nothing.  It is not as easy as some might think.  Whether I drive or not it is at least 45 minutes in rush hour traffic and if I use transit it is even longer.  Now if we were going to decide something or the  meeting was going to last 2 hours, things might be different.  Also if I didn’t have to come back to work the night shift at 1900 it might be different as well.  But the last 4 meetings have done nothing of the sort.

I realize that it is part of your annual review to see how many meetings you presided over, ran or otherwise were engaged in, and I know management is in agreement that meeting indices are not quite what they should be for this fiscal quarter, but please, enough already.

So unless the next meeting will actually accomplish something, or is held in a local pub during happy hour, I won’t even be phoning it in.  I am a nurse, I take care of patients.  I am not a paper-pusher, drone, meeting junkie or have any aspirations to management  so just let me do what I’m good at – no more meetings.

Thanks!

Wanderer, overworked charge nurse

First of a Thousand Words

I’m learning that there is only so much that you can write about on a daily/weekly/bi-weekly basis without getting into things like religion, money and politics – all subjects I learned long ago to steer clear from while at work and the dinner table.  Thees are things that I wish I could write intelligently about and eloquently enough to make a valid argument, but I have neither the time or the inclination to deal with the kooks that would stream from under the rocks if I did.  So instead, every time I get the urge to blather on about the inequities of tax policy, over-reach of global multinational, invasion of privacy, the corruption of our government and political process among other things, I will just post a picture.  It works for me.

Nursing Shortage? Not in Some Eyes.

I know this rant has been making the rounds on Twitter.  It is full of rage, a touch of woe is me and the grim reality of the situation we place so many new grads in.  A quote (shield your eyes if easily offended…)

Image via Wikipedia: They got jobs.

Well, after a year of getting rejected I have finally decided to give nursing the bird. FUCK YOU NURSING FIELD! Too bad the schools and media are still insisting that people go to RN school. Believe me THERE IS NO FUCKING SHORTAGE! New grads are considered garbage. On top of that, the degree serves no purpose in any other setting. BSN is a complete waste of time and money.   …And it is not just the economy. Hospitals turning huge profits stopped new grad programs and hire foreigners.

Wow.  The rest continues on in a rant that she (assuming a she) will never get a job, never put her degree to use and that she wasted 6 years of her life.

First gut reaction:  she’s right.  It sucks to be told there is a ready market of jobs just waiting for new grads.  Read too many job requirements of  “at least 2 years experience” and raged at the screen saying, “How am I supposed to get experience if I can’t get a job?  WTF?!”  I know many, many grads who have cycled through our unit for practicum who have yet to find jobs.  We have nurses on our unit who jumped at the first offer (methadone clinic anyone?) but persevered and got the jobs they wanted.  In fact that was me.  I got lucky.  I can empathize.  The betrayal of it all is painful, kind of like when you realized Santa was not real, or your girlfriend was banging your best friend.

Second reaction:  buh-bye.  Maybe we’re (as a profession) better off not having this person in our ranks.  Nursing is not easy…what happens the first time they get a difficult assignment?  Or have “one of those days”?  Run out?  Quit?  Nothing in this profession is given to you, one has to work for it.  Take for example NurseXY, who landed his dream job in a world-class CVICU.  Seriously, go read his stuff, he worked his ass off for it.  Nothing was easy.  No one ever promised (at least anymore) that a job would be waiting right when you passed NCLEX – and if they did you should make sure they aren’t selling a pile of hooey.  Just because there is a nursing shortage does nothing to guarantee you a job just because you passed the boards.  Anyone who degrades their education to this degree and doesn’t realize that sometimes sacrifice is a needed part of our job has no place being a nurse.

Final reaction:  no seriously, buh-bye.  If you want to work as a nurse enough to devote 6 years and thousand of dollars to do so, giving up isn’t an option.  She never says that she looked out of state for jobs, into different avenues than the traditional hospital based nurse or for other ways to be a nurse.  Our system interviewed over 500 grads for spots in our residency program and they came from all over the Northwest.  They tried to make it work.  There is nothing to say she did this, just a whiny, “why isn’t it given to me!” rant.  We have too many toxic personalities in nursing and truly don’t need anymore.

I know this is harsh.  Maybe this person is a amazing nurse, top notch clinical skills with empathy to boot, is driven far beyond belief and tried EVERY avenue to make things work, but based on what I’m reading, what they posted onto the internet for everyone to read, I doubt it.  And with this rant, I doubt any but the most desperate, worst, idiot recruiter would ever even consider asking for a resume.  I know it sucks, but maybe it’s for the better.

Is Protecting Yourself a Joint Commission Violation? | WhiteCoat’s Call Room

When are you guys going to learn? When a patient is choking the life out of you, you HAVE to offer them milk and cookies then tell them to go to a secluded room before you try to defend yourself. Those are the rules. If they have their hands around your windpipe and you can’t breathe, then just point emphatically to the secluded area.

via Is Protecting Yourself a Joint Commission Violation? | WhiteCoat’s Call Room.

Yes.  Yes it is.

This is the inherent problem of large regulatory bodies like the Joint Commission:  they do not operate in reality.  They exist in a perfect fantasy land where falls never happen, infections are impossible and ED (and all patients) are well behaved.  They do NOT understand the complex and dangerous reality that is modern health care.  Like managers, they should be required to spend an amount, say a week a year, of time where they are the primary surveyors.  Your primary survey (management) area is ED?  You get to spend a week in the trenches.   The people who are writing the rules NEED to be intimately familiar with the true consequences of their actions.  Handing down edicts from on high isn’t as easy when you know what it means to the actual providers.

Of course that is just a fantasy because like most bureaucrats, they got into this line of work to avoid (or couldn’t hack it) just this sort of thing.  Actual patient contact?  Ewww.

Who Cares if I’m Gay or Not?

Can We Stop the I’m-a-Male-Nurse-Who-Isn’t-Gay-Contrary-to-the-Stereotype Routine? « Those Emergency Blues.

Awesome piece!

It’s what I tell my patients:  I am a nurse.  My gender/sexual orientation/going to be a doctor, all of that bullshit means nothing.  I am a nurse.  A professional, educated and capable.  I am a nurse.  Just so happens to be that I’m a man.

And it doesn’t matter.  I am a nurse.

Another Ray of Sunshine

No for real.  Warning, positivity ahead!

In some weird New Agey/karmic/life balances way, I think the Universe knows when we need a pick-me-up.  To say I’ve been suffering at work is an exageration, but it hasn’t been a place I want to be.  I find my co-workers annoying, the workplace politics suffocating and the patients unbearable at times, and it’s been worse more lately than it has been for some time.  Maybe it is because it is time to move on, or that I’m just having a run of bad weeks.  Worst of it is that it is not the acuity of the patients, it is the overall mind numbingness of the repetitve.  I thrive on challenges, new situations and a chance impact my patients, but lately there hasn’t been that.  Suffering from a case of  “give a shit syndrome.”  Which is quite toxic.

The last shift I worked did that.  I wasn’t in charge, had a semi-challenging group of patients, but what’s more important, I actually felt like I made a difference.  It wasn’t just one intervention, but that I was able to be present, be available and be involved and immersed with my patients.  It was the connection that reminded me why I love nursing.  There were the times I wanted to slam my head against a wall, actually wanted to bitch slap my co-workers for their stupidity (really, who tells an elderly post-op patient that their heart stopped when it didn’t?  It just scares them to ask for any pain meds even though they are in agony.).  But those annoyances were far outweighed by the positives.

It’s refreshing to hear a family member stick up for the nurse to the doctor, for the patient to effusively thank you for “being here when I call” and to know that my comatose patient is fluffed and buffed so that the oncoming shift won’t have to worry about it for awhile.  When I got home, there was the feeling of being tired, but knowing it was from doing a job well, rather than the tired of boredom.  It was a nice change.

Orient the Charge Nurse?

Three steps to ensure new charge nurses are successful « Nursing Notes.

No seriously, I’m not kidding, actually orient the charge nurse.  It’s not throw them to the wolves and let ‘er rip?  Odd way of thinking, right?  It’s not however and it’s something that is rarely done.

It’s funny, for an organization that tries to be pro-active with their staff, give them opportunities for education and growth and support their leaders, mine does a piss poor job.

Orientation was three days, the last of which I was on my own while my “preceptor” watched tele due to a sick call.  Mostly it was, “Here are the things you need to do. ”  There was no talk about responsibility, choices, what the other nurses were going to ask of me.  Nothing to truly prepare me for being a charge nurse.

And a preceptor past orientation?  That is about as funny as leadership development.  We talk a big talk.  Have had several conferences that were really not much more than expensive opportunities to talk a big talk but not have any sort of follow up.  Of ideas that were discussed in the last two events, not a single one has re-surfaced.  Not one.  Many were dismissed outright before we even left the conference.

In spite of the lack of support (mostly), I’ve learned.  Learned to juggle being a mentor/resource to newer nurses (and even some more experienced nurses), being a hard-ass when needed, leading from the front rather than sitting at a desk, taking my own patient load and still managing to do the things my manager expects us charge nurses to do like the minutiae of paperwork, flexing staff when not needed and balancing the load as able.

It might have been easier had I been supported and given a structured training, but with typical fatalism, I say, “It is what it is.”  I still get the feeling at times from my manager that I’m missing something, that there is something else I should be doing, but I can’t figure out what it is.  But I get validation in the best way:  from patients and my fellow nurses.  When a nurse is glad that you’re in charge versus another, it feels good and tells me that I’m doing something right after all.

More Thoughts on Patient Satisfaction

How can we keep our patients “happy and satisfied” when we’re trying to carry out the business of being a hospital?

Image via Wikipedia

You can’t.  You can do programs, have meetings and task forces, play up the fact that these are our customers not our patients and roll out a plethora of initiatives to help increase the scores.  It will work for awhile, then the staff tires of being treated like crap daily while being asked to “be nice and please the customer” and things revert back tot he way it was.  Or the more common scenario, nursing busts ass to makes things better, increasing call light response time, hourly rounding and trying really hard to make the experience of being in the hospital as satisfying for the patient as we can, and the someone (docs, I’m looking at you…) comes in and fucks it all up.

I try.  I drink the corporate Kool-Aid and and do my part.  I try to explain to my patients that yes, I will be waking you up every 4 hours to check your vital signs.  Yes, you have to wear this heart monitor all night long.  No, you won’t be able to eat or drink, not even a little after midnight before your procedure.  I level with the ones who are in pain that I will never be able to make them completely pain free.  I will try to make them as comfortable as possible, but I like to still have them breathing.  I teach my other nurses the same, to reset the patient expectations from the get-go to reduce issues later on.  Some days it works, others, not so much.

In the end though, there is no pleasing everyone.  There will always be at least one or two bad apples that no matter what you do, will be upset and “un-satisfied.”  And too often, it is those who think they are entitled to everything that create the most havoc.  And how do we respond as an organization?  We tell them they are right, we are wrong and are taking steps to rectify the situation.

Sorry, you’re a patient, not a customer.  Anyone who tells you different is either trying to sell you something, wants something from you or works in an office far and away from the actual daily work of nursing.

Perhaps this video sums it up the best.