Wednesday, January 25, 2006

Okay, fine, whatever.

I love my boyfiend.

This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."

No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."

Because it *is* that bad.

I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.

Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.

Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.

In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.

This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.

So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.

The response from Subcommandante Merkin today was as follows:

"You have to give her the benefit of the doubt. There is no malice in her."

No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.

When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.

My manager doesn't have the same standards. ....Hello?

So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.

We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.

This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.

Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.

I can't afford to give her the benefit of the doubt. My patients can't afford it.

Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.


Jo said...

Go above Merkin's head.

This from and aide (They still call us aides at my hospital) and an RN student. If it were one of my associates, I'd rat them out.

It's your license to lose. The tech doesn't have one.

Unimum209 said...

I agree. For the benefit of all the patients on shifts when you aren't there to make sure they are safe, something needs to be done. Benefit of the doubt doesn't mean anything if her negligence causes patients harm.

Anonymous said...

Amen to the above comments, from an MD.


BotanicalGirl said...

You've already began, but document document document. Pull all those chart oddities: every patient with 16 resp/hour on the same day?? and make copies.

She is going to kill someone and you will wind up feeling guilty.

This all reminds me of this quote from Anna Sewell's Black Beauty, which has stuck with me since I was a kid:

"Only ignorance! only ignorance! how can you talk about only ignorance? Don't you know that it is the worst thing in the world, next to wickedness? -- and which does the most mischief heaven only knows. If people can say, `Oh! I did not know, I did not mean any harm,' they think it is all right."

Nephronurse said...

Where are you? In some places CNA's and techs have to be registered with a state agency. Is there someone at that level you can complain to?

Jim said...

I agree, go above Merkins head. This woman is dangerous. Good luck!