Tuesday, May 27, 2008

Gracious snakes.

I post, I go to bed. I wake up earlier than God, and bang! Six comments in six hours.

Strike a nerve, much?

Some study I Googled last night said that 430,000 nurses report that they're victims of violence or intimidation on the job every year, and that that number is likely low due to under-reporting. Seems that a lot of nurses think that getting clocked or yelled at is just part of the business of being a nurse, and that some managers think it's whiny if you report being a victim of violence.


You know, what pisses me off most about last night, is this: (well, two things, actually)

First, that the first-line person, my manager, did not automatically go to bat for me. Instead of laying out ground rules, he attempted to perform some weird magical act of conflict resolution that would somehow make it all okay. 

That has two results. The first is that the person who swang/swung/swinged at me has no incentive to change that behavior. "Act badly, get coddled" is the message.

The second result is that I know, now, that if I attempt to set firm boundaries with a person, like "Do not try to hit me. That behavior is unacceptable" I have absolutely nothing with which to back that up. I am really and truly on my own as a caregiver. If the person then complains, or tries to rough somebody up, we're back to Conflict Resolution and Good Customer Service.

And this makes me sit back and scratch my head and slurp my coffee thoughtfully.

The majority of comments left after yesterday's post talked about lawsuits and criminal charges, which tells me this: That I am not alone in working for a facility that has no plan in place for dealing with patient-on-caregiver or family-on-caregiver violence. I'll bet doghair to donuts that all of you guys have codes for civil disturbances or codes for when some nut comes onto the floor waving a gun, but that there's no code to call when a patient tries to cold-cock you.

So. Sunnydale has no plan. Sunnydale's Corporate Manglement has no plan. It's nursing, Three-Stooges style, except the pratfalls are real. So what will I do the next time this happens?

That's a hell of a question. If I'm feeling tough, I might well file charges and insist upon a root-cause analysis of the problem. (RCA's are when all the mucketies get together and go, seriously and with intent, over the entire history of something that has gone Very Wrong.) I might make noises about lawsuits and editorials for nursing magazines. I might even be serious.

Because, as I said before, the only way to get the folks on the carpet to listen is to threaten either their bottom line or their good public image. 

Now: one thing to get straight this second is that I would not, unless Manglement or the hospital were way, way in the wrong, sue anybody for money. I'm not really interested in that sort of drawn-out, pain-in-the-ass process, and it wouldn't end up solving a damned thing, as the facility (if somebody *were* to get hurt) would settle in return for a non-disclosure agreement.

What I *would* do is insist on new standards of behavior for patients, family members, and visitors. What I want is a policy in place that says, If you do X, then Y will happen. What would make me happy about working where I work is a recognition on the part of all the managers that The Customer Is Not Always Right, and that there are some things that are beyond the pale. 

Right now, all of us, whether we're in the ER or on the floor, are subject to threats that would never fly in any other business. If you holler abuse in a bar or try to start a fight, you get thrown out. If you throw a temper tantrum in a restaurant, you'll get thrown out. If you try to injure somebody in public, you're gonna have to talk to the police. But swing at or holler at a nurse? It's all part of the game.

Why are we less safe at work than we are in a bar? Why are the standards of behavior so much lower for the consumers of our product? Because, quite frankly, if the patient is going to be treated as a consumer of healthcare, they need to be subject to the same standards of behavior that consumers of alcohol, groceries, or cut flowers take for granted.

The answer to the problem of violence against nurses is simple: People who are violent or threatening need to be refused care. The way to get that policy implemented is much, much more difficult.

I think I'm going to lean back, furrow my brow, and slurp some more coffee while I think about it.

Monday, May 26, 2008

This "Customer Service" bullshit has got to stop.

Normally, I never post immediately on coming home from work. I'm too frazzled, too scattered, and unable to complete a spoken sentence, let alone a written one.

Today, though, it's different. Today, for the fourth or fifth time in as many years, I had a patient take a swing at me. What's different about today is that this particular patient was alert, oriented, knew where he was and what he was doing, and was trying to hurt me.

This patient was the typical Sunnydale Hospital* frequent-flier: pages and pages of old charts, all of them with extra pages attached from nurses who'd had run ins with him. The documentation was complete and careful and clear: this particular person was a nutjob. No way 'round it; he had enough baggage for the Rolling Stones on tour.

His course was also typical: noncompliance with the simplest of instructions, obscenities screamed at nurses, pharmacists, and doctors, and the final lovely touch of hiding narcotics in his room. That was just recent visits. It didn't take him long to get a file this (holds fingers apart at arms' length) thick.

So he took a swing at me. And screamed obscenities. And I reported it, as I was supposed to, to my boss, one of the Manglement Trifecta on the floor. (Winky, Blinky, and Nod, as I call them, do the work of one person, and do it.... Anyway.) Winky went on into the room, and there....

...Practiced Good Customer Service and Conflict Resolution.

The upshot? I got told the patient didn't like me--big shock, as he didn't like anybody--and was told not to do whatever it was I did to get him upset again.

Managers, read this, if you read nothing else:

Customer Service Does Not Mean Putting Your Nurses In Harm's Way.

This was a patient who'd already threatened to kill two surgeons. He had come up on out of the bed with a pharmacist and had caused three of the toughest nurses I know to refuse to take him on as a patient. Now, I am not the shrinkingest violet on the block, but one thing here ought to be perfectly clear: The only way to deal with a problem like this is to get rid of the source.

Patients like this ought not to be readmitted to the hospital. They ought not to be "counselled" about their behavior. There ought to be no quarter given: if you swing at a nurse, or scream obscenities, you should be told briefly and bluntly that that behavior is unacceptable, and if necessary, you should have a security guard posted outside your room.

The fact that this guy wasn't ditched from the hospital admit list tells me that Sunnydale doesn't give a good goddamn about their nurses' safety. The fact that my charge nurse, Winky, didn't lay down the law tells me that he cares more about our floor's customer satisfaction scores than about *my* safety.

And that tells me this: Managers, listen up: the only way you guys will ever pay attention is if we, the people on the front lines, start making a stink. 

Next time some direct descendent of Einstein swings at me, I am not going to get out of the way. I'm going to let them hit me.

And then I'm going to file battery charges.

And then I'll talk to your board of directors, Sunnydale, about the whole situation, and how much compensation I ought to get for mental anguish. Because the only way to get large groups of carpeted-area manglement types to pay attention is to talk about negative publicity and dollar amounts.

I'm not fucking kidding. There is no reason in the world that I ought to have to put up with somebody who's actively violent still being in the hospital after he's behaved like a beast. There's no reason that the charge nurse or house supervisor or whatever shouldn't march into the room and tell the person who's a nutjob that nutjobbiness is unacceptable and *will* stop, NOW, or the patient can go home. 

There is, in short, no reason for me to feel less safe working at Sunnydale than I did working at an abortion clinic. And I do. 

*w00t Buffy.

Wednesday, May 21, 2008

Butt Tufts and Other Hazards of Southern Life

Or, what I do on my day off.

Max is shedding. Among those of us with double-coated dogs, there's a less-polite, more-descriptive term: "Blowing the coat". Max is blowing his coat.

Yesterday it was close to 100* here. In one day, Maximus Doggitude went from looking like a gentleman, albeit a shaggy one, to looking like he'd earned the nickname "Banjo" by living under a bridge for six months. My neighbors, who live with a good-natured pug and a corgi who never ventures outside except under duress, were amazed to see me pulling handfuls of hair out of Max's coat, especially on his hindquarters. Anatolian shepherds, being a mountain breed, tend toward large poofs of fur to keep their hrbls warm in the winter. Max's hrbl frbls were out of control.

Doggie dreadlocks, only six days after his last intensive grooming session. Every sparrow and mockingbird on the block is wearing comical mustaches of Max Fur, soon to be lining their nests.

Speaking of sparrow nests, I had a heartbreaking moment the other day when I noticed that a piece of decorative trim had come off the side of the house, just around the soffit. It had exposed a long empty space, and in that empty space were shreds of grass and other material. That spells "sparrow nest", which in turn spells "rodents looking for prey" and "rotting wood", so I climbed up on the world's shakiest hand-me-down ladder to have a look. I got out the entire nest (why does a small bird need a nest as long as my arm?) and dropped it to the ground before noticing it contained unhatched eggs. Two were broken. Three were intact. The parent sparrows were flipping out.

I put the nest, as close to whole as I could manage it, in the crook of a tree nearby. Given that the only bird with a sense of smell is the vulture, I figured the parents would adopt the nest again with no problem. They did...until the next big thunderstorm. *sigh* I feel like a baby bird murderer.

In gardening news, things are mixed. The dill and lavender are doing well (though Max chewed up half the lavender plant today; why I do not know) and the tomatoes are fruiting. The Romas are behind time, having gotten munched by some unknown bug, but the cherry tomatoes and heirlooms are already setting tiny green fruit. The cilantro got as high as my shoulder before seeding out. I pulled it yesterday morning and tossed it on top of the compost pile, intending to dig it in later on, once I'd bought a pitchfork. Before I was able to do that, I saw Max, head and shoulders into the compost pile, delicately yanking strands of seeded cilantro out and eating them. 

I had wondered why, for weeks on end, the cilantro seemed to be self-pruning. I know now that the Weirdest Dog In The World had been chewing bits of it, perhaps to freshen his breath for the pug next door. Fortunately he doesn't seem to have the same taste for basil as he does for cilantro and lavender. The dill and basil are safe, which is good for him. If he were endangering my future pesto binges, we'd have to have a talk.

I'm already planning the garden for next year. I want to build four raised beds, two square and two long, with cedar poles and plenty of fencing to keep the dog and the neighborhood tomcat, who sleeps in my lettuce, out. One bed will be for perennial plantings, asparagus and strawberries. The other will be for things like carrots and tomatoes and radishes and bush beans. Lettuces and cabbages (fall crop), brussels sprouts (ditto), and pole beans will go into the long beds, along with cucumbers melons perhaps kiwis peppers herbs etcetera.

In the front beds, which I have yet to till and de-grass (dammit, sigh), will go perennial herbs like rosemary and lavender and dittany and oregano.

There's a lot to do when you have a house. I'm just now learning this. I've not even mentioned the difficulty of finding a black toilet seat (better in keeping with the theme of the bathroom and its historical roots) or an affordable vented oven hood. Or what it takes to find a really good screen door, or the spasms I'm having over whether to save the original, Art-Deco doorknob and plate from the back door when I replace it with something that's not mostly glass.

Even with the sleep I lose over such things as whether the wallpaper for the kitchen ought to be 1950's vintage repro or 1940's, it still makes a nice change from primary leptomeningeal melanoma and Ted Kennedy's brain tumor.

Saturday, May 17, 2008

Today I got yelled at 4.3 times in twelve hours.

And it didn't bother me a bit.

I've grown inured to the yelling-at that some doctors, pharmacists, other nurses, house supervisors, patients, and facility management specialists (read: Janitors) do.

I used to bristle. I used to take offense. Occasionally I would vent.

Now, if the person doing the yelling is doing it face-to-face, I imagine that person covered with banana pudding. If the person doing the yelling is doing it over the phone, I giggle. Audibly.

Because, you see, *everybody* yells at nurses. We get caught between the proverbial rock and steel plate, and we are the recipients of everybody's frustrations. Toilet broken? Yell at the nurse. Did payroll fuck up your overtime again? Yell at the nurse. Can the pharmacist in Alabama not read your handwriting? Inform the nurse stuffily that that's the same DEA number you've used for the last five years. 

Then listen to the nurse (well, *this* nurse, at any rate) giggle helplessly at your stuffiness.

This is the time of year when I face both burnout and brilliant ideas simultaneously. The time I don't spend updating the blog is time I spend out weeding the garden and grooming the dog. This time of year, I'd like nothing better than to get fired for smarting off to somebody, just so I could work for triple or quadruple what I'm making now, with plenty of time off to weed and groom and just lie in the sun. I know I won't feel that way come January, though, when things are cold and rainy, so I mostly hold my tongue.

And giggle. Audibly. Audibly, but not offensively. Because, honestly? Not one damn thing I got yelled at today had anything to do with me or my nursing. One was a doc who was pissed at a pharmacist; the next was the pharmacist who was pissed at the doc. The third was a patient who had an entirely different nurse. The fourth was a manager who got annoyed that I actually followed hospital policy (and they wonder why I'm such a loose cannon) and did what I was supposed to do.

Keep your yellow "Live Strong" wristbands. You can have your pink ribbons and red dresses and grey ribbons and God knows what else. I am wearing, from here on out, a smiley face. Giggling is my new cause.

You may be next.