Saturday, April 28, 2012

Big Drama at Sunnydale.

Phiddipus audax, the Daring Jumping Spider (how much do you love that name?) is making its summer home in my house. We do this every year: I see a cute black spider with white spots and bluish-green what-d'ye-call-em (those things that the fangs come off of. Not pedipalps, the one that starts with "c") and catch it and put it outside. This year I missed the Mother of All Audax, and she spun a nest at the corner of the wall and ceiling in the kitchen.

After some research, I decided that the thought of several hundred, maybe as many as a thousand, spiderlings was more than I could stomach, and sucked her into the Miele. I feel awful about it, but we need the rain. (Bonus points for the first Minion who understands that last sentence without using Google.)

Sunnydale's NCCU is in the grip of Big Drama these days. A particularly difficult doctor and a couple of grouchy colleagues of mine have made it their mission in life to submit incident reports for everything, and I mean *everything.* Unfortunately, the doctor writes up nurses for things that she, the doc, should've done (like writing orders) rather than get in trouble with *her* boss, and the grouchy colleagues are sending off irate and insulted emails about things like the lack of housekeeping standards 'round those parts.

I got written up for three things, two of which my boss and I agreed weren't really relevant. The third was not only totally justified, but pulled me up short. I've gotten careless about making sure orders get written, so it looks like I've been haring off on my own, making treatment decisions. This is obviously bad. Nurse Jo is going to spend more time checking orders prior to punching out, and probably doing a lot more last-minute running around to fix things as a consequence.

So yeah, I fucked up. I got called on it. Though I'm not crazy about the *way* I got called on it, it's a good reminder that you have to behave like a brand-new nurse all the time in order to make sure you're not getting careless.

The whole shebang also pulled me up short because it made me realize how scatterbrained I've become in the last few weeks. It made me analyze, thoroughly, *why* I might've gotten scatterbrained and careless, and I came up with what I think's a pretty good reason: I'm overburdened.

When I'm primary nurse in the NCCU (we usually have three nurses, with one taking three patients, another taking two or three, and a third helping out in the absence of a patient care aide), I have a patient load of three. These are acutely ill people who are generally leaping out of bed or desatting or doing some combination of the two, sometimes with a third fun thing thrown in.

I'm also charge nurse, dealing with staffing and bed assignments and crises. I'm also acting as secretary, breaking down charts and answering the phones and entering orders. The facilities management and biomedical repair staff deal only with me: they ignore the other day-shift nurses and hold on to their questions or problems until I'm on staff. I'm also the only person who's allowed to do certain tests (with hyperagitated goo and saline), so I do all of the ones in the entire hospital, as well as the clinic next door. Plus, I do around a hundred chart audits a month to make sure we're in compliance with whatever brilliant idea the Joint Commission's come up with this week.

Some of this stuff has *got* to be delegated. The most obvious solution is to delegate the chart audits, probably to the night staff (which will, I'm sure, make me their most favorite person ever). The other stuff, I'm not so sure about. We've got to get more people trained in the more obscure test protocols; the obvious solution is to train the charge nurses for the other CCUs. I'm not sure how well that'd go over, though, as they're just as overwhelmed as I am.

My first step is to chart exactly how much time I spend doing things other than direct patient care. Given that I round three times a day with residents, midlevels, and attendings, then implement whatever they want implemented, I think that charting'll show I'm really busy. Add in all the other stuff, and. . .well, it'll make a good argument for me getting some relief.

And hopefully, if I get some of this crap off of my to-do list, I'll be able to concentrate on what I'm there for: you know, taking care of sick people and not screwing up.


clairesmum said...

Oh my - I'm tired just READING what you are responsible for! Sunnydale is sure getting a bargain, as it sounds like you do enough to keep 2 RNs running for a whole shift! Coworkers who are not team players...that's like having a big anchor attached ton one ankle for the shift. Is there a way to rejuggle stuff so you can be charge RN and have 1 patient and do some of the other stuff?
I know the superstition that if you squish a spider it will rain, but I don't know the origin of it.
and kudos to you for realizing that getting written up is not a personal flaw or attack, but a huge red flag that the systems are starting to break down.
take care of YOU, Jo!

messymimi said...

Agreeing with Clairsmum; i know they don't want to have to pay another nurse to save money, but do they prefer to pay out big for higher malpractice insurance premiums because they are losing so many cases? And worse suffer the resultant decline in hospital reputation? said...

When I can, I put spiders outside too. Anything that eats mosquitos is my friend.

Good luck with administration. If only they would trade places with you!

Rosanna said...

"O.v.e.r.w.o.r.k.e.d." and "O.v.e.r.l.o.a.d.e.d." ~ *ARE* ~ the words here, for sure, Jo!!

By the way----(and I don't know if this makes sense and/or would be feasible)----but, just to save time, would it work to *discreetly* quick-RECORD the many things, (i.e., that you do in a shift's time), into a Personal Pocket Recorder, to write down later? I guess I think of myself trying to chart----(even intermittently)----*everything* that I was doing, WHILE I'm actually super-rushed/swamped; and, if you wait until after your shift, it might be harder to *remember* every-single-thing, (unless you had something to actually jog your memory)!! Anyway, 'just a thought for you, you know.

Editor and Publisher Shelly Burke said...

I just love reading your posts! I'm an RN turned at-home mom, writer, newspaper publisher...but miss nursing at times so live vicariously through your life. The nursing part anyway!

Had to google the phrase "I feel awful about it, but we need the rain" and all that came up was your hope you'll share because it sounds vaguely familiar and is going to bug me until you provide the answer. :-)

RehabRN said...

Aww, jo, I thought I was the only one who knew about spiders and rain and cleaning windows (also brings rain)!

Don't even get me started on opening umbrellas in the house....bad!

Gotta love those old wives' tales (or crazy Irish grandmas).

Ree said...

I thought only killing Daddy-Long-Legs caused rain? Maybe the rules are different up yonder.

Anonymous said...

I would be really unsatisfied with your patient:nurse ratios. This is why I left the great state of TX. I couldn't handle more than 2 ICU patients at a time. It is too much and I was sure I was going to screw up and kill a patient while valiently trying my best to give reasonable care. I wish you the best in working all this out.

florid nightingale said...

Agree w anon above; no more than two in ICU!
Also wondering why getting orders written is your job; phone orders? Our EHR did away with verbal orders, but I'm at a teaching hospital. Good luck!

- Teresa