Why I want a day off.

I'm frustrated. I'm worn out. I'm a little bit angry. And a little bit country and a little bit rock and roll, but that's a subject for a different post.

I'm learning that, in the absence of competent managers and anybody who gives a damn about staffing, good time management skills can be a bad thing. They'll land you with extra work when other people are drowning, and you'll have to help the drowning folks as well. Not that I mind doing that, generally, but it's a bit of a stretch to expect that one person can carry six or seven high-acuity patients while still starting IVs and putting NG tubes down other people's patients. Something has to suffer, and it's usually the care of the least-acute patients.

Or it's the nurse. As it is in this case.

See, we're having staffing problems. We're having problems with management, in that management simply doesn't give a damn. We're having problems getting supplies. We're having problems getting answers.

And what that means, for us on the ground, is this: there is no guarantee that the person who manages the floor or the poor sod who's been tapped to charge will be around when you need them. More likely one or both of them will be stuck on the phone, trying to put out fires somewhere. That leaves the most experienced nurses, the ones with the best time-management skills and the broadest clinical knowledge, to juggle things like signing off orders and implementing bizarre drips and titrations, all the while trying to take care of their own patients and clean up messes left by people in other departments who are so overworked they can't see straight.

This is why I want a day off.

The last three weeks have been hellish. We've all run our bohunkeses off, trying to keep it together, and nobody seems to notice. Nobody in charge, that is. A group of five of us got called in to the Big Mangler's Office last week to get quizzed on why we haven't earned enough Customer Service Points to get the nifty T-shirts that proclaim us TEAM players.

We all stared at each other for a few seconds, glassy-eyed, before another nurse said, "Um...well, we've been too busy doing our jobs."

And that, my friends, is the root of the problem. If your manglement cares more about the external signs of Good Customer Service than the basics (which translates to "being able to provide good care to your patients"), you'll get screwed...and then dinged for walking bow-legged.

I want a few simple things for Christmas this year:

Enough staff to do a decentish job keeping people from coding.

Support staff that knows what they're doing.

Enough supplies to do my job. We don't need hinty-quintillion thoracentesis kits on a neuro unit; we need enough urinals and suture kits.

Managers that aren't too busy with customer service issues to notice what's going on in patient care.

Ten extra minutes in a day. That's all. Just ten minutes.