Wednesday, July 08, 2015

Well. A whole lot just happened all at once.


To recap: I work in a critical-care unit that's embedded on a floor that is not critical-care. My immediate managers, the Assistant Manglers,  are not critical-care nurses. They don't have neurological or neurosurgical backgrounds. There are two of them, and both of them have shown a positive disinclination to be trained in the way we take care of critical or acute patients, despite having been told to get that done fourteen months ago. As a result, we folks in the NCCU deal mostly with our Head Big Mangler, who is a critical-care nurse.

(I should mention here that we are the only unit in the wide swath of hospitals that Ginormo Research, Inc. owns that does exactly what we do. If you're in reach of a Ginormo ED, and you have a specific problem, you will end up on my unit.

Four months ago, give or take, Keith showed up. Keith has been nothing but badly-groomed, unhygienic trouble since he showed up. He makes decisions on a weekly basis that, if he were working for Planned Parenthood, would get him fired the same day. . .but because this is a big corporate bureaucracy, have been allowed to accumulate in his file. He endangers patients and makes bone-headed mistakes that are simply inexcusable in somebody who has as many certifications as he does.

I bypassed the Assistant Manglers last week to report a particularly dangerous Keithism, and was written up. I discussed it yesterday with the Head Big Manager, and today got called into her office. Here's what happened:

I presented her with the rebuttal I wrote to the quote-unquote verbal warning I got. She read it, and then cross-referenced it with the writeup that the Assistant Mangler had submitted. I watched as her eyebrows climbed and she made little snorting noises.

Then she said, "I hope you understand that I can't, unilaterally, take this off your file. . . .but I am going to talk to Assistant Mangler about removing it."

I didn't know that using gentle terms like "misunderstanding" rather than the more accurate "I checked this out and it's a baldfaced lie," or "lower-acuity skillset" rather than "this person refused to complete mandated training" would be so effective. But they were.

Head Big Mangler agreed that I had done the right thing by going to the unit coordinator. She agreed that I had done the only thing that was logical, in light of various issues I didn't expand on here. She asked me to pass the word that any future Keithishness be brought to her attention, immediately, even if she weren't physically there.

I heard a distant hum, like large machinery.

And then she said, "So. . . how do we deal with our weakest link?"

The hum grew louder and more distinct, and all I could think of was

But unfortunately that would leave us short-staffed. I said, "Well, we're already manipulating the assignments so that we can keep an eye on Keith's patients as well as our own. . . ." and Manager cut me off. "No," she said, "you guys have enough going on with your own assignments. We need a way to keep an eye on him without burdening you further."

The hum resolved into the singing of a choir of angels, bursting through the Keith-colored clouds that have made my life a misery since March.

End result, TL;DR, was that Manager will be auditing charts and being much more present. She won't delegate this, since there aren't any sub-Manglers that can make good decisions about critical-care patients. And she promised to keep us in the loop. She told me, "I've noticed that people have been calling in rather than work with Keith, and I don't want to lose strong nurses because of one person."

So damn if I didn't get all validated and shit.

And, much more importantly, the entire unit, working as a group, got validated. We saw a problem, we followed the rules in so far as we could follow them rationally, I broke a couple because what the hell am I here for otherwise, and it's all slowly working out.

Now--whether this actually happens is a different deal. Having seen Head Big Manager's face today, though, and learned the meaning of the words "her lips narrowed into a grim line" as she was reading my write-up, I feel a bit more hopeful.


thursdaynextgal said...

Hell yes!

Penny Mitchell said...

I still want to kill Keith.

I am no longer actively planning his bloody demise.

So there's that.

bobbie said...

Oh you wonderful squeaky wheel!! All digits are crossed for you that soon he will be gone... (I'm sure there is a C/W song in there somewhere)
Please keep us posted!

Silliyak said...

Don't know why, but I was reminded of this "Remember Red, hope is a good thing, maybe the best of things, and no good thing ever dies."

Anne said...

And--Here's hoping that things continue in the right direction.

Unknown said...

Phew indeed, It had to be done and you did it. When confronted with a similar situation, which nobody really wanted to deal with, I kept thinking if we don't and something happens the Coroner will say to us "and you knew about this a yet you did nothing". Well that might be my nursing badge gone right there, so you just have to do it, hard as it is.

Dr. Alice said...

Hooray! I hope things continue to improve. And I'm glad you've got a competent Head Honcho manager.

Anonymous said...

Good for you! You just made the world a little better. Thank you.

jimbo26 said...

The other thing is : what's happened at other hospitals Keith's been at ?

JEN said...

Let me understand - you were written up for telling them about Keith?

Jo said...

Jen, I was written up for embarassing the Assistant Mangler. That's what it boils down to.

This whole situation has redefined clusterfuck for me. From the beginning, there were major gaps in communication from midmanagement to the folks who are answerable for things like safety and liability. When I reported Keith to a Higher Authority, people's hair started to catch fire. And I got written up because, by following my Big Manager's instructions, I had inadvertently shown that the AMs weren't privy to the more delicate stuff that was going on.

I should mention here that I don't think the AM acted out of malice, just without thinking things through. We have a cordial working relationship, and I think that once a couple of days have passed, the AM will be happy that he doesn't have to deal with this.

Anonymous said...

Hmmmm. One administrative solution that comes to mind is that Jo ends up an AM … or more likely some kind of AAAM. If the existing AMs don't do critical care, the Org Tree People might think the only "fix" to this is to have some kind of "Critical Care Assistant Assistant Manager."

Upside- more say in hiring, more control.

Downside- meetings, meetings, meetings, paperwork, meetings.

Did Big Manager have a sense of how long she will have to chart review before she can remove Keith from her purview, if not the premises, and start re-hiring for that position?

Also, not to be paranoid, but one would hope you have all your physician allies lined right the fuck up and ready to escalate majorly on your behalf … just in case?

Jenn said...

I want to echo the comments above, but I also want to say how excited I was to see Rose Tyler on your page! So, huzzah all around!

Anonymous said...

Validation = Wonderful, terrific news.

'"her lips narrowed into a grim line" as she was reading my write-up' = Priceless

Elle said...

This is a very positive development. Won't be ready for the happy dance until I hear that the exit door has hit Keith on the ass and he is gone from Sunnydale forever.

Jo said...

A quick mass-response:

Anon, I will happily pop my nipples off with a rusty spork before I take a manglement job. I'm a bedside nurse; my strong suits are education and general patient care, not meetings and paperwork. I've done management before, twenty years ago--and that's why I've actively avoided management positions during this career. If nominated, I will not run; if elected, I will not serve.

Oh, and yes, I do have a flying wedge of doctors behind me. One of the things that's been so heartening about this whole deal is that everybody, from Boy Genius to Vizzini, has put their collective shoulders behind my particular wheel.

Elle: I agree. I did a very minor happy dance last night, but only because there's going to be a degree of skepticism about this write-up. One won't end my career, true, but it will make things much more difficult for me if I want to transfer to a Ginormo facility closer to home.

Jenn: The day Rose TY-lah doesn't end up somewhere in HN is the day I get flang into an alternate universe. Next to SJS and DN, she's my favorite. "It was our first date." "We had chips."

clairesmum said...

Any chance that person who put the initial nasty review in your file can take it ou, as long as you are in agreement? Or perhaps her next entry into your record can be to give an example of your super bedside nursing skills and teaching of pts., families, and staff? Maybe.....tho the cynic in me says not to celebrate til Keith is gone from the hospital and moved far far away....glad that speaking truth to power is working!

Heather said...

FUCKYEAH (did I say that out loud??)

gela said...

Crossing my fingers for you.

Anonymous said...

Lurker Doc - disturbed by the ire oft raised when physicians do comment or try to go up the chain in regards to nurses lacking certain be polite.
I would expect specialty docs to get at least some attention when issues get raised; for the rest of us it can get dicey. Most know to pick your taegets carefully.
As well, it has long been noted that "nurses eat their young"... Not seen that change over my four decades of clinical exposure.