Friday, August 31, 2007

Relaxation technique

Step one: plan a vacation. make it simple. a week at the beach sandwiched between two or three days of just doing nothing. and i do mean nothing.
Step two: avoid stuffing anything else extra into your time off. like thinking.
Step three: why are you thinking?

My symptoms began innocently enough. Irritability, anergia, hypersomnia, anhedonia, dysthymia... my mind began wandering to greener pastures. Suffering from sheer exhaustion and lack of patience, my thought process turned on me and I began to envision finding a new place of work.
For as long as I can remember, I've employed a certain sense of all-or-nothing to cope, or otherwise entangle myself in what I perceived as proactivity.
Just go on a diet? Not enough. Let's try loosing weight while stopping smoking, and throw in a new radical haircut to deal with, too. Frustrated with work? Why not look for a new job while going back to school, joining a few committees, and plan a move out of state, too!
The latter plan of action is exactly what I employed to being about change.
What am I, nuts? Don't answer that.

For some time now, I have been estranged from my spouse due to his work obligations. We have endured the separation by frequent visits and thrice daily phone conversations, but recently have been hoping and/or planning to regroup sooner rather than later.
Where he resides offers more opportunity for professional growth - and a higher rate of pay - yet the cost of living and general frustration are out of control. Sounds like a good option so far, right?
As luck would have it, one potential employer I had my eye on advertised an opening that got the ball rolling. (that would be the little red ball in my head that spins around on a hamster wheel)... I spoke with the recruiter, who was so very interested and so very encouraging she suggested I consider the next level of responsibility (supervisory!) and booked me an interview complete with shadowing for half a day and lots of anticipatory angst. This was to take place at the tail end of my vacation; I intended to cut my beach-time short by two days to attend the meeting.
The next few weeks were fraught with worry and planning, browsing rental property, preparing the resume and references, shopping for "the" outfit that would be just perfect to land the position, reviewing successful interview techniques and pondering how best to pack up ten years of crap and whether to sell this place or rent it out. That is just how delusional I am. On the one hand I know that a single interview does not mean I'm going to GET the job, but, you know, what if? I found myself drifting away at my present job, emotionally separating myself, subconsciously letting go and forcing myself to not drop too many hints of intention. Add to that the fretfulness about performance and compatibility, and did I really think I could do this job, it's a huge leap, was I ready, is it too much, ad nauseum...
As it turns out, someone with the power to HIRE, not just recruit, reviewed my experience and called me just a day before I left for vacation. Would I consider applying for the lesser position available? The supervisory position availability was kinda "iffy" from the get-go, she said, they preferred to staff it from internal resources, and maybe I would feel more comfortable as a staff nurse. It's like she read my mind. Yes, perhaps the level I option would be more in my comfort zone, but.... the salary structure was not what we required to make the move. We would barely be able to exist in that metro area, we'd have to find a place out in the sticks, and I was not looking forward to a two hour commute each way. I decided to cancel the interview, and told them I appreciated their consideration, in a "keep the door open" kind of way, and they will hold onto my information for a year just in case I change my mind.
My vacation was so much more enjoyable. Rather than thinking about the maybes, I focused on the present, and completely vegetated while working on my tan. We fished, we packed our cracks with sand, we ate at restaurants (actual sit-down-and-be-served places!), and I didn't even wear my watch the entire time. We had no plans, no obligations, nothing to worry about except the SPF15 not holding out. It was AWESOME, and just what I needed to gain a little perspective. Upon my return, people commented on how relaxed I looked, and that I was positively glowing (the SPF15 did not hold out, I'm sorry to say).
All in all, I'm refreshed, rejuvenated, and ready. Bring it.

Friday, August 17, 2007

On a hospitable workplace

Reading the latest posting over at Mother Jones', and pondering the phenomenon of nurses eating their young, I would like now to discuss those ornery coworkers who strive to find issue with everyone else on the team.
You know the ones. The people who complain about others to the point you just roll your eyes and walk away from the conversation.
I've long since decided that getting caught up in the gossip wheel is too much like junior high. To quote F0rrest Gum.p (sort of), "My mamma always said... if they is talking about her, they is gonna talk about you, too."
In the distant past, I worked in the corporate world. Women outnumbered the men in my office 5:1. I learned back then that women rarely get along with each other. I noted that I had very few female friends from the get-go. Just too much cattiness and insincerity. Maybe I had trust issues; maybe I still do. I was burned several times during my formative years, and I have the char marks to prove it.
The antagonist in my present tale is a young nurse with superb talent and skills, someone who I actually enjoy working with. She is unhappy. With what, in life, I am mostly unclear, but I do know she has anxiety issues and unchecked OCD in a mild yet workable format. She has tried medication in the past, but being newly married and desiring a pregnancy in the near future, she decided to let her brain chemistry go au natural. I mention this because, if I were allowed to do a little psychoanalysis, this gal has some baggage.
She came to psych directly from nursing school, and has not yet lost her touch with the med-surg side of things. If she were to transfer to a medical unit, she would shine, I am sure of it. She doesn't wish to do so, because 1) they won't take her anyway because she's wasted four years on a non-medical unit* and 2) she feels as though the pace on a medical floor would push her over the edge. Thing is, I'm not sure she belongs on psych. She quickly becomes frustrated due to lack of control of patients' behaviors, and her therapeutic communication often resorts to hugs and "Awww"s. But mostly, her attitude toward other nurses and ancillary staff is surprising, due to her sympathetic nature.
*(her words, not mine)
Her expectations of others are rather lofty, and she lets that be known. Not to your face, of course; she'd rather complain about you to anyone who will listen. Not a shift goes by that one doesn't hear "I don't know WHY so-and-so can't keep up/didn't do more/isn't swinging from the light fixtures while charting and transcribing orders and wiping poo with her free hand!"
When we used to listen to taped report, there was eye rolling and heavy sighs that signaled her growing frustration, and the occasional comment about whomever/whatever she felt could have been said or done to her exacting standards. Now that we're doing face-to-face report, the reaction has been muted to a neat little silent treatment and an "I'm too overwhelmed to discuss your mistakes with you" demeanor.
Can everyone say PERFECTIONIST?
I'm not sure if her childhood was wrought with never living up to daddy's expectations, or if her new husband is the culprit. Perhaps the spouse is what keeps her on the level and offers support and encouragement out the wazoo. Any way you slice it, my take on the chick is that she has some self esteem issues. By striving to be perfect, and taking down anyone who stands in her way, she is feeding her need to be lauded as A-number-one and attain recognition.
I must admit, I have not noticed any mistakes made by this little princess. I'm sure they're out there, but I don't play that game. In my opinion, she does her job (and then some), and does it well. But, so does everyone else on our crew, no matter the shift. We have some seasoned staff who are able to do a little more, and we have some that just do the bare minimum - and that is acceptable, too. We all have "our days" when things go in slow-mo and you just can't find the gumption to do one.more.thing.extra; these days are often interspersed with full throttle doitallness, and things just balance out.
I hope with some experience and maturity she is able to find her happy medium and some satisfaction in herself.

Wednesday, August 15, 2007

Strong-arm tactics, and (possibly) Dumb Luck

It has long been a concern that physician's conversation with patients in a hospital setting is anything but private. Besides the nurse, physician's assistant, intern, students, and any other staff (housekeeping?) that may be in the room, there is also the roommate who can hear every last detail about the patient's complaint(s) and what the plan of care might be. Sure, the curtain between the beds will be pulled as a visual shield, but the audio is at times more interesting by a long shot.
Unlike the med-surg unit, our psych unit can -and usually does - afford a little more anonymity to what meds are being given to whom, who has what diagnosis, and what their follow-up care will entail. This is not fool-proof, of course. We still have some semiprivate rooms, and community group sessions are a staple; in addition, for any patient who has a psych history with occasional (read: frequent) hospitalizations, one pretty much 'knows', or can certainly guess correctly, the potential diagnosis of their peers. Not to generalize, but yes, sometimes you can tell by looking at/interacting with someone that they are most likely schizo.
Our (newish) psychiatrist that covers the majority of our inpatients understands the need for privacy, and has established a suitable, if rather inconvenient, location on the unit for treatment team sessions. The other shrinks prefer the "walking rounds" method; one in particular likes to create an impromptu "office" smack-dab in the middle of the hallway near the dining room. I often wonder if the patients we bring out for him feel a bit like they're in a spotlight. None of our staff cares for this set up, but he has done it for years, and he's a bit of a diva anyway, so we comply. (To our defense, we keep the the audio to a low level, and do provide a human barrier to the visual access.)
Aaaanyway... on with the story.
One patient is a good candidate for ECT. Over this past week, various members of his healthcare team have suggested this to him as an option. He is on our unit as an involuntary committal. To get the ball rolling, we would need him to sign consent for this treatment, as well as agreeing to stay with us for a while without the court's involvement. As the treatment was intended to occur, like, tomorrow, Dr. Bigshot stepped up the process by hounding the patient In an act of desperation, I can only assume, the physician enlisted my help. Although he had to look at my name tag twice during our conversation, he did personalize the request by addressing me, by name - twice. Really gave me the warm fuzzies. He felt I showed a good rapport with the patient, and he needed a witness to the signatures he felt sure we could obtain.
We went to the patient's room to coerce him some more. Long, detailed explanations of the procedure had scared the patient before, in my opinion. This time, short descriptions were offered and loads of encouragement were piled on top of it all. Finally, the doctor warned him that he might be forced to seek out a guardianship if the patient wasn't willing to agree voluntarily. That tactic *sort of* got the patient's attention, but only momentarily. Then, in what I can only describe as an amazing twist of luck, the patient's ROOMMATE intervened.
Yes, for all the harping we do about invasion of privacy, this time it worked to benefit a patient.
The roommate came over and and simply stated, "I've had ECT before, and it really helped."
When I thought Dr. Diva might just spin around and growl, he said nothing. He laid his hand on our subject's arm and said, kindly, "You know we want what is best for you."
The patient (who does not make eye contact), turned to his roommate, looked him in the eye, and spoke to him about his experiences! I was floored.
We got the requisite signatures, and began an immediate clearance workup for therapy to begin in the morning.
I fully expect the patient to backslide on this decision many times until the treatment begins to show efficacy, but I am glad this first step was taken.
Of course, I can't end the story without a touch of irony thrown in for good measure. We got what we wanted at the expense of violating whoknowshowmany rights, a point that was beat to death during report at the end of our shift. One nurse went so far as to say that the roommate was out of line, and should be reminded to stay out of other people's business; he was being "intrusive". That was a fine line, I admit; had I the opportunity to do it again, I'm not sure I'd even agree to be present.

Friday, August 03, 2007

All over the place

Where to begin...? I'm having flight of ideas!
Today, two families presented with our new admissions, and both parties agreed that "This unit isn't what we thought it would be."
Today, two families and the patients themselves complained that the degree of dementia our other patients were suffering was making them (the new admits) actually feel WORSE and they wanted to leave. The doctor replied with a terse "You need to be here" and told us they could sign their 72-hour notice(s) if they really wanted to, but otherwise they would be leaving AMA, which of course means no meds or follow-up.
Today, one husband said he would be contacting his lawyer.
And, today, three of our staff nurses have penned letters to the nurse manager and director of the unit regarding the (in)appropriateness of our current clientele.
It's what we have been saying all along.
We are not intended to be a dementia unit.
It's not that we don't enjoy the Alzheimer patients. Being that we are a geriatric psychiatry unit, one would expect to find a certain degree of cognitive decline and behavioral issues that are associated with dementia... along with the accompanying psych issues that we are intended to treat. But! But...
We also are supposed to care for patients who have a major depressive or anxiety disorder, schizo-affective disorder, schizophrenia, bipolar, and post-traumatic stress disorder (to name a few). None of these are an ideal mix with the wandering, yelling, confused patients who drive them to the absolute brink of violent madness. The depressed patients become more withdrawn and isolative, helpless, hopeless, needy, and at times, even suicidal. (If I'm going to end up like that one day, there's no point in going on...). The anxious patients become even more anxious, to the point of hypomania if not full-on manic. The psychotic patients become nearly unmanageable because their thought process is already disordered, and this new distraction is too much to handle.
We are asking that some consideration be given to the psych patients that need our services. The ones that can benefit from group therapy, activities, medication management, and a safe environment with caring staff who are attentive to their needs. Instead, our time is spent changing diapers and feeding patients who have regressed to the point that a meaningful conversation is out of the question. We have no gripe with providing ADL support and the usual nursing care that any patient might need at any given time, I promise you that. However, the purpose of this unit is to treat psychiatric disorders, not provide a holding bed until a nursing home is chosen.
At our last unit meeting, fingers were wagged because there haven't been afternoon/evening groups held for quite some time. When we do manage to get one logged on paper, it reads "nutrition" or "hygiene" because all we can get done is feeding and showering.
The patients we have had recently include a 79 year old completely with-it woman who has been bipolar for 40+ years. She is severely depressed and very worrisome. She sensed a worsening of her symptoms and requested to be admitted before she goes "over the edge".
Today, she said she couldn't take it here anymore and did sign her 72. She said she'd rather lay in her own bed all day than listen to patients X, Y, and Z one more minute. Then there's the 70-something patient with worsening DM, hemodialysis, and a BKA. She's pissed at life, herself, and her doctors. She wants to die. SHE needs help with her ADLs, of course. But she belongs here. We can work with her, try to improve her mood, her outlook, her hope. Sadly, she gets to wait in line because patient Y just pooped himself and is crawling out of bed again.
A 50-something patient with history of severe depression and SI, who is also a cutter, wanted to be admitted to our unit. She had been here a few years ago, and we had helped her. She has been seeing a therapist who helped her uncover some demons, and she knew she needed a safe haven to protect her from herself. Most of us got to see her once or twice a shift.
Yes, there are some serious safety issues at play. We get 'spoken to' when a patient maneuvers their way out of the w/c with alarm, seatbelt, pummel cushion, and lapbuddy, and still manages to fall; yet when we try to afford the treatable patient with the appropriate therapeutic milieu, we should have been somewhere else, like babysitting.
We had a 64yo woman with newly diagnosed CRF who receives peritoneal dialysis. Her depression over her health issues was overshadowed by complete irritation at the demented ones. She said she had hoped we could help her with coping skills and positivity as she adjusted to her new medications and lifestyle. Instead, she attended one group that centered on "some memory-trivia game for the old folks" and colored some pictures. We have been offering one-on-one sessions for therapy as appropriate. The rest of the time, these folks are bored! The social worker, COTA, mental health technicians and nurses all agree that holding "groups" for two or three patients who would benefit, is all but impossible, when all available staff is needed to monitor the wanderers and fall-risks out there. And, when the day shift office people are gone, you can bet we use geri-chairs with.the.trays.up. Just don't tell anyone, mkay?
I have been considering a move to the adult psych unit. Or back to med-surg. I really don't *want* to, but if I gotta, I will go.
That's what sucks about the geropsych situation.
As a rule, I do like my job.
But I see two possible scenarios.
One, we limit the admission of dementia patients who can be managed at their current facilities. Or,
Two, we make some serious structural changes to our unit to accommodate the needs of those patients; invest in adaptive equipment; and add some more staff, for Pete's sake! Then, they can divide up the dementia pts from the regular psych pts, and everyone is warm and fuzzy.
In other news, as the fall semester looms on the horizon, I have yet to get my three 12's, as promised. They're working on it, I am told. I even offered to work the goofy 3P-3A to help out the evening/night crew (which I currently work on, anyway). Waiting.
And, I joined a committee to placate my NM and fluff up the ol' resume'. Why is it, all committee meetings tend to be a boring rehash of the previous meeting's minutes and intense planning of what to accomplish at the next meeting (and so little tends to get done!)? Then there are those action words we all love to hear: utilize, implement, exercise, augment, accomplish, enhance, enrich, efficient, proficient, fiscally sound. Bah! ::vomit, hurl:: Now I know why my bandage scissors have the nub at the end of the blade... Julie doesn't need to handle sharp pointy objects.
Ahhh. Well now that's off my chest... I have little else to offer right now.

Here's to a wonderful end to a sensational summer season! Cheers!

Wednesday, July 25, 2007


A respiratory therapist in our hospital was assaulted in a stairwell the other day. She was knocked around a good bit and the man took her ID badge and ran off. He has not been identified or found. He didn't attempt to steal anything else from her, keys nor phone; there was no attempt at rape. The badge was immediately deactivated, so I guess he'll have to pay the $2 to get out of the garage. When I think about the things that could have happened, I get the willies.
Our hospital has been involved in some acquisitions in the past several years. As they continue to grow and expand, the other facilities are converted for use as necessary. The building I work in, where this occurred, is one such facility. Once a hospital of its own right, for the past 10 years or so it contained mostly admin. offices and - of course - psych. Slowly, they began to add one medical floor, and then another, and now plans for yet one more. They have built a cross-over to connect the two hospitals and now have a tunnel for patient transport between them as well.
The tunnel has cameras every few yards.
The major public access areas also have security cameras.
We have security personnel who make rounds at least once per shift.
While the bulk of the secure-ness is maintained at the "main" campus (especially the ER), we never really worried much about our building.
On our floor, we have three security cameras to monitor the patients in the hall and the people who wish to gain access at the front door - but none of these have feeds to the security office. If we aren't sitting at the nurses' station to watch the monitors, we have no idea what is going on.
They don't record.
There are no cameras in the stairwells, nor near the entrances to the stairs or elevators.
Whoever did this probably had a pretty good idea of when the last security officer passed through, and just waited for the right moment to jump.
What did he want? Why her? She didn't have keys to any med room. Her badge didn't allow access into our top-secret alchemy lab. She holds no clout with the HMOs.
Coming off shift tonight, walking the long empty halls to the parking garage, knowing that one camera's view drops off for about 10 yards before the next one picks up, and peeking into every cubby hole, blind corner, and sunken doorway along the way, I wished I had my pepper spray. Or an alarm. Even a whistle. But who would hear it? The areas I had to navigate are quiet and without traffic at midnight. Should I have asked for a chaperone?
How safe do you feel at work?

Tuesday, July 03, 2007

Luckily, my neck broke my fall.

I receive several visits a day, though my lack of comment(er)s seems to prove otherwise.

Along with random landings and those lent in my direction from other's lists, I garner some unusual search hits, as well.

Today's weird inquiry :

"Do rectal swabs hurt?"

My guess is, you may feel some slight discomfort.
I'm saying, is all.

Can't quite figure out what content in my blog led this person to me of all places, but what the heck.

And anyway, I should be thankful for the attention. Seems I have fallen off of some high-profile blogrolls, and it sort of makes me sad. Sure, my content hasn't been all business lately, and that's because I have a life full o'crap going on at the moment. Glad I don't need to feel validated or anything trivial like that.

As such, I'm sure the bloggers I read appreciate positive affirmations too; therefore, I'll try to be a better blogger & commenter, and I will finally put together my very own link-list. So there.

How 'bout this weather, huh? Friggin' awesome. Now, if I could just get my ice-cold coworkers to realize its effing JULY already and we can turn the thermostat down past 75, all will be right in the world. Put on a durn sweater, I'm dripping over here.

Thursday, June 21, 2007


They took MaryAnn off the vent this morning. Funeral tomorrow. I'm sad for her family. She will be missed.

Tuesday, June 19, 2007


They've weaned back the complete sedation so she can nod her head and squeeze your hand for communication.
Her husband says the "plan" is to get her back to "where she was" (meaning, three days ago when she was bucking the BiPAP); his goal is to 1) keep her comfortable, but 2) able to carry on a conversation. He wants the family to be able to have final moments with her.
There are discussions about a hospice center vs home care.
Funeral arrangements and a plot purchase.
How does she do the bills? Utilities must be paid. Mortgage is due. Car payments can't be late.
She's 57. Fifty-seven years old. Bald, pale, swollen with fluid. There are many boxes of kleenex in the room, for family and friends, and to wipe the tears from her eyes and the drool from her mouth.
She'd bought a purse like she always wanted. She worried he'd be mad she spent the money. He cried now because she even had to ask.
She'd had a sudden burst of energy recently; was able to do some quilting and finish a few crafts. Started cleaning out her closets and drawers, clothes that didn't fit.
I called her house, to leave a message for her family. It was strange to hear her voice on the machine. When I was leaving her bedside today, she raised her hand up from the soft wrist restraints and gestured with a few fingers. I have no idea what she wanted to say, but couldn't. But she knew I was there. Her husband gave her a foot massage. Her sister rubbed lotion on her scalp. The flowers her son gave her are at the nurses' station.
Too many thoughts, jumbled.

Saturday, June 16, 2007

Fingers crossed

My very good friend with the SCLC is in ICU; they were sedating her for intubation when I left. Her family is terrified of the vent. I'm just sad.
It's hard just being there for them when I can't fix it and make it all better.