Friday, May 11, 2007

yawn...stress stress stress....yawn

Wow, It has been a while since I posted. Thank you, Marcia, for checking in on me, and to the others who have left comments.
I'm okay! Busy at work! Things are just great.
We managed our way through JCAHO. Lost one nurse, gained another. Survived the winter doldrums. Keep getting readmits of the same patients, over and over.
Why, you may ask?'t.fix.dementia.
The bane of the unit is the need to keep beds filled. When I came here, the lure was that of psychiatric patients who just happened to be geriatric as well. Say, a person who had battled schizo-affective d/o all their adult life, and now just happen to be over 60 years of age. Simple?
If I had wanted to work in a nursing home, I WOULD HAVE STAYED IN THE NURSING HOME.
Everyone is so completely burnt out. We have had a flux of call-offs and people (even myself) who will not reply to a call-in because we just can't bear another minute of it.
The number one diagnosis we try to pre-cert? Dementia with behavioral problems. Please understand that these individuals are inappropriate for the therapeutic milieu.
1) If they are unable to attend or participate in groups, they are not appropriate for the unit.
2) If it is merely medication management that is required, that can be achieved at the facility where they currently reside.
3) The facility where they currently reside likely has the adaptive equipment and necessary staff available to properly care for these individuals.
4) If the person is returned to us in under two weeks of discharge, conversations must be had regarding alternative placement.
Currently, the most pressing issue is that of providing 1:1 observation for the acutely psychotic patient(s) who are a risk to themselves and others. Staffing seems to feel this is a minor issue (as we are a locked unit), and they offer preference to manning the patients who need this on the medical units. While that sounds like plausible reasoning, it is not. They need to hire more people. They ask us to "cover our own". We don't even want to work our scheduled shifts right now, much less come in extra for that. We have a seclusion room that doesn't lock. That's a restraint. ICU pt pulling at an IV? Soft wrist restraints. Hallucinating male pt who punched an 87-year old female in the face and knocked out her tooth? IM haldol and level 1 observation.
We have an 'executive' level person employed by our managing entity who is in charge of marketing (i.e. patient recruitment). This person has little to no actual healthcare experience. She is not a nurse, nor a social worker, nor has she spent any time on the unit to see how it works. Received a call the other day from her, while she was visiting a far-away facility. "We need to direct admit this man, for blahblahblah reason." Did he sign consent? No, he's too confused. Does he have a POA? No. But don't worry, she will spend some time to try and get him to sign the voluntary! Of course! Because that's appropriate. And legal. Not.
First, you need to have him medically cleared; he needs to come through the ER, and the physician and consulting psychiatrist need to determine his need for admission. You are not a doctor. Then, if they believe he will benefit from our program, or is a threat to himself and others, he can be involuntarilly committed. That's how it works. You should already know this, that's why you get paid the big buck$. Furthermore, there's the little issue of insurance. If I have to spend an hour on the phone trying to convince Big Insurance Company that he would be better served here than at his own facility, then Miss Marketingpants needs to come and do my charting, meds, and assist with ADLs.
Argh. Just venting a little frustration.
Since I began this post many moons ago, things have shifted much more pleasantly of late. After running at full capacity with no fewer than 5 patients surpassing the one-month milestone, we suddenly find ourself near half capacity, and are calling off or loaning out staff to other units! From the big picture standpoint, this isn't such a good thing, but right now, it is bliss. And, as we know, will be short-lived. Hey, I take what I can get.
In other somewhat-related news, several of our staff have expressed an interest in doing the three-12s offered. I'm one of them! Since the previous 6 months were so craptacular, it seems as though we'd rather concentrate our pressure rather than spread it out over 5 days a week. Makes sense, right? We have one girl going part time, two others wanting to go back to school, and a GN who expressed an interested in working with us. Wow! (sucker.... you have no idea. heh heh)
So, maybe I'll find more time to write again. Who knows?
If I have an extended absence again, I wish each of you a terrific summer!