January, 2007 Archive

between 0600 to 0630, most of the nurses are usually in the unit circle, rubbing their overwashed hands with lotion.

patients have been repositioned and cleaned, meds have been passed, blood sugar levels have been checked, wounds have been dressed, charts have been completed.

unless there is a patient in distress or coding, this 30 minutes are the most relaxing minutes.

it is the wait for the shift to be officially over, the anticipation of going home after 12 straight hours of pure, unadulterated, back breaking, leg killing work. 

usually, this is the time that the staff get to talk about anything unrelated to the patients. we talk about spouses. boy/girl friends. families. in laws. weddings. divorces. kids. debts. deaths. lives. and everything in between.

most of the times, our fellow nurses who were born and raised here in the US, or in any other developed countries get really fascinated with our “stories from home”. home meaning the philippines, a third world country. when i talk about people back home, i talk about people like me, a large percentage of people who are lower middle class, have jobs, but just get by.

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back home…

we try very hard to use only 1 pair of unsterile gloves per patient, per shift.
in between use, we rinse the precious gloves and hang them to dry. we reuse till they break or till the shift is over. whichever comes first.

we do not discard single dose vials of medicine.

our insulin does not expire 28 days after it is opened. it expires when the vial is totally empty.

we are not able to give antibiotic on time, with the prescribed number of doses per day. we only give the available antibiotic, when the patient’s family is finally able to borrow money from his neighbor to buy the next dose.

we do not wash our hands even if we need or want to.

depressed or suicidal patients are not always referred to psychiatry.

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the lack or absence of money is a sad thing.

it is sad that you subject your patients to possible spread of infections by reusing gloves…but if they can’t afford to pay for the gloves, there is no way you can buy gloves for every patient you get to take care of.

it is sad when you start a dose of antibiotic, and stop on the third dose even if the patient needs 14 doses.

it is sad when you have to gamble with the possible effects of expired meds.. just because you reason that your patient is better off having something than nothing.

it is sad when you cannot wash your hands after every patient encounter… not because you are clueless about the importance of handwashing, but because a lot of times, there is no water.

it is sad when people go home depressed and suicidal without being helped… but you turn your head and ignore it because there is nothing else you can do.

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back home…

we don’t do warm showers or warm baths.
no hot water. no shower. no bath tubs.

we don’t drive. we don’t do garages.
no cars. no garages.

we don’t do eat out because we have no time to cook.
nothing to cook. no food.

we don’t balance our checkbooks.
no checkbooks. no money.

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five years ago, when i just came here, it wasn’t a shock that it aggravated me to see nurses who waste supplies like they think all the supplies drop in their pockets for free. it wasn’t  a shock that it amazed me to observe that a lot of people have very little appreciation for the food they have and can have.

as i begin to blend into the stream of the american life, i begin to realize that wanting more is almost a national obsession. an obsession that at some point in my life have entered my being at such an alarming intensity, it actually made me dizzy.

here, we have everything a human being needs. food. roof over our heads. clothing. actually, not only do we have all of our needs, but we have all of it in abundance.

we have excess of everything, but we want more.

a lot of people are unhappy. they complain about their lack of everything, sounding like they are deprived of their basic needs.

a lot of people are not contented. they want things that are bigger and newer. and more expensive.

it is difficult but it must be done. in my mind, i went back to where i came from. i then remember that during the times when i have less, to some degree, i was happier, more content. now that i have more, (not rich, but defintely more comfortable than how i was back home) i owe it to myself to be happy. to appreciate what i have, not to whine about what i do not have.

it is not an easy thing to do, but i will dare say i have done it. and i am at a point in my life where not having a bigger, newer, better something does not bother me anymore.

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between 0600 to 0630, as people get fascinated with the stories, i get nostalgic. as they ask “really?” in disbelief, i am reminded of how blessed i am to enjoy the comfort of a lot of things i have never imagined i can and could ever have.

as people get fascinated with the amazing stories, i am fascinated with the idea that sad stories can be fascinating. i hope we can go beyond fascination. i hope we can go far beyond that. i hope the stories will make people think, as it often makes me think. think about the things we tend to ignore, and think about how to appreciate them.

whoever said that “happiness is not having what you want, but wanting what you have” was a very smart person.

he was pointing at the spot where there was supposed to be a cleavage, only, there is actually none.

“be careful, you might embarass yourself and be like…”, he said, saying a woman’s name i do not recongnize. i looked at the badge that was sort of pulling my scrubs a little lower.

“uh, she was on a famous band years ago.”

and?

“and they were having this live concert on TV, she was wearing this tiny blouse, her back to the audience. then, she turned around and the strapless blouse just got pulled down like that.”

and how is it possible that i could be like her?

“well, your…” he coughed a little bit, smiled a little bit, and again, pointed to my supposed cleavage.

okay. call when you need anything else.

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“oh May, you have no idea how i appreciate your kindness.”

i gave him a little touch in his shoulder and told him it was okay. that he got teary eyed because of too much emotion was a little over the top but understandable. but that he grabbed my forearm and and started rubbing it with his two hands was way too much for me. i didn’t know how i managed to pull my arm back and still appeared professional, but i did it. his action was unexpected, it threw me off.

“you have such smooth skin and nice arm. mine is all bony and dry. i used to have a really good body you know, a lot of muscles. i used to go to the gym a lot. now, i am just this disgusting skin and bones.”

he looked like he was in a contemplative mood, so i exited quietly.

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if i didn’t know that the first guy is going to have a surgery to amputate his foot while having a big issue with his chronic breathing problems, and that the second guy is going home after being told that his rectal cancer has spread all over his abdomen and bladder, and is inoperable,  i would have thought these guys have a little too much time in their hands, that they were actually getting sexual on me or something.

but i didn’t. because they were actually nice patients who didn’t really match the description of creepy maniacs.

now, if i do have a cleavage and do have really smooth skin and nice arm, i would have thought they were sexually harassing me. thing is, i don’t. so i can only assume the morphine is to blame, next to the fact that they were extremely stressed out with their difficult medical condition. between you and me, i confess that sometimes, i can’t help but think that old men (in their late 70s), even when they are sick, are still preoccupied with sex, or anything related to it.

i could be wrong though. because honestly, the quiet thoughts of the male species in general  still continue to boggle the mind.

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on other news. i did have cardiac ultrasound today. good news is, my heart is as healthy as it can get. bad news is, while doing the ultrasound, the cardiologist accidentally saw that i have gall stone. i’m not sure if the image he showed me was magnified, but the stone was a little pointy and appeared to be about a quarter of my little finger. i will call the doctor who saw me at the urgent care clinic last week, when i was having that chest pain (which turned out to be a gallbladder pain) and see what he will suggest.

although i remember (back in nursing school, a classmate did a case presentation on this) that the cause of cholelithiasis is something that is really unknown, i know too that it is common in persons with the 3 Fs.

fat. female. forty.

fat. check (5′ 4″, 161.3 lbs)
female. check. (tubes ligated, but ovaries and uterus intact)
forty. check. (in 2 years and 7 months)

for now, i will think of something productive to do with my stone, if the doc does suggest surgery to take it out. maybe, i can sell it on ebay? or if not, maybe i can just keep it so i can be cool and walk around claiming i have a rock inside me. hhhhmmmm. people of the blogosphere, any reasonable suggestions?

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i held back in posting yet another long, boring rant about our staffing issues. my decision is to make my life less complicated by accepting the fact that we are stuck in this situation for a year. i  made a choice. i will close my ears when somebody complains. i have enough of the whining.

also, i am tired of hearing people telling me they were so proud of me for standing up and saying what they really wanted to say. seriously, what were they afraid of? most of them  have two or three jobs. even if they piss the manager off by speaking out and they fire her, they still have other jobs. this is my only job. it was discussed that we will speak up, and as i said it was stupid of me to believe they will honor their words, but it is over now. so, the next time somebody pats my back and say how proud they are of me for being so gutsy, i will not acknowledge them with a smile anymore.

as for the thought that i am not looking at it from the nurse manager’s perspective, i disagree. i know exactly where she is coming from. i am not asking her to do something against what the management is asking her to do. i just want her to consider the fact that the concept that AM shift needs 3 PCAs and we need none is just wrong on so many levels. for the record, she is allowed a total of 3 PCAs if the census is 21 and below. she can choose to have 2 on AM shift and 1 on NOC. that’s all we are asking for.

there, it is still a bit long, but this should be the last one. i am gonna rest my case on this PCA issue. so please, cut me off when i start whining again.

i admit. i got carried away. i got emotional.

first, she told us that for the year 2006, up until november, our unit had a total revenue of X million dollars. yes, millions! not hundred thousands, not thousands. millions! then she told us, that for the past 8 months, she has not hired any staff, which means, nobody has resigned.

then, she discussed the PCA (patient care assistant) issue. to refresh our memory, she explained what we’ve already seen in the past 2 weeks. for NOC shift, there is 1 PCA for patient census 22 and above, NO PCA for patient census 21 and below. for AM shift: 3 (yes, three!) PCAs for patient census 22 and above, and 2 PCAs for patient census 21 and below.

she explained how AM shift needs more PCAs because they pass food trays, feed and bathe patients, send more patients to procedures and tests.

i don’t know if she meant that nothing happens at night, (because that’s how it sounded) but this is what i know: i know that patients are being prepared for GI procedures at night, which means they poop more at night. patients who are confused get more confused at night. patients still go to procedures at night, and yes, they still need to be repositioned at night!

anyway, there were 20 RNs present. this annual competency class and staff meeting was scheduled three different times and was/is mandatory. our group was the second group.

when the PCA issue came up, the NOC nurses started fidgeting in their chairs, but were very quiet. “fine”, i told myself, i will raise my hand, express my concerns, and for sure, they will either talk about what they tell me at work every night, or at the very least, back me up.

well, what happened next totally threw me off the edge! nobody said a thing. nobody! they all sat there, like they all lost their tongues! they looked at me, they looked at our nurse manager. then, they  stared at the wall like they couldn’t care less about what we were talking about, because frankly, they thought May is a loony and a liar.

i ended up saying with a sarcastic tone: “if you said we gained X millions in the past 11 months, will it really hurt to hire another PCA for the NOC shift? also, since you have been sort of bragging about the fact that nobody has left the unit in the past 8 months, you have to watch out because people are definitely planning to leave. lastly, just to let you know, the PCAs are happy when they get floated to another unit, and you can’t blame them.” i know, i shouldn’t have, but obviously, i feel very strongly about this.

then, i zipped my big mouth.

our nurse manager (very calmly, bless her heart!) went on to explain (in technical terms i honestly do not understand) how they came up with the staffing ratio, and corrected me on the issue that the PCAs are not always happy to float.

everybody was quiet. their silence made me think i was working in a different planet, or that i was a complete bitch for bringing up the issue. their facial expressions made me feel like i was this nagging wife who has nothing sensible to do, but complain, complain, complain.

the thing is, these are the very same people who complained to me every single night i was at work. every single night! the very same people who are convincing me to apply to other units and leave. the very same people who said they will sign a petition for a change in our situation if i just write the petition.

we had a much needed 10 minute break.

outside the conference room, one of the NOC charge RNs thanked me for “speaking up”! others tapped my shoulders. what do they mean?

well, they mean two things:
first, i’m stupid for speaking up when i know nothing will change the administration’s decision.
second, i’m stupid for assuming that people who speak up behind their superior can actually face that superior and say what they say behind her.

lesson learned: it’s easy to be stupid, but it doesn’t hurt to be smart. 
                      next staff meeting, i will not say anything even if they pay me.
                      and for the record, they can only pay me in millions.

anyway, just before we went home, i went up to the nurse manager and apologized. not for the things i said, but for the way i said them. “i apologize if i sounded like i was attacking you personally. that was not my intention. i just want you to know that is what’s happening in reality, i hope you didn’t take it personally.”

she was very professional about it and told me i didn’t have to apologize. “i know all about the issues, but i just can’t do anything about it at this time.” she was very calm, never emotional, very professional.

so, in case you are wondering, that’s why she is the nurse manger, and i’m not.

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by the way, i wasn’t able to escape the applause. the nurse manager, unaware that i planned to totally let all my complains out in the open, asked me to stand up before the meeting started. she kept the fancy plaque all this time, and presented it to me to recognize my so called positive attitude.

at least this early, we already know that i will not get the same award (if ever i miraculously get one!) next year. don’t we?

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i was gonna write about how i spent three hours in an urgent care clinic as a patient yesterday, but this post staff meeting rant got in the way, i have no more energy. so, i’ll reserve that for future posts.

in the meantime, before i forget…to those students who are interested in winning a $5,000.00 scholarship sponsored by nursing jobs.org, go ahead and check it out. this is something i would have joined if i was eligible. it’s big money, and if you have great reasons why you chose nursing, writing about it wouldn’t be that hard, right?

the edited version:

dear nurse manager,

this may not come as a surprise to you, but i still want to let you know that this is not really working. please, do something. i believe you know how important teamwork is in taking patient care to the highest level. there is no room for teamwork, when there is no team to do the work.

thank you for your time,
may

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the unedited version:

nurse manager,

from the time of the implementation of “1 PCA (patient care assistant) for patient census 22 and above, and no PCA for patient census 21 and below”, most, if not all of the staff have been contemplating on leaving the unit. a few have been on the verge of tears in the middle or beginning of the shift, and in case it escaped you, patient care has been extremely crappy. actually, almost nonexistent.

don’t get me wrong, i still love my job. but believe me, i won’t be a hypocrite and say my back does not hurt. i won’t sugar coat it and say, “i actually did a pretty good job today”, when i know for a fact that my patients are not being turned on time, not being cleaned on time, not being attended to on time, not being given enough time.

what do we have to do to convince you that this is not just all about us and our lazy asses? if you take time to really listen to your staff, there is actually a big percentage of us who truly care about the patients. we are frustrated with the way we neglect some of their needs because we just can’t do it anymore. we go home worn out, not only physically but emotionally. we look back at the past 12 hours of work and we don’t get to experience the satisfaction of making a difference in our patients’ lives because really, there is just too much to do, and not enough energy to do everything.

have you ever felt that way? back in the days when you were not a manager yet? has it been that long, you can’t remember? you know, the days when you know you have done everything, but still, you sort of accomplished nothing? didn’t that feel awful? have you ever gone home and your legs felt like rocks, you wanted to cry? have you?

i won’t go on and on and on, saying exactly the same things. all i’m asking is you go to that meeting, and fight for what you believe in, by saying something about it. i know the big bosses may not like you, but shouldn’t principle be more important than being liked? i mean, aren’t we supposed to be the patients’ advocates? obviously, this situation is affecting your staff, but this is really about the patients. don’t you care about them?

i would like to think you do care about them.  i have that little flicker of hope that you do care about your staff. let me hang on to that belief, so i can continue to believe in what i do. don’t push me over the edge, and make me forget the very reason why i became a nurse.

please. do.something.
now.

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my apologies. it’s just that two weeks of working in this new situation has tested my patience and strength to its limits, it is not funny anymore. the little time we have before or after shift change is spent on discussing what we need to do to get this message accross. everybody is frustrated and tension is very palpable in the unit.

the sad part is, a few staff have already complained formally by writing our nurse manager, but her response is not for us, or the patients’ favor. i have had my taste of rebelling against my superiors back when i was younger and blatantly stupid. i do not want to go there anymore. at this point, there is really no point in letting your voice be heard, when you know that others’ voices were ignored.

so please, bear with the whining. also, understand that this might go on for a while. at least, until i finally convince myself that change, is necessary. and that maybe, the grass is really greener on the other side. who knows, one of these days, when i get really really tired, i will be able to convince myself that i am not THAT old to go through another grueling experience of interviews, orientation, and adjustment. after all, old age doesn’t really erase one’s ability to be flexible, right? 

lastly, here’s hoping that your work is not wearing you down like this, because life is too short. at the end of the day, all that matters is the fact that you have tried to make a difference in another person’s life. the idea that you did not succeed is really irrelevant. it is your intention that truly matters.