Minding the House
cherigraceblog
The night before last I was House Supervisor for the community hospital that I work at. The regular supervisor is on vacation. This is something I've thought about doing, but for some reason was a little intimidated about. It was an interesting night and now I kind of wish I had applied for the position when it was open. I've never liked the feeling of being cooped up, and sometimes when you're on a unit for twelve hours, it kind of gets that way. Oh, the joy of roaming the House (the hospital that is) with freedom. I used to think before I became a nurse - and maybe even in the early years- that the House Supervisor must be an important personage who certainly was busy with very important matters. Hmmmm....sometimes, not always! So here's a synopsis of twelve hours in the life of the House Supervisor of a 100 bed hospital...
7 pm- Pick up the keys and the dreaded beeper from the pharmacist. Complain to the pharmacist about my earache. She gives me a couple of antibiotics.
7:15 pm- Make my first rounds around the hospital, to ensure that all personnel are Doing What They're Supposed to be Doing, or at least pretending to be. Nothing much going on in the ICU- one patient in a coma, one nurse checking her email on the computer. Psych unit, pretty quiet- 16 patients, a few outside smoking, a couple of young girls talking to each other on the couch in the front. Appears to be plenty of staff, and they are suprised I have come by. I guess most people don't think about the Psych unit too much. Walk through the ER- they're busy and everyone is running around. No one has anything I can do to help and I feel like I'm in the way. Nothing critical= I look up at the board with the patient's first names and complaints: Headache, laceration, headache, stomach pain, headache, headache. I figure I'll come back later and get the ERP to look at my ear- perks of the trade. oh well, at least I don't have a heaache!
7:45 pm- Check on the med/surg floor- two wings- medical side looks quiet, surgical side, young graduate nurses running around looking stressed. One tells me the lady in 414B has asked to see the House Supervisor because she has a complaint. I rummage around in this enormous black book I'm carrying (which I'm hoping will see me through the night as it is the House Sup resource book) and find the complaint forms. Enter 414B- older lady and her very large daughter, both sitting on a bed looking disgruntled. The older lady is the patient- she doesn't look very sick. I introduce myself and they state the nurse Mom had on day shift was very rude. I write up a report and put down their quotes. Tell them it will be forwarded to her nurse manager as well as administration, which is what we do with all complaints. I know the nurse they're talking about, and I secretly think she's pretty rude too. I assure them we Take Our Patient Care Seriously here at **** Community Hospital! and feel like I'm a big sap. They seem happy though, state I have been very nice, and that they like the nurse they have tonight. I go up to the desk and leave a note telling them not to give that patient to that nurse tomorrow, and turn in the complaint form to the proper persons. What happens to nurses who are rude? Not much, unless they're really, really rude, and to the wrong people. I've known nurses to be rude to patients for years before they finally get the boot. I don't know why- I was a nurse manager for a year and not a very strict one, but I think after about the third or fourth complaint they'd be gone. Sometimes it's just the patient and they're never happy with anything, but usually there's something to it.
8:30 pm- Make a trip to the kitchen to get food for a patient who has just had his npo status revoked (in other words, he couldn't eat because of tests, but now he can) The kitchen is very big, silent, and kind of creepy at night.
8:45 pm- Look at staffing on the units and, this is a minor miracle, there is actually enough staff for tomorrow!! No begging and pleading phone calls will need to be made in the am.
9:00 pm- Second trip to the kitchen for the lady in 414B who also can now eat. Definitely don't want her aggravated again. I bring her a whole bunch of food and an actual real Coke. She states I am the best nurse ever. It's amazing what sugar and caffeine can do.
9:15 pm- Apparently an agency nurse on the floor has given the wrong patient Dilaudid (a very VERY strong narcotic) Not a good thing. Luckily the patient isn't having any adverse effect; in fact, he appears quite cheerful about the whole business. Ha! The agency nurse is in the break room crying. I give her the little pep talk about how-we-all-make-mistakes so she will finish out the shift (she has six patients, and who's gonna take them? not me!) No doubt she won't be allowed to come back but, I don't have to be the one to tell her that. We notify the Dr and write up an incident report. Here's a tip for people who are inpatients in a hospital: tell them you don't want to have agency nurses taking care of you. I have done agency myself and some of them are excellent, but some of them are very scary. They're often not given enough orientation and don't know the facility which adds to their stress and likelihood of making mistakes.
10:00 pm- A patient in the ED waiting room would like to voice a complaint to the House Sup. Out come the forms again. Down in the ED waiting room, a well dressed businessman type is loudly proclaiming that his wife has been waiting ten minutes- Ten Minutes!- and she has a sprained ankle. It is going to swell up, and she may never walk again if we don't Do....Something.....Now!!!!
Here's where I'm happy I've been a nurse for 19 years- I've kind of seen it all. When I worked ED, we used to get this a lot. At first I would try and tell them that other people were sicker or in more danger and that's why they have to go first. This never had any effect, because to these kind of people, the words have lost all meaning. they really aren't interested in anyone else- these are people who have a very small world and it's ALL THEM. I found a much more effective strategy is what I say to the gentleman- "Now sir, if you or your wife were having a heart attack, you would be very upset if someone with a sprained ankle was taken ahead of you." He can agree with that, because it involves Him. I encourage her to keep her foot propped up on a chair and reassure them this will keep the swelling down and gee, she probably won't actually lose her leg.
11:30 pm- Trip to purchasing to get batteries and a colostomy bag. Hey, what kind of fun can a person have with batteries and a colostomy bag? Lots I'm sure. No, they weren't for the same person.
12 MN- Psych calls me and tells me a) their charge nurse has to go across town to the other hospital we own and do an assessment, and b) they are getting three patients at the same time. The LPN sounds a bit panicked. I go over to psych to be the RN on the unit ( the licensed practical nurse is the medicine nurse, and they can't be in charge) and help out. The LPN and tech bustle around and are cheerful, efficient ladies. I tell them I'll do one of the admissions and they almost fall over from amazement. Apparently this is not something the House Sup ever does. Nurses who haven't worked psych tend to shy away from it, either because they just don't like it (the usual scenario) or it makes them uncomfortable. Since I worked psych my first 5 years as a nurse, this isn't a problem- I kind of enjoy getting back into the groove. The lady I'm admitting is in her fifties, is addicted to pain medication, methadone, Valium, has suicidal ideation and homicidal ideation (in other words, she wants to kill her husband and herself) She is a very angry lady who states her two adult children have "nothing to do with her". Sad, sad. States she has no religious beliefs and no support systems. Years of bitterness are etched on her face. I feel bad for this lady and am relieved to be away from her at the same time.
2:00 am- the charge nurse is back on the psych unit, so I'm free to go. I go around to the Med/Surg side and everything is quiet. Two of the new grads are chatting at the desk and one has his feet up. He looks guilty and jumps when I walk by. I find this pretty hilarious and tell him to keep his feet up while he's got the chance- don't I know how bad your feet hurt after twelve hours of running around on those noncarpeted floors! He still looks like he's afraid of me. oh well, a little fear isn't too bad- I've done some crazy stuff on nights and probably would have done worse except for fear that the House Supervisor would come walking in the unit just as I was having that wheelchair race with my coworker past all the comatose patients' rooms. The ED is now completely empty, and the ERP is looking at cellphones he wants to buy on line. He seems kind of snappy when I ask him to look at my ear, but I don't care. ERP (ER physicians) are all pretty much rent-a-docs- and they get paid very, very well by the facility. He tells me I have an ear infection which I already know, because I get them all the time. He writes me a script for some antibiotics and I tell him thanks. He grunts and goes back to the computer.
3 am- All seems to be quiet everywhere in the house, so I wander outside. I have my beeper, so everyone can get in touch with me. It's a lovely feeling to sit outside under the stars and not have anything to do at the moment. It's still 78 degrees and humid, but that's the South in the summer.
4 am- I start writing up my report for the night. Stop by the ED and pick up packets from the ED secretary that tells who all they have seen, who left without being seen, who got admitted, transferred, etc. All these packets and reports have to go to a bunch of different people in administration. Copies, copies. Paperwork is tedious. One of the ICU nurses wants to leave early and I tell her that's fine, because there's only one comatose patient and no admissions that appear pending at the moment. Obviously this could be a decision I might regret, but it works out tonight. I sit on the unit and talk to the remaining nurse, who is the most cheerful, sweet nurse you could imagine.
5 am- Go to medical records to get old charts on some old woman who has appeared in the ED with a UTI (urinary tract infection) This lady is 96 and lives by herself. Pretty impressive! She is cheerful and talks about all her family and grandchildren and great grands and how the Lord has blessed her. I think of the difference between her and the psych admit lady.
6 am- The ACNO (Assistant Chief Nursing Officer) comes in. Now the fun of night shift is officially over, because the Suits have arrived. (Suits are administrative, non clinical people) She is chatty and tells me a very long story that goes on forever. It's kind of hard to keep looking interested because I'm pretty sleepy at this point and hey, the lady's boring. But one must be polite, especially to one's Higher Ups.
7 am- Get the GI lab keys and take them over to the girls in the GI lab. Return the house keys and beeper to the pharmacy. Go back to the ICU and help them count narcotics.
7:15 am- whee heee!!! I am free to go. This was a great night, especially when you consider all the things that didn't happen (codes, physicians acting out, nurses coming to work drunk, fighting between departments, etc) In a few days I do House again- hopefully all will go just as well!
The night before last I was House Supervisor for the community hospital that I work at. The regular supervisor is on vacation. This is something I've thought about doing, but for some reason was a little intimidated about. It was an interesting night and now I kind of wish I had applied for the position when it was open. I've never liked the feeling of being cooped up, and sometimes when you're on a unit for twelve hours, it kind of gets that way. Oh, the joy of roaming the House (the hospital that is) with freedom. I used to think before I became a nurse - and maybe even in the early years- that the House Supervisor must be an important personage who certainly was busy with very important matters. Hmmmm....sometimes, not always! So here's a synopsis of twelve hours in the life of the House Supervisor of a 100 bed hospital...
7 pm- Pick up the keys and the dreaded beeper from the pharmacist. Complain to the pharmacist about my earache. She gives me a couple of antibiotics.
7:15 pm- Make my first rounds around the hospital, to ensure that all personnel are Doing What They're Supposed to be Doing, or at least pretending to be. Nothing much going on in the ICU- one patient in a coma, one nurse checking her email on the computer. Psych unit, pretty quiet- 16 patients, a few outside smoking, a couple of young girls talking to each other on the couch in the front. Appears to be plenty of staff, and they are suprised I have come by. I guess most people don't think about the Psych unit too much. Walk through the ER- they're busy and everyone is running around. No one has anything I can do to help and I feel like I'm in the way. Nothing critical= I look up at the board with the patient's first names and complaints: Headache, laceration, headache, stomach pain, headache, headache. I figure I'll come back later and get the ERP to look at my ear- perks of the trade. oh well, at least I don't have a heaache!
7:45 pm- Check on the med/surg floor- two wings- medical side looks quiet, surgical side, young graduate nurses running around looking stressed. One tells me the lady in 414B has asked to see the House Supervisor because she has a complaint. I rummage around in this enormous black book I'm carrying (which I'm hoping will see me through the night as it is the House Sup resource book) and find the complaint forms. Enter 414B- older lady and her very large daughter, both sitting on a bed looking disgruntled. The older lady is the patient- she doesn't look very sick. I introduce myself and they state the nurse Mom had on day shift was very rude. I write up a report and put down their quotes. Tell them it will be forwarded to her nurse manager as well as administration, which is what we do with all complaints. I know the nurse they're talking about, and I secretly think she's pretty rude too. I assure them we Take Our Patient Care Seriously here at **** Community Hospital! and feel like I'm a big sap. They seem happy though, state I have been very nice, and that they like the nurse they have tonight. I go up to the desk and leave a note telling them not to give that patient to that nurse tomorrow, and turn in the complaint form to the proper persons. What happens to nurses who are rude? Not much, unless they're really, really rude, and to the wrong people. I've known nurses to be rude to patients for years before they finally get the boot. I don't know why- I was a nurse manager for a year and not a very strict one, but I think after about the third or fourth complaint they'd be gone. Sometimes it's just the patient and they're never happy with anything, but usually there's something to it.
8:30 pm- Make a trip to the kitchen to get food for a patient who has just had his npo status revoked (in other words, he couldn't eat because of tests, but now he can) The kitchen is very big, silent, and kind of creepy at night.
8:45 pm- Look at staffing on the units and, this is a minor miracle, there is actually enough staff for tomorrow!! No begging and pleading phone calls will need to be made in the am.
9:00 pm- Second trip to the kitchen for the lady in 414B who also can now eat. Definitely don't want her aggravated again. I bring her a whole bunch of food and an actual real Coke. She states I am the best nurse ever. It's amazing what sugar and caffeine can do.
9:15 pm- Apparently an agency nurse on the floor has given the wrong patient Dilaudid (a very VERY strong narcotic) Not a good thing. Luckily the patient isn't having any adverse effect; in fact, he appears quite cheerful about the whole business. Ha! The agency nurse is in the break room crying. I give her the little pep talk about how-we-all-make-mistakes so she will finish out the shift (she has six patients, and who's gonna take them? not me!) No doubt she won't be allowed to come back but, I don't have to be the one to tell her that. We notify the Dr and write up an incident report. Here's a tip for people who are inpatients in a hospital: tell them you don't want to have agency nurses taking care of you. I have done agency myself and some of them are excellent, but some of them are very scary. They're often not given enough orientation and don't know the facility which adds to their stress and likelihood of making mistakes.
10:00 pm- A patient in the ED waiting room would like to voice a complaint to the House Sup. Out come the forms again. Down in the ED waiting room, a well dressed businessman type is loudly proclaiming that his wife has been waiting ten minutes- Ten Minutes!- and she has a sprained ankle. It is going to swell up, and she may never walk again if we don't Do....Something.....Now!!!!
Here's where I'm happy I've been a nurse for 19 years- I've kind of seen it all. When I worked ED, we used to get this a lot. At first I would try and tell them that other people were sicker or in more danger and that's why they have to go first. This never had any effect, because to these kind of people, the words have lost all meaning. they really aren't interested in anyone else- these are people who have a very small world and it's ALL THEM. I found a much more effective strategy is what I say to the gentleman- "Now sir, if you or your wife were having a heart attack, you would be very upset if someone with a sprained ankle was taken ahead of you." He can agree with that, because it involves Him. I encourage her to keep her foot propped up on a chair and reassure them this will keep the swelling down and gee, she probably won't actually lose her leg.
11:30 pm- Trip to purchasing to get batteries and a colostomy bag. Hey, what kind of fun can a person have with batteries and a colostomy bag? Lots I'm sure. No, they weren't for the same person.
12 MN- Psych calls me and tells me a) their charge nurse has to go across town to the other hospital we own and do an assessment, and b) they are getting three patients at the same time. The LPN sounds a bit panicked. I go over to psych to be the RN on the unit ( the licensed practical nurse is the medicine nurse, and they can't be in charge) and help out. The LPN and tech bustle around and are cheerful, efficient ladies. I tell them I'll do one of the admissions and they almost fall over from amazement. Apparently this is not something the House Sup ever does. Nurses who haven't worked psych tend to shy away from it, either because they just don't like it (the usual scenario) or it makes them uncomfortable. Since I worked psych my first 5 years as a nurse, this isn't a problem- I kind of enjoy getting back into the groove. The lady I'm admitting is in her fifties, is addicted to pain medication, methadone, Valium, has suicidal ideation and homicidal ideation (in other words, she wants to kill her husband and herself) She is a very angry lady who states her two adult children have "nothing to do with her". Sad, sad. States she has no religious beliefs and no support systems. Years of bitterness are etched on her face. I feel bad for this lady and am relieved to be away from her at the same time.
2:00 am- the charge nurse is back on the psych unit, so I'm free to go. I go around to the Med/Surg side and everything is quiet. Two of the new grads are chatting at the desk and one has his feet up. He looks guilty and jumps when I walk by. I find this pretty hilarious and tell him to keep his feet up while he's got the chance- don't I know how bad your feet hurt after twelve hours of running around on those noncarpeted floors! He still looks like he's afraid of me. oh well, a little fear isn't too bad- I've done some crazy stuff on nights and probably would have done worse except for fear that the House Supervisor would come walking in the unit just as I was having that wheelchair race with my coworker past all the comatose patients' rooms. The ED is now completely empty, and the ERP is looking at cellphones he wants to buy on line. He seems kind of snappy when I ask him to look at my ear, but I don't care. ERP (ER physicians) are all pretty much rent-a-docs- and they get paid very, very well by the facility. He tells me I have an ear infection which I already know, because I get them all the time. He writes me a script for some antibiotics and I tell him thanks. He grunts and goes back to the computer.
3 am- All seems to be quiet everywhere in the house, so I wander outside. I have my beeper, so everyone can get in touch with me. It's a lovely feeling to sit outside under the stars and not have anything to do at the moment. It's still 78 degrees and humid, but that's the South in the summer.
4 am- I start writing up my report for the night. Stop by the ED and pick up packets from the ED secretary that tells who all they have seen, who left without being seen, who got admitted, transferred, etc. All these packets and reports have to go to a bunch of different people in administration. Copies, copies. Paperwork is tedious. One of the ICU nurses wants to leave early and I tell her that's fine, because there's only one comatose patient and no admissions that appear pending at the moment. Obviously this could be a decision I might regret, but it works out tonight. I sit on the unit and talk to the remaining nurse, who is the most cheerful, sweet nurse you could imagine.
5 am- Go to medical records to get old charts on some old woman who has appeared in the ED with a UTI (urinary tract infection) This lady is 96 and lives by herself. Pretty impressive! She is cheerful and talks about all her family and grandchildren and great grands and how the Lord has blessed her. I think of the difference between her and the psych admit lady.
6 am- The ACNO (Assistant Chief Nursing Officer) comes in. Now the fun of night shift is officially over, because the Suits have arrived. (Suits are administrative, non clinical people) She is chatty and tells me a very long story that goes on forever. It's kind of hard to keep looking interested because I'm pretty sleepy at this point and hey, the lady's boring. But one must be polite, especially to one's Higher Ups.
7 am- Get the GI lab keys and take them over to the girls in the GI lab. Return the house keys and beeper to the pharmacy. Go back to the ICU and help them count narcotics.
7:15 am- whee heee!!! I am free to go. This was a great night, especially when you consider all the things that didn't happen (codes, physicians acting out, nurses coming to work drunk, fighting between departments, etc) In a few days I do House again- hopefully all will go just as well!
posted by cherigrace | 3:34 AM
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