Hard Work

The first order of business has to be sincere, heartfelt condolences to family and friends of our recently deceased patient and to the heroic staff who worked so hard to help her. That staff now continues to work hard - helping the other patients on the unit, and helping one another through the inevitable trauma of the event. Thanks, you guys, for working so hard and so well. I know all of our thoughts and prayers are with you as you move through this storm. We are so sorry. And we appreciate and admire the job you did...and are doing.

This team is facing a number of other problems, too, at this time. The Nurse Practitioner I mentioned last blog was the "psychiatrist" for half of this team's patients...now the remaining Psychiatrist has twice the case load. I certainly don't blame the Nurse Practioner, who - while performing the exact same work as the M.D.'s, was getting paid about a fourth as much, I'm told; and I sympathize with the remaining Dr. who now has twice the case load.

So there's that problem.

And here's another one: As I'm sure you know, the Psychiatrists are complemented on the teams by our "Medical" Doctors...i.e., Doctors who look after the physical (as opposed to the psychological) needs of our patients. As if this team wasn't having enough trouble, they are also experiencing the mis-ministrations of their "medical" Doctor. This doctor is notorious. A comment early in the blog remarked "I wouldn't let him take care of a potted plant". I'm pretty sure the remark was about this doctor(using the title loosely). This is the same doctor that refused to order a pain consultation - in direct violation of written hospital policy - for a patient with severe, daily back pain. This patient would cry out every morning as he tried to get out of bed. It went on for months and months, getting worse and worse, until finally a grievance was written...and this guy still would not order a pain consult. (The grievance itself was "stopped" - apparently by Herr Direcktor - it just was not allowed to go beyond the patient advocate's office.) A pain specialist was never used....in-house doctors finally started medicating for the patient's pain.

Anyhow, to get back to the present:

Currently, on this team there is a patient, transfered there after a stay on an admission team, who decompensated very rapidly within a few days of his transfer. Nobody could figure out why. He's become so disabled that staff finally had to help him shower. While they were doing so, they saw that his entire body is covered in sores. They asked the doctor to examine him. The patient didn't want to remove his clothes (remember he is decompensated), so the doctor didn't push it. Since the patient's eyes are running, the doctor allowed as how there was an eye infection and ordered medication for that. The sores remain undiagnosed. The sores are getting worse. The staff wonders if they should wear gloves when caring for him. The staff is wondering if this patient is suffering from advanced Syphilis or AIDS. The doctor is content to "not push it". Meanwhile, of course, the patient cannot take advantage of any behavioral or psychological treatment offered; and the state is paying a daily amount for his psychiatric treatment...from which he cannot benefit; and, of course, the patient is suffering. Thanks, doc.

(I'm told the same guy also wrote a "death note" in the chart before the patient who died had actually died; and was heard to laugh about it in the nurses station. That note has now been removed, naturally. I'm guessing that the one and only reason this guy is still employed is that the Boss protects him...for some reason...Maybe one makes the other look good...and, hey, they BOTH get the big raises.)

And speaking of patients being "unable to benefit" (As I know we were somewhere back there)...there's another paient who's teeth are so bad, causing him so much pain, that all he is able to do is pace and hurt....The patient refuses dental intervention, however. So weeks and months have gone by, are going by, while the State houses this patient...untreated. This really is a sticky ethical dilemma, I think. Should we ask the court for permission to involutarily treat his teeth in a case like this? Certainly the patient has the right to refuse treatment...yet if he can't benefit from treatment, why are we keeping him in the hospital?...and could he benefit if the constant pain and infection from his teeth were gone? And if so, and he's psychiatrically disabled...are we obligated to pursue such intervention? And who, exactly, is the doctor who would take the time and effort to make the appeal to the court? The one who's case load has doubled? Or is it the potted plant doctor?

So many problems all at once! On the upside, this team does have the very best Head Nurse in the place. She's an engaged, compassionate, nurturing person who will be wonderful help to this staff. Thank Heavens!! Imagine if they had the Protected, Personal Info Looser as their Head Nurse at a time like this! Nobody would be allowed to mention that anything at all was wrong. Yikes!

Hang in there, guys. Let us know if we can help!



Comments since last post on Hospital Dangers...comments there will direct you to new comments on other blogs!

Hospital Dangers

Did anyone else notice all the police at the hospital lately? Last weekend, I crossed paths with a big group of them heading for a team where a patient had apparently phoned police with a death threat...they were there to investigate, I understand. And then a few days later, another big crowd of police arrived to transport a patient back to jail. I can't remember any previous events like these...I find it unsettling to see groups of uniformed, armed officials in the hospital. Did they go on to the units armed? I hear that they did. That seems...well, risky. I thought there was a policy about guns, etc. on the units...perhaps not.

Why do we need groups of police now...now as opposed to ever before. Are our patients more dangerous? I know a lot of people say that they are...why is that? Are we less effective ourselves? I think, for one thing, that our current disarray in terms of consistent adequate staffing has a real consequence for everyone's safety....repeated staff competencies nothwithstanding. Are we failing to screen out malingerers, sociopaths, and other inappropriate admissions (like brain injuries), which we are not equipped or mandated to treat? Or were these two events just anomolies that are unlikely ever to occur again? Can we just ignore it and it will go away? (Our hospital's motto). I'm pretty sure we'll try that first. Might work.

And I heard another story this week. It's second hand, so take it as such. I'm repeating it here because it illustrates what I've heard so many times about our leader - stories like these, oft repeated, are what motivates me to want him promoted to some other agency. So here's the story: at a meeting recently of doctors, the top Doctor repeated that all the Doctors are getting a 33 1/3% raise. When a Nurse Practitioner, present because she functions as the Doctor for one of the teams, asked about raises for Nurse Practitioners, the top Doctor said dismissively, "no raise for you...you were only hired in the first place because we can't get enough Doctors"...or words to that effect. Of course, the Nurse Practitioner promptly turned in her notice. Perfect. Now we're one more Doctor short. Rudeness, Arrogance and A Genuine Lack of Appreciation - the hallmarks of our leadership. Talk about dangerous.

One change could change so much here. It's the old trickle down effect.

I've really enjoyed the comments lately...such wonderful variety of points of view. The blog is a great "conversation" between strangers who occupy the same space. The conversation gets disjointed, I know...but, hey, that's the way they are in the real world, too, especially at work.

By the way, the courtyard looks great.

Blog On!

Comments since last post on Hope Never Dies

Hope Never Dies

Insubordination Update: I turned in the paperwork on the Grievance this week. The "other guys" now have 30 days to respond. It's been discouraging to find out that a corrective action doesn't usually end in a firing, even though the letter's phrase "further action up to and including termination" seems to hold out that hope. Apparently a lot of us have been "corrected" at some point in our sojourn here, and few have been fired. I may have to take responsibility for whether I go or stay, after all. Drat. Even so, this grievance business has been fun so far. It's nice to have a concrete way to express an objection. Of course, I'm all too aware of the fact that, after this step, the system will toss the whole issue into File 13 (the circular file). Look what happened to the grievance about the Adolescent Unit, and that issue is as pressing today as it was when it was when it got tossed into the void at the Personnel Board level. Even so, I think it's important for the soul to try to check the wrong and support the right whenever possible.

Check this out, for example: If you figure that each total package of "competencies" training takes (appx) 22 hours to complete, and there are over 200 staff persons who are required to take that training, and you use a figure of $35/hr as an average salary (trying to average the new MHC with the Directors), you find that a complete batch of staff competencies costs $154,000. That's a lot of toothpaste.

And, when you read the "Plan of Action" that this expenditure was a part of, you find that the plan's "measure of success" doesn't require it at all...the "measure of success" turns out to be: "90% of employee files will have identified competencies included in their evaluation plans by 6/30/06."

We did not need to spend $154,000, endure the tedious and time-consuming retaking of already completed competency workshops, figure out how to cover shifts while staff took workshops, etc. etc. etc. in order to satisfy ourselves and JCAHO about this issue....it was just thrown in there...God knows why. Arrgghhhhhh.

Which brings me back to the ever recurrent question, "Who's supervising the Directors?". What other bizarre and wasteful decisions are being made that account for the hospital's inability to give staff raises, retain already trained staff, provide intact furniture for the patients (I refer here to the numerous rips and tears in the sofas and chairs on the units) (oh gosh, get ready for another Director's parade through the unit...they'll be looking at seat cushions this time), ... or get through the month of June without adequate patient toiletries, slippers and snacks... or repair the sprinklers...or...well, you know, it goes on and on (just like this sentence).

I think (again) a total performance and financial audit of this place is in order. I think we can do better.

Perhaps if all the blogs readers would "comment" about wasteful practices that they have observed, we'd get a list so long that even the Governor would consider taking a look.

Hope never dies, eh?

Comments since last post on Main Mental Health Worker, Insubordination and Food for Thought"

Food for Thought

CrazyGate Report: The First Meeting went smoothly, I thought. Grievance not resolved, as expected. On to the second step!

Did you know that the final four were (emphatically) notchosen. They were, in fact, the four who scored highest on the test that all applicants were administered. What does that tell you about the test? Boy, would I like to see that test! Would this be a matter of public record? I should think so, this being the civil service and all. And what were the test-scorers looking for in the way of answers, one wonders. What did the range of scores look like? etc. etc.... Food for thought...food for thought. I understand the candidates had their team interviews - a pro forma exercise, apparently, since the decision will be made by "HMG". The process reminds me of elections in places like Cuba. After the voting, the Leader decides who wins.

On another subject, the other day the Director, an Assistant Director, the Director of Nursing and the one of Psychology all entered one of the units, in a group. At the time, the unit's patients were outside planting flowers in the courtyard, and the unit was quiet. Staff sat at the "staff table" in the mileau and greeted the approaching dignitaries. After pleasantries were exchanged, a dignitary asked if the "Visiting Hours" were posted. Staff directed them to the patient info board. "No," they said. "We mean, are they posted on the door outside the unit, as you come in?" This was rather an odd question inasmuch as the entire group had, in fact, just come in by said door themselves. Had they been interested in the existence of the sign, one would think that they would have looked for it themselves on the way in.

Nevertheless, staff (helpful and accomodating as they always are) volunteered to go down the hall and out the door just to have an official look for the sign. "Yep. It's there," was the staff's report back to the dignitaries. "Would you care to see the patients? They're in the courtyard planting flowers. You're welcome to go on out and visit with them," offered the staff.

"No, thank you," said the dignitaries and they left.

Food for thought...food for thought.

Reminds me of the day I was working on a unit and an even greater gaggle of dignitaries came in together. Gosh, must have 7 or 8 of them. They all flowed past me like a parade, giving me friendly nods as they passed. They marched right down to the "Men's Room", opened the door and looked in. They all looked. Then they stood around a little while, making remarks to one another, occasionally peeping into the men's room. They they all left.

.....

It's probably just me, but I always wonder what that costs. These are relatively highly paid persons. Even twenty minutes of say, 6 of them, could cost upwards of a few hundred bucks. Are we taxpayers getting our money's worth? .... I don't know.

I just don't know.

But I'd like to. I'd really like to know how much it cost to have double completencies administered, too. How many hours of staff time (HST = number of hours per staff times total number of staff) times average hourly wage (AHW) equals how much. Shouldn't be too hard to figure out. It's HST x AHW = $X, am I right?

One thing I feel reassured about, though, is that the Grievance Process in the current instance is bound to go smoothly. Which will be a really refreshing change for me, having experienced - one way and another - 3 which did not. The problem, of course, with a grievance process that doesn't work is that nobody uses it anymore...and then there's really no way to deal with patient-care issues as they arise. Patients become frighteningly at the mercy of the team...Just think for a second, if you were at the mercy of the team, no recourse. I'd sure be hoping for a engaged, ethical, compassionate, experienced team. And hope would be about all I'd have to work with, here lately.

Comments since last post on Insubordination and CrazyGate