Friday, April 15, 2011

A Cautionary "Old Age" Tale, and Some Advice for New Nurses

I’ve had a bit of a rough day today with pain and all… my back aches, my left hip hurts. I’m getting my neurotomies on Tuesday so the end, for awhile at least, is on the horizon. I need to earn a little more money to see an ortho doc about my hip. I have three projects in various stages of readiness; two have tight deadlines that I won't meet if I can't sit at my desk.

So it’s been one of those days I have been reflecting on how I got here, all beat to shit. There are two reasons why I am such a physical mess today: horses and working as a nurse. One gave me pleasure, the other money and heartache.

I rode daily from fifth grade to my senior year in high school. I rode anything with a mane and tail that I could climb on. Several times that meant I climbed on something a bit rank and paid the price by hitting the pavement. But I wouldn’t change a thing, because horses kept me out of a lot of trouble and you truly do not know companionship with an animal until you have teamed with a horse. I miss contact with horses on a daily basis. I love my cats, I really do, but there is nothing like the challenge of an equine.

The second reason I am paying physically is from working as an RN in a small community hospital that enjoyed being understaffed. I suffered too many back injuries to count, doing work that should have been done by housekeeping or a nurse’s aid. Might I have put up with the pain longer had I been properly “engaged” in the job?

I remember a pair of days when I showed up to work and the other RN was an older woman, older than I am now, who worked v-e-r-y slowly and was usually better at passing medication all day. It was all she could do to keep up with the medication needs of anywhere between 10 and 24 patients. There was everything at that hospital—med/surg, OB & newborns, pediatrics, and a 4-bed ICU/CCU. As I recall there were no critical patients in that room those days. During the day shift an RN would be called upon to stay with a patient in post-anesthesia recovery, which was the ICU. Same location, slightly different duties.

One of us had to be charge nurse. I stepped up, but the director of nurses said “Rose is older than you, so she’s charge nurse.” So I passed pills, took care of a couple of post-op patients, and took care of a woman in labor while Rose sat on her duff and took “reports” from nurses’ aids. I did the work of two RNs that day. I didn’t even have time for lunch. Rose took hers. And both breaks.

The way that hospital was set up, all the meds nurse did was pass pills (scheduled and as needed) and make sure she charted what she had done on the medication record. IF she had time on her hands, she could volunteer to help where needed. Because Rose was so slow, that seldom happened. Because Rose was so slow, if I had a patient who needed a pain med, I’d get the chart, find out what I could give, go to the medication cart where Rose was no doubt hanging around, ask for the narcotic key and medicate the patient myself. Rose usually made patients wait awhile, because she didn’t want to wreck her train of thought.

Fifteen minutes before the shift was to end, there was a medical admission from the clinic next door—I believe the guy was a possible pancreatitis, because the doctor told me the patient was an alcoholic and to give him some Librium STAT to keep him in the bed. Rose should have taken that patient and prepared his nursing assessment, but she said, “I am busy charting and getting ready for report, you do it.” She wouldn’t even take the doctor’s call—I was called to the nurses’ station from another patient’s bedside to take the admission orders! Again, something Rose as charge should have done.

So when I claimed 2 hours of overtime that day the supervisors flipped. (I did not finish my paperwork and the paperwork of the new patient until 5 p.m., shift “over” at 3:30 AND I’d had no lunch break that day, because if I didn’t do it, no one on my shift would have!) I told them Rose had been utterly useless, that I had done the bulk of the work that day (easily verified by looking at the patient charts, I was flying!) and that I would NEVER be put in that situation again. “You either work me as charge, pay me that differential and I’ll run around and do the work while Rose plugs along passing her pills, or you will not expect me to work with Rose as the charge nurse EVER again.”

A month later I looked on the schedule, and lo and behold, there were two RNs scheduled for one anticipated slow day—me and Rose. There was a “C” by Rose’s name, which meant she would be charge nurse. I went to my immediate supervisor (the one who made the schedule) and said, “I told you that I will NOT work in that situation, and if you don’t fix it, I won’t show up. I will NOT do the work of two nurses because one is too slow!”

Their excuse for doing it again: “We want to engage Rose more.”

Mind you, she was retirement age then. I was in my late 20s or so, and had worked as an RN for six years at that hospital. I was the nurse who never refused a shift. I was the nurse physicians inquired about regarding my availability to take care of their laboring women or women who needed elective labor inductions. I was the nurse who would come in for the night shift and stay for the day shift, or work the p.m. shift and stay into the night shift to help.

And which nurse SHOULD they have tried harder to engage?

I did not work that shift. Well, I didn’t work it as it was… I was taken off the schedule for that day, but the place got busy and asked me to come into work, which I ALWAYS did. There was Rose, plugging along with her precious pill cart, where she needed to be. I delivered babies, covered ER, and had a great day with a nurse closer to my age who worked as charge twice a week.

So what is the moral? Don’t kill yourself doing your job, because 20 years later, no one cares. You have to care for yourself, NOW. Be careful, and make smart priorities. You will thank me in the end.


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