Vacation...all I ever wanted!

Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!

Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.

I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.

One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.

I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.

We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.

I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.

As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?

Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!

Stay tuned...back to work next week!