SEMI-RETIREMENT IN 2017?

HAPPY NEW YEAR and HAPPY NEW STATUS!!! After working since 1980 as a behavior specialist, behavior analyst, behavioral health worker, substance abuse technician, mental health worker, caregiver, and now a relief intake coordinator/behavioral health worker, I have decided to cut down on my work hours and try my hand at semi-retirement. Prior to that, I was a physical fitness instructor in the Philippines for 2 years. If anyone is counting, that would be 38 years of working full time except for a brief 6 month stint of being unemployed after being laid off in 2013.

Why just semi-retirement and not full retirement? Well, there's this thing called medical, dental, and vision insurance that I still need from something called a job, and I am reducing my work hours to the most minimum required to still obtain the insurance benefits, although I have to pay more for them. By the way, if it at all matters, I'm 59 and a half years old and 5 and a half years away from qualifying for Medicare.

Since November 2016, I had been considering cutting back on my work hours. Our full time schedule calls for three 12 hour shifts a week, and in the past 5 months, I particularly, had been assigned to work 2 nights a week on the psych units as a behavioral health worker with the patients, and 1 night a week as a relief intake coordinator in an office (which pays slightly more). I had been waiting to see how much of a pay increase I would get which I found out at the end of November. It was decent enough so I started calculating my monthly expenses against my possible income based on the lesser working hours, taking into account the taxes which would be taken out automatically from my paycheck. Based on this, I figured I might be able to survive with still a little leeway for unforeseen expenses, without dipping into my retirement nest egg.

Finally, a month ago, I emailed my Nurse Manager with a request to change my status from full time to part time, effective New Year's Day 2017. My last shift working full time was New Year's Eve.

I haven't figured out what to do with my free time between nights off yet and that's something I'll have to ponder. I've been having insomnia lately so maybe I'll be able to maintain better sleep patterns. Whatever happens in semi-retirement, it's going to be a new journey.

New Year's Eve at work

CHLB Center for Mental Health NOC Shift BHW Duties and Responsibilities

          I just finished my 3 month probationary period in my new job as a Behavioral Health Worker, and while in orientation the first couple of weeks, I learned about my duties and responsibilities, which I now list below. Although the list may  be longer than what I had to do as a care manager in assisted living, it is not as physically demanding. At least not yet.

          First of course is clocking in to work, then checking the assignment sheet to find out if I'm assigned to Unit A, Unit B, or the Geropsych unit one floor up. Then all the staff hang around the lobby area between Unit A and Unit B in what they call the huddle. During the huddle a short report is given on the number of patients on each unit, how many possible admissions are expected, and how many are being evaluated in the emergency room downstairs or in other hospitals. Reminders are also given on any special things that need to be done. After the huddle, we proceed to our assigned units to listen to report about the patients from the day shift.

          Then we do our first rounds checking the location and behavior of the patients. We do this every 15 minutes throughout the shift. Next, we check the vital signs of all patients (temperature, pulse, respirations, and blood pressure). We are usually accompanied by a registered nurse so they can also check on their assigned patients. After all vital signs are done, we give a copy of the vital signs sheet to each nurse, then we enter the results in the Epic electronic medical records on the computer.

This is as far as I will write in narrative form. What follows is the list of my other duties:

• Make sure water container has cold water (add ice from freezer as needed).
• Assist with admissions as they come in (vital signs, papers signed, belongings; contraband; valuables check).
• Snacks at 2030, Canteen run to vending machines,  and Contraband time right afterwards.
• Prepare new rounds sheets for next day. File old rounds sheets at midnight.
• Break down discharged patients charts & keep dividers in binders. Place D/C chart in cabinet near copying machine.
• Make admission chart packs after 2300. Put nursing paperwork and admit packs in empty binders for new admissions.
• Clean tables in dining room with disinfectant wipes. Order staff pantry supplies from Dietary Department as needed (fill out form then fax). Straighten out dayroom, contraband room and donated clothes (in solarium) as needed.
• On geropsych unit, give a shower to at least one patient in the morning (red key in nurse's station for shower & vending)
• Continue Q-15 minute checks throughout the shift. Approximately 5:30 a.m., enter patient's number of hours of sleep and sleep quality in EPIC./ Print out vital signs sheet and meal/shower/BM log for the a.m. shift./Serve decaf coffee at 0600.

Admission papers:  BHW - Release of Information, Notification of Patient Admission, Telephone List, Consent to Photograph, Patient's Rights, Valuables List, Rounds Sheet.

                                 RN - Medication consent , Interdisciplinary Treatment Plan (multi page), Physician's Initial Assessment, Skin Assessment, Patient Education Record, Discharge Recommendation.

EPIC for BHW's:

• Log in. To find your patients: Click System List on left side, Click Units-CMH. Click CMH 4A or 4B or 5. Click and drag Unit chosen to My list on top of left side of screen.
• To chart vital signs: double click on a patient's name to open his/her chart. On left side of the screen, click Doc Flowsheets. On the tabs on top, click Vital Signs. Enter the vital signs in the designated areas. When done, click File on upper left corner. Close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.
• To print labels and ID wristband: on the left side where you found Doc Flow sheets earlier, click Form Reprint. Click on what you want to print and enter how many, then click Print.
• To chart hours and quality of patient sleep: as above, click on Doc Flowsheets, click Sleep on left side, enter number of hours in designated area, click Quality of Sleep, choose appropriate description from drop down list or type in your own comment (F6 key), click File on upper left corner, close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.

Public comments below, private comments: E-mail Me!

Hell of a Night at the Psych Ward

          And then there was this assignment in the most acute Psych Unit of the hospital. The first night was unremarkable and that was when I was able to make those 70 chart packs which I mentioned in my previous post. I was surprised when I was assigned there a second night in a row when things didn't go as well. For starters there was a plugged up toilet because the patients in that room were throwing their trash in it. So I donned a pair of gloves and dug out the trash from the bowl but despite my efforts, the toilet was still clogged and it took a few plunger attempts by the maintenance person later to fix it.

         Meanwhile a female patient was awake and laughing all night long for no apparent reason other than whatever funny things was going on in her head. Another patient was retching and throwing up in his room except for one time when he did it on the full length of the hallway. Guess who had to clean that up? 

         An insomniac who had been complaining of being unable to sleep for days finally did so only to be woken up by the loud snoring of a newly admitted roommate. So he got upset and tried to sleep on the toilet floor (no, not the plugged up one) which wasn't any help because it was too hard. Another man was compulsively pressing the call light near his bed and in the bathroom, and also punching in numbers on the exit keypad. Not because he needed anything or was trying to escape but rather a compulsive habit. 

         A woman was trying to talk to staff all night and was demanding and argumentative at times when she didn't like the responses. A newly admitted religiously delusional pregnant woman who was calm when she was being interviewed, suddenly went postal on a male patient whom she thought was going to harm her baby. She said she was going to protect the baby with her life. The surprising thing was that she went from speaking proper English to ghetto English when irate. Unfortunately she couldn't be medicated at that time due to her pregnancy until properly evaluated by her doctor. After resting for a couple of hours and waking up very early in the morning, she underwent another transformation and started bouncing around the room and talking about how blessed and holy her baby was, all the while bowing and praying and lying on the floor.

          The staff were counting the slow minutes until it was time to clock out. It was just another day at the office. Would you believe I was assigned to that unit 4 consecutive nights that I was on duty?! On that fourth night, 3 patients became menacing towards me because I couldn't give them a second cup of coffee in the morning. I had to request the supervisor for a reprieve and assign me to another unit the following night and thankfully, he did.

Center for Mental Health Orientation, Chart Packs, & Epic Electronic Medical Records

          After hospital-wide orientation, Crisis Prevention and Intervention training, and Epic electronic medical records training, I had unit specific orientation as a Behavioral Health Worker at my new job last month on the Center For Mental Health and Wellness, and I was glad that my preceptor was a pretty cool woman who was gentle with me. We started with the assumption that I didn't know anything, which was what I preferred so I could learn the ins and outs of how they wanted things done. The duties and responsibilities were thankfully very familiar to me since they were what I was doing before I got laid off, and was a stark contrast to my brief foray into the assisted living job. The only problem I had was having to wake up at 4 a.m. so I could work out before what was supposed to be 4 day shifts. Well my body isn't quite used to that since I've been working nights for three decades so the body rebelled and my stomach was in knots. So much so that my preceptor and I requested our director to put me on night shift orientation after just 2 day shifts. After that I got three more nights of orientation from three different preceptors on the three psych units of the hospital. Then I was released to fend for myself.

          One of my first projects was learn how to make admission chart packs. The forms were significantly lesser since the hospital started using electronic medical records on September 1st. What used to be about 40 to 50 forms were down to 14 (even lesser than what I used to handle at the job I was laid off from). On my second night post orientation, I made 60 chart packs even though the supervisors only required 5 each night. Well I'd rather make a lot more during nights that are not busy rather than scramble to make them when there are numerous admissions or when patients are acting out. Later, I was surprised to learn that nobody ever made that many before. Before electronic medical records, I probably wouldn't have either. I just lucked out by being hired there at the time that I was. A couple of weeks later, I made 70 more. Apparently I made so many in such short time frame that the psych units ran out of some forms and welcome folders. To add to that, between the time I made the first 60 charts and the next 70, there were four changes in what forms were needed because they were trying to sort out what they can include in the electronic medical records system. After about three weeks, it appears like they have settled that issue.

         One of my coworkers, upon seeing that I was new, asked me how I became a behavioral health worker. I said I used to be a psych patient, and having observed what BHW's did, I figured I could do the same as well, so I applied for the job. My new journey has began.