Dazed and Confused - How I Feel While Training in the Intake Department

Well, I've been training as a relief Intake Coordinator for 6 night shifts now and after the first two, I thought I already had enough learning to be able to do it independently soon and I told the charge nurse so. Boy, was I badly mistaken when I finally trained with Jonathan, the Lead Intake Coordinator, on my third shift.

The first night, I was oriented by Marlana, one of the night shift coordinators. That time, I observed what she did and took notes, then compared my notes to the resource or reference book that the department had. I noted as much details as possible, or so I thought. I never got a chance to even answer any phone calls because the only 3 or 4 that came were answered by Marlana and after that no other calls came in. I didn't even touch the computer that night. I typed up my notes in my own computer, which I kept adding on to later after subsequent training nights.

The second night, again with Marlana, I went to the intake department at about 10:40 p.m., having been asked by the charge nurse to help in the detox department first since7 p.m. By the time I arrived at the intake department, there were no more beds available in the hospital's psych units and with the phone calls I answered, I only had to tell the callers that we were full. No computer work again that night.

After somewhat digesting the notes I had in combination with the resource book, I thought I had more or less a grasp of what needed to be done. I still needed to be connected to a shared network drive though, to access some logs that the Intake Department used. The hospital uses the Epic electronic medical records system and I thought that I was already set up to access all the sections that the intake coordinators used. Of course, was mistaken, as I learned later.

Finally, this much older Kwai Chang Caine had the opportunity to train one night under the Shaolin master himself - Jonathan. After setting up my personal desktop on the hospital's computer network, we found out that I still needed access to the shared network drives that the intake department used, as well as areas in the EPIC electronic medical records system that I had no access to as a Behavioral Health Worker. Jonathan asked me to contact the Information Systems office so they can resolve these issues. Eventually, after a few phone calls and email exchanges with Information Systems, I was finally given access. In addition, the hospital's admissions department gave me a username and password for the Passport One Source insurance verification system.

On that first night with Jonathan, he went into finer details about medical insurance companies and verification of coverage, what insurances we accepted and what we didn't, Medi-Cal from other counties, and I finally had the chance to enter information on EPIC after we received some calls regarding possible admissions. Entering information was where I started getting bewildered because there were so many things to remember, e.g. - click here, type a note here, close here, open this section, pend here, sign here, reserve here, and so on and so forth. It didn't help that I didn't sleep well the night before and my concentration was already poor. Jeez, how am I going to remember all of that and even if I did then, will I remember them again on the occasional times I'm going to be asked to relieve the full time intake coordinators?

I told the charge nurse the night before, that perhaps I may be ready to undertake the job on my own after orienting with Jonathan for one night. When the charge nurse asked me how I felt at about 3 a.m., I told her I was dazed and confused and that my brain felt so numb, like I just finished 3 finals tests in college. It was then that I asked her to give me as many training nights as possible. In the back of my mind, I was thinking I was never going to figure out the system and was reconsidering whether I still wanted to do it or not. Boy, oh boy, what have I gotten myself into?!

A few nights later, I was able to train with Shaolin Master Jonathan again and he let me sit on the captain's chair. We answered the phone on speaker and he was able to listen in and help me answer questions from callers which answers I didn't know. When it was time to enter information into EPIC, I would turn around to him to ask for clarification on what data to enter and where, since I had already forgotten most of them from a few nights back. It was a pretty busy night because we were barraged with calls from 7 p.m. until about 1 a.m. It was a great challenge to try to multitask and I was glad that Jonathan was there when I couldn't catch up. But, on a good note, I had a lot of opportunities to enter data on EPIC and it was very good practice. Still, I had to turn my head backwards to Jonathan so much that night that I may have gotten whiplash if not for the swiveling chair. Towards the end of the shift Jonathan told the charge nurse that this grasshopper was doing a pretty good job. He was being supportive of course because I felt that I didn't do as well as he said I did.

Did I tell you that I developed insomnia while I was training in the Intake Department? Well, when I tried to sleep, things I was trying to learn and how to do them kept creeping into my mind and made for bothered sleep. I kept thinking about how to do things the right way that it was starting to stress me out.

On my fifth training night, I was with Jane. Jane was a little bit more animated in the way she taught me as compared to the more relaxed way that Marlana and Jonathan did it. I still had to refer to Jane a lot that night when I had doubts on what to do next. One thing different that Jane taught me was to create a template for the End of Shift Report. After five training nights, I still didn't feel comfortable with the process.

It helped that I was able to orient with three different coordinators and I was able to see how they did things their own way to arrive at the same result. Hopefully, I will be able to incorporate the information I learned from all three into my learning process.

On the sixth training night, which happened to be the first time I trained two nights in a row (the others were separated by several nights off or working on the psych units), I was back with Marlana. I took all the calls that night other than one when I was using the bathroom. Between referring to my notes, a cheat sheet that Jonathan had given me, the resource book, and an occasional look back towards Marlana, I seem to have navigated my way through the system, remembering the sequence of steps to be taken, inputting which data and where, and doing updates as necessary. There were only a few calls and that helped me pace myself, and other than a few frantic moments towards the end of the shift, I thought I had done a fair job. I'm off from work for a few nights and so far I haven't received any feedback negative or otherwise, by email or by phone, so far.

Do I feel a little bit more comfortable with the system now? Perhaps I do with the routine stuff, I but I still have much to learn about the finer points of medical insurance verifications, of course how to answer phones in a tactful, customer service-oriented manner, and how to multitask when calls come in simultaneously. Lord knows what's going to happen if we don't get paid by the insurance company for a call I took. My boss is probably going to chew me out!.The job is much harder than I initially expected. I remember back in the mid 1980's when I was working for Tenet Los Altos Hospital, and had to occasionally take intake calls at night. All we had to do was ask the caller a few questions and arrange for him/her to come in for a free evaluation during the daytime, and if he/she came in, I would get an extra $10 in my paycheck. It's much more complicated now and I hope I hadn't already forgotten what I've learned so far after a few nights off. Can this old dog still learn new tricks?

Pregnancy and the Bipolar Patient

Well, whoever made this sign misspelled monotherapy and arrythmia.

Prologue or perhaps I should call this a disclaimer - Let’s just say this is a fictional account and the writer makes no claims on it being based on a real people. Any similarities real or imagined are merely coincidental.

A woman shows up at the Emergency Department and is admitted to the Psych Unit. Almost a month later she is still in the hospital without any signs of improvement. Thus the difficulty of treating a pregnant woman with Bipolar Disorder. The foremost issue is to protect the baby, then treat the mental illness. Medications must be chosen which do not affect the pregnancy and at lower doses and sometimes like in the case of this woman, it has not worked. The psych ward had a similar situation before but with good fortune, even at her worst the woman was still verbally redirectable and she reconstituted quite quickly.

Just a week or so ago, it took four very patient nurses taking turns in keeping the patient and baby safe because she was wandering all over the unit and jumping on and off beds. The mental health worker (MHW) had never witnessed such patience and compassion before from staff in all his/her years working in psych units.

Then the MHW had his/her own opportunity to take care of this patient since she had to be sent to the semi-medical unit for rehydration, i.e. she had to have I.V. fluids infused. Since she was the type who could not stay still for even a short amount of time, the MHW was tasked on pulling the I.V. pole along with her wherever she went, while at the same time trying to keep her steady. Well, even though the MHW had gained more patience in recent years, part of him/her wanted to quit within the first 2 hours of trying to take care of this woman. If not for the possibility of being charged with abandonment of duties, he/she may have seriously considered walking out. There were other things at play though. They were supposed to have an extra worker take care of the patient but that worker was moved to another unit. The hospital did the same thing to the MHW the previous week when they provided an extra worker then pulling him out after 3 hours. Guess what happened after that? The patients started acting out!

Going back to the pregnant bipolar/manic patient, she ran the MHW ragged, thus his/her thought about quitting. What do you do when medications don’t work and the patient doesn’t listen to redirection? You do the best you can but it’s mentally tiring. She wasn’t the type who slept well at night and that’s the reason why 4 different nurses had to deal with her. The MHW was dreading having to chase her around for the 12 hours of his/her shift. Then, as luck would have it, the meds kicked in and the patient fell asleep close to midnight. The MHW was thankful that the patient as well as he/she was getting some rest. Knowing this patient, the MHW was aware that she never sleeps all night and is usually awake by 2 or 3 a.m. and the chase starts all over again. But one can always hope for miracles like for example if she doesn’t wake up until after the MHW leaves at 7:30 a.m., or if she does sleep well (which she hadn’t for the several weeks she had been in the psych ward), maybe by the time she woke up, her mind would be finally clear. But that would be asking for too much, wouldn’t it? She woke up at about 6 a.m. and she and the MHW started a new trek up and down the hallway with the IV pole.

Mind you, the MHW had to rely on his/her past as a lapsed marathoner and dig deep into his/her muscle memory to keep up with this patient. At least the MHW thought he/she could outwalk the patient if need be. When daylight came, the supervisor who happens to be a runner too, came up to help the MHW, which was really good timing because the patient started dropping herself to the floor and it took two people help her up. The minutes ticked by slowly until the day shift took over. The IV fluids were supposed to run for another three hours before the patient was to be sent back to her previous unit. Knowing that made the MHW feel a little better about coming back the next night. But…

When the MHW returned for his/her shift the next night, the patient remained on the same unit with plans to return downstairs soon after change of shift. Once again, the MHW was supposed to stay with her, but at least this time she was no longer attached to the IV pole which made it much easier to walk up and down the hallway. However, her behavior remained unpredictable. The doctor saw her and made a change in her medication. Another nurse soon joined the MHW from downstairs so he/she could help take care of the three other patients on the unit. At least now he/she didn’t have to concern himself/herself with them but rather focus on just one patient. The supervisor informed the staff that the nurse’s aide from the registry never showed up so they were short staffed again. To add to that, they were keeping Mrs. Manic  for another night. At about midnight, another MHW came to the rescue and relieved the other MHW of his/her duties for a couple of hours. Why just a couple? Well Mrs. Manic woke up at 2 a.m. and began screaming and when the first MHW came in the room with other workers, the patient called him/her a child molester and a one minute man/woman among other things. The two female nurses tried to calm her down to no avail. With great relief, the first MHW was able to break away for his/her half hour lunch. When he/she returned, they had taken the patient to the TV room where she was pacing around but also trying to toss magazines and papers from the bookshelf. So the first MHW took her out to the hallway and they started another 10K walkathon. When the patient finally said she was tired, the MHW escorted her back to bed along with the second MHW who needed to be present as a witness in case the patient claimed the first MHW did something inappropriate. She was restless in bed and would drift off for a few seconds before awakening again. It was like a startle response. The MHW talked to her softly and gently trying his/her best to emulate the horse whisperer. It didn’t work too well because she never went to sleep. After two hours of this, the first MHW had to cut himself/herself loose and let the other MHW take over so the first one could check on the other patients. The other MHW gave the patient a shower and changed her clothes before the first MHW did another 10K up and down the hallway until it was time for the night shift to go home. The MHW was glad to have the next two nights off.

Epilogue – What can the whole treatment team do better to make this patient functional again while protecting her unborn child? Perhaps they can consult with the family on what their expectations are so they can make decisions about the care of their loved one. They need to provide some input about what to do next since the present treatment is not working and thus not making the patient any better. It’s a big dilemma trying to save the sanity of the patient and trying to save the life of the baby too.

Well, that’s the writer’s fictional account of what happened one weekend in the Psych Ward where dull moments are sometimes few and far between.

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.

Questions and Concerns at Pacific Hospital - Part 2

          After writing about my questions and concerns a few months ago (Questions and Concerns at Pacific Hospital) following the FBI and IRS raid at my place of work, it has been quiet until recently. The employees have always known that the hospital was looking for a buyer as well as a new management company for the psychiatric units, and it may be possible that the buyer might manage those psych units as well.
          Unverified rumors have been abounding in recent days about Pacific Hospital already being sold and that an announcement will be made in early September. As to who the buyer is, rumor has it (pardon me Adele), it is College Hospital, who owns College Hospital in Cerritos and Costa Mesa. That company has done several tours of Pacific Hospital in recent months so they definitely showed an interest. Some employees have mentioned (again unverified) that when Pacific Hospital hands over the operation to College Hospital, the employees will be asked to sign some papers ending their (our) employment with Pacific and start anew with College, essentially from scratch. The speculation includes forfeiting our accrued vacation time or PTO and a possible decrease in hourly salary, plus elimination of shift differential for the night shift. With a little search on the internet regarding California Labor Law, unused vacation time will have to be paid by the employer upon termination of employment, so it's illegal to forfeit it. Doesn't a change of ownership constitute a termination? Getting paid my vacation time is a great concern for me because I have a lot of hours accrued which I had intended to use for emergencies. This is the section of the Labor Law which covers vacation time: http://www.dir.ca.gov/dlse/faq_vacation.htm which specifically states:

Q.	What happens to my earned and accrued but unused vacation if I am discharged or quit my job?
	A.	Under California law, unless otherwise stipulated by a collective bargaining agreement, whenever the employment relationship ends, for any reason whatsoever, and the employee has not used all of his or her earned and accrued vacation, the employer must pay the employee at his or her final rate of pay for all of his or her earned and accrued and unused vacation days. Labor Code Section 227.3. Because paid vacation benefits are considered wages, such pay must be included in the employee's final paycheck.

          There are a couple of scenarios that have run through my mind. One is to wait for the announcement and just go with the flow and be rehired by the new company with the possible loss of vacation time (if their lawyers found some kind of loophole). The other is to resign as soon as possible so the accrued vacation time can be cashed out before the new company takes over, then after a few weeks, reapply for the same job for lower pay. Of course being rehired is not a sure thing, so that's another concern. Like I mentioned before, there are not too many jobs available in the psychiatric hospital business nowadays. If I quit and cash out my vacation time, I may be able to get by on it for 2 to 3 months, but also have to sign up for COBRA insurance so I continue to be covered by medical insurance, that is, until Obamacare takes over in 2014 (in case I get unemployed for the long term). For now, it's all up in the air because the employees have been kept in the dark and have been left with rumors and speculation. Meanwhile, time is running out. I wish I had the facts.
A couple of days after I posted this entry, the facts were revealed to the employees: Questions and Concerns at Pacific Hospital - Part 3

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

Questions and Concerns at Pacific Hospital

Good lord, what have the owners and administrators of Pacific Hospital done now? As you may know, that is my place of work. Two weeks ago, the FBI and other federal authorities descended upon the place and inspected computer files. The local newspaper reported that the hospital was being investigated for fraud. This usually means insurance fraud and that doesn't bode well because in past years, hospitals have been closed for that reason. Is Pacific Hospital financially stable enough to absorb the penalties that may be imposed upon it? I'm surmising that this is the least that the government can do. The worst of course is to order the hospital to cease operations. So the question of many is how is this situation going to affect the people who work there, especially the nursing staff. This uncertainty is giving us a lot of angst. Will we be joining the unemployment rolls in the next few days? It was bad enough that 4 other hospitals unrelated to Pacific Hospital had to close the previous week for fraudulent activities. Those 4 had sizable psychiatric units so if PHLB closes, there would be a glut of psych workers out of a job and a dwindling number of psych units in LA County. No psych units equals no jobs for psych workers. And where would all those psych patients go?

When things like these happen, rumors fly and one of them is that the hospital had applied for bankruptcy a few days later. Was it a Chapter 7 or Chapter 11 bankruptcy? Nobody knew. I later found out this wasn't true but due to a knee jerk reaction, I believed it was initially. But nobody else other than the person who texted me knew about it and it became apparent the next day that the rumor was unsubstantiated. When I heard who the source was, I should have doubted it already, because I knew that this person was unreliable. Where he got it from initially, I don’t know. For me, bad information is worst than no information.

A few days after the raid, the president of the hospital had an open forum where she told the employees that she still doesn’t know what the Feds were looking for. In an article in the Wall Street Journal three years ago, it was mentioned that the owner of Pacific Hospital had gone into some kind of spinal surgery business arrangement with somewhat of a shady character who had previously been incarcerated for fraud in his dealings with another hospital for the same type of business. So I brought this up at the open forum and asked if the FBI may be checking up on the hospital’s spine surgery operations. As the president mentioned beforehand, she did not know. The owner’s and shady character’s names were mentioned, so I followed up and asked if those two names were on the list of people the Feds were looking for. The president told me that she was not at liberty to answer my question but she admired my boldness for asking it, after which she mentioned that she was the daughter of the hospital owner. I was appalled because I would not have asked my follow up question had I known she was related to the owner! After all I have more discretion than that. I was anxious enough on asking my first question that I could feel my blood pressure rise and the additional embarrassment didn’t help any.

So where do we go from here? The president told us to continue taking care of our patients because the hospital is not closing down. It was one of the stipulations in the subpoena that the hospital will continue operating. Of course, questions persist. If worse comes to worst, what will happen to us? What will happen to our accrued vacation time? Will it be paid out or will we lose it forever? I'm concerned about this because I consider this my emergency money. How about health insurance. Do we qualify for COBRA? If we lose our jobs, do we qualify for unemployment benefits? Will there even be severance pay available? I’m also a contributor in the 401K plan but this should not be affected because the funds deducted from our paychecks are forwarded to a separate investment company. And my biggest fear is that I don’t have any other marketable skills anymore. I've been working in psych since 1981 and it's the only job I know. Even though I’d like to retire, it’s too soon and I don’t feel that I’ve saved enough. For now, we can only hope for the best in spite of the uncertainties. One of those hopes would be for my paycheck to clear tomorrow. WILL IT???
Disclaimer: 

The views and opinions expressed here are not necessarily those of Pacific Hospital of Long Beach, its agents, or affiliates.
OTHER POSTS ABOUT PHLB: http://aboutlifeandrunning.blogspot.com/2013/09/questions-and-concerns-at-pacific.html
Public comments below, private comments: E-mail Me!

Explanation of Papers Signed by Patients

As Behavioral Health Workers (a.k.a. Mental Health Workers), when a patient is being admitted to the psych unit, we are tasked to have the patients sign admission papers. The forms listed below are those papers and I’m going to provide a brief explanation of what the patients are signing in the simplest language I can that they can understand, which may not necessarily be what is exactly written on the forms. This is how I’ve simplified the process:

Conditions of Service – This is basically a consent for treatment form. I tell the patients to sign this paper so the doctors and nurses can treat them while they are in the hospital. The form itself is more elaborate and is in very fine print.

Message to Medicare – This form explains Medicare rights for patients who have Medicare, however most of our patients don’t. So to simplify it, I just tell the patient that we are going to check if they are covered with Medicare insurance.

Patient’s Rights – This is self explanatory. It lists the rights of patients in a psychiatric unit.

Privacy Notification – What I tell patients about this form is that – we respect their privacy and will not release information unless they give permission to do so. It also asks if the patient has and Advance Medical Directive.

Consent to Photograph – We ask the patients’ permission to take their photograph so they can be identified correctly by the staff (in addition to their ID wristbands).

Release of Siderails – In case a patient does not want to use the siderails on the bed, they have to sign this form, but since most of the beds on the psych unit don’t have siderails, I just tell them to please be careful to not fall off the bed.

Notification of Patient Admission – Contrary to what some workers tell the patient, this form is not to get the name of the person to contact in case of an emergency. This form asks whom the patient wants us to notify of his or her admission to the hospital. It also asks if they want to notify anyone in case he or she is placed in locked seclusion or restraints. The third part of this form is in case the patient doesn’t want anyone notified. And the fourth part is a list of people the patient gives consent for us to release information to about their well being.

Hospital Ownership Disclosure – This form is fairly recent and it just to disclose that our hospital is owned by a group of doctors. I’m surmising that this is required by law.

Property List – This form is where we list all of the belongings the patient brings into the hospital. Some workers also list the items being sent to the safe with the security guard. However, the security guard also makes a list of those items that we don’t keep on the unit, so it’s a waste of time to double list them. In fact, our previous department manager said so and most people have forgotten that.

Well, that’s about it. I don’t know how else I could simplify the explanations and in my experience this hastens the admission process which the patient has too many papers to sign. Heck, in the emergency room, they only have to sign 2 or 3 forms!

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

T’was The Night Before Christmas in the Psych Ward

T’was the night before Christmas and all through the psych ward not a creature was stirring except for an occasional loonie who was med seeking. The patients were doped up on their meds with care, with hope that a few more patients like Nick or Claus soon would be there.

The patients were nestled all snug in their beds, while visual hallucinations danced in their heads. The computer screens made the  nurse’s faces glow, and work on the ward had begun to slow. A potluck dinner was had by the staff, and all of us gained at least two pounds and a half.

   

When out from the parking lot arose such a clatter. The ambulances had arrived and the doorbell was rung. The staff’s ears perked up to listen to what was the matter. Davonna had arrived with a patient in tow, with three more coming, all in a row.

No Dasher, no Dancer, no Prancer, nor Vixen. No Comet, No cupid, no Donder, nor Blitzen. Instead through the door in came the EMT’s. Along with patients named Dander, and Blunder, and Fix'em (names changed to protect the insane), none dressed to a tee.

We started work and had patients sign admission papers. While the nurses took care of medical matters. The patients brought clothes and all sorts of things in our presence. Alas, St. Nick they were not and the staff got no presents. We sent the patients off to their beds, all taken cared of, thanks to their meds.

As dawn approached with no sight of St. Nick, we’d done those admissions, I’d say pretty quick. But the intake office called out of the blue, saying five more patients were all in a queue. Without a full moon in sight yet we were getting patients all night, we couldn’t wait till 7:30 to bid the psychos Merry Christmas to all and to all a good night.

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

An Unfortunate Sexual Incident At Work

I have three fears in this Psych Unit business that I’m in and I’ve touched on this in a post a few months ago: first, death of a patient by suicide, second - sexual behavior between patients, and third - being out of a job. That is why I walk a straight and narrow path and have always remained as vigilant as possible in the 30 plus years I've worked in my position as a mental health worker. I have never relaxed and that's the reason why I don't do overtime work - because working just two days in a row, I give 100 percent all that time. However, in my opinion, you can’t catch them all because things can happen in an instant with just a brief turn of the head or being in a partially blind corner. As much as we attempt to be omnipresent, which is an impossibility, we still miss things. Case in point: on December 6^th just before 7 a.m. I was assisting a phlebotomist by escorting her to the patients’ room so she can draw blood and give TB tests. Neither I nor my other coworkers noticed that a male patient had slipped into another male patients’ room. See, we don’t allow patients to visit in each other’s rooms even though they are of the same sex. Just before 7 o’clock, I excused myself from the phlebotomist to do my second to the last rounds of the day before the end of my shift. When I checked one particular patients’ room, I didn’t see him there, which was not unusual because they come and go all the time. I proceeded to check on the other rooms that I was assigned to and when I opened one of the rooms, I saw one male patient lying on his bed in the knee-chest position while another male patient was facing him with his genital area directly positioned towards the lying patients’ buttocks. If that was too graphic for you, I apologize. Well, in a psych unit setting, sexual behavior is a no-no, regardless of whether it’s heterosexual sex or gay sex. All I could do was ask the male in the dominant position to get up and leave the room. He arose and pulled his pants up and left the room while I asked another staff member to call the charge nurse. To complicate matters, we were aware that the dominant male was infected with something I shall not disclose. I described what I saw to the charge nurse and she wrote a report about it.

This is the kind of patient incident that can get someone fired because you may be blamed that you had not done your job well for something like that to happen. I went home agonizing over the incident even though I thought that I had done the best that I could in checking on my assigned patients. I ruminated about how it could have been prevented, so much so that I did not sleep well. Upon waking from my restless sleep, I had three voice mails awaiting me, all saying to call my supervisor so I could give my input on what happened. I composed an email explaining what happened, sent it to my supervisors, then called them. Both calls went to voicemail so I left a message telling them I sent them an email. While waiting to return to work in the evening, I kept on checking my email for a response, but didn’t get any.

If there is anything that would probably support my telling of the event, it would be the omnipresent cameras recording our every move on the unit. The video would show that I was indeed with the phlebotomist and at the time I said I caught the two patients in the act, I was also indeed doing my rounds then. I don’t know what else I can do to prove that I was doing the job I was supposed to be doing. Regardless, I lament that we were not able to prevent it from happening and assigning blame is fruitless because it was a collective failure. I’m awaiting the fallout with trepidation.

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

An Assault With No Visible Triggers

I've been working in Psych Units since 1981 and as psychiatric workers (nurses and mental health workers) we are trained how to manage assaultive behaviors (MAB). We are taught to watch for signs of an impending assault so it can be nipped in the bud, so to speak, before an assault happens, and the cycle that follows. When we see a patient starting to get agitated, we could intervene verbally and/or with medications to calm him/her down so that a full blown assault doesn't happen. Basically these are the steps to an assault: Baseline behavior where a patient is acting normally, a trigger which gets a patient agitated, the assault itself if the patient perceives that his/her needs are not met and attacks somebody, the recovery phase when the agitation declines, then back to baseline when the patient is acting normally again.

So what can you do when the usual signs of an assault cycle do not exist like it happened to me? There did not appear to be any triggers when the patient jumped off the bed twice nor when he tried to punch the respiratory therapist. Certainly none when he punched me at least three times on the head and face, since I was only helping him go to the bathroom. Whatever triggers all appeared to be hidden in the patient's mind. How does one defend from that especially when the patient exhibits baseline behavior right before and immediately after the assault? It was like turning a light on and off.

The doctor could have ordered a tranquilizer after the patient already tried to strike the respiratory therapist, but was concerned that it may impair his breathing if he fell asleep. But that was why I was assigned to watch him 1 to 1, so in case he had breathing problems, I could intervene by at least repositioning him or calling the nurse for assistance.

With the patient's history of assault, I believe he should have at least received a sedative. That may have prevented the attack on me and at the same time, I could have observed him all night to make sure he didn't go on respiratory arrest. Instead, I had to go to the emergency room at 4:15 a.m. to be checked out while leaving the patient alone with his breathing problems. I ended up not leaving the emergency room until close to 8 a.m.

So what happened to the patient after I left him? I don't know and I really don't care. What I care about is my own health because without it, I can't take care of the same kinds of patients who may or may not try to hurt me.

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

Assaulted By A Patient On The Medical Floor

October 9, 2012. 03:50 a.m.

Twenty four hours ago, I became a victim of an assault at work. A patient I was watching on the medical floor punched me on the back of my head and face while I was assisting him in going to the bathroom. But first let me backtrack to the events that led to this assault. I reported for work in South Campus and saw that one of the mental health workers had to float to 1 South. I checked the log book  to see whose turn it was to do it and it was me. I drove to the main building and when I arrived in 1 South I was assigned to watch an elderly Filipino man who the staff reported created no problems during that day, although he had acted out the day before, becoming violent because he wanted to leave the hospital. After getting a snack and receiving his medications, he went to bed and I thought it was going to be a long but easy night for me. At about 10:30 p.m. a nurse discovered another patient having a seizure in his room and the Rapid Response Team was summoned to check him. This patient was just transferred earlier in the day from South Campus for assaulting another patient. He had a previous history of having an adverse reaction to medications causing him to become unconscious. In fact a few days before, he was in ICU because of that. The family also reported that this has happened while the patient was not in the hospital.

 After being evaluated by the doctor, the patient was ordered transferred to the medical floor (2 North). He had apnea and had to be hooked up to the Bi-pap machine. A staffmember was needed to watch him for breathing problems and in case he throws up while hooked up to the machine. Having no other options, the nursing supervisor pulled me from my duties of watching the elderly man and sent me to 2 North to watch what turned out to be a crazier version of Mike Tyson. At first there was no problem because the patient was very sedated from the medications he got earlier in the evening. He was even taken to the radiology department to have a CT scan of the head done, and a chest X-ray in his room to make sure he didn’t breathe anything solid in his lungs while he was having a seizure earlier. Well, after all those tests were done, the patient suddenly woke up and jumped over the siderails of his bed to the ground. He was convinced by the staff to return to bed. As the respiratory therapist was trying to hook him up to the Bi-pap machine, he kept taking the mask off. He was given a regular oxygen mask instead. Then out of the blue, he got up and tried to punch the respiratory therapist. A code gray was called requesting assistance to control an assaultive patient. It was the beginning of a long and difficult night for me.

Due to the recent reactions the patient had to medications, the doctor didn’t want to order anything to sedate the patient for fear that he would go into respiratory distress (I’m assuming). Just a second after the patient tried to punch the respiratory therapist, he looked calm as if nothing happened. He jumped off the bed a second time. A second code gray was called. Again, just as soon as the patient was agitated, he was quiet again. This was a dangerous sign because he was unpredictable and could strike at any time without provocation. Still, a sedative was not ordered. The rest of the staff went about their business after that and I was left alone with the patient. He was also hooked up to an IV and he kept punching numbers on the keypad of the IV machine. When I asked him what he was doing, he glared at me and told me to leave him alone. I checked with the nurse to see if what the patient was doing would affect the operation of the IV machine and he said it did not, so I let the patient do whatever he thought he was doing. He even got angry at a nurse when she told him to put his oxygen mask back on.

The patient fell asleep for about an hour or so, but woke up suddenly at 3:50 a.m. wanting to use the bathroom. I lowered his siderails, unplugged the IV machine, then as I was ready to escort him to the bathroom, I felt a very hard punch land in the back of my head. I felt another one near the same area, then on my left cheek. I yelled for help as I was falling to the floor and a bunch of staff showed up at the door. Then just like a couple of hours earlier, the patient appeared calm right after he assaulted me. He even gave me a urine specimen that the nurse asked me to obtain from him earlier. He was finally placed on soft restraints which I wasn’t sure was going to hold him because he appeared to be too strong for them.

In the meantime, I had other concerns. My head was throbbing and I was dizzy from the punches. I felt a bump where the first punch connected in the back of my head and had some pain on my left cheek. I told the nursing supervisor that I needed to go to the employee injury clinic as soon as possible because I was afraid that I had a concussion. He asked me if it can wait until 7 a.m. because he didn’t have enough staff to cover the patient, and I said it couldn’t. He went to get the paperwork. When he came back, he asked me to fill them out while he contacted the clinic. He planned to have the hospital van take me there because I couldn’t drive myself due to the dizziness. I learned much later that the clinic was supposed to have a shuttle to pick people up but it wasn’t available and not only that, there was no doctor available at the clinic. The nursing supervisor managed to get authorization from the administrator on call to have me treated at our own emergency room. I was escorted there at about 4:15 a.m. and more paperwork had to be completed. Soon, I was evaluated by nurse Jack whom I knew from being floated to the ER once in a while. He obtained an order for a head, neck, and face CT scan. Funny to think about it now, but other than getting my vital signs, neuro checks were not even done on me, nor a doctor see me until was discharged several hours later.

So I was assigned a bed and while waiting to be taken for the CT scan, I just sat there and read a magazine. Pretty soon, I got a text message from Michelle, one of the nurses I work with at South Campus, asking how I was doing. Our charge nurse Jim was checking for possible admissions from the ER and saw my name as a patient there. They haven’t heard about what happened to me. I texted Michelle back saying I was waiting for the CT scan because a patient punched me on the head a few times.

After waiting for more than an hour, the radiology technician showed up and escorted me to the CT room where she took the three ordered tests for the head, neck, and face. She was the same technician who did the CT scan hours earlier, of the patient who assaulted me. After the scan I was back in my ER bed to await the results. My headache and dizziness were still present but felt lesser. Michelle asked me if I needed a ride home and I said I would let her know. Feeling less dizzy an hour later, I told her that I may be able to drive myself home and thanked her for her offer.

Change of shift came at 7 a.m. and I was still in the ER waiting for the CT scan results. This was the worst time to ask a nurse for it as hospital workers would agree, so I just waited until night shift to day shift report was done. I checked with Olga to ask her if radiology is going to call in the results or if they had to check the computer if it was already in. She said they just got the results and the doctor was reading it. Then Jim, my charge nurse and Paulette, the psychiatric emergency team nurse (she was working the ER that morning) showed up to check on me. I told them what happened and that I was just waiting to be cleared by the doctor. A few minutes later, a doctor came to ask me a few questions while I asked him a few as well about my condition and CT results. He said I might have suffered a mild concussion since I didn’t lose consciousness , I was not disoriented, I answered his questions without hesitation, and didn’t have nausea and vomiting. Those were all signs of a concussion by the way. He offered me Toradol for the headache, but I declined fearing it would impair me from driving. He said it wouldn’t but I said no anyway, saying I would just take a Motrin when I get home. After that, with Paulette facilitating the paperwork, I was discharged from the ER. I’m glad she didn’t put me on a 5150 – 72 hour hold J.

My long night wasn’t over yet because I still had to report to the nursing supervisor to find out what to do next with this workmen’s compensation issue. He gave me an authorization for treatment at the employee injury clinic and I was finally able to clock out from work close to 8 a.m. I called the clinic asking them if there was a time limit after the injury for me to show up and the lady said no. I’m planning on going there today for a follow up and see if I can be cleared to return to work tonight barring any complications the rest of the day.

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

A Computer Problem At Work Which Became a Gift Later

Three weeks ago, our IT department scheduled some updates for the electronic medical records system from 2 to 4 a.m. and we couldn’t use the computers for charting. By 6 a.m. they were still not done updating. Well, that went on all day until they discovered that it was not a software problem but a hardware one and it didn’t get fixed until about 10:30 the next night. It didn’t really affect me personally because I was off from work the next several nights. When a computer outage happens at my job, the backup plan is to use our old paper charts. Those papers are being kept under lock and key  and unassembled so that the doctors are forced to use the computers rather than get a form to chart on with their illegible writing.

When I came back to work after my weekend off, the unit secretary approached me and pulled me aside. I thought she was going to tell me about the shelves that were rearranged in the area where I make chart packs. She said that she has been very appreciative of what I’ve been doing with the charts because I made her job easier. She further clarified that during the daylong computer outage, she was about to assemble charts from the cupboards that were under lock and key (she had the key) so they could admit patients. Before she did that, she decided to check the shelves and see if there were old charts left there. Sure enough she found the old charts that I had leftover and kept from the time before we used electronic medical records. I still had about a hundred left. She said she was so relieved to find them and as a token of her appreciation, she handed me a TGIFridays gift card. I was stunned by her offering and was further shocked to see the amount of the gift card! Wow, I get to eat very well for several meals! I haven’t been to TGIFridays in a long time. It was way back when I was meeting chicks from AOL (America Online) IRL (in real life), and we would have lunch or dinner at Fridays. Ooops, perhaps that’s TMI (too much information). Anyway, it was sure nice to be appreciated and rewarded. Hmm, I wonder who I can take out to dinner?

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

The Perils of Working in an Asylum

In an unfortunate night at work early Sunday morning, two of my co-workers got hurt by an assaultive patient. A female nurse got kicked in the head while a male mental health worker jammed his right ring finger while trying to get control of the patient's leg. Because of that they had to be examined at the employee injury clinic. I don't know the results yet because the two hardy souls still reported back to work the next night. So far, there wasn't a visible bruise on the nurse's face which we hope stays that way. You should have seen the stunned look on her face after the kick. She just sat with her back against the wall with blank stare until the charge nurse asked her to get the restraints and set them up. The sprain on the mental health worker's finger might take longer to heal and I'm basing that on my own experience.

It was hard to determine what got the patient agitated in the first place but when they are paranoid, any voices they hear in their heads can set them off at any time. That was probably what happened in this case because all of a sudden, the patient started ripping things off the wall and kicking the wall. At this point no amount of verbal intervention helped. In order for us to keep the patient from hurting himself or damaging property, we had no choice but to take him down to the ground. It's the same as what the police call the swarming technique: three to five people each try to grab hold of a limb then put the patient against the wall or on the ground then hang on until the patient tires him or herself. Kinda like riding a bucking bronco. This is reality. In the movies where you see the protagonist beats up a whole bunch of bad guys? Well that just doesn't happen in real life. We try as much as possible to keep the patient from getting injured but as this case shows, the staff can get injured instead because the patient is the aggressor while the staff has to take protective and defensive measures. We of course have to attend annual classes on how to handle assaultive patients. However the role playing being done in class is in slow motion and often not necessarily the same as how the patient acts or moves. We just try our best to apply the techniques taught to us and hope that neither the patient nor we get injured.

These are the perils and risks we take while working in an insane asylum. Fortunately incidents like the one I mentioned above doesn't happen very often on the unit I work in. That, I can be thankful for. Lord knows that I’ve had my share of hits, grabs, hair pulls, bruises and soreness through the years as part of the job.

A Psychiatric Worker’s Worst Fear

The worst fear a psych worker can have happened to me last Tuesday night – the fear of losing a patient by suicide. The night shift just started and on my initial rounds, this patient was just in her room not giving a clue on what she was going to do next. While I prepared to do vital signs on all the patients, this woman asked another staff member to open the shower for her. A few minutes later, I heard a commotion and three workers rushed to the shower room. Upon opening the door, we saw the patient hanging from the ceiling. She had torn the pieces of cloth that are used to tie hospital gowns, knotted them together, put a noose around her neck, connected the other end to a sprinkler on the ceiling and jumped from one of the plastic chairs in the shower room. She was beginning to gag when we got there and the only thing I had on me to cut her down was a pair of nail clippers that I always have in my keychain. I cut the cord from the ceiling first, then the ligature from her neck. Fortunately, she had no trouble breathing when we sat her down on a chair and her vital signs were normal.

 That just goes to show you that if someone was really serious about killing him or herself, they would find a way to do it despite the precautions we practice, like taking away shoelaces, belts, and sharp objects from them. We were lucky when we found the patient while she was just in the process of doing what she did, which also happened to be the time of my next rounds. If that happened in between, it might have been a different outcome. The patient would have been out of a life and I’d have been out of a job.

Like I said, that’s what I fear the most in my job – finding a patient dead due to suicide. When that happens you might feel responsible because you were not able to prevent it. After all, keeping patients from harming themselves is our main responsibility.  I’ve found a few patients dead before but those were from natural causes or they had underlying medical problems. Even though I felt bad about losing them, at least they didn’t do it intentionally or deliberately.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

NOC Shift BHW Duties and Responsibilities for South Campus (Revised 6/23/11)

Since I don't have anything else to write about, this is what I'm going to post. Ever since my job switched to electronic medical records a couple of months ago, some of my duties and responsibilities have changed and/or have been rearranged. In 2006 I independently made an orientation checklist for new Behavioral Health Workers (or mental health workers) and also as a reminder for old ones in case they have forgotten what they have to do. The checklist below shows the current responsibilities shared by all BHW's.

*Get report from day shift.

*Q-15 minute checks on all assigned patients.

*Pass out snacks at 8:00 p.m.

*Monitor free phone calls at 8:00 p.m.

*Vital Signs – all patients need orthostatic vital signs taken at start of shift. Make 4 copies afterwards and give one to Team 1, 2, and 3 RN’s and Med Room.

*Chart vital signs, nutrition, and ADL’s in Cerner Powerchart.

*Put stickers on Close Observation (Q15 minute checks) Sheets

*Check stickers binder first to see if it is up to date: contains all the patients names in them and in the correct rooms. If any are missing, check the charts if there are some in them. If not, ask the charge nurse to print some out.

*Mark precautions (everybody is automatically on Fall Precautions), write in date and room number of both sides of the Close Observation (Q15 minute checks) Sheets.

*Update Roster (South Campus Combined Precautions Diet Meal & Shower Log) with patient names, precautions, and diet then print out to put on clipboard for day shift.

*Update Goals and Reflections sheet then print out to put on clipboard for day shift.

*Update South Campus NEW Orthostatic Vital Signs sheet for NOC shift.

*Update VITALS-Sherrie Version for A.M. shift then print out to put on clipboard for day shift.

*Monitor smoke breaks at 9:15 p.m. and 6:45 a.m.

*Turn off phones and close dayroom for housekeepers to clean at 10 p.m.

*Insert forms from chart packs in empty chart binders in preparation for new admissions.

*Assemble new chart packs

*When the chart packs in folders run low in the basket, put in new packs in folders and refill the basket.

*Admissions: Check vital signs, height, and weight. Have patient sign forms then witness them. Inventory property and call Security for valuables to be placed in the safe. Orient patient to unit.

*Check showers for items left behind by patients like: soiled towels, gowns, pajamas, empty plastic bottles.

*Assist patients with ADL’s as needed

*Assist with laundry as needed.

*End of the month: Denial of Rights sheets – make new ones for each patient by filling in Month, Year, Medical Records Number and Legal Status. File each under Graphics divider in chart. Tear off white copy from the previous month and place in case manager’s filing tray.

So there you go. This is my job and that is what I do. Oh, and talk to the patients of course.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

Work Matters – Where Have All Our Patients Gone?

The number of patients being admitted to the psych units of our hospital has deteriorated in the past year. Usually, during winter time the units are always full because we get a lot of homeless people with mental problems who want or have to get out of the cold. Lately it hasn’t been that way and I can’t figure out the reason why. Did the government finally catch up with the abuses of some of these patients? It is common knowledge in this field that there are some people who abuse the system. They claim to be mentally disabled, get free medical insurance and social security benefits from the government. After that, they don’t have to work a day in their lives any more. When they run out of money, they check themselves in the hospital until their next check arrives. These are the people whom we usually rely on to fill our units. However their numbers have dwindled lately and that doesn’t bode well for our job security. We are getting sent to other units more often now, or sent home early, or cancelled from work. Still, that’s better than not having a job.

On another note regarding work - I don’t mind end of the shift admissions most of the time except when the patient brings his or her house except the kitchen sink. Inventorying belongings takes most of the time when doing admissions. That is what happened to me last week. As soon as I saw the name of the patient on our roster board, I knew right away that she would be bringing a lot of belongings. When she arrived, I told her jokingly that I didn’t expect any less from her. Since it was 6 a.m. and she had been in the emergency room all night, she was tired and didn’t really grasp what I was saying. Fortunately my coworkers did the vital signs of my other assigned patients for me while I was inventorying this woman’s clothes and accessories. Thank you very much for your help Saganda!

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

Float To The Emergency Room

Saturday night was my turn to work in the emergency room because there were only a few patients on my home unit. I can’t remember the last time I worked there so it was with some apprehension that I showed up at the ER. The night started out slow as I only had to watch one patient who was rather quiet. By 10:30 p.m. others started to show up – a manic woman who talked and laughed loudly, and a doctor from another part of California. Let me just make clear that these were psych patients that I had to watch. I escorted the woman via hospital van to another building at about 1:30 a.m. On the way out of the parking lot after dropping off the patient, what do I see but 3 raccoons foraging for food near the gate! I don’t recall ever having seen a raccoon before in my life but this night more than made up for that by seeing three of them together. That seemed to make an already unusual night even more unusual. Upon returning to the ER, the doctor had been transferred to another unit and my next patient was just being wheeled in a guerney by paramedics. Speaking of mother natures’ creatures like the raccoons I saw just minutes before, this woman was drunk as a skunk. She was brought in the ER because she fell on her face after a bout of drinking. She had a bloody forehead and her nose was slightly swollen. With the x-ray technician, I escorted the patient for a CT scan of her head. She had a bump on her forehead and the scan confirmed a broken nose. This woman was very loud and complained incessantly of pain in her face, neck, back, legs. You name a body part and she probably would have complained on any of that too. Shortly after, a handcuffed man was brought in by 2 police officers. I don’t know the circumstances of his case. All I know was that the cops confiscated his guns. I didn’t ask the patient about what happened as I didn’t want him to be incensed. He was already in a bad situation as it was. Fortunately, he was pretty cooperative and quiet. He spent a few hours watching Law and Order on the TNT network. I could probably have given him a quiz on the show and he would have given me all correct answers. Poor guy had to report to work at 8 a.m. but couldn’t leave because the police put him on a 5150 hold.

Based on the patients I had to watch, the night in the ER wasn’t so bad at all except I didn’t get my 30 minute break until 6:15 in the morning. All I could do was walk to the corner doughnut shop to buy an apple fritter (one of my guilty pleasures that I rarely partake of any more), then return to the ER to wait out the end of my shift at 7:30. Except it didn’t turn out that way. The nursing supervisor called me at 7:05 to let me know that the person who would relieve me of my duties would be late because there was a staffing snafu. Well, I didn’t have too much choice but wait. Fortunately, he arrived at about 7:40 a.m. and soon I was on my way home. Which brings me to the last unusual sight of my day: a man running on the center stripe of a street I was driving on. I think that was even crazier than all the psych patients I had to watch all night.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

Personal Vendetta or Witch Hunt?

Several weeks after I blogged about the fire alarm and intercom system at work (http://noeldlp.blogspot.com/2010/03/fire-drill-that-didnt-work-so-well.html) that got me in trouble thus receiving a final warning (http://noeldlp.blogspot.com/2010/04/final-warning-how-i-got-in-trouble-due.html), and despite my charge nurse reporting the same thing using the proper channels, our findings have not been addressed or maybe just totally ignored.

 I’m starting to believe what my friends have been telling me all along: that the safety officer/head of security has made the incident a vendetta against me by reporting my blog to the human resources department instead of looking at our concerns. I have not arrived at this conclusion easily, but the actions of the two departments who handled my write up didn’t seem to be concerned about how the alarm system did not work so well. Rather, they chose to find fault in the messenger instead of addressing the message. Maybe they took offense when a lowly employee found something they didn’t foresee.

This may be unrelated but there has been a rash of write ups against the Mental Health Unit staff in recent weeks, so maybe the administration is on a witch hunt for one reason or another.

Meanwhile, I’m trying to walk the straight and narrow path so they would not find another reason to counsel me again, or worst, fire me for exercising my freedom of speech.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

The Fire Drill That Didn’t Work So Well

We had a fire drill at work Monday night. Almost everything went well with our response time but there was one or two flaws in the system. If we weren’t pre-warned where the fire was supposed to be, we wouldn’t have known where to run to with our fire extinguishers. First the things that went right. When the alarm sounded, the patients were evacuated to a predetermined spot in the building and all the doors which unlock automatically when a fire alarm is tripped were covered by the remaining staff members in the unit. Three other staff members each grabbed a fire extinguisher and proceeded to the fire location.

 Now the things that didn’t go as planned. We heard no announcement on the intercom about where the fire was supposed to be. The reason for that is aside from the intercom system inside the nurse’s station, there was no other way to make an announcement from the rest of the building. If there was a real fire, the security guard would have to go in the psych unit, unlock a door to expose the fire panel which indicates what part of the building the alarm was set off. Security would then have to run to the nurse’s station to tell the staff there to announce “Code Red” and at what location. In the meantime, time was being wasted and the fire would have grown bigger.

Usually the overhead paging system is accessible from any telephone in the building so that the first person who observes the fire can trip an alarm then use the phone to announce “Code Red” so it can be heard throughout the whole building. Well, there is a disconnect in the way the building and the phone system is set up and the people who ran the drill had no answers except to notify their supervisor about it.

Another flaw in the system is that the lone security guard on the night shift has to do rounds across the street and is not always near the fire alarm panel. If there was a real fire and security was away, the staff would have to run around the hallways of the whole building to look for the fire. Yikes! It doesn’t seem they like planned the system very well.  I hope I’m mistaken and that there is really a paging system that we just don’t know about, but need to know ASAP.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com

Another Harasser or Stalker?

While I was out running last Monday morning, a car stopped ahead of me and waited. I thought it was another case of someone harassing me. I’m thinking – Oh, great! I’m being accosted by another weirdo who is going to harass me like what happened several years ago. Back then, I was wearing running tights during the cold winter months, and you know when a man wears tights, it might show a little bump in the middle front part of the lower extremities. Please banish the thought from your imagination right now because I’m sure it was not a pretty sight. At that time, the man driving a car stopped me in mid run and complimented me on my so called asset (no, not the back part). I thanked him, continued on my run, but this guy kept following me. I had to do some evasive maneuvers by running down some streets in the opposite direction of where he was driving, and just in case he was able to track me down, I headed towards a police substation in the neighborhood. Thankfully, I was able to lose him. I bought my first of several pepper spray canisters after that incident.

Now back to the present and another case of a car which appeared to be stalking me. When the guy rolled down his window, he called out my name! Well I’ll be darned if it wasn’t my former co-worker from the mid 1990’s at a now defunct psychiatric hospital. I hadn’t seen him in more than a decade and only once briefly since that hospital closed, but I recognized him instantaneously even though he had lost a lot of weight since then. What a relief! It was not someone out to harass me after all. Ron M. and I worked together on the night shift for a few years and it was a good partnership. It was too bad that the hospital closed down because it was a good place to work. We exchanged a few updates about our lives and after giving him my phone number and email address, I went on to finish my run while he headed for his next appointment.

At least I wasn’t harassed this time and maybe because I don’t wear running tights anymore.

Public comments below, private comments: E-mail Me!
Back to Main Page: http://noeldlp.blogspot.com