A Perceived Transgression at Work

          SLANDER - 1: the utterance of false charges or misrepresentations which defame and damage another's reputation; 2: a false and defamatory oral statement about a person.

          Apparently I'm being blamed or accused of something I didn't do. It all started at the beginning of the shift when one of my co-workers was ignoring me when I told her where to find the chart dividers. At first I thought she was upset over how I was motioning to her and directing her to where the chart dividers were, but a few minutes later when I asked her something, she told me not to talk to her. So I didn't, because I did not want to further inflame whatever perceived transgression I did. Normally when this co-worker comes in to work, she immediately says hi to me, but on this particular evening, she came in with an angry mood.
We still had to do our jobs so we went through the motions of what we needed to do but without talking to each other, while I remained clueless as to why she was angry at me. When another co-worker asked her about her upcoming schedule change, she said she doesn't want it anymore and wanted to keep her old schedule. This, after working with her for weeks on the change so she could have every other weekend off like everybody else.
          I don't talk much at work anyway, so when she told me not to talk to her, it wasn't much of a stretch for me. However, having someone being angry at me for no apparent reason was bothersome. I learned from someone else that our supervisor was going to show up to talk to my upset co-worker but no one knew the reason why. I heard much later into the shift that someone anonymously emailed the human resources department some pictures of my co-worker sleeping in the hallway and using her tablet computer, and she was called in to explain what she was doing. With such evidence, she almost got fired. How this connects to me, I don't know, because I wasn't the one who sent the anonymous email. But since I'm the one who knows a bit about computers in our group, my co-worker mistakenly assumed that I may have been the one who did it. Thus her silent treatment began without her telling me why she was upset at me.
          First of all, I have never reported anybody to human resources or even our immediate supervisor, because I believe that whatever I report about any of my co-workers will also affect me and not just the person being reported. It's one of those "he who is without sin, cast the first stone" situations. Therefore the whole shift of workers suffer if that happens. One way or another it's hard to avoid drifting off to sleep in the hallway for a lot of night shift workers, and just about everybody uses their computers, tablets, or the hospital's computers to surf the web.
          Perhaps the person who sent those pictures to human resources had some kind of altercation with my co-worker who until now got along very well with me. As far as being blamed for sending the pictures and who actually sent them, well, that's the mystery. Heck, they can check my computer, cellphone, camera, or even IP address and they will not find any evidence of me doing such a thing. And if they wanted to delve deeper into this, digital photos nowadays contain lots of information, from megapixels to date and time they were taken, and even what kind of camera they were shot from (EXIF data). Forgive me for going into CSI mode (or more likely - geek mode), but if I can have access to those digital photos, based on all that available information, I can prove that I was not the one who took nor sent them to human resources.Thus, my conscience is clear because I remain totally innocent.
          Miss S., if I didn't like working with you, why would I put you in the same schedule as I have? Unfortunately, you have accused the wrong person. I should be very angry that you think I would do something like this. Instead, I'm terribly disappointed.

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.

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The Bedwetter Special

We received a particularly difficult new admission Saturday night around midnight. She wasn’t really new because she was just discharged the previous week, and she was difficult because the scrutinized all the papers she had to sign even though she was already familiar with them from several admissions in the past. When it was time to inspect her suitcase, I opened it and the blast of urine stench escaped and surrounded the immediate area. Apparently she was such in a hurry to leave her board and care home that she dumped her urine soaked clothes in the suitcase. As a courtesy to patients, we wash their clothes for them in the unit’s laundry room. After I put two loads of her wet clothes in the washer, I notified her of what I did. I was taken aback when she asked me “did you sort them?”. Excuse me?! It wasn’t like she had whites and colors because they were all colored. And besides, we don’t run a valet service here so I told her in my most pretentious sarcastic voice, “I’m sorry but your only choices are washed or not washed.” Fortunately she acquiesced. The “did you sort them” question was the running joke for the rest of the night. After I ran the clothes in the dryer, I did sort them out: pants, blouses, and undies. Please forgive me for forgetting the fabric softener Downey or some other dryer sheet. They were not available.

The next night, another bedwetter asked me to wash his clothes at 3:00 a.m. Not a problem. As I turned the corner, my coworker asked me to also wash the previous night’s admissions clothes. Well, whaddya know but they were even wetter and more than the other patient’s clothes. I had to carry three pillowcases full of clothes with my left hand while keeping my right hand “clean” so I can use it to open doors with my keys without contaminating them. After I put the clothes in the washer, I told my coworkers that tonight, I sorted the clothes: wet on top, wetter on the bottom, and to add to the yuck factor, bloody in the middle (yes, to top it off, she had her menses!).

See what we have to deal with sometimes as part of our job? The sad thing is I don't even work in a geriatric unit. These patients ages ranged from 37 to 57. Fortunately we can add some levity by joking about them. But not in front of the patients of course. I shouldn’t be so hard on them because I may become one myself some day, sans the menses.
An update: we had 4 bedwetters during the night - probably a record for our psych unit. The patients must have been pissed!

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So Why Didn't I Get a Raise?!?

I started writing this last week upon finding out that all my coworkers had gotten a salary increase in their last paycheck while I did not. Three years ago, our employer gave us a raise and a month later when the recession struck, they not only laid people off, they also took away three percent from the remaining employees’ hourly pay. At the time, most employees got a three percent raise but when the employer took three percent off the new hourly rate, the workers actually got lesser money than before the raise took effect.

 So back to my problem. What I wrote below was in preparation for me to plead my case to my supervisor and human resources, because my annual review was quite good. Well, practically everyone gets good reviews anyway based on past evaluations and if so, why did my coworkers get a raise and I did not. Here is what I wrote last week:

Reasons Why I Deserve a Raise:

*Mentored coworkers when Electronic Medical Records system started.

*Keeps unit stocked with admission chart packs by streamlining the way they are assembled.

*I’m the only one who makes chart packs in our unit on South Campus.

*Does the most frequent rounds of any night shift Mental Health Worker.

*Does not fall asleep while monitoring the hallways at night.

*Developed a list of Mental Health Worker duties and responsibilities and revised them as the job evolved.

**Has been  proactive with having the Registered Nurse sign the back part of the rounds sheet because often times they forget that it needs to be done.

*Does most of the heavy lifting during the works shift (I usually do more work than my coworkers).

*I often go the extra mile by doing work I’m not required to do like filing the rounds sheets before I clock out in the morning.

*When admitting a patient, I’m the only one who automatically gives them gowns, pajama bottoms, and towels (extra blanket too if the room they are going to is cold).

*Cut down a patient from the ceiling who trying to hang herself in the shower.

*I’m very organized and work is done in the most efficient way possible.

These may appear like inconsequential things and they go unnoticed and probably taken for granted because it’s work that I do on a consistent basis. I have never wavered in this work ethic since I started working here, unlike others who become too comfortable and show apathy after just the first few weeks of being on the job.

I’m not the type to toot my own horn but I felt slighted when my paycheck didn’t reflect a raise a couple of weeks ago. I haven't gotten complacent either. That’s why I wrote those reasons above. I started to think that all that hard work doesn’t pay off since the slackers got a raise while I did not. Holding out hope that there must have been a mistake, I decided to wait for the next paycheck to see if there were any changes before calling my supervisor and presenting my reasons. Hallelujah! When I checked my paystub online last Thursday night (we don’t get paper stubs any more, money is directly deposited in the bank and stubs are in pdf), I saw that I was getting two paychecks: one for the a correction of the previous paycheck and the regular check showing that I had indeed received a fair increase for all the hard work I have been doing. Will that raise enable me to retire in a couple of years? Well, it was only a few cents per hour. I don't know how many percent my coworkers got, but I'm happy with mine. Let’s just hope they don’t take that away again in the near future.

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Complacency, Laziness, or Apathy?

I dare say all of the above. I’m terribly disappointed and angry at one of my coworkers whom I feel is not pulling her weight even to the point of shirking minor duties. Even for her, I found it hard to believe what she did last Sunday night. Up till now, I haven’t said a bad thing about this woman, but it appears that as time goes on she has become too complacent with what needs to be done in our job. I dare say that complacent is too mild a word for it. Complacency is something I don’t give in to and that just differentiates my work ethic from others. It’s not as if our jobs are physically strenuous, although it could be mentally tiring, but there are some tasks that just require a little common sense. Let me tell you about last Sunday night that raised my ire unnecessarily.

 I was assisting a couple of patients by putting their clothes in the washer and dryer. While I was in the laundry room, I heard a knock on the door. It was a patient asking me if I could take them outside to the patio for a fresh air break. I told the patient to ask the staff sitting out in the hallway who were doing nothing other than talking with each other. The patient said the mental health worker in the hallway sent him to me. This person had to gall to tell a patient to follow me to the laundry room and ask me to take the patients for a fresh air break in the patio when I was already busy with something else, while she was just sitting there talking?! It’s not as if she didn’t see me carrying two bags of clothes to the laundry room because I walked past her on my way there. She could have easily monitored the fresh air break while the other person monitored the hallway. Instead she told the patient to ask me?!!! I don’t know if she expects me to be in two places at one time. I asked her why she couldn’t escort the patients to the patio and she said because she was watching the hallway. I brought it to her attention that there was an LVN sitting with her who could have done that. She replied that the LVN was passing out medications. Well, that response was not justified because the LVN finished passing meds half an hour earlier. By the way, she doesn’t just reply, she retorts, even though they’re not logical. More like response to cover guilt.

Wow! I still can’t believe up to now that it happened. How can one be so lazy? All because she didn’t want her conversation interrupted for a 15 minute break to assist the patients? That doesn’t even require physical or mental work! It’s difficult to comprehend that kind of thinking and that’s why I was so angry about it. This is not good for me because it spikes my blood pressure and it takes awhile for me to get it back down.

Being the one who does most of the heavy lifting on our work shift and don’t complain about it, I think I’m justified about my complaints about the other person here. Please forgive me for my rant but I’ve been bottling it in and I just needed an outlet.

Here is a draft I wrote a few weeks ago regarding another incident. I was going to title it – Blissful Incompetence:  I don’t know what to think about some of my coworkers anymore who have been working in our hospital for several years. Is it laziness or apathy? Despite being here for years, some of them don’t seem to know or haven’t learned how to do things properly. Even when you delegate the simplest jobs to them, they seem to bungle it. They also take more time than necessary to finish, and not even finish it correctly at that. The diligent ones really shouldn’t have to check up on the others to make sure they did the job right the first time. I guess some people just want to get paid without earning it.

Do you have any coworkers with similar work habits? How do you handle the situation?

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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.

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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.

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Back To Basics - A Uniform and Group Therapy Mandate

          Starting June 1st, our hospital has mandated the mental health unit staff to start wearing nursing garb, i.e. scrubs. We’ve always had to option to wear those instead of the civvies that has been standard wear for psych units for decades. One of the reasons why out administration decided to do this was because they wanted to eliminate the wearing of hoodie sweatshirts. I guess they finally got a clue that people wear hoodies so that the cameras that surround the hospital hallways cannot identify them. As I post this, I would have been wearing my uniform the previous night.
Another thing our bosses wanted us to do was group therapy on the night shift. That would be difficult to squeeze in between the time we report to work at 7 p.m. and 10 p.m. when the patients go to bed. I commented facetiously during a staff meeting that maybe I could conduct group therapy while passing snacks at 8 p.m. Pass the patient a snack and ask him/her how the day went and if he/she met her goals for the day. If not, what he/she could have done better to achieve those goals. In the meantime, the rest of the hungry masses (and they are always hungry) wait in line for their turn. Then a group riot ensues… Just stating the worst case scenario.
In reality, this is how the night shift schedule works out: at 7 p.m. we report for duty and until 7:30, we listen to report from the day shift. At 7:30, we do our rounds, check on how our assigned patients are doing (first we have to make sure that they haven’t run away, and are still alive). The mental health workers do this while the RN’s talk to their patients. It is also in this span of time that patients get visits from family and friends until 8 p.m. The LVN’s on the other hand are getting the medications ready for the evening. At 8 p.m. we serve snacks to all the patients. They line up in the dining room and we pass out whatever the dietary department left for snacks: sandwiches, or fruit cups, or yogurt, plus juice and milk. This can be quite chaotic since everyone wants their share plus more. Some patients want a second helping even when the others haven’t had their first helping yet. Also at 8 o’clock, we offer free phone calls on the hospital phone and there is another queue in the hallway for that. Some patients do their phone calls first, then come to the dining room to get their snack or vice versa. Did I mention that we also check the patient’s vital signs at that time? There is another line in the hallway for that and we have to do orthostatic blood pressures and pulses which take time especially that we almost always have 30 to 36 patients. This takes about an hour and a half to finish.
So there is a constant flow between the hallway and the dining room. How are you supposed to conduct group therapy that way? By 8:30, the medication nurses are ready to pass medications and that requires a separate line in the dayroom area where the medication room window is. So there are actually 4 activities going on at the span of time between 8 to 9 p.m. After that, at 9:15, we conduct the last smoke break of the day, which lasts till 9:30, and finish off the remaining vital signs. Most of the patients go to bed after that and a lingering few watch TV until 10 p.m. after which we close the TV room so that the housekeepers can clean it up before they leave for the night. As you can see by now, the schedule is tightly packed between 7 and 10 p.m. and squeezing a group therapy session in there would be an exercise in futility. Of course the bosses who told us we should do group therapy has never worked the night shift or even observed what goes on in the evenings. Go figure.

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Visiting the Intensive Care Unit and Meeting a Remarkable Patient

Another opportunity presented itself to work on another unit of our hospital. I’m calling it opportunity here, rather than saying that I was forced to go there because it was my turn to do so when the patient count on our unit fell below regular staffing levels. So anyhow, when I heard that I had to go to the ICU, I felt some dread because last time I was sent there, I had to do a 1:1 with a rapid detox patient (http://noeldlp.blogspot.com/2009/11/my-night-in-icu.html) who was so confused that he was practically jumping off the bed. When I arrived, I asked the person I was relieving what the history of the patient was and the reason why she was on ICU. It turns out she originally came from the psych ward where she was on a 72 hour hold for overdosing on her sleeping pills, then because her pulse and blood pressure was dropping to dangerous levels, she was sent to the medical floor. When they were not able to stabilize her there, she had to be sent to the ICU. So that is where I met this totally blind but remarkable Asian woman. For privacy reasons, I will leave some personal details vague so as not to violate any laws.

***Side note: when psych patient on a 72 hour hold or more are sent to a medical floor, they are automatically on 1:1. Because this patient is blind, she was already on 1:1 on the psych unit because her condition makes her unable to protect herself in case another patient acts out.

 I first thought she was asleep when I entered the room, but she stirred while I was getting report from the outgoing shift. So I introduced myself and told her that I would be with her all night and if she needed anything, to please let me know. She asked me where I was from and I told her that I was Filipino. I was surprised when she said I didn’t sound like a Filipino because I didn’t have an accent compared to the other nurses who were talking nearby. I chuckled, thanked her and told her that my accent still comes out from time to time when under stress. So on to her story. She told me she became blind due to a gunshot wound to the head while fleeing the Khmer Rouge’s atrocities in Cambodia during the time of “The Killing Fields”. Her daughter died during that time and she escaped with other people to Thailand where she lived in a refugee camp until being transferred to the U.S. in 1979. While she was only partially blind during her escape, she became totally blind a few years after arriving in America. Even though lacking knowledge of the English language, she not only learned it but learned Braille and typing as well. In the meantime she raised two sons, one who is an engineer and the other who is unfortunately, unemployed. I didn’t ask particulars about her former family in Cambodia and new family in the U.S., however I asked if she was interested in writing about her experiences so she can share her remarkable story with more people. She said she didn’t know how to spell despite being able to speak English fairly well. Plus, it would be difficult to translate from Cambodian to Chinese, to Braille, to English. As far as she knows, there is no Chinese Braille. While in this country in recent years, she has been living independently in her own apartment despite her blindness and she said she likes to clean and cook. Heck, I’m fully sighted and I don’t even like doing those things! I was in awe while listening to the highlights of her life story because of the obstacles she had to hurdle to get to where is now, and which continues to be a challenge due to her blindness. She on the other hand began teasing me to ask one of the nurses for a date upon learning that I was a bachelor. I said, I’m pretty sure that all of those nurses were already married (which was confirmed by listening to their conversations later). Too bad, since they were quite attractive women, LOL!

In the middle of the night, the patient asked me to leave the room and call her nurse. I wondered why until she told the female nurse that she needed to use the bathroom. I wouldn’t have minded assisting her with the bedpan but I had to respect her modesty and preference for help from a female.

                The shift was pretty unremarkable as far as having to work hard. In fact it was probably one of the easiest 1:1’s I’ve had to do. And to hear her story made it even more interesting. She was such a good patient that even though she didn’t sleep well, I ended up finishing a magazine that I was reading plus 6 newspaper crossword puzzles that I had been saving for quiet nights like this. When my shift was ending she asked me if I was going to be back the next night. Most likely, I would not be, so I bid her goodbye, wished her luck, and thanked her for telling me her story.

                ***Another side note: one of the nurses asked me if I was a runner because she said my physique looked like I was one. I responded that I used to run but am no longer able to do so and that I just do cycling now and mostly stationary cycling at that. Nice to hear that I still look like a runner J.

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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!

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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.

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UnGreen Medical Records and Other Work Stuff

At work, we have to assemble admission packs consisting of papers that need to be in a patient’s chart. There are two packs that we make. The first one goes in a binder and the other goes in a folder. The patients have to sign the papers in the folder when they get admitted, and the staff has to witness their signatures. The rest of the papers in the binder are where the nurses, doctors, recreational therapists, and caseworkers do their documentation. After the patients sign the papers, they are filed in the aforementioned binder.

Here is the problem: in a world where people are attempting to be more “green” and try to conserve natural resources, the psych unit in our hospital has the most paperwork I’ve ever seen ever since I started working in the psych field (even after a couple of forms have been eliminated). Case in point: the first chart pack consists of 30 different forms (some with multiple pages), some are NCR (no carbon required) paper with 1 or 2 duplicates, and the others are single sheets. Out of those 30, 5 forms need to be doubled, meaning we have to put 2 of those forms in the chart, so that makes 35 altogether. The other pack consists of 18 different forms and most of them are NCR. That makes a total of 53 forms to make one chart! That’s before the face sheets, insurance info, emergency room documents, and whatnot are added. The charts are so heavy that you can use them for weight training, and if you are not careful, you can throw a joint out!

The hospital is planning on switching to electronic medical records but I haven’t heard of a target date on when that’s going to start. I hope it eliminates most of the 53 forms that we use now. So much for weight training. I might have to lift the computer monitor instead.

A brief anecdote about what happened last Tuesday morning in the frontlines. The phlebotomist came to draw blood from some of our patients. I asked one very anxious and agitated female who was admitted the previous day, if we can draw her blood. This was her response – “You’re not going to draw s… from my a..! That was so unexpected that staff and other patients in the immediate area erupted in laughter. Who says you can't find humor during a tense situation?!

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TLC for the PYT and other work stuff

Tender Loving Care for the Pretty Young Thing -that’s what I call it, and why? I have a co-worker who constantly gives special attention to the pretty young women patients that we admit to our unit. If perchance he is the one who has to take care of the admission paperwork, he takes his good old time doing it because he asks probing questions on the patient’s personal life, even though that’s not his job. But if by chance he gets a homely or older patient, he finishes the admission paperwork in much lesser time. All his co-workers notice this and kid him about it but it doesn’t change anything because he continues to do it shamelessly. He doesn’t seem to care that there is a perception of impropriety in his actions, and his excuse is that he is married and what he’s doing doesn’t mean anything. Methinks he misses the point of the “perception of impropriety”.

Printer problems at work – the other weekend, the computers on our unit were having difficulty connecting with the network printer in the nurse’s station. Sometimes it would print after we turn it off and on but most of the time it would just sit idle and not do anything. We used to have the option of using another network printer but the applications we were using could not locate that printer. I tried to work around the problem by emailing the document I was editing to myself, then accessing my email from a different computer. When I opened the email, I had the option to download the document or open it in a browser running Microsoft Word Online. Downloading the document wouldn’t have helped because the computer I was on didn’t have a word processor. When I opened the document in the browser and clicked print, the missing printer showed up and thus, I was able to print the document. The workaround did the job! The next day we were able to add the printer to the list of options by finding out its network name. Unfortunately, this has to be done for every individual user who logs on to the network. I only did it for myself and my charge nurse. The others would have to rely on the IT department. Isn’t it nice to have a little knowledge of how computers, the internet, and networks work? Who was it who said “a little knowledge is dangerous”?

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Checking Blood Pressures At Work

The behavioral health unit in our hospital was inspected by the Department of Mental Health a couple of weeks ago and one of the things they wanted corrected was covering the electrical outlets in the patient rooms. Although there have not been any incidents regarding those outlets in the hospital, there must have been some in other mental institutions. I know for sure that patients sometimes insert graphite from pencils in the outlets to create a spark so they can light smuggled cigarettes. So since the DMH ordered all outlets covered, the staff could no longer check patient’s vital signs in the rooms. The blood pressure machines do come with rechargeable batteries but the machines we have run out of power pretty quickly if they even recharge at all. Now we have to rouse the patients as early as 5:30 in the morning to come out of their rooms and into the hallway where we can plug in the blood pressure machines. It really hampers the staff by making them unable to finish their tasks if the patients don’t want to get up so early. The best we can do is just mark it as a refusal by the patient to have their vital signs checked since we cannot force them to do it. One solution would be that the hospital provide the workers with better equipment. Given the tough economy, that is not forthcoming. I for one do not like waking patients up very early since that makes them cranky especially when they have nothing to do that early to occupy them. Smoke break doesn’t come until 6:45 and breakfast is at 8 o’clock. Of course there is the option of checking blood pressures with the old fashioned sphygmomanometer and stethoscope.

Taking initiative, I bought my own battery operated wrist blood pressure machine from Harbor Freight Tools, costing $20.00, and the few times I’ve used it, the device was working quiet well. I am now able to check blood pressures of the patients assigned to me at their bedside without having to ask them to get up. I’m still using the hospital’s thermometer and pulse oximeter which don’t need to be plugged in. Sometimes you just have to find your own solutions to obstacles that come your way.

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An Abnormal Night At The Asylum

This is what the staff members look like.

What has this night brought us? A fire alarm at the start of the shift, for one.  A claim for 2 lost shirts second. Third, a complaint of chest pain. And fourth, a lost or misplaced wallet. With bated breath, we awaited what more is to come, for the night is still young. It’s only midnight, and there are 7 ½ hours more to go. If ever there was an abnormal night at the asylum, this was it.

I am talking about the happenings of Tuesday night at work and how I was feeling at the stroke of midnight. There is no more live blogging for me, so I have to rely on memory.

The fire alarm sounded at approximately 7:25 p.m. just as the night shift was relieving the day shift from their duties. We had to evacuate all patients to a prearranged meeting area. After about 15 minutes of the alarm bells’ constant ringing, we were finally given the all clear signal. It turns out that the maintenance people replaced a water heater and when they tested it, there was some sort of combustion that produced smoke which triggered the fire alarm.

The second incident involved a patient claiming the loss of two t-shirts. Some staff members helped him search for the shirts in his room and laundry area, but they were nowhere to be found. The patient was asked to write the shirt descriptions so we could send it to our supervisor. The day shift later told us that the patient had already claimed the loss a couple of weeks back.

Then at about 10:45 p.m., a female patient came out of her room complaining of chest pain. Vital signs and oxygen level was taken. Blood pressure was dropping, pulse was slightly elevated, and oxygen level was within normal limits. Since we are a free standing building with the emergency room at a separate location, we had to call 911. The paramedics arrived in no time and whisked the patient out within 10 minutes. The patient was later cleared in an emergency room and returned to us at about 3:45 a.m.

At 11:30 p.m. a male patient came out of his room after discovering his wallet missing. He said he kept it in his socks earlier. After a brief search, the wallet was found in the drawer of his bedside table. He probably forgot that he put it there in the first place. Disaster averted.

Oops, 1:30 a.m. and a registered nurse had to be sent home due to a decrease in the number of patients. Now we are working with one staff member short while we have two pending admissions. Six hours left to go.

We received our two admissions at 3 and 3:30 a.m. without any further incidents and the rest of the night progressed normally. The staff had survived another night at the asylum.

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An Embarrassing Juice Exchange

A few days ago at work at around 11 P.M., I found a box of Kool Aid drinks in a room where we do patient admissions. It wasn’t labeled with anybody’s name or how long it had been there. It could have belonged to a patient or staff. But since it was not labeled, it was considered public domain, so I passed it around and offered some to my coworkers until just three remained out of a box of ten.

The next morning, one of the day shift staff asked if we saw a box of Kool Aid that she had forgotten to put away the day before for a patient. With much embarrassment, I admitted that I had offered it to everyone on the night shift until there were only three left. Fortunately, I had a box of similar drinks (Capri Sun) in my car so I gave it up as a replacement for what we consumed the previous night. The patient actually had a net gain of two extra containers of drinks when all was done. I hope she didn’t mind too much that it wasn’t the same flavor.

And now, a follow up. I was off from work for one night and when I returned, I asked a day shift staffmember if the patient had any questions about her replacement drinks. The patient apparently didn’t notice the difference. Whew!!! I’m still slightly red in the face.

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Successful Escapes From Psych Units

A couple of weeks ago I wrote about the escape attempt by one of our patients that failed (The Great Escape). Today, I’m going to tell you about some that succeeded.

When I first started working in the psych field in an adolescent unit, we heard a loud sound coming from one of the patient rooms at about midnight. When we went to check, we discovered that the iron window bars have been pulled out of the outer wall. A friend of one of the patients had tied a rope to the bars, attached the other end to his truck outside a fence about 50 meters away, and pulled. Needless to say, the patient escaped through the window and over the fence. Who would have thunk it?! At another hospital, an agile adolescent climbed up the corners of a wall in the smoking patio area a la spiderman, and escaped from the roof. Let me try to explain how he did that: with his back facing two wall corners, he used his feet, legs, and arms to propel himself upwards towards the roof. In another roof escape from a patio, an adult patient stacked tables and chairs to get up and over the outside of the building. Most recently about three years ago, while the housekeepers were waxing and polishing the floors, a female patient managed to strip the caulk off a window leading to an outside patio and left the hospital. We didn’t find out that the patient had escaped until about two hours later, after the housekeepers finished their work. The cops picked up that patient the next day and brought her back to us.

The above are only incidents that I was present in. Other workers probably have more interesting stories about patients trying to and sometimes successfully escaping from locked psych units.

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The Neverending Polish

There was an anecdote I remember which someone said that the painters of the Golden Gate Bridge in San Francisco will never be out of work because by the time they finish painting it from one end to the other, it is time to do it over again. I don’t remember who said it, or when, or if it’s even true.

                Something similar seems to be happening in the building I work in as far as polishing the floors are concerned. One of the housekeeper’s duties appears to be the never ending polishing of the floors. When he finishes stripping the old wax, reapplying new wax, blow drying the floor with a powerful fan which could possibly launch a small plane, then polishing the surface, it is time to move to another segment of the building. By the way, he has to apply five coats of wax and blow dry between coats. In recent months, I’ve noticed that this appeared to be an unending routine not unlike the Golden Gate Bridge painters would do. Maybe this housekeeper has the same job security as long as he survives the nasty fumes emitting from the wax and doesn’t do him in. Best of luck to him.

                In addition, when they have to polish in patient care areas, they block off areas of the unit where staff and patients are not allowed to pass through for hours. There is a consequence to this because it creates a problem with patients going to and from their rooms and it pisses them off that they couldn’t move about. It also pisses the staff off because it compromises the safety of the patients because we can’t check on them as frequently as needed. Nobody has died yet while this happened but a few years ago, a patient was able to strip the glue from her window and escape. We didn’t find out until about three hours later when the polishers finished their work and the patient was long gone. The housekeepers did a good job waxing and polishing, the patient did a good job escaping, but the staff was unable to do a good job due to the waxing.

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Tricks of the Patient Trade

Smokers will do whatever it takes to get their nicotine fix even when a place like a locked psych unit doesn’t allow them to do it other than during scheduled smoke breaks. Case in point: a female patient woke up at about 3 A.M., goes to the bathroom then goes back to bed. But she left the water running in the sink. I went in the room and saw a lot of baby powder spread on the floor. When I opened the bathroom door, there was a towel on the floor blocking the gap between the door and the floor. Furthermore, when I turned off the faucet, I saw leftover ashes on the sink. All telltale signs of smoking. Let me explain: baby powder to mask the smoke odor, towel on the floor to block the smell of cigarettes from wafting out to the hallway, and running water to wash the ashes down the drain. All too familiar tricks of patients in a psych hospital or inmates in jail and I’ve seen it too many times before, so it was not a surprise. This patient had the gall to deny it but then again you can’t expect any less from a habitual liar and manipulator. Minutes after I showed the nurse the evidence and left the room, the patient demanded that her room be searched for further evidence. We declined because who knows what body orifices she tucked the rest of the cigarettes and lighter in?

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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.

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