Thursday, November 08, 2007

Nurse Follies: A Lesson in Diplomacy

Sometimes, I get to play the role of charge nurse. Some people relish this position to the point that I've seen them throw bipolar tantrums when they don't get it. Other people, run from that task because for all the bullshit that comes with the title, it's just not worth the extra $2 an hour. A few people say they don't want the job, but secretly covet the position and work in secret combinations so they can get it. Everyone else just doesn't give a flying rat's ass either way.

Can you guess which category I belong in?

What does it mean to be a charge nurse? You have the standard staffing decisions...which nurse takes which patients. You have to decide where the new admits go. You get to talk to cranky residents who demand to speak to the charge nurse. There's extra paper work involved. Once in a while, you get to serve as a mediator between unhappy patient, and frustrated nurse.

Doing the staffing doesn't bother me too much. I just throw some names down on the paper, and usually the day nurses are content...unless it's the ones who complain about everything. You could tell them that their job is to stand outside the parking garage and wave to everyone as they left...and they would complain that it's too much work. I've been known to tell the chronic whiner that I'm not fielding complaints that morning before they have a chance to start in. I don't pour over the assignments too much. From my personal experience and observations, there are some things in life that you just fuck up even more because you've given it too much thought. It pisses me off when someone agonizes for hours on assignments. I've had many a crappy night due to their brilliant skills in deductive reasoning.

Assigning admits isn't too bad. You have an empty bed, you stick a patient in there. Not too complicated. The only time the charge nurse needs to actually grow a pair is when those trolls down in admitting try to slide a patient in that is not suitable for our floor. Sneaky bastards, they are. Because I'm notorious for being an asshole and catching them in their nefarious schemes, I'm confident they have a picture of me posted down in their office that they routinely throw darts at.

We don't come across cranky residents too often, and when we do, usually it's from a misunderstanding. The residents have grasped the general idea that when they are mean to the nurses, we are going to hang their asses out to dry the first chance we get. Everyone plays nice and gets along...for the most part.

It's that last part of charging that I hate.

There are those occasions that arise where the nurse and the patient are just a bad match. Or when the nurse is a complete dumbass and the patient has figured this out within the first five minutes of meeting them. Sometimes, the patient is unhappy because we are not fulfilling their narcotic requirement in a way that is pleasing to the patient (but probably illegal in most states). Whatever the case may be, patients will sometimes ask for another nurse. Sometimes, they will ride out the shift with the nurse in question, then just request not to have him/her back. In more extreme cases, the patient demands a staff change right then and there.

(In one case long ago, a patient was racist and didn't want a black nurse taking care of her, despite the fact that this nurse was one of the best ones on our floor. The charge nurse (and my role model) then assigned the dumbest nurse on the floor (who happened to be white) to take over their care.)

Such was the case recently when I got to wear the charge hat. I was approached by a nurse, who had the misfortune of being flagged down by an unhappy patient. She reported that this patient didn't like her nurse who was taking care of her...just on sight alone. Therefore, she wanted another nurse. If she wasn't going to get a different nurse, she was threatening to leave.

Heavy sigh, and I go to the patient room. I introduce myself, and prepare to hear the tirade of why this nurse in question was so evil. She was mean. She was rough. She was rude. Etc. Etc.

Patient: I was in the ICU, and I saw her there.
Me: Uh hmm
Patient: And she and her whole group were smoking crack in my room. There were at least a dozen of them.
Me: Uhh.....WHAT?!?
Patient: Yes, they are just a bunch of crack heads, and I've had crackheads before. And I don't want any part of it.

At this point, I really am rendered speechless (if you knew the type of environment our ICU is, you would know this to be impossible), so I sputter that I will investigate the matter further and come up with a viable solution. I leave the room and find the nurse in question (did I mention that she probably could qualify for the seniors discount at IHOP?).

Me: Uhhh...your patient in room 10...
Nurse: Yes?
Me: they have any, uh, psych issues?
Nurse: Yes, a few. Why do you ask?
Me: (dryly) Because you really need to stop smoking crack in front of them. All twelve of you.
Nurse: WHAT?!?

Because we are insanely busy, I decide to take this over this patients care. The patient is over the moon that the charge nurse is now taking care of her. She now feels like a VIP. Situation solved!

I hate psych patients. They teach you all kinds of "therapeutic communication techniques" in nursing school...none of which work in the real world. Psych patients are live happily in their own little reality, and there is nothing you do or say that is going to change that.

God only knows what the patient told day shift about me the next day. That I drug a stripper pole in the room and practiced for a part time gig at Diamond Joe's or that I had a wild orgy with twelve circus midgets in her room.

1 comment:

Well Hell Michelle said...

LOL. And of course there has to be some crack smoking during the wild orgy with the circus midgets.