Telemetry, Work, and a Facebook Connundrum…

I am unsettled by a few things going on in Tele land. At our Hospital, the ICU Nurse takes on the role of Supervisor for the Telemetry Technician because they have many more years of experience reading and interpreting arrhythmias and disarrhythmias than we do, however, that does not mean that they always understand the full parameters of the Tele Tech’s job.

We have been advised under no circumstances are any yellow alarms to be turned off, but several Nurse’s are turning off yellow alarms. I usually don’t say anything, deferring to their expertise since I am support staff. I DO log when they do this because MY JOB WOULD BE ON THE LINE if anything happened to a patient with an alarm turned off.

In my Hospital, we monitor both ICU telemetry and Med.-Surg. telemetry. Over the weekend I felt I had to stand up for my job by telling my ICU Supervisor that “if I don’t report an alarm, MY JOB IS ON THE LINE.” She took huge offense to that because the patient whose baseline heart rate went from the high 80′s (normal parameter/normal heart-rate) to 156 and then stayed in the 140′s for 10 minutes was DNR/DNI and on comfort measures. I have been taught that a person cannot sustain a HR in the 150′s for long, and thus reported this because to me it was a sign of a change for the patient…perhaps a precursor to her HR bottoming out (i.e. going really high, normal, then low, then to asystole) and passing away. As a Nursing Student and someday Nurse, I’d want to know this information;  and, I wouldn’t hesitate to check on my patient…

The patient I was reporting on  was in the hospital to receive hospice care so she would pass gently. She was placed on telemetry because she was assigned to a room that would accomodate visits from her family…it was a large room but  quite far from the Nurse’s station.

The Med. Surg. Nurse in charge of the patient during my shift happens to be renowned for being lazy and is currently pregnant. During each of her pregnancies it has been documented that her level of laziness increases. Well, instead of talking to me about resetting HR parameters she complained that I reported the HR to my ICU Nurse who then asked me to reset the alarm parameters and NOT report the high HR.   That is when I explained that I was required to report…she took my explanation as me being “insubordinate” and then wouldn’t talk to me or look at me for 2 hours.

By the end of the night our working rapport had seemingly returned to normal, or so I naively thought. Because this Supervisor has been a great Mentor and someone who has given me great teaching up until the last 4 or 5 months I thought nothing of our conversation…until I read some of her snide comments that were on my facebook page.

In ICU we had one AMS patient who primarily slept all weekend. The ICU Nurse’s response to the weekend were as follows: “I deserve a nice, long break after  a weekend like that! I couldn’t have taken much more.” AND “Time for an attitude adjustment…Patience is definitely a virtue…one that I sometimes lack…” I felt these were directed at me, not because of what they say exactly, but because of a past experience with this Nurse, who in the past case chose to make snide remarks on facebook and then I asked her about them, which led to a good discussion about how she felt I mis-handled a psych patient. I swear — I am really receptive to constructive criticism and am open. I am not getting why she is choosing to vent to me about what she perceives is wrong instead of talking to me. I am open and usually defer to the Nurse’s suggestions whether I agree or not because I am “support staff.” What makes me frustrated in this situation is that after she acted like I said something wrong she stated “now I will write my evaluations.” (We are doing peer evaluations on each other this year). Also, by the more detailed components of her facebook remarks, I know she has been talking about me to other Nurse’s and staff. I wonder why she is choosing this passive-aggressive stance? Is it because I am pregnant? Is it because she really doesn’t handle confrontation well? Is it because I know that she is not always a perfect Nurse? (I’ve overheard her say some inappropriate things to patients and observed some inappropriate behaviors, but not ever mentioned it to anyone deferring to this Nurse’s expertise).

I have been sick over this passive-aggressive behavior  because I take my job seriously.  Our ICU/Tele unit is a bit cliquey and I feel that I may be pushed out of my job when I take my own maternity leave in a few weeks. So, I decided to be proactive and instead of having our Director of ICU/Med.-Surg. read about my insubordination via the peer reviews,  talk to him.

I explained what happened and he stood by my reporting the change in the patients heart rate. He stated he realizes I am not a trouble-maker or insubordinate. Nevertheless, his support went to the Nurse, whose  job would never be threatened or evoked…so, where do I go with this? It is hard to keep one’s mouth shut when one works hard and is doing things that are advocating for the patient.

Not sure what to do about this…just keep plugging through it…

Telemetry Interpretation is Subjective…

I must remember that by-line. I worked a shift whereby the patient had been admitted as a Medical Inpatient to the Med.-Surg. unit because of Hypertension and unexplained Syncopal episodes. The patient was an 87 year old female. During my shift I happened to capture the syncopal episode on a tele strip. The patient had been in Sinus Rhythm converting to Irregular Sinus Bradycardia (heart rate of 48) then had a 2-4 beat “pause.” The pause had fibrillatory waves and I was noting ventricular conduction with regular QRS complexes. Each time this happened the patient was monitored by the nurse and had a heart rate. Due to the fact the patient had a heart rate and that I had normal QRS complexes I called this portion of the strip an Agonal rhythm because it would correspond with her Syncopal episodes. Another Tech decided to call this Asystole. I don’t agree with that interpretation because of the scenario described above, while I may concede that it was a bradyastolic rhythm, we as tele’s are not supposed to diagnose and the latter would be a diagnosis rather than an interpretation. I verified my strip interepretation with the Hospitalist and he felt that the overall interpretation ( NSR to Irregular Sinus Bradycardia to Agonal Rhythm) was appropriate. However, because the AM Tech called the rhythm Asystole and tends to be very aggressive and argumentative with my Nurse Manager, Nurse Manager has called for a Sentineal Review of my strips…fortunaely, my ICU Nurse stands by my intrepretation, as does the Hospitalsit. I am just frustrated because I work hard to be good at what I do. Admittedly, I am still in a learning stage and do not have the guidance the day Tele’s get from the Cardiologist regarding interpretations (because he is not there on the graveyard shifts I work), but I constantly feel under attack by a certain Nurse and another Tech (who  both think they are absolutely perfect and don’t realize that they miss things from time to time, too). I feel I am diligent and am continually trying to improve my skills and ECG knowledge base because I don’t feel that the two day course I received will always help me identify dangerous arrhythmia’s….but the lesson learned is to continue to document that any unusual interpretation’s by my part are “confirmed by RN or confirmed by MD.” Thank heavens in this situation I did that!!!

Anxiety…

I am having anxiety about work issues, or better yet, the politics of work. In my rural hospital cliques are the norm and some people are given favoritism. Recently, a Nurse who is rude and condescending (and therefore makes me nervous and I don’t do a very good job as a CNA/Tele Tech when in her prescence due to my own esteem issues) indicated to me that her favorite aide had Seniority over me merely because she was a better tech. This Nurse has been assigned to do all of the Scheduling in the ICU. I’ve been with the Hospital a year and a half longer than Better Tech…and at every other firm I’ve worked with Seniority is  based upon one’s hire date. Well at Rural Hospital my manager indicated there was no policy about Seniority, which means that Schedule Nurse is going to bamboozle me out of shifts so she can work with her fave. I am miffed about this…but there are a ton of other things going on too…things that make me wonder if I should stay at this Hospital or move on…

I tend to have a very strong work ethic and work so hard, giving 120% when I am working that the 3 days off I have a week end up being “recovery” days, so to get manipulated out of shifts I want really pisses me off. Additionally,  a Tech who is very lazy dropped her pay check. I say her pay rate by accident and now know that she is making $4 an hour more than I am. I am anxious and frustrated because I work hard, am feeling pushed into a corner over my schedule, and feel that despite my hard work and efforts am considered “not good enough.”

On one hand, I know that my basic skills are exceptional and that I DO take great care of my patients; on the other hand, I am a little slower because I am so thorough so think that perhaps in a crital care setting I am not a good option becasue I don’t rush through the cares of my patient…conversely,  I observe how fast the other Techs perform a Complete Bed Bath on an ICU patient (getting it done in 5 minutes where it can take me anywhere from 15 minutes to 40 minutes) and notice that the patient gets incredibly anxious, so do I change the way I do things and speed up my basic cares or do I continue to be more thorough and calming?

Up until this post I’ve felt that there is a time and a place for speed in the critical care setting (i.e. when a patient is crashing and one needs to focus on the ABC’s) and a time and place for more methodological, soothing care…but now I am not sure.

The final challenge I feel I face is that I am not building skills. Most of my Nurses’ won’t allow me to do things that I am certified to do (i.e. Insert IV’s or catheter’s, or perform inline suctioning) so I don’t feel I am growing. I’ve been an Aide for 15 years, but the last 7 worked primarily as a Med Tech. I lost some of my Hospital skills and that is why I decided to return to the Hospital setting…instead of building upon my basic knowledge I am left with performing the basics; and, I am getting bored.

With the many “mini-trials” I am facing, I am conflicted, which produces more anxiety.

My plan of action, to just ignore other opinions, only be accountable for myself, only worry about things pertaining to me;  and w,ork with a strong work ethic is good but sometimes difficult because I am goal oriented and too much of a perfectionist/people pleaser.

One good friend counseled me to “not sweat any of the work issues until work is my dream job.” Good advice, but not easy for me to follow.

In some way, I know this anxiety has to have a positive outcome…

Miss Kitty?

It has been a long while since I’ve posted, but my recent experience was too funny for me not to write a little about it…just to recap my work background…I work as a Telemetry Technician, but also assist as a Certified Nurse’s Assistant and Unit Secretary. The events I am about to convey occurred as I was rounding as a C.N.A. (and to be forewarned some of the content may be offensive so proceed with caution)….

Entering room 104, I introduced myself, took vital signs, and then proceeded to explain my methodology for HS cares to my patient. My patient was a 90 year old female with evening onset dementia (Sundowner’s). I proceeded to assist with oral care, washing of the face, hands, and underarms. At this point I paused to let my patient know that since she had a foley catheter we do perineal care as part of our HS care routine. I explained that one reason we assist with perineal care was to prevent the possibility of urinary tract infection. The following conversation proceeded:

Patient: “You’re going to clean Miss Kitty?”

Me: [Deadpan straight face although I wanted to die with laughter because I'd never heard a female of that generation give name to her pubic region.] “Yes, if you are comfortable with that.”

Patient: “Now, you know when I say Miss Kitty I mean my PUSSY!” [The latter word was stated in a whisper.]

Me: [Still trying not to laugh because a family member (the primary caregiver) was in the room and I suspected this was the verbiage she used to the patient whenever she was doing peri care.] “Certainly.”

Patient: “My daughter will clean Miss Kitty.”

Later that evening, before I could explain the events to my Nurse the patient called 911 despite getting checked on every 10 minutes. Evidently, the patient told dispatch that she was lost and that her “kitty” was up a tree.

Typing it does not convey how funny it was in the moment. This patient, at other times was more prim and proper than shocking…and everything said was in a beautiful Southern drawl….

Moments like this that make one smile is why I am still working in Health Care.

My Guilty Conscience…

Well, I did it. I said something really horrible without thinking about it…what I said has the potential to really hurt someone I care about.

There is a situation at work whereby a group of female co-workers (the hens) are gossiping about whether or not another co-worker (CQ10) has had an affair with one of our lab guru’s. I typically try not to involve myself in gossip unless it is strictly about me, however, I was charting and just in a place where I couldn’t help but overhear the conversation.

One of the hens said: ” Now she likes Matt.” I said: “I thought she liked lab guy.” The reply was that because CQ10 is getting a divorce, she is after every male in the hospital. The speculation was who she would go after next. I replied: “Hotness.” The name just slipped out…not only is he tall,  and handsome, but beautiful inside and out; and, CQ10 has mentioned to me that she thinks he is cute. However, the reason I said his name would be fodder for a psycho-analyst for years to come…

If I am honest with myself, the reason that his name came up is because I  am a little jealous that he and CQ10 are really good friends. I’ve been trying to build a friendship with “Hotness”  for over 3 years. This has been to no avail…we just don’t click on that level. I do find him very attractive, and I look up to him — just someone I admire on many,many levels. We don’t find common ground about anything, thus, no way to build a conversation let alone a friendship. I’ve been feeling jealous that CQ10 has only worked at our Hospital for 5 minutes and has that built a bond that I’ve tried to have  for a multi-tude of years.

Additionally, his name came up because I think about him at least 50 times a day. He is sexy and on some levels, I think about that.

But foremost in my thoughts was that CQ10 is tall — it would be natural for her to be attracted to and go after tall men.

After I realized that I said something that could feed the gossip mongers, I was mortified. I know that “Hotness” had an extramarital affair and that he and his Spouse have worked really hard to make their amazing relationship what it is today. Also, 3 or 4 years ago that kind of speculation almost destroyed his work credibility and family life, as well as, that of another Nurse.

That one careless use of his name could have the potential to destroy lives causes me agony. That me not thinking before I spoke could mean that someone I love has pain and difficulty in their life hurts my heart.

I didn’t explain why his name came up…I thought if I talked about it too much it could cause rumors. One of the hens said: “everyone loves “Hotness,” he is a cute guy.” Then I changed the subject.

I said: “Do you guys remember Dean? I had the HUGEST crush on him?” One of the hens then stated she had a crush on Doc. I am hoping beyond hope that the part of the conversation that gets remembered and passed along is my crush confession NOT whose name I put out there that CQ10 might have an interest in…I really don’t want “Hotness” or CQ10 to have rumors spread about them…rumors that I may have contributed to by my thoughtless behavior.  I would never be able to forgive myself if something bad came from me throwing my two cents into a conversation I should have never gotten involved in.

I desire that “Hotness” and CQ10 have happy and wonderful lives. When I explained the situation to my partner he suggested I pull “Hotness” aside and apologize…but I can’t really talk to him. I decided if things get ugly over my poor conduct that I will resign my job. I just couldn’t deal with “Hotness,” CQ10, or any of their friends hating me or being disappointed by me or thinking I had cruel intentions, or was mean or malicious. I’d rather they continue thinking of me as a nice, boring girl.

Feeling Weird…

I am an introvert, and in many ways a social moron. I decided to keep the fact that I start RT school quiet because I only fit in with a minority of people at my hospital. I particularly didn’t want our RT department to know of my endeavor…they are all brilliant, and I look up to them but am not really close to any of them — I was asking so many questions about Telemetry, breathing treatments, etc. and doing so in the wrong way that I offended about 4 of them…that’s half of the RT department at my rural Hospital! So, I decided to back off.

Now, I am having anxiety about school — am I making a good decision? Will I get enough clinical experience to have an interesting career? While  I know I have an amazing support system from everyone whom I write to and read about on-line, it would be nice to talk to our RT’s about their experiences. However, my anxiety is making me self conscious so that I feel like a giddy high schooler — I truly am acting weird. I stutter and try waaaay too hard to make sure I don’t piss anyone off, and I am uncomfortable around our experts to the point that I do stupid things. Most of it is because I feel they all can’t stand me and I KNOW I’ve made several of them mad at me in my enthusiasm to be helpful. It is awkward to feel butterflies in my stomach whenever any of our RT’s come into the unit..and even awkwarder to try to have a conversation thinking that whatever I do or say will be the wrong thing.

Because I feel so disconcerted I think my choice to NOT do any clinicals at the hospital in which I work is wise. I don’t feel I will be this uncomfortable around other RT’s…I need to get over this feeling of incompetence…I want to have good relationships with all of my co-workers…

Big Mouth Strikes Again…

It is our Hospital policy that when the census is down and one is placed on call (because there are not enough patients to work one’s regularly scheduled shift) that one a) answer’s his or her listed telephone number; and b) arrive at the Hospital within 30  minutes…

I got a call at 2240 asking me to come in. This Sunday was NOT a regularly scheduled shift. The C.N.A. that was regularly scheduled to work (whom had been placed on call) was unable to be reached.

Well, the Nurse’s were desperate for help. So, I was asked to come in. I decided to be a team player…but only after the Tech calling me in said that she felt the on-call tech wasn’t answering her phone because she was “frustrated” and looking for a new job. Perhaps…we all get frustrated from time to time, but what ethics does it take one to have to abandon ship? Thinking this I said: ” It’s one thing to be frustrated, but to refuse to answer a phone and playing games over it is unprofessional.” There was dead air for about 2 minutes then the Tech said to me: “well, sometimes when you are on-call you fall asleep.”  My snarky comment back: “responsible people, even if they fall asleep, hear the phone ring.”

Tech who called me is very good friends with Tech who didn’t answer. But I stand by what I say…when one works graveyard shifts REGULARLY and is acclimated to that type of schedule…it is unlikely that one is sleeping. Also, who goes into a deep sleep when on call and getting “on call pay?”

I was irritated…but mostly because this person, despite doing things like not take call when she is “on call” calls in sick every 3 out of 12 shifts…she has not had to be accountable for her bad behavior and in my opinion has perpetuated her action to consistently do things that make it hard for her colleagues. Often when she calls in sick, the Nurse’s are slammed and left stranded. You either commit or don’t commit to your schedule…if the choice is NOT to commit, then resign your postion and let someone who truly wants the job have it!!!

Now, because I’ve said something derogatory, I’ll have to either side-step the issue or get into a verbal reposte because I didn’t keep my opinion to myself. Will I ever learn? Me and my big mouth!!!

Se La Vie…

Well, it has been what feels like aeons since I last posted. I’ve been through a metamorphosis of sorts. I realized that when you throw a bone in an offerance of friendship and the person you are throwing it to turns up a nose that it is time to let it go…so, I am letting go of the idea that “hotness” and I will EVER be friends. It was hard for me to do. I get attached easily. I love people freely; and, I put people on pedestals..perhaps that is the problem…even though I think people are perfect no matter what they do, when one has a knowledge of my deep admiration…well, I guess it can be disconcerting.

The “getting over” something that I thought would lead to an amazing friendship was hard to do. I pretty much had a down-ward spiral and stayed in bed for four days (not something I am inclined to do, as normally I am a pretty  happy, bubbly person)…but I was saddened. I felt loss…loss hope, loss of discovery…loss of motivation…loss of enrichment…loss of trust (of myself, mostly)…and loss of a vision whereby I’d have a friend who is an exceptional Health Care Professional give me a little guidance. I know that sounds like I was out to manipulate the friendship I desired in an unethical way, but I wouldn’t have…just to talk about perspectives, to have someone who is brilliant give feedback would have been phenomenal. And, I would have given back anything needed THAT WAS LEGAL AND  MORAL with all of my heart, mind, soul — every fiber of my being.

Another component of  my metamorphosis was realizing that if I am not obtaining means and mechanisms to grow my skills at the facility in which I work that I need to go to a facility, at least a few days a month, that will enable me and empower me to do so….therefore, I am job hunting for a second job. Ideally, I would like to be in an acute setting whereby I see more critical cardiac cases that translates to the reading of harder telemetry strips. This would enhance all the study that I am doing. I plan to take the National Certification test at the end of April. If that opportunity is not available, then I’d like to work in a Dialysis environment since I am a Certified Dialysis Technician.

Another “change” that is positive in general is that I have a definitive start date for RT school. I will start April 13th. I am going over all of the Anatomy, Physiology, Chemistry, Biology, and Pathophysiogy I can to be as prepared as possible. I am reading a book entitled “CardioPulmonary System Review,” which starts at homeostatis and advances to more complex information and formularies.

So, I’ve  had personal progression and digression simultaneously over the past few weeks..and I am somehow becoming a little wiser…to the point whereby I can sometimes non-chalantly say: “that’s life.”

My Newest Curiosity…

I turn 40 in 21 days, and I don’t really think I am a vain person but I am a little worried. My concern is that because we live in a culture that embraces the visual, and that first impressions do seem to matter…that I won’t be competitive in the world of work or socially.

I am pear shaped with thunder thighs, yet  I have a body confidence that I am happy about….essentially, I “feel good naked.”  However, with the advent of  my official “middle age” status I am seeing the wrinkles on the forehead because I use my entire face as a gesturing tool…as well as, fine crinkles around the eyes…so far clever makeup and hairstyles have hidden the wrinkles…but I am feeling insecure — especially at work where all of my brilliant co-workers (male and female) look like Super models.

I always thought that they looked so superb because they won the genetic lottery, or because they took very good care of themselves…well,  I discovered that most have had botox injections here, a little sclerotherapy there, an augmentation or two and done a few “non-natural” things to enhance their genetic makeup and healthful lifestyle choices. SO now that I know the secret used by the people I work with, I feel compelled to go and get botox shots in my forehead (a local Doc charges $95 a treatment and if I picked up one extra shift a month I could logistically afford it)…but realistically,  with all of the educational goals I have I just can’t spend that kind of money to make my face look better …

Then I got to thinking, once I start to correct all of my genetic flaws via cosmetic surgery or procedures when and where does it stop? Isn’t it better for me to develop an internal beauty that is accepting and loving and nurturing of myself? What do other poor women do? Does one need to accept physical ugliness? And, even if I had the money would I? Maybe a little, but I think I’d rather use extra money to take fencing lessons, learn how to fly a helicopter, travel, learn how to sail, travel some more…I’d use the money to enrich my mind and my adventurer’s spirit.

So, knowing that I probably wouldn’t fix stuff even if I had the money readily available made me wonder how I am going to cope with my personal aging issues? I want to look as good as I can, genetics will probably work against me, how do I stay attractive enough to succeed with the goals that I have?  Aging is a natural and inevitable process. Some do it with more grace, class, and style than others…so what distinguishes that? How do I remain comfortable in my own skin despite the physiological changes?

I am really curious…I want to have answers, but I suspect the answers are variable and I will need to figure out for myself the course of action that makes me feel happy and content…

Sex In MY City…

I had the most curious adventure today…I was coming off a graveyard shift and needed to get a new toothbrush and toothpaste. I figured I’d swing by the local Walmart to get these needed items on my way home. So sitting in a knee crunch position trying to decide what toothbrush I wanted a handsome young man approaches me and says: “Excuse me..”  Feeling a little tired, and impatient I am thinking of some snarky comment that would be succinct and to the point in conveying that I do not work at Walmart when his next words were: “are you seeing someone?” I  literally did a double take and said: “Waaahhht?” and the young man , a little more boldly this time said:  “Ma’am are you seeing someone?”   Totally taken aback, I said “Yes.” I wish I would have played along a little more, it would have been fun to say something out of character like: “Yes, I’m seeing you!”

I admired this young man in a way, if that is his pick up line he must get laid date  lot. I wondered why I hadn’t thought of that line when I was 21-ish?

Then I got to thinking about the scenario more and wanted to know the  “back story” of this kid…what would make him bold enough to go up to a stranger and ask: “are you seeing anyone?” I imagined that he only had a month to live and didn’t want to die a virgin, or he was  getting ready to be shipped out to Iraq or Afganastan and wanted to gain a sexual experience from an older woman…or I imagined that he was getting ready to come out of the closet but before he did so had to have a farewell f*ck with a complete stranger…

It was fun to imagine the back story. It was flattering to my almost 40-year-old ego (I’ve only been hit on twice before…once when I was 16 by a lecherous old man; and once from another female when I was about 21).

I am taking a Human Sexuality class and now I am curious as to what causes arousal and desire? What causes people to pair up and become a couple? What makes people feel comfortable and attraced to another enough to ask: “are you seeing someone?”

Evidently, I’ve been doing things wrong…I could have simplified my entire sexual encouters/dating experiences/relationship endeavors had I only listened to my grandmother’s advice…”find, and marry a  nice boy you meet at the grocery store.”

I know people in my rural city are “doing it” because I see the little  peanuts whenever I am floated into OB…but I had no idea that sex in MY city began with a grocery store adventure!