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…

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!!!

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…

Overwhelmed…

I don’t know where all my time goes, but it sure flies fast.  In my youth I remembered thinking that time went by so slowly…now I realize that the sentiment is a bit relative…it is probable to think that time is incremental  to one’s age so if you are 8 time is 1/8th of a year and thus movement of it seems slow. If you are 39, time is 1/39th of a year and moving so darned fast one  can’t seem to catch one’s breath.

My point is that I haven’t posted in what seems like a decade, and I have some really cool 12 lead EKG’s to share, so when I am caught up with my course work I will post what appears to be M.A.T. and another interesting strip that neither my experts nor I can get a grasp on.

So…until tomorrow!

Blessings and Light. AnnieC.

Blitzed Again…

I worked Ick-U last night with THE NURSE. It was going smoothly because we had 3 patients, 2 vented and one DKA. I had 2 nurses…one who is willing to mentor; and then THE NURSE. I had all my work done by 9pm and still stayed very busy helping my Nurse’s with their patients.

THE NURSE has a problem with the fact that I have insatiable curiosity and ask a lot of questions. She often misconstrues my questions to promote my own learning and progression as me being insubordinate, rahter than me merely being motivated to learn as much as I can. Well, I am a Master at the basics, however, because we clash I always defer to THE NURSE. Last night I just couldn’t keep my mouth shut…we were bathing, turning, and positioning a woman who was intubated via an EndoTracheal Tube. She was on 90% O2 and only saturating in the low 90%. She had rhonci and rales in all four lobes. Well, THE NURSE (who has been a Nurse for 40+ years) was nearest to the vent. This position placed her nearest the tubes and the thingamajigs that hold the vent tubes at an appropriate angle from the machine to the patient. I told her she needed to give me slack and disconnect the tubing from the holders (she knows better than to leave the tubes attached…she’s been a Nurse for four decades)…well, she opted not to do as I suggested and take the tubes out of their holders; and, she opted NOT to give me slack…so, sure enough…the T-tube popped off, as did the connection between the ET tube that was in the patients mouth and the inline suction devices. Anyway, the patient started emitting thick yellow-brown mucous (or is it sputum when it is expired…I forget the proper language…but I am hoping you, the reader, is getting a visual)…she also started having spittle and air bubbles emerge from her nose; AND, she was gagging on more spit, phlegm, and mucous that was pooled inside her cheeks. She started to choke and gag, and I was almost certain she had aspirated.  Anyway, THE NURSE got mad at me for not holding the patient correctly! I had her turned using the soaker pad and using the recovery position as the patient was a heavy set woman. My hold was fine, THE NURSE just wanted me as her personal punching bag because she was in a hurry and didn’t follow common sense or prudent care with the tubes.

All ended up being well with the patient because THANK THE LORD our Respiratory Therapist was in the room with all of  this going on and quickly and efficiently suctioned the patient with both in-line suction and yaunker suctioning, flushed the in-line with saline to clear the sludge that was getting clogged in the line, suctioned a little more to clear the airway, and put both the T-tube and the ET tube back together. We were really lucky the RT was there helping us or we well could have extubated the patient (note to self…if I ever become “seasoned” still take time to listen to my support staff, they may be observing something I am missing that ensures the patients well being).

Well, THE NURSE being older and a little on the lazy side had another line mishap — the patients Miller-Frederick tube came out. The patient was in 2 point restraints per our vent protocol but was still agitated and restless. Perhaps when the patient turned her cheek on the pillow she rubbed her face hard enough into the pillow to pull it out? I am thinking this is the only plausible reason the MF feeding tube was pulled because it was intact after the fiasco I just wrote about, and I was in another room…

I was in a room getting some basic education about our vents and learning the importance of inspiratory vs. expiratory breaths, basics about Tidal Volume, PEEP, and the modes used on the ventilator to help a patient eliminate CO2. The RT that was taking the time to teach me some RT basics felt it would be another way for me to help my Nurse’s — as well as, give me an idea of what I should expect RT school to be like. We started our conversation with me taking notes at about 0330 and finished at 0400. Prior to having this experience, I made sure all of my work was completed and also that the 5 ECG mons were being watched and were stable.

Well, THE NURSE, flustered and frustrated about the MF tube pretty much pointed the blame at me for not being at the Tele station to advise the patient had gotten the tube out. She said that it wasn’t appropriate for me to advance my education while on the job and that I didn’t need to know any respiratory information as an Aide/Tele Tech. I was stunned!  I was upset as well…I am entitled to a 30 minute lunch break although I NEVER take one, my educational moment was the length of a break…I also wouldn’t have participated in this learning process had I felt that any of my Tele’s were not monitored or if the Nurse’s needed my help. They both indicated that they were caught up. Furthermore, if one can’t progress and gain knowledge or ask questions so he or she may apply what is being learned what is the point of entry level positions in the Hospital setting?

I am floored that THE NURSE is so old school she is unwilling to mentor, to take responsibility for her mistakes, and for using me as a punching bag. I definitely feel blitzed again.

A Conundrum…

There have been many changes at my rural hospital due to lack of ficiduary responsibility. One of the changes affected staffing patterns, another change affects pay…we used to be able to mix our vacation and sick time when we had need to use it; and, it was convenient as it operated more like a paid time off system. Now, we have been advised sick time can only be used when one is ill 3 or more days and will only be issued with a Doctor’s note confirming one’s poor health. I am rankled over this because I am ancillary staff and am, due to the new staffing matrix, am getting called off often. I used to not worry as I NEVER call in sick and so using a combination of vacation and sick time I have been able to obtain enough pay to afford my bills, school, and meet needs…but JUST BARELY. Now that I won’t be able to use sick time, I am worried how I will have enough hours to meet my minimum needs like mortgage, insurance, utilities, and food.

This issue seems to follow me, thus I have been in Health Care for 15+ years not really progressing my knowledge or skill level (or educational base) because when this happens I go back to the two or three job parameter which puts my education on a back burner, particularly since I pay for it myself.

I am really, really tempted to write an anonymous letter explaining that I really feel that instead of the implementation of a Vacation or Sick time pool that my company consider “paid time off,” thus empowering employees to use time accrued for their own unique and personal needs. I feel the letter must be anonymous because dissention about the changes has led to many getting “pink slipped.”

I need and value my job, however, I need to survive, also. I am scared out of my mind that with the devaluation of the American dollar that mere necessities will be so far out of my budget because of my employer’s restructuring  that I won’t make it. I get that my firm is a “for profit” hospital, and I am sure there is a budget that must be adhered to so that investors can see a profit margin, but it seems to me that employees stop going above and beyond when privileges and perks are abrasively and abruptly taken away due to no fault of the employee.

If I am forced to go back to the life of one foot in the business world and one foot in health care I worry that I will be so burned out that I will be incapable of demonstrating the work ethic that I have displayed, and thus, give those in the upper echelons of management a reason to criticize my work or pull precious commodities like a .3% raise from me.

I feel that most of the people making financial decisons are not in a place where paycheck to paycheck has importance. They make a set scale and have benes and perks that would never deem it hard for them to meet the necessities. I wonder if they realize that they loose something from each employee that fears for the basics…

When I have a steady and stable paycheck, I am more loyal to the company and less likely to bring my personal worries with me to work, and thus always able to give 110% to patient care and exceptional customer service…

I guess I need to decide if I can word my concerns in a way that can even be addressed and then decided if I should coin my name or allow my thoughts to be expressed anonymously. I feel that anonymity could make it so that the letter isn’t even considered, yet I do fear that voicing my opinion could cost me my job…and is my fear worth loosing a job I love?

My Manager…the Epitome of the Idiots…

I am irritated by the following e-mail I received from my manager. Instead of discussing these issues in a recent staff meeting he sent updates that affect everyone’s life via the net. I do not think this man knows how to communicate unless it relates to stuffing things under the carpet…

“We held department manager meeting today and there are a few things I need to remind you all about:
1. There will be a mock JCAHO survey some time in the next two weeks. I asked all of you to come bring your binders into me so we could go over them, so far I have only spoken with a couple employees. Please try to talk to me sometime this week. Please do not ignore alarms either the surveryor will want to see that all staff. tele tech and med surg staff are responding to the patient tele alarms.

**This irritates me for a few reasons…he never asked us to bring our certification/inservice binders to him he left a note on a POST IT with instructions that we had until the end of December to see him…now with plans for a mock JCAHO he wants it sooner? Furthermore, we the Tele’s, watch those alarms and per corporate aren’t allowed to ever silence or turn them off…even when the computer mistakenly calls an irregular heart beat A-Fib or when the patient is dying and has a DNR/DNI status… Also, I HATE JCAHO protocols…it seems to me that it is just a bunch of extra paperwork and protocols to follow (that never have much to do with the patient, but more to do with cya and liability issues) which convolutes methodologies for caring for a patient while at the same time ensuring a rating that the public could care less about….

“2..I will be re-working the staffing matrix. We will try to add to the support staff at night and balance it out elsewhere. Please keep in mind not everyone will be happy and someone will have to give something up in order for it to work. Initially you told us that the most important thing to you was that you were never here alone. We gave that to you and now it is apparent that lack of support staff is a bigger issue. Feel free to offer any suggestions and we will try to incorporate them into our new plan.

**The newest matrix, released about a month ago, caused everyone to rebel. Nurses allowed support staff  (i.e. the Unit Secretaries and the Aides) to work entire shifts when the census didn’t call for it according to the staffing protocol. They did this because we would be down to 2 patients and then get slammed with 4 admits right at shift change…the nurses couldn’t do vitals, total patient care, assessments, med passes, med mixes, AND input orders…Hmmm ya’d think you would have a clue as to why new matrix didn’t work. DUH! Not that I expect the new one to be much better, but maybe management will rethink the 6 patients 1 nurse – 1 aide; send aide home upon 7th admit, bringing another nurse in and thus, placing aide on call until there are 11 patients….RIDICULOUS!!!!
“3.. Our rapid response team is in place and ready. To initiate their involvement page overhead anytime of day “Rapid Response Team to Med surg” two times do not review by the team. This is a team that responds to any worsening change in the patient’s condition. They are the pre-code team and their involvement is
strictly informational.

**What friggin’ legit  hospital has a PRE CODE team? This was implemented because in Med-Surg, the new nurses, right out of nursing school only get 3 days of orientation instead of two weeks and have been calling code blue status on patients when they should have just notified respiratory because the patient was having labored breathing. WHAT THE HELL???? I really am annoyed by this one above all because isn’t it the manager’s responsibility job to engage the employee when mistakes are made? Perhaps give advice when one’s newness doesn’t dictate the correct protocol?
“4. Please don’t become so frustrated of the difficult things at our work that wedon’t appreciate the things that are going well. Please see the article in our med room regarding recent changes at other hospitals and be appreciative that we are not there (yet) The economy will continue to bring changes to everyones work
environment. The trick will be in finding happiness in the things we can do well.”

**This last one is because my manager does not know how conflict negotiation works. He just removed our best Tele and relegated her to work Med-Surg as a full time C.N.A. He did this because his regular C.N.A had many patient complaints and wasn’t working with two of the day-shift nurse’s well. Instead of suspending the aide for bad behavior,  and conduct; and,  enforcing a customer service training or dealing with the toxicity between the employees…he rewarded the aide that was acting up and punished our wonderful Tele. It is an egregious action and so many are fed up and complaining…so much so that corporate has made all of us watch a “disruptive behavior” video. Comment 4…another insult to my intelligence…”let’s just cause chaos and pretend we didn’t by wrapping it in a nice fluffy Christmas bow.”

So…admist all of the dumb shiz going on we are told it is all because we are over budget. Then a week later we receive a brand new copy machine and the hospital gets signage… WHATEVER!!!

But the thing that probably irks me the most about this e-mail to me is that the guy didn’t even bother to capitalize things that should have been capitalized. I know my grammar and punctuation is not stellar but it is because I choose to be a creative writer…I am not in a Professional, Technical position..this guy IS and fails (in my mind anyway) to even have a Professional Presence in his writing. I AM SOOOOO BUGGED!!!!! And I know it is really petty to be bugged, I just can’t help myself….

Feeling Like a Yo-Yo…

We have a new staffing matrix at my Hospital. It doesn’t affect me greatly as I work 2 shifts a week in the Ick-U as a Tele Tech and 1 shift a week on Med-Surg. However, it affects me enough that I’ve been called off every Friday for the last 3 Friday’s (the days I am assigned to work on Med-Surg). The matrix allows for one Nurse and a Unit Secretary up to 5 patient’s. At 6 patient’s the Unit Secretary goes home and the Aide gets called in up until 7 patient’s. At 7 patient’s a second nurse gets called in and the aide gets sent home and placed on call until the unit reaches 11 patient’s, whereby, the aide must come back in. Well, last night Med-Surg had 2 patients, got a patient transferred from the ICU (chest pain and on Tele), and then had a Pediatric admit and a Geriatic admit. This brought us to 5 patients. I was called in at the start of the shift because blood was to be given to two patients and there were additional admits planned. So. When we have low census, I not only play aide, I play Unit Secretary, and back up Tele. It is a very chaotic, unorganized way to work…what I do is vitals, HS cares on one patient and then go back to the Nurse’s station to put in orders, etc. To make matters even worse…after I did HS rounds and midnight vitals, I had to prepare all of the charts for the next day. About 3am we transferred a paitend from Med-Surg to ICU. I had to tear down the Med-Surg chart, breakdown the room (patient had been in ISO for C-Diff), take the patient over to the Ick-U, set up the Ick-U room, put the new ICU chart together, input all of the orders, run Tele strips, and help the patient (who had raging diarrhea)…the patient was not following instructions and being non-compliant with everything so doing a simple maneuver like a pivot transfer to the commode was difficult. I ran my TAIL off!!! I am trying to find the shiny side of the penny, and I am trying to convince myself it is a great matrix that teaches me fantastic time management and organizational skills…but I don’t buy it one minute. We got a shitty matrix because the big-wigs are cutting corners so they all get humongous bonus checks. It was said in a staff meeting that if we as a group could hold on until January, the staffing patterns would go back to normal…we all know what the translation is: “work your current staff beyond belief  so they quit…but only after working enough to meet corporate financial needs and then hire new, inexperienced staff at lower wages.” I’m trying to do what is asked, but it is difficult….to balance the workload, some things get missed. That bugs the hell out of me!

Confession Of An Obsession….

I am a little bit in love with my favorite RT  idol. Honestly, it is a bit silly, really. I don’t know this person on a personal level, but what I DO know about him encompasses all the qualities I find attractive. He is brilliant, empathetic, caring, adventurous, honest, integral, has an amazing work ethic, and  is passionate about life. I have been trying to befriend my idol for nearly 3 years  to no avail. A new nurse was hired who is amazing and lovely and beautiful and smart and they have become fastidious friends. I am jealous as hell. So. How do you stop thinking about someone you adore/admire/are loyal to (and a little bit in love with)? I am not sure. I have a  rich life with amazing friends and people who love me; people whom I love. Why is it bothering me that idol and I can’t be/won’t be/aren’t friends? Why am I sooo jealous? I am puzzled by it all. What is lacking in my character that makes it so we aren’t friends? I realize the friendship isn’t developing naturally  probably because I try too hard…so I totally backed off about a month ago…then enter new nurse….now I feel that friendship will never be and I have so much angst about it I can’t stop thinking about idol or the way people in my hospital pair up.  I am an outsider (i.e. not one of the “cool kids”) and will probably always be. On many levels I am okay with this, however, because I am so obsessed with the why’s of the non-friend issue and am physically attracted to my idol, I would do almost anything to be an “insider.” Thus,  I am strongly considering “running” (i.e. resigning and procuring a position elsewhere) before I do something totally stupid and insane. I am so immature where relationships are concerned!!! Any thoughts or advice on this matter would be appreciated….particularly  because 1) it is hard for me to admit I have an obsession; and, 2) it is hard for me to admit I am jealous. (Damn pride!!!)