The charge nurse who worked on my unit when I first got there whose name was Cindy was a very solid nurse with a lot of experience. However, she was not a player but a worker and as a result was not very popular with the administration and was pushed out to another unit by her counterpart who will be known as “Tina Fae”. She was a person who knew how to play the game. This happened in the beginning of my third year. The new charge nurse was a workaholic and eventually worked herself up to 5 to 6 days a week. So we did not get a full time charge nurse to replace Cindy. We relied on floor nurses to pick up the one to two open shifts a week. It became soon evident that Tina Fae was more of a talker than a doer. She provided little support for her nursing staff. The only time she left the nursing station was either to eat, go to the bathroom and to go to meetings. Otherwise, her derriere never left her seat. Well, that is not entirely true, she had a way of disappearing to the bathroom during code blues and other emergencies. Somehow it fell on me to become the resource person on the floor, I soon ran all the codes and was the go-to person for any nursing care questions. This went on for a whole year.
It was during this year that I met my second wife and well, you already know the story about my critical care ambitions from chapter seven as well. So I won’t rehash them here. So after I trained Julie, I was again asked by management if I wanted to become a charge nurse. They offered me a six dollar an hour raise. So I said, “Where do I sign?” The problem was that Tina Fae was still working her six days. What was unfathomable was that they were hiring me for a full time position as charge when I would only would be doing it one to 2 days a week. I had a heart to heart talk with my boss about Tina Fae. Well, it turned out that she was aware of the situation and received a lot of complaints about her poor work performance. So when I told her that I wanted three days a week as charge because I could no longer work under Tina Fae once I was promoted. Because I knew how she would lord it over me on that 1 to 2 days a week that she was charge and I worked on the floor. So surprisingly, Tina Fae lost two of her days and was chopped down to four days a week. She ended up picking up her extra days at one of our sister hospitals. Being a stubborn soul and one not prone to picking up cues from her surroundings, continued on her same old ways. Eventually, Tina Fae dropped her days down to 3 days a week and I was now the one who picked up the fourth day. After a little less than a year, she simply disappeared. Apparently she had made friends over at her other hospital and they were ok with her working style. So now I found myself picking up another day so I ended up working 5 days a week for the vast majority of my remaining four years at that hospital.
I guess karma is a bitch! When Tina Fae came in she pushed Cindy out, and when I came in I pushed Tina Fae out. However, I did so because Tina Fae was lazy and provided little to no support for her staff, and she was fast becoming hated on the floor. So, she in essence did it to herself. Even though I was the rookie charge nurse I got all the new nurses on my shifts while Tina Fae got to work with only the seasoned and experienced nurses. I guess this was by the design of the administration since they knew that the new nurses would get little to no support from Tina Fae. I originally thought it was the doing of Tina Fae, but now as I am writing this chapter, I think it was the administration’s doing after all.
When I started working at the hospital we had ward secretaries on each shift to help with taking calls and entering doctor’s orders and making sure that there were enough forms in the chart for days. We called the task “stuffing” the charts. They printed up patient labels, and made sure that there were enough blank doctor’s order forms and progress notes in each chart. As time progressed, our administration came to the conclusion that these ward secretaries were superfluous at night and as they left or retired they were not replaced. By the time I became a charge nurse, we only had one secretary left. By the end of my first year, she had also left for medical reasons. Now all the menial tasks that they provided were placed firmly on our backs. As it turned out, it wasn’t really that big of deal since we had to check their work anyway to make sure that the orders had been entered right. So having them there was redundant, anyways, especially because my secretary was not that skilled and constantly required help from me to enter the orders. Some units had much more experienced secretaries and the chart checking was more of a formality than not.
One thing that was a bit of a pain in the ass was that my day counterparts were not overly aggressive in entering the orders from days, so I always came onto my shift with the vast majority of the charts still sitting on my rack at the nurses station with unfinished orders. I only was able to survive because I was organized and soon developed a system that allowed me to plow right through my orders. I basically did every thing at once from order entry to stuffing and chart checking. When I put the chart back in its appropriate slot, I was essentially done with that chart for the night because most of the orders were put in by 10PM, anyways. Since I was efficient, I was able to spend some time helping my newer nurses. Thanks in no small part to me, our retention of nurses started improving and our skill levels also improved on the floor.
However, the burnout rate was very high for charge nurses under this new system of having no secretaries. The work while rewarding was very demanding and fatiguing and the 5 days a week was starting to take its toll on me. Eventually, we found another full time charge nurse to pick up the slack. So I was able to go down to 4 days a week from my previous 5 and even sometimes 6 days a week. One little side note that I will discuss in the next paragraph is the case of plumbing and which ended up being the final straw that broke my back.
It’s Raining Poop, not Men
When I first started working there, we used washcloths and wash basins with soap and water to bathe our patients since time immemorial. However, that changed as disposable wipes came into the picture. Apparently they were more effective in reducing topical and wound infections, because it was believed that the wash basins harbored bacteria. I don’t know if this was true, because we still have the wash basins even now and we still have washcloths. What soon became a problem was that the patients and even some staff insisted on flushing these wipes down the toilet. As you can imagine, this caused untold problems with our plumbing. When the pipes got backed up, we were not able to flush any toilets or run any faucets. They could be down for hours as the plumbers cleaned out the lines. One rather humorous incident occurred when a senile little old lady flushed the toilet while all the lines were opened, and the plumbers got to experience brown rain. I thought it was funny, apparently my sense of humor was not shared by everyone, especially the sodden plumbers. I guess they don’t like wearing raincoats and using umbrellas as they work. Every time I think about this incident, the song “It’s Raining Men” keeps on popping into my head, and I don’t know why. 🙂
So, as is always the case when the system breaks down it becomes the responsibility of the nursing staff to fix it and by staff, I mean the charge nurses. I am going to provide two pictures below to show what our engineering staff and professional plumbers came up with. Apparently, the problem with wipes being flushed down hospital toilets has reached epidemic proportions, so companies have come up with systems to fight this problem. I guess going back to only using washcloths is not an option.
The metal ring pictured in Figure One goes down into the bottom of the toilet and keeps the wipes supposedly from going down into the drain and plugging up the pipes. However, you still have to fish out the wipes, with the handy little tool that is shown in Figure Two. I can tell you one thing, I went to school for nursing not to unclog toilets. This was the final straw coupled with the burnout that I was experiencing caused me to tender my resignation. It also gave me the perfect opportunity to cash out my 401K. After taking major loses in 9/11 and in 2008, I was no longer willing to keep on throwing money away in the market. Besides this gave me enough money to live for a while without having to worry about how I was going to pay my bills. We bought and paid for a car in cash and I bought some much coveted digital camera equipment. We also were able to take a nice and relaxing trip to visit my family in Florida and to do some scuba diving in the Florida Keys. For the first time in my life since college, I did not have a job and I was loving it. I ended up taking a couple months off from work and recharged my batteries so to speak.
Now that I have given you a time line of my years at this hospital, it is time to talk about the more interesting aspects of my stint there and that is the staff and the patients. I want you to know that not only in my two previous chapters and including this one and the two to follow, I am only scratching the surface. I could devote a rather lengthy tome on just my experiences while working as a nurse. I am not sure if the reader is quite ready for that, so I will just hilite some of the more entertaining occurrences that I experienced and the unique individuals that crossed my path.
Don’t Sit in that Chair!
We had a rather sweet and somewhat simple and yes obese CNA who for a time worked on our floor. Bless her soul! She really did try to do a good job but her size really did get in the way of her performing her job. I am not sure what the reason was but eventually she and the hospital parted ways. She had a bit of a stress incontinence problem and would pee on occasion while sitting in her chair while she entered her vital signs and did the basic charting required of a CNA. Everyone knew that she had a designated chair that she sat in, however, sometimes she forgot that and we would have more than one wet chair. This would not have been a problem but our chairs at the nursing station were cloth chairs. I don’t know what dumbass came up with that idea, but we still have them in the hospital even now. So you soon can tell which chairs she sat in by the bath towel that covered them. The problem arose when a nurse from another floor came to help us out and nobody warned her of the situation. Now you had a nurse and a CNA walking around with a wet ass. How embarrassing! She had another bit of a problem, her hygiene left a little bit to be desired. Well, if you want to admit it she had a few more problems. She would eat the rest of the food on the patients’ trays and she would even eat some of our lunches in the break room. So maybe that is why she left our hospital. I guess I will never know.
Push-ups with Sam Kinison
I am not trying to pick on CNAs but they sometimes are the most interesting of individuals. This young lady was a bit of a fire plug and was rather stocky in build. But one thing , she was the strongest woman I ever met. When she tugged on a patient, they moved. However, the real reason she was so strong and stocky and also why she had a bit of a stubble on her chin, was that she had low estrogen levels. She did not realize it until her and her husband tried to have a child. I felt bad about it, but maybe it was for the better, she certainly was a strange bird. I am going to include a picture of Sam Kinison (Figure Three) because I believe that a picture is worth a thousand words. Of all the time that I worked with her, I did not put two and two together until she came in on one cold and blustery evening wearing a cap and a scarf wrapped around her rather thick neck. It is a good thing that I wasn’t drinking anything or that I did not have false teeth, because they both would have gone flying. I had to go into another room , so I could laugh my ass off.
I will just call her “Sammy”. Now you know who I was working with. She even sounded a little like him. I am not sure how we got on the subject but we did. We started talking about push-ups and exercise in general. Sammy chimed in and said that she used to be good at doing push-ups. Well, I double dog dared her that she could not do 5 push-ups. So she dropped down on the floor in the nursing station and proceeded to prove me wrong. After almost stroking out after her third push-up I stopped her before we had a code in the station. I have seen beets that were lighter in color to the shades that she turned trying to do those push-ups. So that is how I got to see Sam Kinison do push-ups, well, not really.
Sex in the City
I know I mentioned that homeless patients were pretty common at this hospital. What I may have neglected to mention is how delightful they can be. Sarcasm is dripping here. This male patient had a constant female guest accompanying him. We soon found out why she was so close to him. Well, my little Hispanic CNA found out not once but twice why she was with him. This CNA never could seem to grasp the concept of knocking on a patient’s door before entering. I think after this night she finally grasped the concept. I think that is so alluring about being in a hospital to the homeless person is that they get to sleep in clean beds and eat warm food. Food that was not found in a dumpster that is. However, this couple took it to a whole other level. We did find out one thing, our homeless patient was not as sick as we originally thought and his partner was extremely athletic. Come on, guys do I need to paint you a picture?! Both times my Hispanic CNA entered the room unannounced all I heard was an “eep” and the sound of a quickly closed door. You would have thought that she would have learned her lesson the first time, or maybe she thought that she gave a long enough time for them to finish. But damned if it did not happen a second time with the same result. So either they were still going at it or they had started another round, I don’t know which. But I do know one thing, hats off to them. I think the second time was a game changer for my CNA. After that she continued to knock on doors at least till the end of the shift. When much to my chagrin she quit, saying that she could not work under these conditions. I was sorry to see her go, she really was a hard worker.
The Infested Patient and the Housekeepers
In the previous chapter, I mentioned that I could not stand people getting abused, especially ones that could not speak up for themselves. Well, here is a story to prove this. The patient in this story actually spanned two hospital visits, the second one ended in the ER and did not make it to the floor. But the grapevine provided me with full details of those events. Since it involved the same patient and I think it is germane to the story so I will include it here. I am not sure why this patient was admitted to the hospital but I am sure it was an unnecessary admission. This patient was a truly filthy patient. I actually think if he whistled to his clothes they could have come to him. If you have not smelled a longtime homeless person just think of the following…dried sweat that had cycled several times followed by stale cat urine, feces and vomit. Now you have an idea what the truly disgusting homeless person can smell like. I am also not saying that they are all like this but this one truly fit the bill, right down to being infested with body lice and probably bed bugs as well. When my CNAs went through his clothing, a whole black cloud exploded from his clothes as they shook them out looking for illicit drug paraphernalia. They immediately stopped what they were doing and promptly left the room. They both hastily called for hospital scrubs and took showers and vowed not to go back in the room. Thankfully the patient was discharged the next morning. Yo know what the kicker was, my daily counterpart gave the patient a bus token. Can you imagine that, I am sure the bus became infested too.
Now, this takes us to the housekeeping staff. The fumigators refused to go into the room until it had been cleaned up. Can you believe that shit? Isn’t that their job to wear hazmat suits and kill vermin with noxious chemicals? These two housekeepers were great ladies, they came to all my parties at my house, so needless to say, I was pretty close to them. Their boss, also a friend of mine and someone who should have known better sent them into the room to clean it up. Well, they got infested themselves, the bugs actually got into their underwear. They had to also to take showers and change into hospital scrubs. They also had to throw all their clothes away. When they told me this they were in tears. Well, needless to say I blew a gasket. I called the housekeeping supervisor and I let him have it, friend or no friend. I made him give the two housekeepers a clothing allowance to replace their outfits. How demoralizing was that, they both had the right to quit without notice. But they staid the course. One good thing that came out of it, the supervisor treated his staff a little better.
Visit number two. This time he never made it out of the ER. Of course, he infested it as well. The reason that he was not admitted this time, was that they caught him having sex in the room with his male lover. Ok, talk about being really gross, can you imagine that?! I never heard about him being readmitted, so I guess they finally learned their lesson. It turns out that all he wanted was three “hots and a cot”.
Randy, The Friendly Ghost
I once worked with a male LPN named James. He was a big muscular man that made me look small. To give you an idea I stood 6″2′ and weighed 230 lbs back then. So when I say he was a big man, he really was a big man. I, however, had no idea how strong he actually was until he helped me with a patient. He was very hard working and very friendly and we soon became fast friends, that is until he up and disappeared with no notice. But his vanishing act is not why I bring him up. We had this overly large gentleman who weighed in at a svelte 500lbs. I do not know what possessed my two CNAs but they thought that after covering him in a white moisturizing lotion that it would be a good idea to get him out of bed and escort him to the bathroom. Well, as soon as they got him out of bed they became aware of the error of their ways. Because he immediately became unsteady on his feet. He could neither walk to the bathroom nor could he get back into bed. So they yelled for help out in the hallway. Well, James and I raced to the room. I chose to get behind the patient and placed my arms under his armpits. I guess I thought we could pivot him onto the bed. James grabbed him by the front mirroring my armpit hold. The next thing I knew, I and the patient are both in bed. He lifted up over 730 lbs of humanity like it was not even there. Unfortunately, I was in a bit of a pickle because now I found myself underneath a 500lb human being. All you could see were the tips of my hands and feet and the top of my head. I could not breathe or move. All I could do was gasp out the word, “Help!” Well, my staff soon realized my demise and they helped me out of my predicament. When I came out from underneath my large patient, I was covered from head to toe with that damn white lotion that they had lathered all over him. I looked like Casper, the Friendly Ghost…I kid you not. The patient was so embarrassed and apologetic especially when he saw me limp out of the room in such a state. All I was thinking as I left the room was that I was glad that James liked me.
Viagra and the Nurse
This patient was a biker dude with an overly sexed biker chick as a girlfriend. She was at least 10 years younger than him. So why did this patient get admitted? He took 10 Viagra and after having an erection that lasted 6 hours, he came to the hospital. His girlfriend, of course, drove. This can actually result in the patient never being able to get an erection again, so it is a bit of an emergency. What it calls for is to have a urologist put a small drain called a Penrose drain into the blood vessel that fills with blood causing the penis to become erect. I have included a little monolog discussing the process a little more in depth directly below.
How does an erection occur?
When the blood vessels of the corpora cavernosa relax and open up, blood rushes in through the cavernosus arteries to fill them. The blood then gets trapped under high pressure, creating an erection.
- An erection begins with sensory and mental stimulation. During sexual arousal, nerve messages begin to stimulate the penis. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand and creating an erection.
- The tunica albuginea (the membrane surrounding the corpora cavernosa), helps to trap the blood in the corpora cavernosa, sustaining the erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.
(referenced from my.clevelandclinic.org)
Eventually with time the effects of the Viagra wears off and the penis can become flaccid again. The drain in the meanwhile prevents the penis from becoming fully erect and thereby preventing permanent damage being done.
The one reason that I mention this patient at all, is one, what the hell was he thinking? Second of all, the nurse I assigned to him was a small Filipina who informed me about how large his penis really was. Apparently she was quite impressed. Well more power to him.
Menage a trois
There is an old saying that “Three’s Company”, wasn’t that a TV sitcom? 🙂 This was certainly a unique situation. The patient was the male partner of this threesome. He always had at least the wife or the girlfriend with him sometimes both. I asked him how he did it. He said “I don’t know but they are the best of friends” and he is living the life of Riley. Apparently there is no jealousy at all. One night, the girlfriend came out asking for towels and wash clothes, I guess it was her night to shower with the patient. The next night it was the wife’s turn and the last night he was there, it was time for all three of them to be in the shower. Sometimes I think I could write stories for “Red Light Diaries.” I don’t remember what he was in the hospital for but who in the hell cares. Oh, one more thing, both women were gorgeous, so eat your heart out.
I dropped the Dilaudid, Honest
I mention this story because it involves Linda and it covers both of her weaknesses… gullibility and her overly trusting nature. We had a nurse float from a different floor one night. She seemed to be all right at first but then I began to have my suspicions. She would run around like a mad woman and had a ravenous appetite eating patients trays that were left over and eating extra food in the refrigerator for patient snacks. Then she would start slowing down and eventually she would disappear only to come back 20 minutes later and start the cycle all over. I really became suspicious when Linda comes up to me and tells me about what has been happening. She had been witnessing the waste of Dilaudid without actually seeing the wasting part. First of all, she was an LPN, so I am not sure if she should have been wasting the medicine at all? But that is neither here nor there. What finally clenched it was when she asked me at the end of shift to waste morphine for a patient that was being discharged. I looked the patient up and he had never asked for pain meds the whole time he was at the hospital. So I refused. I contacted the pharmacy and notified the house supervisor and then my nurse manager. I am not usually the whistle blower, I know everybody can make a mistake from time to time, as long as it is not malicious or affects the patient. But this was too obvious. I hope Linda learned a lesson from this experience.
My Patient Has No Blood Pressure
I include this story because even the most experienced nurse can experience tunnel vision. This involved a male nurse. In a medical/telemetry floor there is only so much we can do to increase a patient’s blood pressure. One is to give them extra intravenous fluid. We can also give them albumin which is a volume expander and draws fluids out of the surrounding tissue and returns it to the blood vessels. Thirdly, we can change their position. By lowering the head of the bed and raising the feet we increase the volume of blood in the core of the body, thereby improving the blood pressure. If the blood pressure does not improve and it reaches a critical level, that patient has to be transferred to the ICU where they can receive more advanced blood pressure support. So after the third time of my nurse coming out to ask for guidance, I said “I will go in to see the patient and see what else we can come up with before we woke up the doctor”. His blood pressure was not critical…just worrisome. That is why we had not already called him. By the way, the position change we initiated is called the Trendelenburg Position (Figure Four).
What is the first thing I saw when I walked into the patient’s room? Well, I will give you a hint…I was looking for the blood pressure cuff. After I saw where it was located, I gave the nurse a wave of my hand to have him come outside in the hallway. The patient was alert and I did not want to embarrass him in front of the patient. I asked him to stop and think of one thing. I asked him where he had placed the cuff? He immediately knew what he had done. He had placed the cuff on the patient’s ankle. So the higher he elevated his legs the lower the blood pressure got. There was nothing wrong with the patient. The fluid bolus was enough by itself to fix the problem. He was just a little dehydrated.
It’s A Boy!
I will wrap up this chapter with a little of the supernatural. We had the patient who used to work at our hospital. She had been very sick the whole time she worked on our floor. She never asked for any sympathy, as a matter of fact, I never even knew that she was a terminal case. She just loved caring for patients. She worked right up to the last month of her life. After that she was unable to continue because she had just become too weak. The only thing that was keeping her going was that she was waiting for the birth of her grandchild who as it turned out was a boy. The family had made her a DNR because they didn’t want her to suffer. So half way through the night, the family called to tell me that her daughter had just given birth to a healthy baby boy. They asked me to go into the room to tell her that her grandbaby had arrived and was healthy. I went into the room, mind you nobody had entered her room after the call had been made. I was the first one to do so. When I went in to the room I saw her lying there with a smile on her face. She was no longer breathing. She had just passed away. Her waiting was finally over. Now you tell me doesn’t that give you goose bumps? I know it does to me.
Well, that concludes this chapter and my eight plus years at this hospital. I hope you found it interesting and entertaining. The next chapter will pick up at another hospital entirely where I had a brief stint as a charge nurse and then moved on into the critical care field.