The Making and Life of a Registered Nurse in the Era of COVID-19: Chapter Seven–My Life as a Charge Nurse

The Charge Nurse who worked at my new unit was a very experienced nurse whose name was Cindy. 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 or 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 in my first book as well. So I won’t rehash them here. However, since this book is dedicated to nursing I will spend a little time discussing it later. So after I trained Julie, I was again asked by management if I wanted to become a charge nurse. They offered me a $6 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, she continued with 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 a deal since we had to check their work anyway to make sure that the orders had been entered correctly. So having them there was redundant 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 the doctors, 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 everything 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.

As my time passed at this hospital, I started hearing rumors that we were having problems with our patient satisfaction scores. It was rumored that the CNO or chief nursing officer would lose her job if they didn’t show an improvement. Well, anybody working in corporate world knows that shit rolls downhill. So, in actuality it meant that the nurses managers jobs were at stake. Again this was not going to happen either. So who do you think this meant? The charge nurses were the problem, damn them to hell for not making the patients happy. Of course, it had nothing to do with 9 to 1 ratio at nights for medical telemetry patients and the fact that we had to cover for the LPNs as well. It was the charge nurse who was responsible. I was the senior night charge nurse and Hazel was the senior day charge nurse. Well, needless to say that our seats became quite hot. After a few weeks of the constant assault on us, I gave my notice and a couple of days later my day counterpart threw in the towel as well. I cashed out my 401K and took some time off. My wife and I went to Florida on a nice trip to visit our respective families and that closed my 8.5 year chapter of my life. When I left I was put on the rehire list which made you wonder what was really happening.

To wrap up this chapter, I will cover a few doctors that I knew and became newsworthy. I will start with the most famous one and that is Dr. Conrad Murry.

Dr. Conrad Murray was a cardiologist who worked at my hospital in Las Vegas. I would see him making rounds on a routine basis at night. He was always polite and respectful of the nursing staff. That is why it was such a surprise that I heard that he became involved with Michael Jackson. It did not make any sense. I would have expected that if he was having problems sleeping he would have hired an anesthesiologists instead. Murray met Michael Jackson in 2006 in Las Vegas and treated his daughter Paris when she fell ill. Jackson hired Murray to be his exclusive personal physician prior to his tour in July 2009. Jackson insisted that Murray be employed by his show promoter, AEG Live, for $150,000 monthly. However, AEG later claimed that there was never a contract with Murray.

In May 2009, Murray began working as Jackson’s personal physician. By that time, he had reportedly fathered seven children by six different women. He was in arrears on the mortgage for the Las Vegas home occupied by his first wife and children and owed child support to the mothers of children outside of his marriage, which he could not pay due to the amount of money that was owed to him by Michael Jackson. He was married to Blanche, his second wife, whom he met at medical school, and helped pay rent for another woman, Nicole Alvarez. Murray met Alvarez at a gentlemen’s club in Las Vegas when she worked as a stripper, and Alvarez gave birth to their son Che Giovanni Murray in March 2009. Another relationship, with a cocktail waitress from Houston, was also reported.

Murray was at risk of losing his California medical license due to unpaid child support to one of his children and owed $13,000 to a California woman, Nenita Malibiran. Murray was a defendant in numerous civil lawsuits. By 2008, he had accumulated over $600,000 in court judgments against him for medical equipment and unpaid rent for his practices in Texas and Nevada. He also owed $71,000 for student loans at Meharry Medical College. Murray filed for bankruptcy in 2002, in California. 

On June 25, 2009, only weeks after hiring Murray, Michael Jackson died due to a lethal dose of Propofol administered by Murray. Court documents released in August 2009 revealed that the coroner’s preliminary conclusion indicated that Jackson overdosed on Propofol. However, the coroner’s office declined to comment on reports claiming that the death was ruled as a homicide. Several offices of doctors who were believed to have treated Jackson were searched. Based on the autopsy and toxicology findings, the cause of Jackson’s death was determined to be acute Propofol intoxication with a contributory benzodiazepine effect and the manner of death to be a homicide, eventually, so that the focus of the investigation shifted toward Murray. He admitted administering 25 mg of Propofol intravenously, for insomnia, on the night of Jackson’s death. He claimed that he tried treating him with other drugs and that he only administered the Propofol after Jackson insisted, according to a police affidavit. Murray said he worried that Jackson had become dependent on the drug as a sleep aid, and was trying to wean him from it. Propofol is usually given in a hospital or a clinical setting with close monitoring, mostly used for general anesthesia during surgery. It is not indicated or approved as a sleep aid and is administered only by anesthesiologists, nurse anesthetists, anesthesia assistants or intensive medicine practitioners who have extensive training in the use and monitoring of anesthetics. Murray did not have any such training.

In February 2011, Murray was formally charged with involuntary manslaughter. On September 27, 2011, Murray went on trial in Los Angeles and was convicted of involuntary manslaughter on November 7, 2011. His bail was revoked and he was remanded to custody pending his November 29 sentencing date. He received the maximum penalty of four years in prison. His Texas medical license was revoked, and his California and Nevada licenses were suspended. After serving two years, Murray was released on parole on October 28, 2013.

The information on Dr. Murray was taken from a Wikipedia article on him.

While this did not involve a gastroenterologist that actually practiced at my hospital it adversely affected a relative of his who practiced the same discipline and who had the misfortune of sharing the same last name. Our poor doctor received death threats and had to go into hiding for some time until all the furor died down. So you can be found guilty by association even if it is unjust to do so. While I have never met the guilty party I have had the fortune to work with the poor victim. He was always respectful and kind and never had a cross word to any of the staff. Eventually his life did return back to normal and he was able to return back to his practice. I will include some information on his guilty uncle below.

The article posted below is taken from an posting made by HO&P law firm, and was posted on May 6, 2013.

A jury awarded $524 million to two patients who contracted hepatitis C from contaminated anesthetic Propofol vials used during colonoscopies at a Nevada clinic in 2007. Helen Meyer and Bonnie Brunson contracted hepatitis C when they underwent colonoscopies at a Las Vegas endoscopy facilities operated by Dr. Dipak Desai. According to the plaintiffs, Dr. Desai and his staff improperly reused Propofol vials and syringes and failed to sterilize equipment between patients.

In addition to the sheer size of the verdict, the case is unusual because the jury actually found liability against the HMOs who had hired Dr. Desai for their network. Specifically, the jury found that two UnitedHealth Group, Inc., subsidiaries were liable for failing to properly monitor Dr. Desai and the clinic he owned and operated.

At trial, the plaintiffs argued that UnitedHealth officials knew Desai had a reputation for sloppy practices and failed to check the quality of his work. Witnesses testified that that the doctor would see as many as 20 patients in a three-hour period. The plaintiffs argued that despite these practices, prior complaints of failure to diagnose cancer and Crohn’s disease and numerous hygiene problems at the clinic, the insurance carriers awarded Desai a contract to handle colonoscopies and later renewed the contract. One of the attorneys who represented the plaintiffs stated, “None of the defendants took any steps to prevent the unsafe practices that resulted in the spread of hepatitis C throughout the Las Vegas community. Instead, they placed profit over patient safety.”

After hearing all of the evidence, the jury found that Health Plan of Nevada and Sierra Health Services were negligent in failing to properly monitor Desai’s performance. They awarded $24 million in actual damages and $500 million in punitive damages. The defendants plan to appeal.

You may ask why I included information on these two doctors? The answer is that I want this book to be not only about nurses but about the medical field as well, and that also includes doctors. I have included in this book many anecdotal accounts and stories of not only patients but staff as well, so why should I exclude medical doctors? I have known many doctors over the twenty years I have worked as a nurse, and the vast majority of them have been exceptional, but there have been a few that have succumbed to the siren call of bigger pay-offs. I have only included the two biggest ones I know of. There are several others that I could include as well, but have chosen not to do so due to lack of room. Even though I have narrowed down the scope of this book to the medical field with a particular emphasis on nursing, there is just too much information and as a result, I have to be circumspect in what I include.