There's the fact that I'm providing healthcare to people who've committed crimes. Sometimes horrific terrible crimes. The guy I'm running down to save from the heart attack? He's been cooking up meth and selling it to the poor souls in his area for years. That old man that I'm passing along the Lopressor and Norvasc to? Yeah, he raped his grandchildren. That kid that I'm drawing up the insulin for? He murdered three people. They fella who's wound I have to clean and pack every day? He kidnapped a girl and kept her as a slave for three years. The guy who I'm giving comfort and education to regarding his recent diagnosis of HIV? He was driving drunk and took out a family of four, leaving a little six year old girl to grow up without her parents and little brother. And while I'd never share real health information or real patient information, those are all real crimes committed by random people where I work. I try my very best to NOT know what they did to earn their time with the department of corrections, as it's already difficult to know I'm treating a convicted felon. It's even more difficult when I know what their particular crime is. But yea... I've treated and helped and comforted some horrible people that I'd rather punch and throw into a ditch and leave for dead.
That's frustrating.
Outside of working on felons, there's the whole healthcare system. I imagine this is a frustration that any nurse would suffer through. Struggling to figure out why certain procedures and medications are covered while others aren't. For example, we cover the Hepatitis C treatment. Depending exactly how long the patient needs to be on the treatment and how many side effect drugs he needs to take, the treatment can cost between $80,000 and $250,000. A quarter of a million dollars. At the very same time, our medical providers can no longer prescribe Excedrin Migraine for a patient that suffers from migraines. A 300 count bottle of that costs $12 at Amazon (and would cost WAY less than that from our Pharmacy as we'd use a generic), and we'd give our patient only 30 per month. But if that same patient is prescribed Topamax, he can get THAT and it only costs the state around $15 a month. There actually IS a logic to it, but it's a convoluted logic that's difficult to understand and far more difficult to explain to a patient that simply wants their migraine to go away.
That's frustrating.
Then there's working inside of a secured perimeter. I explained a couple posts ago about not being able to use a hard sided glasses case to protect my sunglasses, but there are plenty of rules that we have to abide by. Plenty make sense, like no knives or weapons. Most are frustratingly are understandable, like no cell phones. But some are just downright idiotic like no CDs. Seriously, we can't bring in music CDs. We are in a large reinforced brick building surrounded by several electrified fences... we don't exactly get a good radio signal. A good collection of music CDs would be wonderful but we can't bring them in. For the past 3 years the only beverage we could bring in is water. No soda, no coffee, no energy drinks, no Gatorade, no tea. I can appreciate only bringing in sealed beverages, and maybe only sealed beverages in a clear or at least translucent container so that an officer can see that it's a liquid without something floating in it, but come on! I can buy my low calorie Gatorade from Sams Club at just over fifty cents a bottle. It comes in clear bottles and they are sealed. But I can't bring them into the facility, so instead I have to buy that same beverage inside the secured perimeter for $1.65 every single day. You can bring in over the counter meds like Tylenol or Motrin but they have to be in single serve sealed packages. And if I want to bring in my prescription medications, I have to get special permission from the warden.
That's frustrating.
The paperwork is frustrating. Working in healthcare where healthcare is not the first and foremost activity is frustrating. Having monthly drills involving mock riots or escape attempts that last for hours and have the entire facility on lock down is frustrating. Having to be randomly patted down when I come into work is frustrating. Having to sign a paper that gives up my right to freedom (they can search my car and locker for any reason or no reason at all at any time they want and if I don't hand over my keys I can be fired on the spot and prosecuted by the state's attorney) is frustrating. Working on outdated software on outdated computers on outdated operating systems (Windows 7) because it would literally cost the state hundreds of millions of dollars to upgrade us all and they can't upgrade us in pieces is frustrating. Having to send a patient out to the emergency room for a life saving procedure via an ambulance and still having to wait for the officers to get the chains around his waist and locked to his ankles and wrists is frustrating. Having a convicted felon and current inmate as the custodian in my area, a man that walk around and listens in to my and the other nurses conversations, is frustrating. Not being able to display private things like photographs or the names of family members or people that I love and that would remind me why I work at all around my work space because it would let these felons see those people and maybe use that information against me or possible seek out those that I love and hurt them because I didn't give them Motrin for their boo-boo, is frustrating. Being lied to about having serious medical conditions like seizures, sickle cell disease, diabetes, fibromyalgia, and even cancer so that the patient can get a better cell, a bottom bunk, and tennis shoes, and of course better drugs, is frustrating.
But I've had all of those frustrations ever since I started my correctional nursing career. Yes, some days those do get to me. But lately I've been coming home from work just out of my mind crazy and angry and upset and it takes me hours to calm down. And some nights I don't calm down before I go to sleep. And some mornings I'm still not calmed down before I wake up. And in the last couple months, that's extended so far that on some mornings when I'm driving TO work I'm not calmed down from the day before and it has absolutely nothing to do with any of those frustrations I've written about above.
It has to do with Her.
I work with a nurse that I have absolutely no professional respect for. I have so little professional respect for her that it's leaked over into personal disrespect for her. I probably wouldn't ever really be friends with her outside of work, even before I got to know and dislike her professional, but now I'm starting to wish her ill in her personal life. I think the best way to demonstrate just how deeply she's gotten under my skin is to tell you about the dream.
When I was telling a coworker about this dream I really had to think about this and I've kept thinking about this and I have to stick up for this fact; I'm not violent in my dreams. I've been sexually dominant in my dreams on many occasions, and I've been in fights in my dreams but those were always in a self defense type position. For example, someone's beating me up and I'm lashing out to make them stop. But I'm not violent in my dreams as in I'm trying to hurt someone in a malicious way.
So in this dream I'm falling over a cliff. I'm terrified and I fall into a cloud bank. I'm straining to reach forward and I feel my fingers touch someone, but instead of touching their arm or chest or face, I'm touching their throat. I keep trying to reach around and grasp their shoulder or something else that I can grasp and hold on to so that I can save them with (no, I don't know how I could have saved them but it's a dream and that's what I was trying to do in the dream was save them). But nothing... just their throat over and over. I'm getting more and more scared feeling like I'm going to come out of the clouds and see the person that I couldn't save and have to watch them die and know that I failed but I still can't reach any part of them besides their throat.
Then we finally do leave the cloud and I do see who I'm reaching for. And it's Her. And without thought or even a moment's pause, my hand snaps out and grasps her by the throat and gasps it as hard as I can. I don't just hold her by the throat I grip her and start to dig my fingers into and around her windpipe. I can see the terror and horror on her face and I don't pause or care, I just keep gripping and doing my very best to kill her before the ground can do it for me. Because I want to kill her and I don't want it to be the fall or the ground or anything else. I want it to be my fingers that kill her.
When I wake up it takes me a long long minute to come to grips with the dream. My heart was beating so damned fast that I was afraid it might not return to a normal rhythm. My hand, the same hand that was griping her throat in the dream, was balled up into a fist and it was so tight that it was sore. It was sore the next morning too. Eventually I was horrified at the dream and I spent a long time trying to figure out what it meant, but that was for the rest of that morning... it's not like I could fall back asleep after something like that... because the moments immediately after waking up I felt that same visceral feeling from the dream. The anger, the disgust, the urge and need to hurt her in as personal and visceral a way as possible. And immediately upon waking the most pronominal feelings I experienced was loss and anger. Loss and anger because I woke up before I got to kill her.
I really REALLY can't describe just how disturbing it is for a dream like that to come from my own mind. I'd love to blame this on a drug but none of my current medications claim to affect dreams. No, I think this is just her affecting me in such a deep way that my subconscious is letting me know in the only way it can. By dreaming.
So what is she doing to get so far under my skin? Well, first and foremost let me say that it's nothing to warrant what I did in my dream. She hasn't killed anybody nor has she hurt anybody directly. No, she's just incompetent and someone that I can't trust at work whatsoever. I'm not going to act like I'm some wizened old nurse that has decades of experience, but I have the respect of the nurses around me. I've had nurses with years and years of experience come to me with questions. I'm sure if I wasn't there, they would have been just fine but they still felt comfortable with my judgement and my experience to pull me into their problem and ask me what I thought, ask me how I would tackle the problem. I've had medical providers trust me, my nursing skills, and my nursing judgement. I think the best example of this is Dr B. He's the only physician at our location and he oversees all the other medical providers as they're all nurse practitioners or physician assistants. As an RN, if I have a problem I can easily go to him especially if it's his turn as the 'extra' medical provider. I recently had to come to him with a patient complaining of chest pain. It's the medical provider's responsibility to clear all chest pain complaints as being NOT a cardiac or pulmonary emergency. Almost all of the providers know that this is just a bureaucratic hoop to jump through as most of our chest pain complaints are actually acid reflus or anxiety or some combination of the two, but it's still their license on the line so they'll take the 30 seconds to pull out their stethoscope and listen to the patients heart and lungs to make sure. Dr. B, while in the room with me and the patient, asked how his heart and lungs sounded and I told him that his heart sounded good loud and regular and his lungs were clear bilaterally. I didn't go into any great detail as I just assumed he was going to listen anyway, but he surprised me... he didn't listen. It may only be a small thing, but a physician that I respect trusted me on something he is going to sign off on.
I know damned well that he wouldn't have trusted Her.
I can't keep calling Her 'Her' this entire post, so I'll call her S. Yeah, I've had plenty of S people I've talked about. Deal with it. I'm talking about this S for now.
So, as I was saying, I'm not a highly experienced nurse, but I AM good. In this setting, we Registered Nurses work with a lot of autonomy. There are certain circumstances that we have to go to the medical provider for, but there are a lot of protocols that give us the permission to do things that the Registered Nurse in a hospital setting would need direct permission from the medical provider to do. The Medical Providers, for the most part, are happy to help us out. They know that we have that autonomy, so when we come to them it's because we either need something that exceeds our licence (for instance, we think they need a prescription drug of one type or another), or we simply have run out of options and are looking for help.
Let's take burns for an example. Our patients work in the kitchen and getting someone who burned himself in the kitchen is common enough. They very all over the board from their skin is barely turning pink and it doesn't even hurt, to it's damn near third degree burns and they may need a skin graft. The lower end of the spectrum doesn't require the medical provider unless it's impacting the inmate's eyes, genitals, ears, and maybe his mouth or hands. We'll get it cooled down with some cold water, give him some ice and a detail to continue using ice, a follow up with nursing to see how it looks after the swelling, and see if any blistering has occurred. Of course we'll give some tylenol or motrin for pain management and then let the patient decide if he can work or not (its actually quite important for these guys to keep working if they can so I let them make that decision unless medically they absolutely should NOT be working).
Now if it's worse than that... if there's significant swelling or there's blistering, then it could still be handled at the nursing level but it requires a really good medicine called silvadene. It not only helps the burned skin heal, but it also helps it with the pain at that local level. But silvadene, at the department of corrections, requires a medical providers order. So even though I can assess it and use the medication, I have to involve the MP. And as they are responsible providers, they're going to at least peak in before they order the medicine. Anything worse than that and I"m asking the MP for their assessment and putting it that way. I'm not merely letting them know I have a burn and would like to put some silvadene on it, I'm letting them know it needs an MP's eyes to look at it as it may need to go to the hospital for specialized care.
S, on the other hand is all over the board. I've seen her report an incredibly minor water burn to the MP. It in no way needed silvadene. It needed a little cold water, some ice, and some tylenol. I'm not even sure I would have scheduled a follow up visit with a nurse to check on it. I wouldn't let the guy go with out instructions... for example I'd let him know that if it wasn't feeling better in a couple days or if it was feeling worse after the first 12 hours, then he should come back and see us, but that there's no reason we should expect that and it should feel fine in a couple days. But S went to the MP and told them she had a burn they needed to look at.
On another occasion, she had an inmate with a similarly minor burn and she went ahead and put silvadene on it. She did report it to the MP but only after the inmate left. The MP was understandably upset about it as that goes under their name. They tried to explain to S that they would like to see the patient before any medication is applied but instead of listening to the explanation and hearing the difference between this situation and the previous situation, S got upset because she 'got in trouble' for going to the MP before and thought she didn't have to.
A couple weeks later an inmate came in with a bad burn. Bad as in several large blisters, one of which had already burst open. While I don't believe that he would have needed to go to a burn unit, I most certainly would have wanted to go to the MP and have him looked at as it MIGHT have warranted getting looked at by a burn specialist. Regardless of the specialist, it was going to need something beyond ice and tylenol, so it would NEED an MP. So what did S do?
That's right.... Ice and tylenol.
She claims she got yelled at for bothering the MPs and didn't want to do it again.
That's burns and that's just the tip of the iceberg when it comes to burns. And burns is just the tip of the iceberg when it comes to injuries and injuries is just the tip of the iceberg when it comes to the RNs job where I work. But that's S's response... erratic and all over the place and looking for a single answer to a wide and varied set of problems. There's a system in nursing called SOAP. Its primarily for documenting, but it can be used for the thought process while assessing a problem. It stands for Subjective, Objective, Assessment, Plan. You look at the Subjective data... that's whatever is told to you or data that you can't verify objectively. A patient tells me that he notices blood when he wipes after a bowel movement. That's subjective data. Objective is data that is directly witnessed by me or is confirmable. If I do an exam of his buttocks and anus and notice a hemorrhoid and see that it's bleeding or see that there's blood in his underwear near his anus, that's all objective data. The Assessment, or nursing diagnosis is what you believe is going on. It's taking the subjective and objective data putting it together with the knowledge inherent in nursing and putting it together in a way that explains it. Plan is just that... what's the plan to take care of the problem.
It's as though S wants a list of Plans and then wants to skip the S O and A stages. Just ask a few questions, and then move right onto the plan. But nursing for a Registered Nurse is all about that Assessment. Every single situation is different. Every single answer is different. Every single solution is different. And therefore every single plan is different.
Another problem I have with her is authority. Now I don't care where we're at, the RN is a healthcare authority. We don't waffle, we don't 'think' we 'know'. We don't 'guess' what you should do or 'suggest' how you should take your medication, we 'tell' you how to take your medication. That's true in a clinic, that's true in a hospital, that's true in a doctor's hospital. And that is so especially true in a correctional environment. Our patient population is full of people who have problem following directions and they need clear directions that are easy to follow. The best example I can think of is handing out what we call KOP medications. That's Keep On Person medications. It's the meds that a patient can keep on is person. Think of stuff like blood pressure meds or antibiotics, prostate pills, or other fairly harmless pills. Medicine that messes with your mind (seizure or mental health meds), narcotic medication, meds that are easily abused, or very expensive medication is restricted and given one pill at a time.
Every evening one of the RNs give out the KOP medications. A normal night will include handing out meds to about 30 patients and each patient will get between 1 and 5 different medications. If it's a refill of a med that the patient has been taking we simply ask if they have any questions. If they do, we answer them then hand over the pills. If not, we just hand over the pills. But if it's a new mediation we read off the instructions from the prescriber and then give any information we believe is relevant. For instance if I were to give a new prescription for penicillin I'd say something like this:
"Okay, the doc wrote you a prescription for Penicillin 500mg. You take 1 by mouth four times a day until they're all gone. It should take you about 7 days to go through them all. If you miss a dose, don't double up at your next dose, but just keep taking them at 4 times a day until they're all gone. The easiest way to remember to take them 4 times a day is to take them with each meal, breakfast, lunch, dinner, and then take one just before you go to bed. You might get a little upset stomach while taking these, but that's normal. Just keep taking them. And drink plenty of water while you're taking them. Do you have any questions? No? Okay then, you're all set." And then they'd walk away.
S's would go more like this:
"All right, I've got an antibiotic for you here. It's, um.. it's Penicillin. It's a big dose too. Like 500mg. Now they wrote this for you to take four times a day. If it were me, I'd take them with meals and maybe once just before bed. Do you go to sleep around 10? Yeah? Then that should work, just before you go to bed. But if you stay up later, just go ahead and take it around 10 okay, so then you're taking it around the same time every day. It's not that important but it's kinda important ya know? So, anyway, four times a day. There you go." And then they'd walk away.
That's not a direct quote from her handing out KOP meds... but that's only because I haven't written down exactly word for word and um for um exactly what she says. I try not to listen now a days as it's like listening to fingernails on a chalk board. I can picture a lot of people being able to simply read the instructions as they're clearly written on the card. In fact the patients I'm giving the instructions to will clearly see me reading the instructions from the card. But when I"m done with the direct instructions "Penicillin 500mg. 1 by mouth four times a day until gone" the rest is said with me looking at them. S is looking from side to side, looking at the officer, looking at the counter in front of her, looking at the other meds she has to give out, looking at the other inmtes and yes, occasionally looking at the inmate shes actually talking to.
So she doesn't make good assessments and doesn't parlay information well to others. On top of those things, she's also lazy. Just generally lazy. She will want to do the least amount of physical work as she can. I can't count how many times I've heard her say "Oh, I was just about to do that". At first when I heard her say it I'd think that she was being honest and that she was just learning the ins and outs of this new place and finding her groove. Now all I can think is "Well then why the fuck weren't you doing it?" I never have to say "oh I was just about do do that" because if I was about to do something then I'd have been doing it before someone else got to it.
And I know that everybody works at their own pace. What I do in 5 minutes might take someone else 9 minutes. Or 2 minutes. Or some other time. But in general, there are plenty of tasks that you can time. Every week we have to do what we call the 'Big Count'. That's count every 'critical' tool in the storage room and then sign a book for each tool stating that it was there and present. It takes about a half hour to do it if you're fast and about 45 minutes if there's a problem or if you're slow. 50 minutes if there's a problem AND you're slow.
S does it in 90 minutes.
Doing the SMHU rounds takes us between 15 minutes and an hour. It takes S between 45 minutes and two hours.
Locking up the doors to the clinic and the cabinet doors in the nurses station at the end of the day takes all of 5 minutes. It takes S 15 minutes and 4 tries. And even then, I can invariably find at least one door or one cabinet that she missed. And when I do she'll just laugh and say "oh geez, did I miss one again!"
It is beyond maddening.
I can come up with example after example after example after example. But the terrible truth is this is not only a civil service job (a state job), it's also a union job. The UAW (yea... the Car Union guys) protects us. And as a dues paying member she gets the full protection of both the union and the civil service commission. The nursing supervisor and the HUM have both been actively trying to either get her trained up or fired for months now. Not because they personally dislike her, but because they are constantly having to deal with employees like me who seethe and complain about her.
Just one more example.
We had a buy on quarantine and he couldn't speak English. We have a cellular service device that will connect us with a medically and legally certified translation service so that we can have a translator everywhere we are and can even assess this guy in his cell. But remember what I said about the radio earlier? Well, the same problem applies to the cellular service of the translation service. It gets absolute shitty service in the block. So we had a call out there that this patient was in pain, but since no one could understand him they were calling us. I wanted to prove once and for all that this service wasn't going to work and could actually harm him in an emergency situation so I grabbed an emergency bag, a wheelchair, and the translation box and started to head out. At the last minute I realized I'm just one man and that to do this right I should have another RN with me to show that an assessment can't be made without a translator and that our translator didn't work out in the block. So I took S.
To my credit, there was no one else TO take at that moment and it's not like I could just say 'Oh he'll wait 40 minutes until I get someone responsible and trustworthy'. I mean after all, she's just there to back me up and follow my lead. So we run down there and the officers surprise us with a different inmate complaining about chest pain. Chest pain trumps abdominal pain so after a quick once over, I take the chest pain guy back up to the clinic. I leave S with the translation device and tell her if it doesn't work to call up the ER and get him over there where they can get him their translation device and/or decide to keep him even if he IS under quarantine.
After I got done with my charting, S got back and started telling about her adventure. It turns out that the translation device didn't work. But it wasn't a problem as one of the officers got another inmate to act as a translator. And she used him just as that.
Waitagoddamnedmotherfuckingminuterightthefuckthere
Yes, you read that right. She conducted an assessment of a guy under medical quarantine for stomach problems, currently holding his abdomen and in distress, by using another inmate as a translator. Or to put it another way, she could be using a prisoner as a translator that had previously poisoned this prisoner and was now hiding it buy 'translating' this man's pleas for help into claims of faking his illness and claiming he was vomiting only by putting his fingers down his throat. And yes, that was what the translator said was going on.
And then to top it all off... to add that cherry on top and make it the perfect cluster fuck... she charted in his official medical record that that translation came from our official translation service. A service that is medically and legally certified. Even IF the prisoner was translating truthfully, we're talking about discussing private medical information with someone who is not bound by privacy or HIPAA laws.
She even think that was wrong until it was pointed out by several nurses at the nurses station and the nursing supervisor.
So, how does this affect me? Well, I feel that I have to keep my eye on her. I feel that I can't trust her to NOT hurt a patient. That it's my responsibility as someone who gives medical care to patients to guard them FROM her. When I see that I'm caring for a patient after they've been cared for BY her, I can't trust that she followed the department's policies, that she sought out an MPs help when the situation obviously called for it, or even that she conveyed the information to the prisoner in a way that he could follow. It means when she thought it was a sprained ankle and I'm doing a follow up, I'm immediately concerned that it was a broken ankle and that it might have permanently disabled him by walking on it for 3 days. Or that it was nothing but that she got a doc to order X-Rays and gave him crutches, an ice detail, and half a box of tylenol and motrin.
We're short one nurse on our shift. So it's C, S, and me. It should be 4 of us. And even short handed, the day just goes better when S isn't there. Yeah, it's busy as all get out and it's tiring, but I'm more mentally happy and satisfied as I"m not constantly up and nervous and aware when she's not there.
The bosses want her gone. Almost every single nurse wants her gone. The MPs want her gone. The LPNs want her gone. Most of the officers want her gone. But that's been true for months now and she's been under investigation 4 times and got it beat every single time. I don't know if the team trying to get her fired CAN get her fired. And as long as she keeps in the status as she is, she can't transfer. And as long as she's blissfully unaware of how hated she is, she's not going to be looking for another job.
I've often said that if a nurse can't stand their job and stays in it anyway, then they're just a stupid nurse. There are so many jobs and so many TYPES of jobs for a nurse that it's plain old stupid as fuck to stay in a job that you can't stand. So maybe it's time I moved on. Maybe it's time I got out of here. Sure, it's every 5 weekends, sure it's 10:30 to 7, sure it's almost no mandated overtime, and sure I love most of my other coworkers. But I'm miserable with Her. S is driving away ALL of my calm. And I think I'd be better off someplace else.
I think I'm going to start actively looking through the state's website for nurse manager jobs. At the department of corrections they are Monday through Friday, so the weekend thing will take care of itself. The shift will be earlier, but I can get up earlier and just be grouchy at work. I won't get the annual bonus, but I can simply ask for more money per hour and make up the difference that way. I've been doing this in a passive way... keeping my ear into the wind and listening for any choice jobs that might open. I'd have accepted any jobs at the 3 other nearby facilities as it wouldn't have been any hair off my back for driving. But now I'll expand my search out to the other three or four facilities that are within an hours drive. I'll deal with the wear and tear on the car because it will be worth it.
It will be worth getting away from Her.
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