To cover the job I have to cover several disparate things.
- The Work
- This is the tasks that I do during a shift.
- The Company
- I'm not working for the State now.
- The Co-Workers
- Not just my fellow admissions nurses but everybody that I work with.
- The Shift
- Nights, three days in a row, and how it affects my days off.
I'm still working all of this through my mind so excuse me if this is a little here and there as I write.
The Work
This is the easiest thing to talk about. Not to say that it's an easy job, but it's black and white. We're a behavioral health hospital. While some patients can walk up to us and ask for admission, almost all of our patients get referred to us via a doctor or a hospital. Most through the ER. And they come from all over the state. We had one the other day come from the upper peninsula (we're about 40 miles from the Indiana border.
A walk in just walks up to the counter and asks for help. We double check their insurance and if they pass muster, we bring them in and start filling out our admissions paperwork.
The referrals are mostly handled by an offsite staff. They monitor our fax number for incoming requests and then check to see if they'd be a good fit. Of course they check their insurance first but they also check to see if they meet our physical and mental health criteria. Since these are not medical personnel, we have a 'Tier System' for them to follow. For all of us to follow. Tier 1 is basically "They're Fine" bring them on in. Tier 2 is basic problems that a house supervisor or even one of us admission nurses can make a judgement call on. For example, they're aggressive or they need a C-PAP or walker. Tier 3 needs either a psychiatrist or medical doctor to weigh in. Like they need specific wound care or they're violent toward hospital staff. And then there's Tier 4. Tier 4 is an automatic no. People straight out of prison, people with a warrant for their arrest, people that require oxygen, patients with severe dementia, or patients that cannot complete their own ADLs (activities of daily living, such as getting dressed and feeding themselves).
If the offsite referral team sees that they don't have insurance that we accept, they deny them. If they see that the patient is Tier 4, they deny them. If they see it's a Tier 2 or 3, they contact us and we make the end decision. And finally if we approve the Tier 2 or 3 or they see the patient is a Tier 1, they pre-admit the patient and get us an arrival time. These arrival times can be anywhere from twenty minutes to the following day. Mostly they're a few hours out as we schedule them (i.e. "hey, can you send that patient to us at 1 pm so that they arrive here at 2 pm?).
Once we get a referral we start their paperwork and put them into our electronic medical record software, WellSky. The paperwork consists of three folders. One will be given to the patient and is mostly information about our services, their rights, and the rules of the units. One is ultimately for billing so it has all the insurance paperwork and paperwork regarding getting paid (the patient's singing their agreement to get assessed, agreeing to treatment, so on and so forth). One is another department, but I forget which one (it has a lot of paperwork though). And finally we'll get an envelope when the patient arrives that will have their voluntary or involuntary paperwork and their ER charting paperwork. We'll add all the originals of everything else and that goes to medical records.
We can start about half of the paperwork. If you're good at it and work at a steady pace, it takes about an hour to get the paperwork ready. You'll then be taking about half of it with you for the patient to sign (as well as handing them the folder of information).
Starting the EMR takes a little longer. We start up a total of 5 or 6 forms (the 6th is needed if they're actively suicidal) and fill out what we can. Some of these will be electronicky signed by the patient (they sign the laptop screen) and others are just us reading the information off and clicking that they agree or disagree. The last few are truly informational, asking for information we don't' have and of course asking about what brought them to us this time.
We hopefully get all of that done well before the patient steps into the facility. Just before they leave the other facility we'll get a nurse to nurse report. This should be relevant information as to the patients current condition. We find that much of the time, the nurses lie. Straight out lie. They'll tell us a patient is calm, collected, participant in their care, and conversational. When they get to us, they're manic, hyperfocal, have tangential thought processes, and are sometimes even violent. I have one just the other night where the nurse told me the patient was fine, that she was a little tired, but could speak clearly and wouldn't be any problem. When she got to our door, she could barely walk. She was slurring her words. And she told the nurse that was with me that she'd been gang raped as a young girl and had a major problem dealing with men. Understand I took report and this patient told the previous staff about the problem with men, so that would be incredibly relevant to tell me (a man) that she would have a problem dealing with me.
Anyway, after we get everything ready and get report, the patient shows up. They mostly come to us via ambulance or hospital car transport. They can't come to us if they're restrained (that would be a Tier 4). Naturally, they do sometimes come to us restrained. Once we get them into the facility we check their paperwork and make sure any involuntary paperwork is signed properly (it's four pages of legal work and we're looking for the name of our facility, the number of days of required treatment, and signatures from the person to petitioned their involuntary treatment and a judge that certified their treatment. If any of that is missing, we send them right back out as keeping them would be false imprisonment at that time. And yes, it has happened. If they're voluntary we just check that they've signed the paperwork agreeing to be a patient because again, without that it's false imprisonment (just because they agreed to treatment doesn't mean they can leave anytime they want!!).
With all the paperwork in hand, we use a metal detecting want to check for any contraband then have them change into our patient's scrubs (they're actually quite comfortable and a nice burgundy color). If we have time, we'll also do a skin check where we're looking for any scars, wounds, or tattoos. We always at this point ask if they're hungry or thirsty (they almost always are) and get them some food and something to drink. The food can be a tray from the kitchen if they're serving a current meal (breakfast, lunch, dinner) but at night the kitchen is closed so it's a turkey sandwich, a cheese stick, and maybe some chips. Water and juice to drink.
The patient is then brought either into one of our individual interview rooms or directly into our larger and more comfortable observation room. We'd use the observation room if we're not expecting anybody else for an hour or so and no other patients are waiting to be taken back to the units. We go through all the paperwork, have the patients sign everything that needs a signature (or bring another nurse in so we can both sign it and indicate that the patient heard what we said and refused to sign.
Once we're done with the interview, we set them up in our observation room. It has a couple very comfortable chairs that lay out and they can sleep on, about a half dozen regular comfortable waiting room style chairs (seriously, they're comfortable), and a television. This is all mental health facility furniture so it's either bolted to the floor or so heavy that you can barely drag it, let alone pick it up. One side had a window and the other has a mirrored window. The main window faces our parking lot, but the bottom half is opaque so that it lets in light but you can't see. The top portion that you can see through only shows the trees and sky because of the angle. The mirrored window is our admissions work room and we have someone sitting there as the patient has to be under observation while they're in the facility. How often they're observed is up to us nurses and the doctor to decide but it's either constant (1 to 1 where a staff member is always within 6 feet of the patient and the patient is always within site (yes even on the toilet and in the shower)), or every 15 or 5 minutes.
While someone keeps them under observation we call the doctor. At night it's always a psych doctor that's on call and not in the building. We go over the most relevant information with the doctor as we're going to get all medical orders to last the night until they see a psychiatrist the next morning. That includes voluntary or involuntary status, observation status, suicide risk, any other risks (fall risk, sexual acting out risk, elopement risk...) and any medications they may need (sleep meds, oral anxiety meds for when they agree to take them, injectable anxiety meds for when they do not agree to take them, nicotine replacement therapy...). The doc will also include any other orders they deem needed like any particular labs for the morning, any additional risks, an individual room... anything. Finally they give us the diagnosis code.
When we have the orders in hand the doctor will either put the orders in or ask us to put them in on their behalf (remember, we're waking them up at 2 am to get these orders!). Once the orders are in we print out a wrist band for the patient and prep an electronic tracking device called a beacon. It's so that our techs can mark that they were observed as it will only allow them to chart on the patient when they're within like 6 feet. No lying on this charting. The beacon gets placed on their ankle and can't be removed (without scissors). If a patient is triggered by that (like they had a legal ankle bracelet before) we'll put it on their wrist, but it's fairly uncomfortable on your wrist and the wrist can cover it up when they're sleeping so the tech would then have to wake them to check on them (every 5 or 15 minutes).
After we call report to the unit nurse and with those in hand we put them on the patient and walk them down to the unit for handoff to unit nurses. If we didn't do a skin check in admissions, we then stay and help with it on the unit. Once the patient is checked into the unit, we head back to admissions and finish up the paperwork.
First line of paperwork and EMR charting takes about an hour or two. The interview with the patient is obviously very dependent on the specific patient but can be done in about an hour (from walking them in, to heading in to call the doc). Yes, it sometimes takes over two hours but if the patient is uncooperative we perform what we call a 'quick admission' where we simply call the doc with the information we were able to get from the paperwork and get orders for immediate medication to calm the patient down. The rest of the paperwork will be done on a later day in the unit. The last bit of paperwork also takes about an hour. So, at best, a patient takes us from 3 to 4 hours, beginning to end. Problems can come up, however, and I've seen patients take upwards of 8 hours even for experienced nurses.
A couple variables: A walk in patient is the same process without anything being done beforehand. We have no offsite referral staff checking them out and no ER or previous doctor's report to go over. It takes a LONG time to do a walk in. We don't always have offsite referral people on hand. When they aren't monitoring the faxes, we have to do that by watching two pieces of software (one to check the faxes and one to look for referrals from our own hospital group). If we get a referral without an offsite referral staff online, we then have to do their job too. Checking insurance and making sure the patient fits into our tier system.
There are other parts of the job, but not much more. As you can clearly see, there isn't much here that requires a nursing degree or even nursing knowledge. The actual assessment part is when we're with the patient and even then it's assessing the scale of the problem (low risk suicide, moderate risk suicide, high risk suicide) and assessing if the patient is telling us the truth. Other people CAN do those things, but to be legally responsible, it requires a nurse and a nursing license behind them.
It's easy with a capital E and capital ASY. It's 95% a clerk's job and most of it is just busy work because its a lot of paperwork and charting.
The Company
All my previous nursing jobs have been for the State of Michigan. Either the prisons (Department of Corrections) or the forensics mental health hospital (Department of Health and Human Services). I didn't worry about money as our money was all form the state budget. I never had to worry about HOW someone was going to pay as they didn't directly pay (except through taxes). Now, I have to worry and with good reason. Without any insurance deals in place, my hospitals daily charge is $2,500. Just because a patient was petitioned and certified for involuntary treatment doesn't mean that someone else is going to pay for it. Their insurance has to pick it up or they have to agree to self pay. And yes, I've had one patient so far agree to self pay.
This trickles down to everything we do. I work for a FOR PROFIT hospital. No matter what good works we do, their ultimate goal is to make money. So, wasting resources is frowned upon. Getting patients into beds is part of the "goal".
When I started my training the hospital was almost full to capacity. I don't think we ever turned a patient away because we didn't have a bed, but it was close. Now, we're only about half full. And I'm seeing it make a BIG difference. Lemme use staples, dementia, and violence as examples.
On one of my earlier training days we had a referral for a patient that had attempted suicide by stabbing his abdomen (his belly) about 15 times with an eight inch kitchen knife. He had been in the hospital for a couple weeks healing up and had stapples all over his belly holding his wounds closed. A nurse, the COO (not a medical professional), and I were going over the patient to see if we could accept them. The question was the staples and how we'd care for them. After we figured we'd have to consult with the doctor to find out what type of wound care materials we'd need, I mentioned that we'd probably have to have a task to count the staples. At least once a day and likely 4 or 5 times a day. I mean, this patient or any other patient could pull the staples out and then have a small piece of metal that can cut. I.e. a weapon that they could use for a suicide attempt.
Once I mentioned that, the COO brightened up and said to call the referring hospital and tell them we can't accept patients with staples. It's actually a Tier 4 item, I just hadn't memorized the tier system yet. We eventually took the patient as we found out they'd already removed the staples, but that was an example when we were nearly full. Last week we had another patient get referred to us with multiple staples in their side and back (I don't recall what the wounds were from). The referring agent asked us if he was appropriate and we told him no. This is on our MS Teams chat. A few moments later the COO came into the chat and said we could accept him "as the staples are on their back".
Yeah, the patient could still reach them. And other patients could of course reach the staples. They were still a risk and they were still on our Tier system. But the COO was looking for ways to get bodies in beds.
Another patient that was being referred to us had beaten her husband, stolen their car, and driven away with a declared intent to kill 2 million demons as ordered by God. When she ran out of gas she stopped at a gas station and declared that the gas station attendant was a demon and attempted to kill him. She was arrested and put in jail. A few days later she was bailed out by her husband and then when she continued to deteriorate, she was taken to the hospital where they had to forcibly drug her to get her compliant and she was constantly threatening staff with violence (including picking up items around her and attempting to use them as weapons).
She's a big fat no. NO No NO! Violent, threatening staff, actual physical violence committed due to her delusions and a recent jail sentence. We weren't even sure that she didn't have a court hearing that she'd have to turn up to (miss it, and she'd get a warrant). We said no, the COO and the CEO joined the chat and over rode us. She's at the hospital now and has been wrestled to the ground in a hold about 4 times now (that count is when I was last there on Friday, it's probably higher now).
Finally we got a guy with a diagnosed case of vascular dementia. He had a blood circulation problem that led to permanent brain damage. He's barely able to do his ADLs and even then needs prompting or he'll empty his bladder and bowel in his pants. He's also aggressive at times when he doesn't know where he is (which happens a lot because he has dementia and forgets where he is and even forgets people that are around him). This one took the cake for me as of course he doesn't qualify for our treatment but we got overridden by the COO and he's at our facility as I type this up.
Understand, the suicidal guy with the staples? We can help him. He's dangerous and doesn't meet our Tier system qualifications, but we can still help his mental health issue. The delusional demon hunting woman? Same, we can help her. Neither should be at our particular facility but their core problems ARE in our wheelhouse. The dementia guy? We can't help him. The care he needs is long term and likely permanent. We're a crisis center. We stabilize people over the course of a week or so and then send them to outpatient mental health therapy. There is no stabilizing this man. But we still accepted him. That one is a PURE unadulterated money grab in my book.
So, needless to say I'm not a fan of being in a for profit facility. I've seen ugliness raise its head in the name of money (bodies in beds) that threatens our staff and our patients or doesn't even fall under our umbrella of treatment options.
Other than that, the company mostly seems fine. The benefits package is weak. The pay is hidden. By that, I mean that I have no idea what my fellow nurses are making. They could be making $10 an hour more than me. They could be making $10 an hour less than me. There is no 'scale'. There isn't even a system in place for annual raises or bonuses.
The company doesn't seem bad. It just seems like what it is; the biggest mental health organization in the United States that is looking for profit. I can deal with that so long as they don't put medical needs behind that desire for profit. Taking the dementia patient is close to that, but still different. No, we can't help them but we're not hurting him by admitting him (other than charging him for services he could get in another facility for way less money). If they were to deny certain treatments because of money though? Or if they were staffing us dangerously? Yeah, that would be a step too far and I'd have to leave as I couldn't work for a company like that.
The Co-Workers
First, there's the group of nurses that I directly work with. My fellow admissions nurses. A lot of new names and yes, it means a lot of initials here as I won't share their real names. There's A and L, two nurses that work the day shift together three days a week. There's M and J, two nurses that work the day shift together three other days a week. There's C and L, two nurses that work the 3 to 3 shift on alternating three day shifts. And then there's M who was the only night nurse, working three days a week. J and S are both new nurses along with me, both doing the night shift thing. S and I will work together while J will be joining M.
A is young in her nursing career and at the 'knows enough to be dangerous' stage. She thinks she knows everything and bitches about everything. Her partner, L, is older and more experienced but she's also stand offish and doesn't take charge. She also gets easily flustered. Not great, but they're both nice people and good nurses.
J is only a couple years out of school and nervous about everything. She's good, but she lacks the confidence in her own abilities. She's also attending school while working full time to get her bachelor's and eventually her masters degree. Her partner, M is older, more experienced, and the day shift supervisor for our department. So far as I've been able to tell, her being the supervisor has no meaning but I've been focused on learning my job and not what she's doing at any given moment.
M, the lone night nurse, is cocky. I think she's been a nurse for about 6 years. She seems to know her stuff and she knows she knows her stuff. She's also lazy and will put actual work into avoiding work. She's a nice enough person but I don't really like her as a nurse.
J who will be joining M on nights is an old school, very experienced mental health nurse. Like 25 years type experienced. She had been a travel nurse for a decade or so and finally decided to settle down. Beyond being age frail, she's great and will be a wonderful source for information. Obviously not company or job specific information, but mental health and patient care information.
S has been a nurse for longer than me (I think) but is about ten years younger than me. She's hyper and always go go going. She's funny and like me constantly looking for things to do. When she has a patient she wants to do everything as she's still learning. When I have a patient she wants to help even though I'm in the same position as her (wanting to do everything to learn). I think I will enjoy working with her.
Our 'boss' is the director of admissions. M. She's been a nurse for either 25 or 30 years, I can't recall which. She must have started right out of high school as she doesn't look much older than me... maybe even a bit younger. I'd normally judge her by judging her department but she had been gone for months on a medical leave and her temporary replacement evidently fucked everything up while she was gone. Bad enough that the department lost like 4 nurses. She wasn't even part of hiring J, S, or me as she just got back from medical when I started working in February. So far, from what I've seen and heard directly from her (I'll get to the gossip later), she seems like a good nurse, a good person, and a great boss.
Her boss is the COO. He was the one that started my hiring process and the one that moved me from the management job to the admissions path when they gave the management job to someone else. I don't deal with him a lot, but he stops by the department once a day (during the day shift, so I saw him while training). I like him so far, but he's butting in a lot and seems to be making a basic and easy medical decision into a difficult and tedious money decision. I don't want to completely hold that against him as he IS the COO. He's responsible for money stuff where we aren't. But the CEO seems to back him up and there isn't anybody with any clout backing up us nurses and the medical side. I don't' know if M is or not. So... mixed feelings?
There are billing, HR, and other administrative specialists that I see and barely interact with. They seem fine. No one seems like a sour apple. They all have good attitudes from what I can see and respect the fact that we're RNs doing our jobs.
There are the clerks. This is harder to define as one of the clerks sits at the front desk and is more or less a receptionist... but she doesn't answer the phones. If someone calls, they don't have the option to select an 'operator' or 'receptionist'. The first option on the phone tree is admissions, meaning we get almost all of the phone calls, whether they're admissions calls or not. The other two clerks I work with are evidently doing part of the job that used to be for the admissions nurses. Something about running actual authorizations on insurance companies. They also help by answering the phones in admissions and running the doors (answering the bells, letting in food deliveries, letting us know when ambulances are there). S, the day clerk in that position is kind of a pain. She's a sourpuss. She was NOT happy when she tried to show me how to do the authorization job so that I could do it on my down time and I simply told her no. Evidently M, our boss, had told her to show me and the other nurses that job, but her whole attitude was she was going to 'train' me like she was the boss of that job and then dole out tasks for me to do. Yeah... no. If there is a hierarchy between the clerk's position and the nurses position, I am HER boss. Not the other way around. Just because the other nurses let her get away with shit like that, doesn't mean I'm going to and she wasn't happy to learn that little lesson. The other clerk (another M name) is fine. She's a little goofy and acts like she's not smart but I think she IS smart... just not confident in her knowledge base.
Then there is everybody else. I barely deal with them and don't have a strong opinion on them as individuals. The ones I'll get to know better are the floor nurses and techs (the techs have a specific name like Behavioral Health Assistant or BHA, but I can't remember it right now). I talk to them regularly on the phone when calling the units and hand patients off to them. I just haven't dealt with them enough to have an opinion yet.
Now with everybody at this facility, there is a LOT of gossip. The COO this and the COO that. The CEO this and the CEO that. The new Chief Nursing Officer (CNO) this and the CNO that. The director of admissions M this, and M that. And it's all contradictory. If I listened to it all and took it all to heart, then everybody is evil, they're all mean and incompetent, and out to stop the nurses from doing their jobs and possibly even get them in trouble. Its not that way, but everything gets blown out of proportion. For example I was told that if I messed anything up I'd get "yelled at". Now, I've been yelled at before. So long as I deserve getting yelled at, I don't mind. In fact, I'd appreciate it when people take my job seriously enough TO yell at me. At one point I mistakenly identified a patient with the code of them being in one unit while placing them in another unit. I got a quick email about it from the billing department (as it was a billing code) reminding me to be careful on that.
And yeah, that was "getting yelled at". Pfft. That wasn't getting yelled at. It was simply telling me that I did something incorrectly and reminding me to do it correctly in the future. I wouldn't have yelled at that situation if I were the manager, but I wouldn't have minded if someone DID yell at me. I just recognize the difference.
For the most part I like working with the nurses. I'm sure I'll get stronger opinions as I work more with them, but for now they're all fine.
Two final things on co-workers. One, M the night nurse told us that they're seeking to unionize. Now, I'm a union guy and think that's a great idea. Safe staffing levels, even pay, better benefits... all of that should come with unions. BUT, when you're trying to bring a union into a company that has 25,000 employees spread out over hundreds of facilities, you tread carefully. Sure, it's illegal for the company to retaliate against staff trying to unionize... but it's not illegal for them to be nit-picky on how much they discipline you for minor offenses, or even to fire you over something minor. There isn't a union in place to protect them. So while I support the idea of bringing a union in, I told her point blank that I won't sign anything until the union is there in person to say they'll protect my job. I can't afford to go two years without working and then losing my first job after only a couple months.
Two, I believe I'm destined to move up. The nurse that got the Nurse Managers job instead of me is... well, she's a fine nurse. She's not a great manager and after a couple months, not showing much in the way of management skills. She still has time, but I could easily see her flaming out in 6 months or a year, making that an open position again. I'd now have my foot in the door and be in a far better position to get it. They also opened up a position with the title of Assistant Director of Admissions. A new position working directly under M (my boss). Like the nurse managers job, it's an evening position so that there would be more administrative coverage every day. I think I could do that.
I honestly have no idea what 'level' this position is. Is it higher than the nurse manager? Is it lower? Is it basically just a supervisor's position? Is it a co-leadership position? All I know is that it gets paid more and works afternoons/evenings Monday through Friday. I also heard from several of my fellow admission nurses that I'd already applied for the position. Not that they'd ASSUMED I'd applied but they were told I had already applied for the position. I hadn't and hadn't even heard about the position, but find it to be a good thing that someone either assumed I'd applied or someone actually already threw my name into the hat for the job.
The Shift
All the nurses in admissions (and I'm assuming all the nurses and techs) work three twelve hour shifts in a row. There is no eight hour shift like they had at the prison to bring it up to an even 80 hours per pay period. That means the pay period is only 72 hours. Not ideal as I budgeted on 80 hours per pay period. That's a loss of 10% of the money I thought I'd be earning. That being said, the shifts seem to work out well. They're lined up right going between 7 and 7 every day. The day's just ramping up at 7 am and it's just starting to taper off at 7 pm.
There's also an extra nurse between 3 pm and 3 am. So for the first eight hours of every shift, S and I will be working with C until she leaves at 3 am. That's a good crew and a good number of people. Not so many that we'll be falling over each other but enough to handle us getting fairly busy.
No, the big problem is doing the shift at night, three days in a row. For the past two weeks, I've worked the opposite shift of mine. That's Thursday, Friday, Saturday one week and then Wednesday, Thursday, Friday, the next. That means that one week I'll have three days off (Sunday, Monday, Tuesday) and then five days off the next week (Saturday, Sunday, Monday, Tuesday, Wednesday).
Once I get into the rhythm of working those days, it's fine. I wake up around 4 pm, get in the shower at 5, get everything ready and leave for work at 6 pm. Clock in just before 7 pm, take 'lunch' at 1 am, clock out around 7:30 am, go home and eat around 8:15 am, in to bed by 9 am (and thank Goodness for my blackout curtains!) and repeat. Yeah, it's barely a couple hours 'off' for myself between driving and work and getting ready for work, but it's fine. I go to work Wednesday, follow the routine, and then wake up Saturday afternoon. The days in between just didn't really happen.
The problem is the days off and getting INTO the rhythm. I don't want to live on that schedule, sleeping through the main part of every day. Being awake with R and mom for a couple hours on my days off but otherwise being a vampire alone every night. So far, my sleeping rhythm has taken care of that. In the above example I get off on Saturday morning, get home and am still in bed by 9 am. But I wake up WAY before 4 pm. I get up around noon. And then around 10 pm, I get tired again and go to sleep through most of the night waking up Sunday morning at a far more normal time of like between 3 and 6 am. I've caught up on my sleep and am ready to tackle the days and sleep through the nights. The day before I work (Wednesday in the continued example) I have to force myself to take a nap in the afteroon. That's so that I can stay up 'all night' and then go to bed at 7 am the day that I work. That lets me get a good 'nights' sleep during the day and get up at a 'normal' time for work.
That's why I'm writing this right now. It's currently a little after midnight but I work tomorrow night meaning I'll be up until 7 am.
Now, if you're paying attention, you noticed that I'm going to work on Monday. That's because I was training with M, the lone night nurse. I moved to HER schedule to train. Now I'm moving back to my schedule. And that transition sucks. You see, I worked three nights then got three days off Sunday, Monday, Tuesday). Then I worked three nights and got two days off (Saturday and Sunday). Move to my schedule now which means another three nights on, then three days off (Thursday, Friday, Saturday). Only then will I get the three nights on and five days off.
The reason that sucks is that it's not three or five days off. The day after working is sleep. Sure, I'm up for part of it but I sleep, wake up, then go back to sleep only a few hours later. Then, I have to nap in the middle of the day the day before I go back to work so that I can stay up all that night. Yeah, that's like tonight where I get seven or eight hours to myself, but it's still 'working' to get ready for work. I'm not shifting my schedule just a bit, I'm taking a day to recover from it and then a day to get ready for it. So realistically its more like one day off and then three days off.
Once I fall into that rhythm, it won't be bad. I'll learn to live with the weird day/night shifts. It's just this longer run right now of three (one) days off, two (none) days off, three (one) days off, and only then five (three) days off.
Now, if I get one of those other, more administrative evening jobs I'll be a lot better off. Getting off at 11 pm means getting home around midnight. Eat, goof off, then go to sleep around 1:30. Sleep for seven hours, getting up at 8:30. Then I have until 1 to goof off. That's four and a half hours every day. PLUS I'd be getting 80 hours a pay period. PLUS I'd be getting paid more. PLUS I'd be managing.
So, conclusions?
While it's been almost exactly two months since I started, I can't say much. I think this could work out to be a good job. Not the best, not as good as the prison, not as good as managing at the prison or the forensic hospital... but still good. And managing here might be better.
I guess the best thing I can say is that I haven't seen any barriers of this being a good to great job. Not the people, not the shift, not the job. About the only thing missing is actual nursing. Sure, I'd rather be doing MORE nursing, but I'm still getting to see patients every day. I'm also getting to make a difference in their lives when I DO see them. They might not see that the same way, but I'm the one seeing them, I'm the one assessing them, and I'm the one informing the doctor of everything they need to know. And you can easily see the power in that, right? I tell the doc to get the result I want. I can't make the doctor order oral and injectable meds for anxiety, but I can tell them that they have a history of being anxious and seemed on edge when I talked to them. I can even add that I'm worried they might go off tonight and we should be prepared. Boom, orals and injectables will be ordered.
No comments:
Post a Comment