Thursday, January 17, 2013

The pissed off nurse

I do not like nursing.

I cannot figure out if it is the dynamics of a very small outpatient clinic with a staff that has known and been personal friends, and thus cliquish and exclusive....or if this is simply related to nursing in general.

I remember I left nursing the first time because nurses eat their young and I grew tired of the idea that before you could be accepted into an environment, the seasoned nurses had to deem the correct pound of flesh had been extracted first. However, that was much less than what I am experiencing in this position.

I did not realize when the truly incompetent nurse was asking me questions about my education and experience on my first day that she was not, in fact, being sociable and curious. She was, in reality, trying to find ground to prove that despite my being a 15 year seasoned nurse in a non-traditional manner and she was only a new nurse of just over one year, that she was in fact superior to me. I bombed that test quite badly by accidentally informing her that I was already admitted (and was readily given a one semester extension to address my grief) to the very same nursing program she has been rejected in her application twice now.

In all fairness, I also now know the girl way overreached in her applications. Instead of choosing one of the local, run of the mill Bachelor's programs, she opted for a top tier program with national ranking. Given she couldn't get admitted into the local, run of the mill Associate programs and had to go to what is locally known as the worst nursing school around AND she barely graduated even then, she was just asking for a rejection from this particular program.

However, I forgot that this dynamic exists. Yet, I am convinced that this tiny clinic is far more exaggerated than the normal dynamics at play. I enjoy my work and dealing with the patients. I have fantasies of telling these henish women what I truly think of them and spend a lot of time biting my tongue while realizing I am back in high school.

Yesterday, I had my first day officially off orientation. Getting off orientation has been it's own drama filled experience. When I applied for this job, I had a personal connection to the hiring manager. I made it clear before I ever submitted my resume that I could NOT work more than three days per week. I actually spoke with her specifically before submitting my resume because the job listing was unclear and I wasn't going to bother to apply if it was going to require more than three days per week. When I started working, the clinic nurses felt that even though once I was off orientation it would be three days or less per week, I should absolutely be required to orient at the same 40 hours per week they were all required to endure when they began the job.

I did buck the consensus on that point. If the hiring manager could not allow me to orient at the pace I was clear from the beginning I could work, then she should have hired her second choice candidate. For the hiring manager, there was never a question. She agreed to my terms when she hired me. She was at a conference the week I began working, or likely the speculation on my work hours would have never occurred in the first place. When she returned to work, it was immeidately established that I would only orient three days per week, no discussion permitted.

My co-workers then decided that if I was going to only orient three days per week, then I MUST orient signficantly longer so as to ultimately have the same number of hors orienting that they all did. Except for one glaring problem. I didn't need that long to orient. They put in six weeks of five hours per day before they were permitted to drop to part-time hours. To orient that same number of days, I would have needed to stay on orientation for ten weeks. I did seven weeks.

My co-workers were staunchly attempting to force me into eight weeks of orientation when I asked a very basic question of my hiring manager Monday. First, if all of my skills reqirements have been met and signed off on, why am I still on orientation. Second, since yesterday I was scheduled to be one of two nurses, niether of us being my mentor, how was I supposed to "orient" when I MUST take the role of a non-orienting nurse since the clinic MUST have two RNs on the clock to operate. Furthermore, if I must be clocked in "OFF" orientation yesterday and tomorrow, do I then fall back to orientee next week when we are back to three nurses?

Those questions prompted my manager to take a more honest assessment of my orientation status than what she was being told. It resulted in my being officially taken OFF orientation Monday. I should have been off orientation at the six week mark. I was signed off on all of my required skills AND I have been doing the duty of a second duty nurse, not an orientee. In fact, I've been functioning as a second duty nurse since Christmas, including being left alone to cover everyone's lunch breaks and to fully manage patients on my own for long periods of time.

The two other seasoned nurses are well aware that I can handle the job at this point. The new nurse cannot stand the fact that I spent one more week on orientation than her and am officially off now. The seasoned nurses openly admit that the new nurse has a personality that you either love or hate. In eight years with this company (only the last 17 months as a nurse) she has burned every bridge with every department she has worked eventually. The floor she came to us from won't even allow her to come back on a per diem basis and work when their are desperate for staff. This clinic, however, adores her. They find her hilarious, and because of that they completely overlooking the serious deficiencies in her nursing practice skills they can openly admit they are aware she possesses. She spent several years as a plebotamost, so she's extremely skilled at starting IVs. It is the ONLY skill she is good at.

I had to speak to my manager in December when this girl's behavior became so egregious she attempted to bully me into administering a medication that a doctor had ordered in a mistake. She felt that checking the medication order with our office assistant was sufficient to ensure the medication was correct, even though the order clearly contradicted the office notes included in the records sent to us. I had to become very firm with her and insist that I was calling the doctor to clarify what was ordered because I was NOT putting my license behind the administration until I determined why the order did not match the medical record.

I'm reasonably sure that disagreement is when I earned the title of "Know it all" to this coworker, a title I can see she exerts to the other nurses. I can tell when she has worked and when she has not. When she works, I return to work and feel as if I have stepped into high school all over again. The two seasons nurses who respect and work with me ordinarily spend the morning reverting back to petty and irritating attacks against me. Typically, they settle down by lunch as I simply stay polite and do my best to do my job and avoid their emotions in the situation.

Yesterday, my first day off orientation, I nearly did not manage to hold my tongue anymore. When I came to work, the most experienced and skilled nurse in our clinic began her day using the same antics and behaviors as the incompetent nurse. She was refusing to allow me to provide direct patient care, was refusing to communicate information with me, was refusing to be polite to me. Late in the morning, the clinic was calm. We had a terminal patient who was struggling with the required paperwork we must complete for new patients. He was there for a palliative treatment and was struggling to even stay awake. He had choosen to keep his curtain closed around his cubicle, which means when you stepped behind the curtain you were cut off from the rest of the clinic. He requested my help with the paperwork, and since the clinic was calm and quiet, I disappeared to help him with the ardous process that he stated was simply confusing him.

Unfortunately, while I was assisting this patient, two patients entered the clinic. Our clinic is ONE ROOM. It is a simple matter of asking a patient to take a set in one of the cubicles and letting them know that a nurse will be with them shortly. The other nurse was starting a treatment on a regular (weekly) patient in full view of the full room. One of the patients who entered is a child who must spend about 20 minutes with heat packs on her arms before anyone can even attempt to start an IV, as she is that difficult to start an IV on.

Had I not been the nurse behind the curtain, I would have greeted the two patients, finished starting one patient's treatment, started the heat packs on the child and then addressed the other new patient without complaint. I know this for a definitive fact because I HAVE been the nurse not behind the curtain. This nurse choose to spend the day clearly angry and stewing at me, and then lash out angerily in the mid-afternoon.

I would like to give this nurse credit that at least she did communicate directly with me. However, since she steweed for the bulk of the day and then exploded, I would suspect that in reality my manager kept her promise when she allowed them to use her at 30 days to ambush me. I was lectured on my performance at my 30 day review, which is when I learned that I am referred to as a know it all. That was also the ambush when I learned that I was being cited not only for the sypmtoms of my Psoriasis that were present when I began working there, but also for the fact that apparently the treatment for my Psoraisis leaves the back of my hair greasy. I was also told that while we are all "equals" in the clinc, I am an outsider and have no right to express my opinions on how things are run nor what the future plans are for the clinic. I apparently enraged someone, or everyone, for simply being aware that Obamacare requires all medical records to convert to electronic in the very near future. Evidentally, that I have taken the time to educate myself on Obamacare means I have condemned them and am again... a know it all. When my manager behaved so unprofessionally, she also informed me that if my coworkers had any further complaints, she would refuse to be their mouthpiece and would require they speak to me personally. I suspect the late afternoon hissy fit by a 50 something woman was merely a reflection that my manager did at least keep her word on that stance. So, I cannot truly give her credit for communicating with me afterall.

Ironically, in all of these struggles, only ONE complaint related to my actual nursing care and how I handle the patients was ever expressed. At 30 days into the job, there was a serious complaint about my ability to start IVs. They assumed I could not find veins. They were incorrect. I am extremely skilled at hitting veins. I had a very hard learning curve to converting that to starting IVs because there is a different technique. Because all of my coworkers refused to believe me in where the problem was, they were worthless to help me problem solve to correct this. Ultimately, one phone call to the nursing education director and she walkd me through EXACTLY where my problem was. I corrected the mistake in one shift and viola I am having no problems with IVs now. Their complaints are personal, petty, and frankly irritating. My manager's suggestion on how to resolve them is to tell me I need to attend every after hours social event I am invited to and make friends of my coworkers. Really? I'm REQUIRED to not merely be friendly and professional but somehow be friends? That's ridiculous.

So, yesterday after a very irritating and frustrating day with yet another nurse refusing to be professional in how she interacted with me, I was unhappy as I headed home. II encouraged me that we are within a month to the end of the extremely tight finanicail situation created by all of the medical crisis we've faced. He assured me that I am free to quit and go back to being a strict stay at home mother at any point if I want.

I don't WANT to. I like having the descretionary funds. They are small at the moment, but they make a huge difference. In a month, they will be bigger and make a HUGE difference. Significantly, I want those funds to finish getting rid of the debt and save up the down payment to purchase this farm we rent and live on. Furthermore, I refuse to allow pettiness to drie me from a job. If I quit this job, it will be on MY terms, after I have proven that I am stronger and better than their petty behavior and they cannot and will not drive me off acting like teenage Queen Bees. I have a deep love of acadamia and truly believe I will hold a PhD before my children are all fully grown. However, I am unwilling and unready to throw away nursing, certainly not simply because they drove me out of it.

It's a strange change in attitude to go from longing to be able to quit and go back to full-time homemaker to realizing that I CAN balance this. I CAN enjoy working with patients. I will NOT be driven away by petty catfights. Give it your best shot, but I'm here to stay until *I* move on.

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