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  • Davey Do

The Weekend of....

Updated: Aug 28, 2019

7-5 to 7-8-19

I was charge nurse on the geriatric psych unit last Friday. I had a bad attitude, but it was a busy shift with good coworkers, so all in all, it went well. I successfully dealt with a brittle diabetic, a couple of behaviors, and was graciously complimented by two patients.

Saturday night, my work wife Eleanor acted as charge nurse. There were four other positions on the 11p-7a portion of the shift: working the floor, two 1:1's, and the stupid sentry position of a staff member who acts as a door to the community room so patients won't go in there and hang themselves with a chair. The four positions rotate every two hours.

I worked the floor the first two hours of the rotation, which I truly enjoy because there's always something to do: 15 minute rounds, behaviors, meds, direct patient care, documentation, laundry, etc. The next few hours of the shift are typically slow unless there are behaviors or admissions.

Saturday night there was an admission who was also a behavior problem. The patient was on the floor at the end of my rotation and I dealt with her behaviors basically through direction, limit-setting, behavior mod techniques, and meds. I think I did a pretty darn good job of keeping things in order.

The next part of the two hour rotation had me acting as the "stupid sentry position". I sat at the end of the long partially lighted hallway with the darkened community room at my back. I got to watch Mickey Weird, ex nurse extern, try to deal with the lithe, loud, psychotic new admission. With the dark community room behind me, and the partially lighted hallway, I felt like I was in a theater watching a stage show!


I drew this as I sat with a sleeping 1:1 patient on the next part of my rotation.


Sunday night, I worked with Sharn who took her turn as charge nurse. Again, I was assigned to work the floor for the first two hours of the 11p-7a portion of the shift.

Ranger Rodd use to be a regular ole staff MN nurse on the adult male psych unit for a few years, which is the totality of his nursing experience. Rodd is a decent nurse and we got along well whenever we worked together.

A few months ago, Ranger Rodd became the MN psych house sup a few nights during the week and our relationship changed. I take a portion of the responsibility for the change, for I am a bureaucratic basher. However, Abraham Lincoln said, "If you truly want to test a man's character, give him power" and I believe power has changed Ranger Rodd.

Case in point: In a recent HIPAA forum thread, I noted and openly disagreed with, Ranger Rodd when he said that it is not a HIPAA violation if only the first name of a patient was mentioned in a public place.

Well, Ranger Rodd was untypically assigned to be house sup Sunday night, but we were short of staff, so Rodd had to work geriatric psych. I mean, heaven forbid if we don't have the "stupid sentry position" covered! 

So, as I worked the floor, Ranger Rodd sat as the sentry. I was making a round when the bed alarm went off in the room next to where Rodd sat. I went in and assisted the patient in using a urinal and got him squared away.

As I was halfway up the hall, Rander Rodd said, "Dave! The bed alarm's going off again!"  I went back into the room, dealt with the situation, and came back out into the hallway. I said to Ranger Rodd, "You know, administration has changed the guidelines of the sentry position. They now say that the sentry can assist with patient care in the area of the door". Ranger Rodd replied, "Well, those guidelines are open to interpretation".

I internally exploded.

I approached Rodd and said in my best Clint Eastwood whisper, "Okay, this will be documented: Patient safety- a bed alarm going off on a high risk fall patient- is more important than some stupid non-door! End of Spiel." 

Those were my exact words because I wrote them down in my little pocket journal immediately upon returning to my station in the hallway. Rodd's reply: "Okay." 

When I spent my portion of my two hour rotation with the sleeping 1:1 patient, I sketched this, giving the stupid sentry position a worthy title as to appropriately merit its high importance to those in charge:


I meant for the title to be akin to the opera "The Barber of Seville".

Just for poops and giggles, I looked up The Barber of Seville on wikipedia and found something fascinating: The Barber of Seville is also known as "The Useless Precaution"!

https://en.wikipedia.org/wiki/The_Barber_of_Seville

HA!


Sunday night, the lithe, loud, psychotic female patient became the third 1:1 and Mickey Weird was sitting with her. I was working the floor. 

The patient had received Haldol 5mg/Ativan 1mg IM earlier in the shift without incident but continued to act out. She had Vistaril 25 mg ordered q4hrs PO PRN, so sometime later I approached her and offered her the med. The patient was sitting on the hard plastic box of a bedside table in the dimly lit room and proceeded to urinate as she took the med. You could hear the pee as it spilled onto the floor.

Mickey Weird loudly asked, "Did she pee?" I said yes she did and was immediately called away to deal with another behavior. A male patient, who had punched me in the forehead the week before, as I was placing him in a therapeutic hold, was again acting out.

The lithe, loud, psychotic female patient continued to act out as I later sat with her on the 1:1. The PRN Haldol/Ativan could again be given, so I called to Sharn and asked her to prepare the med for administration.

I wanted to inform the patient of the forthcoming med administration and went to sit on the hard plastic box of a bedside table in the dimly lit room.

From my journal:


Interesting note: The patient that was loud and verbally aggressive when their glucose level was 447. I contacted the NP and got orders for some insulin. After monitoring the patient for a while, I found their level dropped to 40. The patient became docile and was no longer a behavior problem.

With some interventions, their level eventually came back up to 100.

But during the interim, I thought, as I noted in my journal:



In 1979, when I worked at the Anomaly Children's Home I was introduced to the concept of "tiny murders" through a well-seasoned worker: "Tiny murders", he said, "Are those little things with which you have to deal that kill you just a little bit".

Ranger Rodd informed me in the wee hours of Monday morning, "I'm not sure, but I think Roof Elmo (my supervisor) told me she's coming in early to do your yearly evaluation".

A tiny murder.

"Great!", I thought, "Ranger Rodd thinks Roof Elmo's coming in early to do my yearly evaluation after I have worked three 12 hour MN shifts! She could have informed me via email, but nooooooo! She instead tells Ranger Rodd who's not sure! I am going to be a bit prickly!"


Well, alright then.

Never mind.


During the mass med pass, a patient compared the geriatric psych unit to the old TV show, "Gilligan's Island".

"Why Gilligan's Island?" I asked.

He replied, "Because I thought this was just going to be a three hour tour!"

Took me back...


Nursing is like that- it can be so difficult and rewarding at the same time. Nursing balances out my life and gives me fodder for my art.

Being able to empathize with others also allows me to see that I'm not in these difficult situations alone. For example, Dr. Banjo was the only psychiatrist for all five psych units, with Dr. Hobbit and Dr. Dadda taking vacation days or whatever this past weekend.

Dr.Banjo can be rather hard-nosed and, while covering for both docs, he d/c'd low dose HS benzos on one extremely nice patient.

As I said before, "I was... graciously complimented by two patients".

I helped this one particular patient who had had his benzos d/c'd get through a rather restless night. When I was saying my goodbyes to the patients Monday morning, this particular patient complimented me and asked for a hug.

 The patient and I probably both thought this:



THE WEEKEND OF... 7-12 to 7-15-19


It was another eventful weekend on my three 12 hour MN shifts at WRMC (Wrongway Regional Medical Center).

Being assigned to act as a door for two hours periods gives a body a lot of time to think.  Oh- for those just tuning in, you may want to get some background on "being assigned to act as a door" and check out this thread:

As I sat in the dim light acting more like a doorstop than a door, since all the patients were sleeping, I began reviewing specific situations that made me want to become a nurse:

As a kid, I liked to catch and cut up frogs, but I think that really only exposed me to A&P, and was not the reason I would eventually want to become a nurse.

I enjoyed grabbing onto my little sister's wrist, dragging her over to the electric fence and giving her shock treatments, but I think that was more of a reason why I became a psych nurse. I enjoyed studying her behavior- you know, the stimulus/reaction sort of thing?

The fact that my high school sweetie's Dad was a doctor may have influenced me a bit, as I truly enjoyed hearing his tales of medical adventures.

But I came to the conclusion that it was my destiny to become due to the result of a situation which occurred in 1976 when I was 19 years old:


Yeah- I think that situation inspired me to take a first aid course in 1977, become certified in CPR in 1978,  an EMT-B in '79, NREMT-A 1981, then eventually become a nurse- an LPN in 1983 and an R N in 1990.

Another thing that happened as I was acting as a door was that a male patient made a vague threat of harm while complaining about his new room mate. I immediately (in a sense) gave him a little reality orientation and let him know he would have to deal with the ramifications of his actions.

The patient had the wherewithal to apologize for what he said and committed to safety. I told him that I appreciated his quick turnaround, insight, and apology.

A portion of the conversation (sort of) went like this:


L ast weekend, a "lithe, loud, psychotic" patient was admitted and became a 1:1 due to her behavior. This patient has been put on a forced med of Zyprexa 20 mg BID and has regularly received doses of Haldol 5/Ativan 2 mg q6 hour PRN along with Trazodone and Doxepin at HS, which has done little to slow her down and curb her behavior.

Attempts by staff to enforce guidelines or advisements of appropriate behavior have resulted in things like the trashing of her room and name loud, defiant, profane name-calling.

On the MN shift, this patient will sleep only for intervals of about 15 minutes, wake for a bit, and again wreak havoc.

I sat with this patient for a two hour interval in the wee hours of Monday morning. She had just taken the PRN Haldol/Ativan POabout a half an hour before I sat with her. I enforced guidelines, kept the lights low, and initially did not respond to her profane insults.

As the patient intermittently slept, I made some notes and sketches in my journal. I wrote down the words "oppositional personality" and drew a sketch of a cartoon Jesus saying, "Compliment those who berate you".

The next time the patient woke up and began her inappropriate behavior, I found something positive in what she said or did.


When the patient awoke and began grunting, I said, "Hark! Is that the sound of an angel awakening from her beauty rest that I hear?"

She got up and stood by the window, looking out of it, saying nothing. In a low tone I said, "She stands by the window, appearing pensive". In a few minutes, the patient returned to her bed and slept again for about 15 minutes. I repeated the positive approach thing each time and had no inappropriate behavior from her.

My conclusion: The patient was displaying inappropriate behavior in order to get a response or attention. It has been said that "Bad attention is better than no attention". If she was not acting out, it seemed others gave her no attention. When she acted out, staff gave her attention.

By giving her positive attention before she displayed a behavior, I was feeding her monkey, so she did not act out.

When my two hour interval was up, I informed my relief of my findings. The patient was standing nearby and I said, "Look at her. She's listening to us, attentively; focused. A marvel of meditation!" The patient looked at me and smiled. She may have even chuckled.

"You mean I should patronize her?" my relief asked.

"Yeah, well..."

Continuity, consistency, and knowing what to expect all give us a sense of security and helps to prevent cognitive dissonance. However, continuity, consistency, and met expectations are on short supply when it comes to staffing at WRMC.

Even though my pre-work mantra is "Expect the unexpected", I did not expect to be pulled to the women's psych unit Sunday night. I had worked the past two nights on geriatric psych, I knew the patients, and in my recollection, I have not once been pulled from geriatric psych on a Sunday night. I get pulled on Friday nights about once a month, but never on Sunday nights.

A nurse must have had to have worked extra in order for me to be pulled, I have seniority, geriatric psych is my home unit, so "Why was I pulled?" I asked Mandy, the MN house sup. "I don't know", she replied, "It doesn't make any sense. I'll find out and get back to you". So, with a passable good attitude, I clocked in and went to the women's psych unit.

Two nurses, an RN and an LPN, who usually work the women's psych unit, were also scheduled for the 12 hour MN shift. After report, when the charge RN asked me what I wanted to do, I replied, "As little as possible". "Okay", she said, "You can take the day room"( which has doors).

Taking the day room duty is basically where a staff member sits with a clipboard of patient precaution sheets on their lap and fills them out while a loud TV blares programs and commercials and patients sit around and stare at each other.

I stared off my sojourn with a public announcement of who I was ("Hello ladies, I'm Dave- I'm a nurse.") and then went around and chatted with each of about 15 patients. 

After my meet & greet, I stood there and watched the patients  stare at each other. I remembered the complaint of a particular patient years ago, "We never do anything on the weekends- get any therapy- we sit around and watch TV!"

So I asked if I could turn off the TV and if anybody wanted to have a group. It was pretty much unanimous: "Sure. Why not?"

We introduced ourselves and said one thing we liked about ourselves. Or passed. We talked about such things as meds acting as catalysts or inhibitors. We talked about the sympathetic and parasympathetic nervous systems. We talked about all emotions stemming from the two basic ones: Love and fear. We talked about the difference between logic and emotions. We talked about things you shouldn't talk about:


The group held the majority's attention for about an hour and fifteen minutes when it trickled down to about four patients who I sat down and continued chatting with, mostly about meds.

I had a good time on the women's psych unit but was pulled back to my home unit of geriatric psych at 2300.

Rooty Payne is a psych tech who is worthy of respect, for he is a good coworker, gets along with just about everybody, and is very good with the patients. When Rooty works the floor, I never have a concern about the patients' safety and care.

However, Rooty is mischievous. On three different occasions, that I am aware of, nurses have inadvertently left their work keys in areas accessible to patients. When Rooty has found the misplaced keys, he secures them, but does not return them to their owner until the end of the shift.

The nurses who misplaced their keys have loudly proclaimed so and have frantically turned units upside down in search of their lost keys. They have gone as for as, but not limited to, doing room searches and digging through trash and dirty laundry.

Rooty believes that staff who leave their work keys in areas that are accessible to patients need to be taught a lesson, for this is a grave compromise of patient and staff safety.

It is worthy to note that staff who have inadvertently left their work keys in areas accessible to patients have never repeated the act after they have gone through Rooty's Aversion Therapy.

I had a good time on the women's psych unit but was pulled back to my home unit of geriatric psych at 2300.

On my way to the geriatric psych unit, I stopped to use the restroom just off the main hospital entrance. There, on the urinal, sat some security guard's work keys.

I thought:



I was working the floor, providing direct patient care Saturday night and Eleanor, my work wife, was finishing up an admission. As I passed by the nurses station, Eleanor said, "Mandy called and said she wants you to call her back".

Always thinking the worst, I asked, "What did she want?"

"I don't know", Eleanor replied, "I didn't ask".

"The least you could do is ask 'Can I tell him why?' or something like that!" I scolded her.

"It's none of my business, and besides I am not your secretary!" she retorted.

"Oh Jeez", I whined, "I'm probably going to get fired!"

I called Mandy and she asked me, "Can you pee?"

"I can pee in Morse Code", I said.

"I'll meet you down at the lab", she instructed.

Mandy was waiting for me outside of the lab when I got there. I thought of Lloyd Bridges' character in the movie "Airplane!" and said to her:




I learned how to mix colors while working in a paint store some 42 years ago. The elderly lady who taught me how to mix colors told me, "Don't let anything distract you while you're mixing colors. If you are distracted, you may make a mistake".

I learned a truism on nurseswebsite which goes, "All bleeding stops eventually".

As I set up the patients' HS meds last Friday, with the phone ringing in the nurses station that is adjacent to the med room, I thought of both of these situations from which I've learned:


I tell myself, "What you're doing right now is the priority so don't risk bungling an important task for some unknown variable which, in 99.9% of the cases, is less important!"



The Weekend of 7-19 to 7-22-19:



I jumped for joy like some jerk excited over new phone books as I came onto the geriatric psych unit on Friday for my MN shift. Everything was going to be okay now- no more sitting for two hours being a door.

However, new problems have arisen. 

Only one of the double doors open, which means some things cannot pass through the single door, like wheelchairs, meal carts, or crash carts.

The doors are to stay locked 24/7, so the staff member assigned to the community room during the  patients' waking hours, are locked in there with them. The staff member assigned to work the floor and make rounds use to be able to sit in the community room and walk the hall. Now, an extra staff member is required to just walk the hall in order to make rounds.

The video monitors are down, so staff at the nurses station have no idea of what's going on in the community room. And, like deep space, with the doors closed, 'no one can hear you scream'. 

Scary!


On Friday night, we had four staff members, sufficient enough to cover the desk, meds, the hall, and the community room. However, on Saturday night there were only three of us. I did meds, Eleanor was doing an admission, and Fridgett was to cover the community room AND hall. 

"t has been noted that neither doors on the men's and the women's psych units have the community room door locked during the day- only from 2200 to 0700.

So, seeings how this 24/7 locked door thing does not jive with the other psych units, this shift, due to a lack of staffing to cover both the hall and the community room, the door was propped open with a chair.

Fridgett did this of her own accord and I supported her decision:


We'll see how administration responds to this when and if they review the video monitors that may or may work outside of the geriatric psych unit.

I'll keep you posted!

Stay tuned.

Fine tuned.


The Weekend of 7-26 to 7-29-19



Due to insufficient staffing, I worked three different psych units in two shifts. But maybe more about that later...

Saturday I was scheduled on the geriatric psych unit with two non-licensed staff members. No big deal, as there were only six patients, but it meant that I had to do all the VS, nurse assessments & charting, pass meds, plus oversee the direct patient care.

Near the beginning of the shift, there was an "all available staff" code called for a patient behavior. Unbeknownst to me, a therapist working as a tech left the unit and went to the code. A tech working in the locked community room informed me of this.

When the therapist tech returned, I informed her that she needed to allow the RN to make the decision if she should leave the unit. I said that I would not have advised that, as she was not available. We needed her to cover the hall for patients not in the locked community room.

Two points of contention reared their ugly heads: 1) The therapist tech said she took her "stuff" to the NS on her way out of the unit and the (off going)  nurses should have known she was leaving, and 2) she was told two staff members were to be in the locked community room at all times.

First, I informed the therapist tech that I was the RN on the unit after shift change. Secondly, if two staff were in the community room and I was in the NS/med room, all staff would be behind locked doors and the patients in the hall could not be directly monitored.

Well, one thing led to another and, basically the therapist tech refused to follow my assignment, walked off of the unit and said she was going to talk with the house sup. I ended up propping the community room door open with a chair and asked the tech to station himself in the community room and make the 15 minute rounds on the other patients, which he did.

I immediately informed Mandy, the house sup of the situation, and although she was dealing with staff injures due to the patient behavior, got me another tech in a short amount of time. Mandy suggested that I email my supervisor, RoofElmo, and inform her of the situation.

I sent an objective report of the situation, noting that two of the patients not in the day room were bed-bound, incontinent, non-med compliant and psychotic. I added this as a postscript:

"...please allow me to declare my firm belief that keeping locked doors between staff and patients for as long as 15 minute intervals decreases monitoring capabilities and greatly compromises patient safety."

Hence, the above cartoon.


I was working with the same tech tonight and he used the staff toilet. He said when he went to flush the toilet, it erupted like a volcano. "I've never seen anything like it", he said. He described the bathroom looking like one described to Martin Lawrence's character in the movie "Wild Hogs": "Some truck driver must've crapped and entire cow in there, man!"

Maintenance was summoned and the tech and I cleaned up and disinfected the over spill into the hallway. Maintenance came and went while I was doing other things, did their job, and mentioned to the tech that housekeeping would need to clean things up. 

Since I was also busy cleaning up an incontinent patient when housekeeping arrived, I did not see them come and go. The tech informed me that two young giggling girls from housekeeping open the staff bathroom door, looked inside, stopped giggling, closed the door, and left.

"They didn't clean it up?" I asked. "No", he said, "They just left".

So I called housekeeping and spoke with a couple of dudes with whom I am on a good basis. "Maintenance has to clean that mess up before we go in there", I was told. "I said "Noooooo, maintenance is for maintaining and repairing. Housekeeping is for cleaning up- you know: housekeeping?"

"We're not going in there until maintenance does their job". "Wow", I replied, I don't like to do this, man, but I've got to report it to the house sup". "Do what you have to do" he replied as a matter-of-fact.

So I let Mandy know and she basically said "What?!" "Just let me know if there's anything I need to do", I told her.

Time went by and nothing happened, so I went to gain empirical knowledge to see if maybe, some way, somehow, I could clean up this mess described to me as something akin to a volcano erupting or the brutal slashing of a Poop Person.

I opened the door and saw a puddle of standing water in the middle of the floor and three turds on the toilet! Not even big ones! Breakfast sausage-sized turds!

So, I donned my gloves, got some bath towels and Dispatch and tackled the overwhelming feces flow of the erupted Mt Toilet!

Sheesh!



I was pulled to the men's psych unit Friday night and was scheduled back on my home unit of geriatric psych Saturday night. At about 2230, Mandy telephoned me and said, "You can yell and scream and be mad at me but I'm going to have to pull you to the women's psych unit at 2300!"

It seems that I was the only male staff member on the 2300-0700 shift and the patient who had sent two staff members to ER had orders for the 1:1 staff to be male only.

A bump in the road is nothing when working with a great supervisor like Mandy and I was glad to help out.

But still- I bargained for a future favor:


There are several full time and fill in house supervisors on the psych side of WRMC and they are Chandelier, Mandy, Jason Hiney, Ranger Rodd, Bestica and Valerian.

I've mentioned Ranger Rodd in a few other threads, on how he was a decent staff psych nurse but epitomized the Peter Principle once elevated to the level of his incompetence. For example, Rodd believes that saying patients' first names in a public place is not a HIPAA violation and being a door is more important than patient safety. There are more, but I'm in a good mood and don't feel like Rodd bashing right now.

The woman's' psych unit patient who had sent staff to the ER, whose name is Miralax, also injured a nurse with whom I'm quite fond, Lil Orphan Annie, LPN.

Last week Miralax walloped Annie in the side of the head to the point she experienced pain, hearing loss, and some other symptoms. Annie requested to be seen in the ER, but Rodd denied her request all the while sending extra staff home on low census.

Annie had a few choice words for Ranger Rodd!


One nurse on nurseswebsite wrote, " I always enjoy hearing your weekend updates - almost feel like a Saturday Night Live skit sometimes "


The Weekend of 8-2 to 8-5-19


There are some patients you just don't forget, and Bob is one of them.

I have fond memories from last February of preventing a naked Bob from falling off a bedside table to him grabbing my crotch to the point that I could feel my spermatic cord pull my testicles up into my inguinal canal:


Bob presently has the honor of being the first patient in over a decade to have to be put into mechanical restraints on the geriatric psych unit!

You see, while being on a 1:1 status, Bob attempted to do swan dives from his bed onto the floor and needed to be restrained in a 40 minute therapeutic hold to assure his safety. He was then placed in mechanical restraints, received Haldol 5mg/Ativan 1mg IM, and stayed in restraints for the entire four hour time length of the order.

Bob is currently resting quietly on a gurney in the seclusion room after taking the majority of his HS meds from me. 

I got the "important" meds down him before he lost steam and began refusing them.

I don't think him not taking meds like his fish oil is going to do much harm, do you?


Bob was very impulsive and Friday night, when I went to attempt to give his meds, he spit them out  and spilled the cup of water. I immediately retrieved the meds, got a towel, and was stooped down in the process of mopping up the water when Bob grabbed me.

I turned to be face to face with Bob when he started stepping backwards. Fearing we were going to fall, I directed Bob toward a mat on the floor. Sure enough, Bob went down and I landed on top of him. 

As I lay there for a moment, regrouping, Bob sang:


I worked the floor on geriatric psych unit Saturday night, as my work wife Eleanor was charge. Nickle the tech and I switched off every two hours making rounds and sitting 1:1 with Bob.

Bob had been med compliant and had received some PRN doses of his Haldol and Ativan, so he slept the majority of the night. He was awake when I took over the 1:1 watch at 0530, so we sat and chatted.

Some of my most favorite people to talk with are diagnosed with schizophrenia, as Bob is. People diagnosed with schizophrenia often use loose association, in that one expressed thought can be connected to another, usually in an esoteric manner.  

Bob and I were chatting about this and that and the other thing when I went to look up something on Google for Bob. I said, "Just a minute, Bob, I need to put on my glasses. I've had myopia- nearsightedness- since I was 8 years old. Then, in my 40's, I got hyperopia- farsightedness. Heck, now for all I know, I've just got plain ol' presbyopia!"

Bob asked what presbyopia was and I told him it was the term for failing eyesight due to the aging process. Bob replied, "I've got an uncle who is a Presbyterian minister who's an old guy and he wears glasses!"

"Gee, Bob", I replied...


There is a patient on the women's psych unit, Miralax, who is psychotic and physically aggressive who has sent several staff members to the ER. Miralax is a 1:1 and the doctor's order says that only male staff are allowed to cover her.

Being the only male staff member in the psych division on the 2300 to 0700 portion of two of my three shifts this weekend, I was assigned the duty.

Friday evening, Miralax acted out and required both chemical and mechanical restraints and sent two staff members to the ER. By the time I arrived for my duty, Miralax was asleep in her bed. The two female RNs sat in the hallway, one for patient rounds, the other merely to be at hand should Miralax go off. I sat in the doorway  just outside of Miralax's room.

Around 0230 Mandy, the house sup, was making her rounds, chatting with the other two RNs. Miralax arose out of her bed and I immediately stood from my chair. All three RNs saw my move and assumed a stance nearby. I was impressed by their vigilance and told them so later. Miralax merely used the toilet and returned to her bed to sleep.

Around 0500, Miralax again awoke and asked:


Well, I thought about giving her the Yogi Berra reply, but didn't want to push my luck.


Miralax refused to take her HS meds Sunday night, which consisted of, among others, Thorazine and Haldol.

When Miralax awoke at 0500, I contacted the charge RN and asked if she'd bring me two of Miralax's PRNs, Zyprexa and Vistaril. I assisted Miralax in making her bed and suggested that she take these meds in order to keep calm. She did as I suggested and we sat down on a ledge in her room and chatted.

Miralax said she wanted to give me 10 million dollars, but I graciously declined, saying that I was financially okay and suggested she give the money to a worthy cause. She said she would and then I asked, "Where'd you get all that money?" "Oh", she said, "I'm on SSD and they send me 130 million dollars every month!"

"Wow!" I replied, "And the government says they're out of money!"

Our conversation went from here to there when Miralax happened to mention that she was born in 1971...


I guess that Zyprexa and Vistaril really knocked her out!


The Weekend of...8-16 to 8-19-19

I said to the new HR director, as I gave him The Look: "I am being called down to HR after working my THREE. TWELVE HOUR. MIDNIGHT SHIFTS."


"So forgive me if I seem a bit prickly".

It seems that I was being written up because I went against and "did not adhere to safety measures by propping the NS door open".

Guilty as charged.

"I will adhere the the safety measures", I wrote on the form. "In my defense, I wanted to hear what happens out in the hallway, as I was recently attacked by a patient and no one heard".

There were only a couple of lines on the form for a response, so I just put down only the very basics, for the time being.

This situation is actually a long, drawn out story, a journey fraught with convoluted twists and turns, past transgressions & broken promises, and multiple other thises & thats, but that's the gist of it.

I was allowed to inspect a full color photograph of me pushing the waste can up against the NS door taken from the video monitor.

I was impressed by the likeness in the perspective of my cartoon to the perspective of the actual monitor photograph.

However, I was embarrassed by the fact that I was currently wearing the very same gray scrubs that I wore on the night the monitor took my picture.

And, the camera really does add ten pounds.


I pointed out that I believed there were two staff members in the NS during my "workplace assault". When I called out for assistance, no one heard me, because the NS door was closed, even though I was in the quiet room which is directly adjacent to the NS. I gave this as the reason I had propped the door open; I did not want the situation repeated and wanted to increase staff and patient safety by being able to hear what was going on outside of the NS. When no one was in the NS, I would close the door.

"We're looking at ways to improve safety", my supervisor RoofElmo, said.


Bottomline, I believe Wrongway Regional Medical Center (WRMC) needs to prove that they are enforcing safety measures for surveying and accrediting agencies. If WRMC presents problem areas, show they took action, then everyone can say, "We're doing our job which proves that we are necessary entities!"

This whole being called down to HR thing is a merely a tactic so risk management, HR, JC & Co. can show their worth. I do not expect any far reaching ramifications of this write up to affect me.

Except maybe for the can of worms I opened:

In March 2017, I was called down to HR by the psych division director for not completing a redundantly superfluous piece of paperwork after a fall. To make another really long story short, let's just say that I confronted the HR director on her inappropriate behavior, caused the psych director to get red-face and teary-eyed, and filed a grievance against her.

I attended a "fact finding meeting" with the HR director the following week, but other than that, and nothing else happened. No follow through, no closure.

I started off this current write up meeting by declaring that it is customary and appropriate to resolve old business before bringing up new business. HR had not completed the old business concerning my grievance and was now bringing up new business through this write up.

The new HR director said he would look into the old business which is really my area of interest. Even though I had requested other administrators to follow up with the old business, nothing ever came back to me. Now, both the old psych division and HR directors have new, higher standing positions.

I'm really interested in seeing the way in which this can of worms is dealt.


The geriatric psych unit is "Filled to the Gills with Mentally Ills". Due to patients acting out psychotically requiring PRN injections, patients with dementia, comorbidity, or on forced meds, the med pass takes well over two hours, even though I set up as many as I can beforehand.

Then, in the middle of it all, a loud, obnoxious, profane, entitled, high maintenanced, sporadically med compliant patient who refused some meds after they were scanned wheeled up the med room window and demanded, "Gimme my Narco!" I said, "I'm sorry, sir. The only pain medication available to you is Tylenol".

He glared at me and said nothing.

I asked him,"Do you want the Tylenol?" 

He continued to just glare at me.

I become an Auctioneer/Baseball Announcer Nurse!

The loud, obnoxious, profane, entitled, high maintenanced, sporadically med compliant patient who I had been auctioneer/baseball announcer nurse with would yell "NURSE! NURSE!" to any female who walked past his room. For me he yelled, "DOCTOR! DOCTOR!"

"I am a nurse", I would say, "How may I help you?"

A patient's toilet was stopped up, maintenance was summoned, and after dealing with the toilet, the maintenance man walked past the aforementioned patient's room with plunger in hand.

"DOCTOR! DOCTOR!" the patient yelled, then paused, probably remembering that sometimes nurses are male, and yelled, "NURSE! NURSE!"

"He's not a doctor or a nurse," I said, "He's a plumber".

The patient yelled, "PLUMBER! PLUMBER!" 


I was charge on two busy 12 hour MN shifts dealing with five 1:1's, an admission, behaviors, a therapeutic hold, forced medications, a couple of medical concerns, a worthless pulled med tech, and disgruntled patients & family members.

Eleanor, my work wife, picked up eight hours, 2300-0700, Saturday. She and a PRN nurse, who has a full time job as an RN instructor, walk into the NS. Eleanor asks, "How's it going?" I say something like, "It's been busy! I've been dealing with five 1:1's, an admission, behaviors, a therapeutic hold, forced medications, a couple of medical concerns, a worthless pulled med tech, and disgruntled patients & family members!"

So Eleanor sits down, picks up a patient information sheet, finds a pen, and is poised for report. The PRN nurse/RN instructor asks, "So, Eleanor, how's your nine year old?"

I internally explode. EVERYBODY knows that asking Eleanor about one of her kids opens the floodgates to long-winded, detailed (albeit extremely entertaining) narratives!

"NO", I say, looking at PRN nurse/RN instructor, "I AM GIVING REPORT!" Eleanor senses my frustration and replies, somewhat in a whisper,  "I tell ya later". I sigh a breath of relief.

There were seven staff members who need to be assigned a rotating position. So, after a quick report, we began discussing who's going to do what and go where when PRN nurse/RN instructor asks Mandy the house sup something about being paid.

Again, I internally explode. "Let's stay focused here and get our assignments, shall we?" I say through gritted teeth. Mandy says in a whisper to PRN nurse/RN instructor, "We'll talk about it later".

And this person is TEACHING our progeny!

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