I'm not sure if it's a nightmare or a blessing. This summer we had many cameras installed throughout the workplace and parking lot. All views show up on a nice little monitor hooked up to a hard drive that archives the last 30 days. Ain't that special?

The blessing part is if I have a patient care complaint, a theft, a car getting scratched in the parking lot etc., it's all captured by the cute little cameras. A serious offense can be captured making my life with Union reps, grievances and arbitrations a no argument situation. Hard to argue with technicolor proof.

The nightmare part is: somebody has to burn off the time frame in question from the hard drive, take it home and spend hours reviewing the video from all these cameras. Take copious notes and type up a nice summary. Guess who that sucker is?

Needless to say I've spent the last two evenings at home viewing, viewing and viewing. Why can't people just do their fucking job, go home, watch TV...screw around on the internet? Lead a boring life like me?

Anyway, it's just amazing what people will do on camera.

I thought it was time I write an update on what's going on in my life. Maybe it will help me see things with less tunnel vision. I resigned my place of employment on April 30. It seemed to cause a flurry of excitement in the corporate higher ups. I guess my bitching, moaning and groaning over the past year fell on deaf ears until the moment of truth came.

So after multiple phone conferences and "sit down and hash this out" meetings...I've been given promises "to get this situation fixed". So approximately two weeks after I resigned, I rescinded my resignation on the terms the changes will be made.

I readily admitted to them I am so burned out I could not see a way to fix things. So this is what they came up with:

1. I get to hire an assistant DON. Did that yesterday. Quite a chunk out of the budget I might add. Didn't make me bat an eye.

2. A video surveillance system will be installed throughout the building. I could of hired even another assistant for what this baby will cost, but in time saved from having to interview a zillion witnesses to figure out what happened...it will be recorded for all to see.

3. Increased attorney support to deal with the union issues that had become my main focus instead of patient care. This portion of it all actually becomes quite complicated and I'm not even sure I understand it all. Lawyers...what can I say. The "bottom line" is I'll no longer be harrassed by the union. We'll see.

4. A $10,000 reward will be posted for information leading to the ....blah, blah, of anyone who basically does something illegal in the building against a patient or management staff. Where this one came from is a long story...and I'd just as soon skip over it again.

5. Increased corporate support and presence. Damn this could be scarey. Time will tell.

So that's the story. I promised them I would stay for now and try it. The burn out factor is still alive and present. But I'm the one that has to come up with a plan to try and fix that. Unlike them, I made no promises that this problem can be resolved but I am willing to try.

So anyway that's been the recent happenings on the road to Oz.

Friday I did give notice at work. Not an easy thing to do. Sort of akin to breaking up a relationship...although there is relief there you can't deny the grief or ignore the pain of things turned sour. The underlying feeling of failure.

After a flurry of phone calls from corporate people I'm supposed to have been "reconsidering" staying this weekend with certain promises of "changes". I've also been offered taking on another building.

Promises, gifts and little sweet words of nothing. A little too much, too late. The thrill is gone baby, let's just skip the foreplay and move right along to the fucking.

It's been a damn long weekend. I'm usually introspective but when I do it purposefully...well it turns up the volume on my sarcastic cynical side. The world becomes an ugly place without bubbles and princesses. Wait...maybe it just grounds me in reality.

Can you tell I reconsidered and my decision has been made?

I ran across this little gem when I got home from work this evening:

National statistics just released show the average staff turnover rate at nursing homes is close to 100 percent a year.

Don't I know.

My stress level is profound. I have a whole bitch session going on in my head but I'm just too damn tired to even talk about it anymore. What's the point. The old adage "you can't fight city hall", comes to mind. I don't even know what I'm the most upset about...people who care for people who don't give a shit anymore? Healthcare is not about taking care of people anymore...but doing the absolute minimum to save a buck? It's a toss up...and it all sucks.

I need to put in my notice at work...but it makes me feel like I failed, I'm turning my back on my patients and the damn good staff that I do have. Maybe like a traitor? I'm just tired of the war...and you shouldn't have to feel like that at work...should you? You shouldn't have to explain every fucking day to adults that if you don't do your job in a place like this...someone is being neglected? I shouldn't have to hear that I'm spending too much on incontinent briefs, medications and no they can't have fucking milk for lunch anymore. The next person that tells me my expectations are too high...I'm going to get ugly.

Damn, I can't decide whether to laugh hysterically, throw something or just cry. I guess I lied about the "being too tired to talk about it". I'm done now.

No doubt about it...it's time to turn.

I had an interesting conversation with my boss this morning that I really did not have time to reflect on much. Ever have one of those conversations that shock your beliefs and thoughts that you just have to put it out of your mind...for your own peace of mind? Actually I can't even say it was a conversation because it was all one sided...it went basically like this:

"Dawn...I was thinking last night, and I just think you are trying too hard. I mean, what and where is it getting you? You are losing sleep and worrying about things that can not seem to be changed. You have to do all these union grievance hearings...and someone turns around and does it again. I think you should just quit trying. I mean, who is going to notice? Who really cares? Really, what is the point?"

I was speechless for at least a full minute. The only thing I could think to respond was "Well ____, I can do that I guess. But then they really don't need us here, we might as well start our vacation today."

Then she left my office with "well it's something to think about."

I have entered the Twilight Zone. I'm going to think about this conversation later. It refuses to compute. Ctrl+Alt+Del. System is shutting down.

that the birds start chirping before 5am? Dunkin Donuts is open and Bob Evans is closed? Just an FYI.

Well things weren't too bad at work...nobody sleeping, but I did find 3 employees outside that didn't belong there. I'd like to say I didn't find any violations of a greater magnitude...but I can't. One employee tried to get ugly with one of my managers until she seen me coming down the hall, I must be looking damn scarey this morning, because she shut the fuck up fast.

So I inserviced them all on the violations I found, obtained their signature of understanding of what I'm telling them and there will be no further education on certain matters. Signatures hold up nicely in arbitration hearings so I've found out. So now I have to figure out what night I'm going back. Won't be tonight.

Well it's 2:15am and here I sit sipping the first cup of coffee of the day. Yes I'm sitting here thinking "What the hell is with this shit?" too, well my body is, my head supposedly knows what is going on. Time for another graveyard shift surprise visit after rumors of sleeping, carousing and the normal behavior that can be found at any Motor City Big 3 plant at this time of night.

So I'm off to a rendezvous with two of my other managers at Dunkin Donuts to coordinate the surprise entry. Usually I do this alone...but call it a hunch, but I'm not feeling particularly safe walking through the OK Corral this night.

Hopefully I ran all the bad guys down the road Friday. If all goes well, I'm keeping my fingers crossed I'm back home by 7am. I see a big nap in my future.

Yep, today was FUBAR. Sometimes I think I'm having a FUBAR moment, sometimes I think I might be having a FUBAR day. I was wrong, because today was FUBAR. I have witnesses.

My boss was gone today and not to be back til next Tuesday. That leaves me in charge of the facility, damn I hate that. The Gods of long term care obviously found this out and decided today was "Play with Dawn's Sanity Day". They succeeded.

Today started out deceptively calm and peaceful as I planned my day unaware that havoc was hiding waiting to pounce on me. So being the peaceful day I thought it was going to be I grabbed the facility Doctor and decided today was the day we were going to review 150 patients medications for unnecessary drugs. Much to my amazement we did get this done in 2 hours time. That was the good part of the day...but wait..

I'll make this brief....

At 9:30am I hear my maintenance supervisor over the PA system announce "Attention, Attention...due to a major sewer back up in the kitchen all water will be shut off for an undetermined amount of time." Oh hell no. Over 200 employees and patients in a building without water is not a good thing. Ok, we can do this.

10:00am One of my nurses approaches me "Umm Dawn, were you aware the elevators are not working?" Shit. Ok, things are getting a little tougher. We can do this.

11:15am "Ummm...Dawn, can you come into Rm ###, the wall socket is on fire." I think this was the moment I deemed today FUBAR. Luckily the wall socket was smouldering out and unplugging the TV made it quit I guess. The black wall did not look good.

12:45pm Received a call from the corporate pharmacy consultant "I'm going to be in your building in about an hour to do an inspection and review. I'm bringing a team. We should finish up by tomorrow...hope this is a good time?" Oh yeah, great time, c'mon over. Like I have a choice? It's an inspection.

1:15pm A group of men arrive arrive from Houston IT department...yep, Houston, Texas to install 18 new computers and printers. "Dawn, where do you want them?" Umm....no one let you know where they are going? "Well no" Well no one even told me today was the day they were coming. I might of gotten pissed off about this point, but the IT guys were cute. Besides when do I ever get to see "guys" where I work? So...I'm actually not going to include this in the FUBAR moments. Like they are really cute and going to be back tomorrow. Ok...so moving right along.

1:45pm I decide to grab my Lean Cuisine before the havoc monster finds me again. So I grab a corner in the back of the breakroom...trying to hide. Didn't work. I take my first bite of low fat chicken alfredo and I hear "I'm sick of this shit and I'm not going to do it" And a dietary employee gets up and walks out of the breakroom. Good...quiet. That lasts about 3 minutes and I hear "Where's Dawn, I'm not going to take this!" Coming from the Dietary Supervisors mouth and heading toward the breakroom. Well damn. So in comes the Dietary Supe and the employee both yelling they aren't going to take this. Dietary Supe says she told loud mouth employee to punch out and leave, loud mouth employee refuses and proceeds to get in my face. Screaming that she wants a meeting NOW! Ok, so I calmly tell her she's not in a frame of mind to have a meeting, go on home, calm down, and come back in tomorrow for a meeting. At this point she backs me up against that little cozy corner in the breakroom and tells me she's not leaving til we have a meeting. I told her 5 times as I backed her away from me to leave the building. For some reason she didn't get the hint. I had to call 911 to have her removed...of course by this time, it's a permanent removal. Forty-five minutes later...the chicken alfredo is cold but still tastes fine.

2:45pm Irrate relative upset today, because I told the family yesterday that they need to find a new facility for "Mom" because dear Mom is an elopement risk and I am worried for her safety in my facility. She needs a locked down facility. Forty-five minutes later son decides maybe my decision is in Mom's best interest, calms down and leaves, not even bothering to say "hi" to Mom while he's there. Asshole.

4pm Hire a weekend supervisor. (This is a great thing.)

4:30pm Run from the facility fast without looking back.

Damn it's good to be home, even though work has already called four times.
Four more working days til vacation. I can do this. Oh, about the brief part? I lied.

My office today seemed to be a revolving door of employees for counseling and disciplinary action. Whenever I'm out of the building, my employees are just like kids and they have to act up. One thing that happened Wednesday when I was away being "trained" to save and make more money, two employees were in a very loud verbal altercation in the patients dining room.

Both employees should of been suspended on the spot, but my managers failed to act. Trust me they got their ass chewed for their "save it for Dawn to handle" method.

Of course neither employee really understands their part in it. "So and so made me lose my temper." Yesterday I had to interview 6 employees total who witnessed or was involved in the BS. So I completed the investigation and called Ms. D into my office this afternoon to counsel and give the disciplinary action, the last and final one. While she is in there, I show her employee file and we review her past disciplinary actions since I've been there. The things are minor but everyone of them had to do with her attitude and her mouth getting her in trouble. She's telling me she knows that "her mouth is what always gets her in trouble". She goes on to tell me she wants to go to college to be a nurse. She is a very kind and caring person and I tell her so, but also that if she didn't change her behavior and start acting more professional she just won't make it. She hangs her head and says "I know, I know, I have a big mouth." Of course I start feeling a little bit bad that I'm making her feel bad, so I tell her Ms. D...when I call you in here and discuss these things, and give you these disciplinary actions, it's so you can learn from this, and not keep repeating the same mistakes. Well she brightens up a little and says "well I did learn once, but then I forgot." Okay then. "Well Ms. D, maybe you'd better write it down this time."

I'll probably get a bitch slap from the union over this, but I told both of them by Monday morning I wanted letters of apology to the patients, family and other staff that they scared with their BS. I'm tired of apologizing for assholes, it's time they do it themselves.

A few minutes after Ms. D left my office she returned and said "you know, you are the only person besides my mother that can make me feel guilty for the things I do." I told her to be thankful she wasn't my child, because I would of kicked her ass. I could hear her roaring, and I mean roaring with laughter all the way down the hall as she left my office.

Call it a wild hunch, but I don't think Ms. D is gonna remember this little chat and write it down.

Well we had our little corporate banquet last night and I kid you not, it was horrendous. The past two years, corporate hired a comedian for the first hour of the banquet who was very funny and helped to pass the time. Well for last nights festivities they decided a magician would be something different. Oh he was different.

I can not even begin to describe this guy accurately. He began promptly at 4:30 and wanted to tell us something about himself and his life so we "would have a better understanding of him". Forty-five minutes later this guy is continuing to drone on about his house burning down, his parents leaving him, how his grandfather committed suicide in front of him. At the 45 minute mark when he began whining about the town of 400 he grew up in and wanted to share with us the upside and the downside of small town life, I walked out.

Forget Jose, whiskey was in order. I was told about thirty minutes after I left, he did a few "magic tricks". That's right one hour of talking about himself, 15 minutes of magic. This man bragged at the beginning of his "show" that he makes 6 million dollars a year. If he actually does make that kind of money with that kind of bullshit, the world is more fucked up then I possibly knew.

The funny part of it, out of 150 people, the majority of them walked out at least twice during that monologue...to get a drink, smoke etc. Then the fools would go back in, because they were afraid they would get "in trouble" with the big boss. Who I admit did walk out 4 times during this, and yes, he's such an ass he probably was taking names. What annoys me and astounds me even more is that these people were willing to suffer through that shit to look good for the boss.

I learned alot about other people last night and myself. That some people give a shit about "appearances" and frankly I don't. Once again, I was the odd one out. I can live with this.

Martin Luther King Jr Day historically has been synonymous with the Blue Flu Day at my place of employment. I just called work and for some reason, no call ins today. Strange. I had taken certain measures and prepared for sudden chaos. Now nothing. Have I mentioned my staff drives me insane?

My boss informed me Friday we will be heading to Houston next month to once again squander away thousands of dollars to learn how to make money.

I'd say more, but it's a little too deep for me.

Any nurse who is not a Director of Nursing will tell you that the DON doesn't do shit all day. To be fair, I used to say the same thing ages ago. Now I know different. But to a charge nurse on the floor the only thing that matters in their eyes is: Patient Care in the here and now. They are absolutely right.

Being a charge nurse in a long term care facility can be a tough job. In my facility you might have a patient load of anywhere from 27-41 patients. Depends on the acuity of care for that unit. The charge nurse is responsible for the nursing assistants (CENA's) on her unit anywhere from 3-5. She's responsible for medications, physician's orders, and any treatments the patient may need, from respiratory to skin/wound treatments. Last but not least, documentation. Anyone in healthcare will tell you any care given that is not documented is "not done".

So to say a charge nurse position is hectic, hell yes. It's rare for anyone to get more than a 15 minute lunch break, and what are coffee breaks again? So when that nurse is running behind the person she's going to blame and point the finger at is the boss. Everyone knows where the buck stops and damn if she's not in another meeting.

In a 160 bed facility the charge nurse is always looking at a small piece of the pie. It's my job to look at the whole pie and to sum it up in a few words, to keep it from spoiling or getting all gobbled up.

So I thought it would be fun (for me) to post just what it is I do in an average day since so many times I'm driving home at night wondering what the hell I got accomplished this day.

So for the interested:

Today seemed to be exchange Christmas gifts at work day. I suck at that, I didn't buy anyone anything. It seemed I gave a small bank account away over the last couple of weeks for various gifts, parties and who knows what else.

Well I made out good, I think my staff gets me nice presents at Christmas time to make up for the hell and damnation they give me all year. I got a gold cross necklace, varied lotions, gels, candles, candy up the wazoo. Which I always leave there for them. And my favorite present: a black negligee that I guess I'll save for a rainy day. (No...not tomorrow.) The funniest part was when the girl that presented it to me states, "well I guess this is really for G." The guy I gave the walking papers to last summer. So at this point I had to tell them G wasn't part of the program anymore....their immediate response was "well we have to find you a man!" Oh God. Why did I open my mouth? These women are relentless when they set themselves on a mission. I see several brothers, uncles and second cousins in my future. Not to mention every male that walks in that building will think the CIA has sat up shop for questioning. I tried to tell them a man is not on my Christmas wish list, but I was told I was wrong. Alrighty then.

Three years ago I made that same mistake. When will I ever learn?

I've come to the conclusion that I apparently work over an epicenter in the earth from where all energy flows to nourish drama queens in the universe. It's obviously a strong magnetic field there that sucks them in closer. So if a drama queen would drive by...they are compelled to fill out an application.

I've had to think about this theory for awhile, because this could mean I’m actually a drama queen. Anyone that actually knows me knows at work I'm more of the ice queen. I'm adrenaline challenged due to over abuse by others.

So let's say God likes sitcoms, so he puts the ice queen in the middle of a pack of drama queens. Let's face it, if you are bored, drama queens can be quite entertaining.

The basis of the story line is to see how long it takes for the ice queen to start babbling like an idiot and run screaming for the nearest mental health center, forevermore to be a born again drama queen.

Well yesterday God’s little storyline almost climaxed. I had a bomb threat at work. I'll spare you from the drama and the comedy. Nobody went boom. Nothing was found creating a tense moment deciding to cut the blue vs. the red wire.

I just can't wait to see what is in next week’s script. If this keeps up I'm going to have to renegotiate my contract for a stunt woman.

Yesterday we had a little Christmas thing at work for all the employees. Our company only allows a few pennies dollars per employee for Christmas so it's always a stretch of the imagination to come up with something fun and a present.

So yesterday we had nachos with the works for everyone and gave away t-shirts. Last year we gave away turkeys but too many people bitched - including myself, that then you had to cook the damn thing. Ungrateful asses that we are.

The t-shirts have the company logo and said across the front "Heads Up! Our patients count on it." Of course this was a spoof off the little diddy they do when I'm making rounds and they see me coming. "Heads up!" Thats what I can hear being passed down the hall or around corners. Have I ever mentioned that Detroiters are not quiet people?

When you break routine at work it throws everyone off for the day and chaos ensues...always. After all, rules are meant to be broken. At some point yesterday my cell phone number was passed around and I began to receive text messages such as "What's up boss?" "Why are you using your cell phone at work?" "I need to see you in my office." Smiley faces etc. In all their fun, what they failed to realize is: I now have their cell phone numbers. Big mistake. Heh.

Sharing the spirit.

I had something happen at work today that has really thrown me and I'm not quite sure how to handle yet. I can't really post details, but it's one of those things I need to vent and talk about.

I had a visitor in the building today inspecting certain things. I knew this person was coming. I was asked by someone at work to handle one of the issues for another department because she would not be in today. Of course, I said no problem, just give me what I need to present. That was done last night. I glanced at it, not my specialty...everything looked in order to me.

Well this morning on my way to work I get a phone call from this person telling me verbatim what I need to say when I present these documents. An explanation of sorts. Fine, no problem. Weird that I wasn't told that last night..but ok.

So today I'm sitting with this official as the documents are being looked at. Well lo and behold there are discrepancies even I can see when it's pointed out. So I call up this department to attempt to get an explanation so I can explain it to the official sitting across from me at my desk. Well, I talk to 3 different people and I can tell I'm getting the run around. So I end up back on the phone with the first person who admits to me that these documents have been altered and are in fact bogus. I'm looking this official in the eye as this person is telling me this.

Fuck. Fuck. Fuck. Fuck.

This is one of those moments in time where I earn every penny these assholes give me. I calmly hang up the phone and tell this official I'm dealing with idiots and I can't get the answers that I want. That I need to call corporate to assist in getting what I need....and that number is in another office. Which is the truth.

I know I need to call corporate to get my hands on the real thing. Now this is where now, again with corporate I'm covering this person's ass. Corporate knows this official was going to be there and the real thing had damn well better be in place.

Today I found out how good a bullshitter I am. I still can not believe I got out of that situation without lying. Oh I lied when I gave that first verbatim speech...but then I didn't know I was. So does that count? I literally told this official that I don't know what happened here but I'm dealing with fucking idiots, obviously.

Anyway the official wasn't stupid, I had to give a commitment that this fucking mess would be straightened out in a few days. Oh I gave it alright and it will be.

I'm furious. I'm pissed as hell I was drug into this mess and had to be the one to clean it up. I wish I could say I feel bad about the things I said to those three people after that official left. But I damn well don't. This isn't over yet. I'm going to work their asses all weekend long. From the phone. I'll be at home. Not feeling a damn bit of pity.

Oh, and God help that other person when she returns tomorrow. If I go.

I rarely allow vacations during the holiday weeks because no one wants to work. So usually it's first request in gets the time off. Being a 24/7 business holidays can be a trifle scarey. I always get the last minute requests to have the holiday week off. I can rarely grant it at the last minute.

Due to the fact several employees have been turned down apparently I have rained bad karma down upon their heads because my denial has beseiged their families with deaths.

My sympathies go out to my employees who have lost their fathers, brothers, sisters, grandparents, brother and sisters in laws over the past holiday week. By the time the new year rolls in Detroit should damn near be a ghost town.

We do require a death notice by the funeral home to collect the three days pay. Obviously one funeral home in Detroit made a hell of a lot of money last week. They must be the best one of course.

I think as Christmas draws closer I should stop by and pay my respects. What I do find odd, out of all these deaths...no one ever loses their mother. Seem odd to you?

My boss recently asked me what was the hardest part for me about my job. It didn't take me a second to respond:

"This is the first job I've ever had where instead of guiding and educating employees about the job, I am having to start with complete basics. I am having to teach my employees common courtesy and respect for others in the work place, let alone common work ethics. My hats continually switch from mother, babysitter to policeman's cap."

This has been for every job I've had since coming to Detroit. I was a director on Iowa for 12 years before coming here. I never had one abuse case. In 12 years I probably fired 5 employees. I'm sure here I average at least 10 a month. That's a conservative estimate.

I've been told repeatedly that I need to lower my expectations of employees from the Detroit area or I won't have any staff. Sometimes that statement about proved to be right. That thought has never been far from my mind, but this isn't one of the Big 3 factories, this is healthcare. I refuse to budge.

So my day is consistently filled with speaking to employees how it is unacceptable to show up to work 2 hours late, come in dressed like you just rolled out of bed, hanging down in the breakroom when you are supposed to be on the floor, talking to the boyfriend on the phone for 15 minutes with the call lights going off, not calling your co-worker a "ho" in front of patients. That's the minor stuff...I still deal with the abuse, the theft, sleeping on duty and the drugs in the back parking lot. Finally after 4 years...I'm getting the message, I can't teach morals and ethics. It's too late. Momma and Daddy did not do their job correctly.

When I read this article today I had to laugh. A New Spirit at Work-
Leaders Moving to Transform the Business World With Spiritual Values. The goal of the program:

This means redefining business to focus on people and on decisionmaking based on values — like integrity, respect, intuition, and creativity. The shift involves going beyond maximizing profits to considering all stakeholders: employees, customers, vendors, shareholders, and the community.

They might as well save their money. You can not teach integrity and respect. You can hope for an employee showing a proper action at any given point in time, conditioned reflex. Somewhat like teaching a dog to rollover on command and getting a treat. Pavlov's dog comes to mind. It doesn't take a rocket scientist to know what Pavlov's dog would of done if you would of put a bitch in heat in the room.

The majority of my staff now is very good. We realize now if we do our job we get rewarded, it's called a paycheck and a sense of satisfaction of doing a good job. Some will never get the concept that you actually have to work to have a job and a paycheck. Getting a paycheck is not a right for existing.

I had two different things happen today at work. This afternoon I was in a disciplinary meeting with an employee and the union steward when suddenly...and I do mean suddenly I get this stomach cramp from hell. It was bad enough I really didn't think I would be able to walk out of the room before the diarrhea hit. So with butt cheeks clamped and enlisting the aid of those kiegal muscles, I rapidly exit the room.

I decided to bypass the nurses station bathroom, the one I always use, because I know the comments that get made from the staff when some other poor soul answers natures call. I finally make it to the public bathroom, knowing only non-employees use that and it wasn't likely that rumors would be flying through the building within 30 minutes that the boss smells like a dead cow.

So as I'm sitting there all I could think of was Stephen Kings DreamCatcher and shit weasels. The whole thing was not pleasant. As I'm sitting there feeling sorry for myself and hearing people pass by and hoping they aren't hearing me, I look down...and what to my wonderous eyes should appear: a diamond. A loose diamond sitting there sparkling in the florescent lights. Wow.

Anyone that knows me, knows I have this thang for diamonds. Of course I grabbed the diamond at the first available opportunity. It looked like approximately a quarter carat. Fate. Who would of thought I'd leave that bathroom smiling. Well I made it to the nurses station and one of my managers seen my tight walkrun to the bathroom was waiting to ask me if I was ok...she told me I looked a little pale. Heh. Well as I am explaining about the stomach cramps leading up to the diamond a second major stomach cramp hits. Worse than the first. Well I tell her to take the damn diamond, I have to GO. She laughs and says thanks....and I hear her laughing as I close the door saying "I'll go get you some Immodium for this."

I think I should get the diamond back, since I wasn't quite in my right....mind or something. That really wasn't quite a fair trade.

Well life was a little tough today at the Not OK Corral. Actually it started yesterday morning, damn early, with a call from work saying a patient was complaining of arm pain and "a man twisted her arm" and she was wondering what to do. So after recharging the nurses brain cells and setting her straight on the path to enlightenment, the patient was dispatched promptly off to the hospital.

This is when I change my nurses cap into a cop cap and begin an investigation. So after several phone interviews with certain likely and unlikely suspects, I get a grip on what happened. A certain employee was suspended "pending an investigation".

Well sure enough the arm was fractured. Now by law I'm required to investigate and determine if there was "intent to harm" by employee against said patient. If I feel there was intent after my investigation is complete, I am required by law to report this.

Now as I've said on too damn many occasions prior to this, if I "think" there was "intent" and I report it, my facility is automatically given a federal defiency tag, level G. Of course none of you probably realize this is serious shit. Then of course I have to do a plan of correction where I have to ensure this does not happen again. Which I've done that before. Did it happen again? I'm not sure yet. The employee in question has dodged my phone calls all day. This is not a good thing.

So if and when I report this to the state, a state surveyor comes in, reviews my investigation. If they agree with my investigation it will be forwarded on to the attorney general. Then the attorney general comes in, reviews my investigation and decides if they are going to pursue charges.

Now is this fucked up or what? First, if I was not an honest person, I wouldn't report it if I did discover intent. I am honest and always do report. So I report it, I go through 6 degrees of hell with federal red tape for weeks on end, not to mention the attorney general, police, and last but not least the fucking union. All because one person might have done a bad thing.

The thing that really gets me, no one ever does another investigation other than mine. No one. No matter what way I decide I might be wrong.

This leaves me as cop, judge and jury. I don't like being in this spot. It's just a little too heavy. In the mean time one of my babies has a broken arm, and I am responsible for every hair on that head. The whole thing sickens me.

In my corporate meeting today we seen a short motivational film from the concept taken from the book, Fish Tales. It's a 17 minute little fun film of guys in a fish market in Seattle who have a roaring good time on the job. Well, at least in the film.

These guys play with the dead fish, throw it, play catch, make dead fish dance etc. for their own entertainment and for the amusement of customers and those passing by. Potential future customers. They yell, they jump, play and frolic amidst dead sea creatures. Hell at the end of the video I wanted to play with dead fish.

Well the concept of the whole film of course is to have fun on your job. Try to employ these simple concepts to your workplace. So I tried to picture my employees in the fish market. In a matter of 30 seconds I could envision dead clients beat to death by flying fish, half the dead creatures in the back of a relatives van, and the ones not participating in the now riot sitting watching TV complaining they might break a nail.

I don't think the film was supposed to take me there. Maybe I'm wrong. I don't think so.

Anyway at the first coffee break I told my boss about my daydream and that I would be leaving soon. I want to work with dead fish. She agreed, even if it might stink and we could break a nail. Somethings are just worth the price.

Well today is the monthly corporate meeting day. The day where my company brings in other administrators, directors of nursing and corporate yahoo's from three other states. That's right, brings them in from the east coast, rents out rooms in the Marriott and we listen for 5 hours or so how to save a buck.

Makes illogical sense to me.

I left work early for me today, at 5. I was pissed off beyond measure...now I'm in the "fuck it" mode. It's not worth it. Last week I received an email from my corporate HR person after she had left the building that day for union grievance meetings.

The basis of the email was requesting more information on a termination I had done that she forgot to gather herself while she was there. At the bottom of the email she politely informed me that I had 75% more union grievance terminations then any other building, and I had filled my quota. I brushed it off. I figured if she didn't have the "balls" to tell me in person fuck it.

Over the weekend a nursing assistant was suspended by the supervisor for not giving care to her patients. Falsifying patient records that she had showered them and also had been found sitting in a room on her cell phone. According to THE company rule books this is negligence and of course falsifying legal records. Both grounds for termination.

Well I emailed my corporate HR person with the info and what I was going to do, fire her ass and she sent me back an email basically saying she was not happy with my decision. She asked if she had anything else in her file.

This person was a transfer in from another facility a year ago. I know I have given her 4 disciplinary actions in the past year myself. So going through her file, which consisted of the previous facilities disciplinary actions I find that she had been terminated there two weeks before "transferring" to my facility.

So their stupid ass HR person processed a transfer with references on a terminated employee. Hello.

Now my pissed off meter blew a gasket. So I fired off an email to the HR corporate yahoo and told her I was highly upset because if her department had been doing their jobs I wouldn't be in this spot of being damned if I do and damned if I don't.

Within minutes I received an email response from her with two words in it: Do it. Yeah..fucking right I'll do it.

Don't you just hate it when someone tells you how to do your job, when they can't even get their own down? Dipshits.

Ahh...one other thing, 20% of my yearly bonus is based on low turnover rate. Guess that just sucks for me..don't it? Now I can be a little slow on the get go here....but doesn't seem to you I can be highly rewarded for not doing my job? Assholes.

I'm done now.

I had a very whacked out experience today at work. I had an employee of mine deliver a "message from God". Now I have to say here over the course of my life this has to be at least the 10th person, if not more that has come up to me to "deliver a message from God". I've talked to friends and co-workers that say they've never had this happen to them in their life. I'm not talking about people I know well trying to convert me...because I am a Christian, usually it's been people I hardly know. Or completely never seen before.

For instance one message from a nurse from an agency pool about 4 years ago...who I never had met or talked to came up and said "God told me to tell you to call your Mother, she's ill." I hadn't talked to my Mother in a couple of months, so I called her and sure enough, she was sick and ended up in the hospital the next day after I started making calls and got my brother over there. She was diagnosed with congestive heart failure. Now...remember I'm in Michigan, my mother is in Iowa.

The other messages I wish I could say weren't appropriate and these people were whacked....but that would be a lie.

Today was whacked. I had a nursing assistant who is in her 50's come into my office when I arrived this morning, shut the door and immediate begin speaking "Dawn, I have a message from God and I am anxious and upset because if I don't deliver this message immediately I'm going to explode!"

Alrighty then. Well this woman begins this Temptations dance routine thingie and tells me God told her to tell me "that I'm about to feel His administration and He is keeping back satan's devils and I need rest and peace in my life and that (she names my boss here) and that she all her evil spirits is about to be taken down and you need to open yourself for His message."

Ok. She starts becoming louder and louder, she has this holy roller southern preacher accent thing going on, the Temptation routine is speeding up and and her speech is getting faster and faster. Not often am I speechless...but damn, she did it.

She ends this tirade by grabbing me, hugging me and telling me she and God loves me. Well at that point I didn't doubt her sincerity but damn I'm questioning what God is up to.

So I sat this woman down and kindly told her that this wasn't appropriate in the work place especially when she starts saying my boss is going to be taken down. As she starts talking her conversation is completely inappropriate and after about two more minutes of listening to her, I realize this woman in the last 24 hours has become delusional, paranoid and definitely exhibiting psychotic behavior.

I tell her to go on break and simmer down, that I appreciate the message, but please don't be delivering anymore to anyone in the work place. Well I should explain here that this woman about a year ago filed a suit against me for religious persecution. She had been praying for patients in their presence without their permission. I had complaints, I asked her to stop..she hadn't, so she was given disciplinary action. Thus the suit was filed. Far as I know that's still in limbo somewhere.

So I called my HR Regional person who tells me not to say anymore to her until she talks to legal. So I have to watch someone who is delusional and paranoid render care to my patients all day until I hear back from legal. Fucking corporate bullshit. Finally 7 hours later I get an email that legal is closed til Friday. Hang tight.

Sometimes I don't know what is worse, psychotics or corporate yahoos.

LittleA asked in my comments from this morning's post "What next?" Hell if I know. I hate what healthcare has become. I've either been a director of nursing or consulted as a director of nursing for almost 18 years now. I can't believe how fast it's gone.

I read an article in the last month sometime in some periodical I receive at work that the average length of stay for a DON is 11 months in extended care facilities. They can't take the stress. Hell I can't take the stress.

Something started changing about 10 years ago...switching from quality care to the almighty dollar. Things have been declining steadily since.

So what I'm going to do, I don't know. I can go back to consulting, at least I don't have to stay in one place too long. Clean it up and move out. But I hated living out of airports and hotels. I hear through the grapevine about every 3 months my old boss would like to have me back. I always was a little resentful that she billed me out at $75 an hour, I worked 60...salaried at 40 hours a week. Oh well. Need to negotiate better I guess. I learned off that one.

When a door closes another one opens up...I just hope it's a little less bullshit behind the next door.

Sometimes I think you have to march right in and demand your rights, even if you don't know what your rights are, or who the person is you're talking to. Then on the way out, slam the door.
--Jack Handy Deep Thoughts

There is something about this quote that reminds me of how you have to be when dealing with the corporate yahoos. I know absolutely nothing about running a business...but yet somethings are just common sense right?

I don't have time now for posting the 25,000 word essay going through my brain about my company. It's a good one too. I've been just a little too busy up to my ass wading through the bullshit to get it all down on paper.

One thing I have noticed through the years, as you are wading through bullshit, your legs get stronger from the resistant exercise making it easier to jog through the open door without it hitting you in the ass on the way out.

The day my bonus check arrives in the mail is the day my 30 day notice goes in. We all have to have goals in life. Februay or March, damn I wish I could remember when that thing comes. I think I have more budget cuts coming in January....arghhh. I can not lose one more person.

I. Must. Hold. Out. For. Bonus. Check.

I just got home from a management "get together" at Bahama Breeze....and with a couple of Miller Lites in me it was tolerable. These things are always so odd. I like to watch these people out of the work environment and with a couple of drinks in them. Total personality change takes place.

I learned a few things: my staff developer is a shopaholic, the maintenance man likes to drink beer out of shot glass...don't ask, I don't get it either. One of my unit managers wishes she was 21 again so she could have sex "with alot of people". Alrighty then. The dietician smokes and drinks outside of work. Heh. One of the other unit managers won't eat anything green....just because it's green. My MDS coordinator weighs 115# and thinks she's fat because her husband told her she was. My newly wed assistant's husband is buying porn on cable when she's not home.

I really could of gone the rest of my life without knowing any of this. See what great things you learn when you are a powerful listener in a social scene. I can't wait til the Christmas party.

Today was a bitch...so I'm bitching. I fired the human pig that witnesses say abused a woman. Of course she denied it. Of course it's going down the union grievance trail. Of course I have to report this to the state so they can come in and give me an abuse tag. Of course I have to write a plan of correction on how I am going to prevent this from happening again. Of course I can, I am a Goddess. Of course this makes perfect sense because we are talking about government bullshit. Of course we know how rational the government is.

Then at 6pm I have a fucking crackhead - I'm serious here - flies into my office talking 5000 words per minute about how fucked up this place is and Dad's care is always getting delayed. He goes on and on about how he has 8 employees and he knows how hard it is to get people to work. (He just got out of prison last month and applied for a job in housekeeping at our facility last week.) So he's really topping the bullshit meter out, anyway then he starts ranting how the director and the administrator are never there, they only came in last week when the state was in the building and nobody has seen them since.

I tried to tell him I was the director and pointed at a nurses station where the administrator was, so he could see we were definitely here. He didn't shut up long enough to hear me and goes on to say that he didn't want them anyway he was told to find Dawn because she was the one to get things handled so fuck the director and the administrator anyway. Alrighty then.

So he proceeds to tell me he is going to call the state and report that the director and administrator "better known as the head honchos" are never there. He's ranting and raving so I decide at this point I'm going to talk to dear old Dad. So he follows me up to the room ranting that every time Dad puts on his call light he has to wait at least 10 minutes sometimes for someone to answer it. Then it might not be a nurse who answers it, it could be anybody. (Well it's our policy if you go by a call light, no matter who you are, you answer it.) So he's got me there.

So as I'm trying to talk to Dad..the son picks up the phone, calls the state and is reporting to them that the director and the administrator are never in the building. Shit. I think I passed into that parallel universe again.

I hear him tell the state he can't talk to the director, she's never there, so he had to get somebody named Dawn to complain too. Actually this is all just too stupid for words.

When a complaint is lodged with the state, they have 10 working days to come in and investigate. So..with the self reported abuse today, and this fucking crackhead, that means 2 more surveys in the next 2 weeks.

Just for the record, I'm real tired of this shit.

Well it's over. Survey went good. A few tags but nothing big...a few minor issues. A nurse didn't wash her hands at the appropriate time, a nursing assistant was standing to feed a patient, privacy curtains too short, paint chipped door frames. Minor things, and the surveyor didn't give us a tag on the thief thing. We survived.

I read all the responses to my previous question. I really got some great ideas. Thank you for doing my thinking for me. Tomorrow I'll think about normal life stuff again...and bullshit blogging will continue commence.

I have one thing on my mind now. Sleep.

Well I really didn't figure I would have time to post this week, but I didn't anticipate the dipshits at work would call me at 3:15am either. Stupid me.

The survey is going well so far, as far as surveys go. The team leader gave us an exit interview before she left last night. She said things were going well there were "no major concerns but a couple of minor ones." Heh. Who knows what the hell minor is in her book.

So I get a call at 3:15 from a nursing assistant at work who wants to go home because she "has a sore throat". So I asked her why the hell she was calling me and she says the nurse said she had too. Alrighty then..let me talk to the nurse.

The nurse gets on the phone, a nurse that has been there for years. So I ask her the same question...why the hell she is calling me for a friggin sore throat. She says "I was told 6 months ago I couldn't let anybody go home in the middle of the night without permission." So at that point I had to ask her "Who in the hell told you that and why after 6 months are you following the damn friggin rule?"

She laughed. She must die.

So anyway, I told her I'd be in to work in 2 hours, we'll discuss it then.

I hate hell week. My staff loses their minds.

Ok. Not just my staff.

Two days down, two to go.

About 9:45am this morning Hell Week officially opened. We had a state surveyor show up to follow up on a complaint we had reported. The complaint was a former employee stole a bank statement from a patient, apparently the same week she did this was when she walked out and quit. That happened to be the week in July I was on vacation.

Our business manager about 30 days ago noticed some suspicious withdrawals from the account. Well the stupid ass paid her bills with it and had direct TV installed at her house. Under federal law this is considered abuse and when we discovered it, we reported it. This is kind of a fucked up law, because when you self report you get a federal defiency tag.

Ok, fine I knew somebody would be dropping by for a day of survey. So in he comes and during the intake interview with him and my boss I notice another state car pull up, then another, then another...total of 5. Well shit..this isn't looking good. I asked him how many surveyors he brought with him and of course he says none. Uh oh.

Well this week it's annual survey time. My facility is crawling with surveyors. They usually show up in December but have a 90 day window either side of last years survey. Our window opened up 9/18.

Anyway, this will probably be it for me blogging the rest of the week until Saturday. For some reason the song phrase...Send Lawyers, Guns and Money won't quit going through my head.

See you on the other side.

I had another incident with my male Indian nurse Friday, which carried over to today. Friday one of the Unit Managers wrote a disciplinary action for him for 2 serious offenses...failure to give a medication, and failure to properly monitor an IV infusion. Actually these were both termination offenses. I wanted to give him the benefit of the doubt..offer more training and counseling, my managers are against it, but being the boss I get the last word.

He has several excellent qualities and I feel is definitely trainable. His biggest weakness is asking for assistance with something he just don't get..mainly, which he won't admit too, is because the managers are women.

Well Friday in serving these disciplinary actions he didn't take it well at all, but better than the last time I talked to him. At least he agreed to sit down this time and listen to what I was telling him. At least when the 2 other managers were in there.

Well the meeting ended and he was to follow the inservice director for immediate inservicing on IV's...which he did for about 10 feet came back in the office and closed the door so it was just the two of us.

Well at that point he got in my face and asked why I am not treating him like a man. He told me you do not give men disciplinary actions. I am supposed to treat men with respect and tell them what they are doing wrong. That in his country women treat men with more respect. Alrighty then.

I've said before I don't quite respond well when I feel threatened, so at that point I took a step towards him as I pushed him away. Which he continued to try and rant at me...until I told him to shut the hell up. To make a long story short, I gave him a rapid education that I was his boss, woman or not, and he could leave at any time he so chooses or if he continues to screw up it will be at my choosing. I reminded him that in this country...and this is the US, not HIS prior country, nursing is predominately female and no matter where he goes he's probably going to be working under a female. If he can't deal with that it's time to change fields. With that I told him to get the hell out of my office or leave the building. He chose to go back to work.

Well this morning he came in to talk to me and said that the Unit Manager who he is currently working under lies and he doesn't want to work under her anymore. I told him when I had an opening on another unit, he could move.

Well his wife works there also, has for years and is an excellent nurse. There hasn't been any problems because I keep them on separate floors. So today he informs me "You move my wife, I'll take her unit." Of course I told him it doesn't work that way. He says, I'll tell her to move. I told him no he won't.

Anyway..he wasn't threatening today, but he's supposed to be decide by tomorrow if he's going to quit. At this point....good riddance.

Damn it, but I think my managers were right this time.

My blogging and blog reading has been light the last few days. Isn't it funny how the brain works...when there is too much stimuli going in, little can come back out. Well anything back out that makes sense anyway.

By the time I got into work yesterday I decided to sit down with my boss and tell her some of my feelings findings about how communication in the building is affecting my psyche operations.

I ranted listed how the non-existent current communication is non-productive and fucked up frustrating to many. How fucking around much time time it takes to find someone in the building.

I ended the spill with reminding her how much big bucks many potential clients we are losing because of being on hold and not having voice mail.

She decided to go with the $25,000 phone system. About fucking time! This will be a good thing.

I'm not going into work until late today. I brought work home that I have to get finished and actually doing my work at work doesn't seem to be possible lately.

So I told them yesterday they probably won't see me before noon today. Which no one remembers and I'm sure they are paging me for phone calls and stupid shit as I type this sitting here in front of the PC in my t-shirt and Medusa hair.

I already know at 9:35am my phone will ring and someone will be wondering if "I'm ok?". Heh. They really mean "Where the fuck are you and when are you going to get your ass in here and handle the bullshit?". Uh-huh.

Communication at work sucks. The biggest reason is our antiquated phone system. Our facility is three floors, there are 14 different offices spread out the facility. Five nursing units and six dining rooms. Not to mention enough patient rooms to house 160. We do not have voice mail and we do not page overhead, so if you page someone it only comes out through the phone speakers. So if you are not by a phone and someone needs you, you have a phone call etc., you'll never get it. To make matters even more fucking annoying, the phone is constantly blasting someones name or someone blaring through the intercom and listening right into a conversation you might be having in private. The only option is to take the phone off the hook. When I am finally in my office...you bet your sweet ass I do.

Mega time is wasted on finding someone to obtain info or disperse it. This is driving me fucking insane.

To upgrade our phone system will cost along the lines of $20,000. As far as I'm concerned this is chump change in comparison to the benefits. I actually think in lost time this could be recouped in 30 days, if not less. But spending $20,000 to upgrade a phone system is not on the "Raping a Facility" action plans.

So anyway by the time I get in at noon, I'll have at least 25 staff, patients and family members pissed off at me because:

1. They were on hold for 20 minutes waiting for me to answer my page this morning.

2. No one told THEM I was coming in late today.

3. It must be nice to be the boss and only work a half a fucking day, why they are there doing all the work.

Heh.

For the most part I like my job. I just don't deal with bullshit well. Some of the recent family things I'm talking about with the threats of being sued, or actually being sued:

1. Dad was admitted with severe back pain but to recoup from a cardiac problem, but according to the daughter only developed after being admitted. Come to find out Dad was in a serious car accident 30 years ago and several of his vertebrae were fractured, which mended without alot of torture through the years. Well 2 months before being admitted Dad fell at home and the pain resurfaced. Hospitals being what they are today only dealt with the immediate cardiac concern and sent him off to us. Dad after a multitude of years of cuddling up with Jack Daniels actually has a multitude of problems. So he's being sent off to a variety of specialists since admission. Monday, Darlin Daughter takes Dad out to the nephrologist and swings by his favorite chiropractor for his back pain on the way back. When he returns, he can't hardly move. So now she's "going to sue your ass if we don't get to the bottom of this back pain". Hello?

Second case: Dad who has had a stroke who needs thickened liquids was found by Darlin Daughter sitting in the hallway sipping a glass of water - unthickened. Some well meaning passerby (staff, patient, visitor)? Gave him a cup out of the drinking fountain because Dad was thirsty. Well shit happens. Mind you Dad has lived there for 2 years without problems. Darlin Daughter visits every other month and goes off the deep end seeing this. Yells at me that she is going to sue my ass if he ever gets aspiration pneumonia. Well yeah Dad can...happens alot if you have swallowing problems, especially when you choke food down and don't want a tube feed. Dad ate his meals by my office because of the problems and I had performed the heimlach manuever on him several times in 2 years. So I told her I wouldn't live under that threat, and I'd have Social Services contact her in the morning regarding alternate placement. Seven days later Dad was taken to another facility, fell 3 days later and fractured his hip and died during surgery. Yes I feel bad because I lost my temper and let psychotic family members interfere.

Last but not the least, this is a current lawsuit:

Mom was admitted from the hospital after being found by Darlin Daughter at home with multiple bedsores and a massive weight loss. Obvious Darlin Daughter who lives close by hadn't visited in a while. In our facility she continued to refuse to eat, continued to lose weight and of course the bedsores were not healing. No matter how much we had family meetings telling this bitch that if Mom didn't have tube feeding, IV's etc....she was going to die. Hospice was offered. "NO"...Mom wouldn't want that. Well it gets down to the wire, and Mom is dying and all of a sudden it's "what have you done to her? Send her to the hospital!" Of course, where Mom dies, it's too damn late. Did we do everything possible? Yes, I have no doubts. Still doesn't stop the lawsuit mess.

Yes, I actually feel the daughter planned this.

I deal with these asswipes several times a day. Families who want to postpone transfusions, IV's, tube feedings, medications etc...to wait and see what happens. I make sure everyday that they bluntly hear: "Ok, that's your decision to make, but (Mom or Dad) will die." The same thing that would happen if we postpone food and fluids on you. It is on you. Then they invariably ask "When will Mom die?" I answer the same each time "I'm not God, I have no idea. Call in the family and be prepared." Although this didn't work with the Darlin Daughter on the lawsuit...my conscience is clear. I did my job.

This new HIPAA law that went into effect in April has not made my job easier. Many family members by law I'm not allowed to tell a thing too. Families don't take kindly to this. By the time mom or dad enters a hospital to a nursing home, even if they have their right mind, many children want to do a role reversal. They think they become in charge. If mom or dad says "no" don't share with them...now I'm smack dab in the middle of a family feud. Guess who the bad guy is?

Many people have the foresight to obtain a durable power of attorney for healthcare or here in Michigan it's called a patient advocate. Many children think that gives them a right immediately to be in charge. Not true...only if the patient become incapacitated and deemed so by 2 physicians.

Now if neither of these two things are in place, before major decisions can take place there has to be a family consensus and all children in agreement if the patient becomes incapacitated. The more children the bigger the zoo party. Then they start throwing down and guess who is stuck in the middle. Then we have to petition for a court appointed guardian, which at times can take too long. Sometimes at this point I'll ship the patient off to the hospital just to get it out of my hands. Talk about a lawsuit waiting to happen there.

Ok, I've rambled enough...this could be a non-stop entry. Sometimes I feel like I could write the book:

Idiot's Guide for the Elderly with Fool's for Children

One piece of advice, if you do pick a child for DPOA in the event someone needs to make your decisions. Pick the child with the most common sense. Please do not pick the 30 year old who still lives at home and can't hold down a job. That is a clue this person can not function in the real world, that person necessarily wasn't hanging around home because they had your best interest at heart.

This is a bitch session, whine session...yes I want cheese with it, I'm sitting on the pity pot and the smell stinks.

I'm angry at my corporation, I'm angry at my boss, I'm angry at myself for being pissed. I'm burned out. I've been on this road before, and usually able to get a mind set going to get passed it, but it ain't happening this time.

I'm tired of working 10+ hours a day, bringing work home on the weekends and never being caught up. I'm tired of being on call 24 hours a day. I'm tired of not having enough staff. Im tired of dealing with the pharmacy, the hospitals, the labs, the shitty employees and stupid families. I'm tired of my corporation telling me to review every fucking thing to see where we can save a buck.

My boss is proud of the fact we made a profit of $280,000 last month. I don't give a rat's ass. I need more staff. What she is proud of just made me angrier.

I yelled at my boss today....I told her to try spending 4 hours out of her office on the floor and seeing how everybody is humping and still never even close to being caught up.

I yelled at an employee today who was suppose to be at work at 7am and came toodling in at 3:50pm with a doctors excuse for the day off. Didn't bother to call and let anyone know she wasn't coming. I asked her when she was going to grow up and take some responsibility for her job? She asked me not to treat her like a child...I told her when she quit acting like one. She asked me to change my tone...I told her if she didn't like it to get out of my office. She said no...I then told her to go before I removed her. She left. Oh yeah, this is the same damn employee who called in all last week with a "cold", who showed up at our works outpatient clinic yesterday trying to claim a work place injury. Apparently she missed the clue boat to get an understanding that you have to actually work to claim an injury.

Was I out of line? Oh yeah. I really don't give a shit. I'm sick of lazy ass employees with the work ethics of a god damn pig. I'm sick of money grubbing families looking and waiting for someone to fart wrong so they can sue. I'm sick of corporate people raping healthcare and compromising patient care.

Oh yeah, I'm burned out. 7-11 is looking damn good. I can't even blame PMS.

Ok, I'm finished. No, I don't feel better. But. I. Will. Get. Over. It. Maybe.

It's viral meningitis, not bacterial. Amen. Finally got it confirmed around 11am this morning through the public health department.

Channel 4 was ringing us off the hook though. How do these people scoop out a story that fast?

Long story, long day, and damn if I want to repeat it one more time. Now it's time to veg.

About 5pm this afternoon I was enlightened by a phone call that I'm dealing with a potential disease outbreak in my facility. An employee contacted the facility to say she has been diagnosed with this, confirmed by lab tests.

It is not SARS, hepatitis...or the usual outbreaks you read about. I'm not going to post what it is, til after the threat is past. And hopefully nothing will come of this.

This is something I've not encountered directly before, so I did some research online at work, and here tonight. I gave a rapid inservice to the staff in very generic terms to avoid panic and a massive "blue flu". Made a zillion phone calls to the corporate yahoos and tried to locate the Medical Director...his day off. Lucky me. Never did make contact.

I'm sure the hospital will contact the public health department so who knows if I will be dealing with them too.

Now it's just a waiting game.

I'm. Not. A. Patient. Person.

Well I just got home from my budget meeting. I was there 4 hours. I feel like I just drove 200 miles northbound on the southbound expressway.

Corporate yahoos are crazy.

I don't know if I can do this conversation justice in writing but one of the conversations:

Me: I want to hire a physical therapy assistant for my restorative program.

Yahoo: You can't, a nurse has to head restorative.

Me: I head restorative.

Yahoo: So you are the restorative nurse there?

Me: No, I'm the DON, I head the restorative program.

Yahoo: You can't do that. A nurse has to do the progress notes.

Me: I do that.

Yahoo: Well a physical therapy assistant has to be under a physical therapist.

Me: I have 2.

Yahoo: Well a physical therapy assistant can not do hands on.

(Hello?)

Me: Yes they can.

Yahoo: Well there is no code for that in the computer.

Me:

Then the yahoo left the room. My boss turned to me and says "Dawn, never argue reality with a concept person. They don't get it."

Well color me fucked up.

Well it's 4:30 in the morning. I've slept very little tonight, ummm..this morning. Today I have a budget review at 3:30 this afternoon. This happens once a year and all the corporate yahoos fly in, rent a conference room at one of hotels on airport row.

Last year, this happened and I wasn't invited, by my boss. I learned very loudly the next day I was supposed to be there. So this year I am mandated to be there. Which is fine, I took some damn serious cuts last year that I'm still pissed off about.

I was looking forward to today, finally a chance to voice my opinion on quality healthcare vs financial gain. Yesterday I was pretty much told to keep my mouth shut. After contemplating this for about 5 seconds, I told my boss. Fine, I'll not offer any opinions, but if I'm asked I won't speak anything less than the truth. This didn't make her happy, but what could she say.

I was given some bogus response that anything negative I say will reflect on my regional director. Well my regional director is a very nice, smart woman. I would not want to reflect negatively on her...but in the same aspect, she's had a year to ask me what I think before this meeting. She hasn't.

If I have to take anymore cuts in staffing, I have to resign. As far as I'm concerned I'm staffing now where I am teetering on the border between safe and unsafe levels. If myself and my managers didn't put in the long hours we do, this building wouldn't make it. We would be in the survey cycle of hell.

One more thing I want to rant about...before these cuts, our building made more above the projected gain than any facility in their organization. That's over 300 facilities. We are still making a shitload of money...although not as much over the projected gain this year because of the cuts. Does this make sense?

When you are talking Medicare reimbursement, the higher the acuity of patient care needs the higher the reimbursement. Say the difference of $200 per day to $400+ a day. Now I won't admit many patients with higher levels of care because of staffing. We run 30-40 Medicare patients per day. Do the math.

That's right...a loss of close to 200,000 per month because I admit easier patients, or even worse, let my beds sit empty. Then the numbers get staggering. As of this morning, I have 8 empty beds that I could fill with higher acuity patients, but I'm letting them sit. Waiting for easier patients. Do that math at $400/day. I could add a shitload of people for that money and still come out ahead. Way ahead.

Now I could probably get fired if the wrong person read this. Maybe I will today if someone ASKS me what I'm doing. After all it is my license on that wall. Not theirs. Something goes wrong, I go to jail, they get a $10,000 fine. Chump change to them.

I could go on and on...but I won't. Corporate people really are too fucking stupid for words.

Well it's almost 8:30 and I haven't left for work yet. I have to fire a nurse this morning and I hate that. She's a single mom with kids for that I feel bad, but she's a menace to my patients. What she did and didn't do yesterday was outright blatant neglect and malpractice.

For the life of me I will never understand how people willfully harm another person. What is so corrupt in their minds that even allows them to sleep at night?

I would love to be able to ask her how she rationalizes this behavior, but it's a waste of time. It won't change a thing.

Something absolutely amazing happened at work today. The company sent me a brand new Dell. It's still in the box, so I have no clue if it has any good shit on it.

My company has all these web sites that I'm supposed to be obtaining information from for the past 2 years, but the computer I have is so old that it's unable to configure the sites when I finally get there.

They did forget one little detail though...they still haven't sent me a printer to print off all the wonderful stuff I'm supposed to be using. Maybe next year.

My company changed their policy on evaluations and raises this year. Which absolutely sucked. I had to evaluate all my non-union employees in June on a somewhat stupid numbers based form that when you added it all up and divided by 6 it comes out to their raise. Which the cap was a whole 3%...but since nobody is perfect (except me) no one received the full 3%. Now I had the option to give someone 3% even if the numbers didn't correlate...but the catch was I had so much money to play with..of course.

So I did the chickenshit way out...all salaried employees got 3% the hourly had to take less. Do you know how stupid I feel telling someone...well you got a 2.5% raise this year? Damn stupid.

The two previous years I had a 4% cap for an evaluation - everyone got 4%, and a merit raise if I felt someone deserved it.

Union raises of course, I'm not involved in..thank God for that. I can pass the buck. I love doing that.

The point of all of this is that the following was printed in the Detroit News today. Now am I going to hear it or what?

Velociman is back and he has some things to say about women in the workplace, it's some of the best words that I've read or heard. I wish to hell I could post this at work. At least give it to my managers.

First I disagree with this statement in part:

I had a theory, once : women think there are only a few jobs that The Man is going to allow females to take, and then only for quota's sake. And that may be true. It is, in fact, most certainly true.

The jobs are there, they are available, women are in those jobs and it's not always because of quota filling requirements. It's because they can do the damn job.

This is where he hits it dead on:

Well, let me tell you two things: Number One: there are only a few jobs cracker-assed motherfuckers like me can get, too. I'm no corporate officer, although I play one in the shower. Number Two: remember the two women I said DID have Senior Management jobs? Remember what I said their work ethic was? Do The Job. Show Respect to Your Coworkers. And for God's sake shut the fuck up about how it's too hot or too cold in here! Step away from the thermostat, bitch! You should have sweat burning your eyeballs before you EVER EVER admit to a man that it's 1.5% degrees Fahrenheit off your optimal comfy zone. Don't you get it? Nobody wants to hear that shit. Shut The Fuck Up!

Did you catch that important part: Work Ethics, DO THE JOB

The temperature thing is a little far out, but this isn't:

I've worked with 100's of women over the years. Women are always whining at work about childcare issues and they don't know how they are going to continue to keep juggling work and kids. This is one of my damn pet peeves and if you can't even juggle safety, security and someone to watch over your kids...you sure the hell aren't going to do a damn good job for 8 hours in a work place. Quit the damn whining and take care of it. Quit having your damn kids call you at work at the drop of a hat and to tell you they made it home from school safely...hire a damn babysitter.

Here's a few other tips mostly for women, but I know a few men who might learn a thing or two:

1. Don't call in every damn month when your period starts. You know what? Most of us feel miserable, have cramps, bloat etc. Get the fuck over it, expect it...deal with it. No, you are not worse than every other woman who bleeds. If you do show up, no it's not an excuse to not do a damn thing all day.

2. Leave the showing up late, having to leave early for absolute emergencies. Enrolling your child in school, dental appointment, is not an emergency. Take a vacation day, plan ahead.

3. No I do not want to see the pictures of your children, your sister's wedding or the color scheme you are redoing your bedroom in. If I wanted to take that kind of time, I would go home and redo my own.

4. Don't call in sick to work and show up the next day with a new hairdo, manicure and pedicure. C'mon...how stupid do you think we are? How stupid do you think we think YOU are?

5. If you have your work done for the day don't sit and do your nails, cruise the internet or pull out a magazine. Go help someone who is not done.

6. Stay longer and work harder to get your job done if that is what is required. If it happens alot speak to the proper manager, don't whine to everyone else who really doesn't give a shit and will tell your manager. Besides you are not working when you are whining.

7. If someone asks you a question you should know the answer to..don't bullshit your way through it. Say you don't know, but you will find out. For God's sake go find out and deliver the answer.

8. If you want to be treated like a professional at work, then dress and act like one. If you want to be treated as a hooker...then keep letting those boobs fall out and keep on wearing those red spiked shoes, and yes that black bra looks lovely under that white see through blouse. Hello.

9. You are not there to make friends. Leave your personal life - all aspects - at home. No one cares who you are fucking, if your husband is an ass, your mother-in-law is a queen bitch or bill collectors kept you up all night. To quote Velociman "Shut The Fuck Up".

And last but not least...and the most important:

10. Do not bullshit, coddle or patronize your boss, employee or anyone in the workplace. If he/she asks your opinion on something in the work place about the workplace, give it to him/her straight. Even if it hurts. No one can stand or respect a suck up or someone who is wishy washy. Always be honest, sincere and respectful. Then you are never back peddling or apologizing. If you don't know who you are and what you believe...don't expect anyone to notice you.

Then again we work with too damn many people who don't give a shit about what kind of job they do. They are just there to put in 8 hours on a good day, and collect a paycheck. There is no help for them...men or women. They just need their asses fired. Funny how they never can quite figure out why they are being picked on. I guess the boss is just an ass. Hopefully for them US Clueless is hiring.

Well here I am cruising news and blogs. I was sleeping like a baby since I had been up since 3am the day before when the phone rings at 1:30. It's a nurse from work, Mr. J.

Mr. J is a nurse from India who joined our staff in May or so after becoming licensed in the US. Mr. J's wife also from India has been a nurse at my facility for over 2 years. Both are excellent nurses, BUT..Mr. J has some communication problems in more ways than one.

Mr. J. understands English very well, writes excellently...but has a very difficult time speaking English. As you can imagine it's creating problems with patients, families and definitely the MD's. At 1:30 this morning it was definitely a problem trying to understand what he was telling me. Mr. J's English gets even worse when he is nervous or upset. Unfortunately I seem to bring forth both of those qualities in him.

He was supposed to get off duty at 11:30 but had a minor problem with a patient and did not want to leave work without the problem being solved. The MD was not returning his pages...so he had been at work 2 extra hours before he called me, trying to decide what to do. He'd rather sit there for 2 hours waiting on the MD...then call me. Which I much rather had preferred a call at 11pm then 1:30, which by 1:30...he realized this without me having to say it.

I've had to do 3 or 4 different counseling sessions with him since he's been there...and it never goes well. The first couple of times he refused to sit down...as a matter of fact he refuses to be seated at all in my presence, which makes discussing anything very uncomfortable for both of us.

I've been encouraging him to practice speaking English...encouraged him to even use it at home. He really needs to improve his skills...and rapidly. I have 3 other nurses from India on that shift...and I know they speak their native language to each other there. This is not helping Mr. J to improve his English.

Anyway...this situation is frustrating as hell and I'm not getting any new insight here...so I might as well leave it alone for now.

I had an interesting conversation with one of my Arabic patients family today...one I was not quite prepared for. I was sitting up on the 2nd floor at a nurses station charting when I hear

"Who talk to about transfer?"

I look up to see who is talking and the family member is standing about 8 feet back from the nurses station looking at me. By herself. I thought I heard what she said but I was engrossed in the chart and not sure...so I say "I'm sorry, what did you say?"

Well this visibly irritates her and she repeats the question. I've had one previous conversation with this woman and we obviously had a failure to communicate. I ask "What kind of transfer?" She never approaches the nurses station and says "You know, transfer?

I ask "Does Mrs. So and So need help out of bed?" Reasonable question.

She getting louder states "No, no..transfer to rehab."

Ahh...I think I got it. "Oh ok, the physical therapist will be up to get her for therapy, you don't have to take her down."

Now she's just plain pissed off and states "NO NO transfer!"

Ok...."Mam, I'm not sure what you are asking."

This is when she stomps her foot and bellows "Don't you understand English? What matter with you?"

This is the point where I WANT to say...Are you fucking kidding me you pompous ass bitch, you've only used 10 words out of the English dictionary and you are asking me?" But of course, I don't. I turn to a couple of nurses behind me and ask....."Does anyone know English better than me who can help this woman?"

Of course the chickenshits don't say a word. Who can blame them...a 250# pissed off Arabic woman is nothing to sneeze at.

So I turn back to her and say "No Mam, no one here can help you...try Social Services." She was obviously pissed when she stomped off. She can get over it or get out.

So about an hour later I get a call from a male relative who thankfully sounds American born and has a much greater command of his English and temper. His request "I want Mom in a room with another Arabic person now."

For cryin-the-fuck-outloud...does this asswipe think I grow Arabics on trees?
So I politely tell him "I don't have a another bed open in the place..this is it." Actually he was very polite but states "I want this arranged as soon as possible."

Well ain't that special. Why is it always the ones that my tax dollars are paying for who are always the most demanding...I never did get that. So I politely tell him of another facility where the administrator is Arabic...and maybe he should look into placing Mom there.

That always pisses my boss off when I invite people to go elsewhere...but sometimes you gotta do what you gotta do.

The insurance man came to visit at work today. We all had appointments to see him so he could tell us about the "new and improved" insurance we will have come October 1st.

My varied health, life, dental and disability insurances will be now costing me over $500 a month. Shit. I think the disability insurance has gotta go.

As I'm talking to this guy we are BSing some about the work place, where he's from etc. while he's waiting for the right screens to come up on his laptop to ask me some medical questions.. I can't see the screen. So in the middle of the BS he asks me "Do you have a problems with aides?" I give hi