Nurse Jobs London

I’ve been here in Capital City for two weeks, and it seems like I’ve been here forever. Part of it is that I was here as a traveler a couple of years back, and I’m living in the same part of town I lived in then, only south of the main drag instead of north. I know pretty much where everything is, what supermarkets are where, and (very important!) where Wal-Mart is. I wasn’t as familiar with this side of the main drag, so I was delighted to find things like a neighborhood Indian restaurant and grocery store right up the street. I know where the libraries are and have decided I like the older branch better than the new one. I’ve found the post office. And best of all, my new apartment is just over a mile from the hospital.

My apartment is in a townhouse community and is spacious and quiet. I wanted a townhouse because I’m tired of people stomping around overhead and didn’t want to live on a third floor somewhere. I’d actually been looking at another complex, but when I found this one I knew it was right. It’s not a huge community, and though there are quite a few kids, it’s not overrun and they seem to be well-behaved. I couldn’t imagine living in an adults-only community! Downstairs I have a kitchen, dining area, and sunken living room with a *working* fireplace. Upstairs are two bedrooms and two bathrooms. I have a private patio and even a small garden plot
(and yes, I do plan a tiny kitchen garden!) as well as a small area out front where I can plant flowers.

OK, the hospital. It’s HCA, which has its pluses and minuses as they all do. Decent benefits and retirement plan, pretty reasonable working conditions, and this particular one has an excellent reputation. The minuses are an antiquated computer charting system which I am already familiar with from other HCA hospitals, and maybe not the most up-to-date equipment. But everyone has been very positive and very welcoming. Probably the only place I’ve felt that welcomed was the one where I was last summer. I’ve done my mandatory week of nursing orientation and Sunday night I start actually working. Amazingly, they’re not making me orient on days for a week either; I start right in on nights. I never could figure out why most places make you do day shift orientation first; it’s a completely different animal from nights. One excuse sometimes given is “so you get to know the docs” but you don’t see much of them during the day because you’re busy running yourself to death. But then you have to learn a whole new routine when you go on nights, and that loses you another week. I’m delighted someone has actually seen the light!

Oh, and the patients? Well, surprise, there’s no decrease in acuity. We still have all the cardiac and vasoactive drips, our chronic vent, the recently extubated, complicated wound care, blood to give, and those who aren’t too terribly tightly tied and like to climb out of bed and do “face plants” on the floor, not to mention a few who think they have a private duty nurse who will cater to their every whim. This morning we got a call “Can you take a labetolol drip?” (this is a continuous infusion of a heavy-duty blood pressure drug which can take a nasty turn if you’re not careful) and the oncoming charge nurse said “No, not even if we had a bed, which we don’t.” Technically we *might* take such a thing, but it would be dangerous with the number and acuity of our current patient load. Oh, and the category I forgot.the gynormous, those weighing over 300 lbs., who are killing our backs and shoulders.

And how do they justify all this? It’s being done in the name of “productivity,” a model designed by the bean counters who have no clue about what really goes on out here in the world. Everything is measured by some formula which appears to be completely divorced from the reality of caring for the sick. “But we have to make money to keep going!” they wail. Right, and how many of YOU do we need? How much middle management is required to keep an outfit going, and why does the CEO need to make that much money? My dearest dream is that part of the curriculum for all programs in health care administration will include a year actually working as a tech, and at least 6 months closely shadowing nurses in a variety of units. In the best of all possible worlds.but it will never happen.

The result is burnout, despair, and a lot of bodies heading for the door. Our assistant manager left for one of the critical care units; one of our best day nurses took an assistant manager position at a smaller inner-city hospital; another went back to New Jersey; and almost everyone else has applications out or is looking either in the system or out. Of course there’s a hiring freeze on in the system, it being the end of the year and all.

I thought about posting an account of what happened last night, but just thinking about it makes me exhausted all over again, and considering what we might have overlooked is painful. Meanwhile our other 7 patients went unattended, and one nurse was there for nearly 20 hours. ame in for day shift, stayed over for 4, and it was her patient that tanked, so she was there past 1:30 charting. Please tell me how this can be safe?

Last weekend started with a thud as I got pulled. Now, according to our manager, we are not supposed to take an assignment if we are pulled, only float, doing admissions, IVs, whatever. I told the staffing person that, but was informed that I *would* take an assignment as she “had a desperate need for nurses on that unit.” I was further threatened that if I refused the manager would call the administrator on call (the subtext being that my contract would be canceled). So I went on up there and it was the usual disaster you walk into when being pulled.

It wasn’t that I had a huge number of patients.actually there were only 3 and an empty bed.but the floor was barely controlled chaos. It looked like everyone up there was a traveler with the exception of one LPN, and a traveler was in charge. No clerical person whatever (well, I’m used to that now). Oh yeah.and after I got situated I found that there were *two* other RNs working as CNAs. Well, one left at 11, but still, how did someone who’s used to that floor get to do that, and I had to take patients? Also, there was a CNA who was working extra hours as a sitter, yet he was hauled out of his patient’s room and told to do vitals, etc. I found that out when I went to put a patient’s oxygen apparatus on her, found her wet from neck to shoulders, and was told by her nurse (who seemed to be busy chatting with a couple of people from another floor), “Just get K to help you.” K and I cleaned her up and changed the bed, and that nurse never showed up in the patient’s room at all.

My own patients weren’t too bad, actually, a couple of pulmonary types, one with a sitter, the other just as pleasant a guy as most chronic lungers *aren’t*. The third was a fresh post-op who’d had a radical resection for prostate cancer. He was also Hispanic and I was told had minimal English. He arrived shortly after I did along with an Anglo couple who may be neighbors or employers or some such. He later told me the man was “the best friend I ever have in this life.” He actually spoke more English than he’d been given credit for, and I think understood more than he spoke. I have a similar situation with Spanish, so between his pidgin English and my pidgin Spanish we did quite well. He was a *very* busy patient with frequent vital signs, a catheter that wasn’t draining quite as much as I’d have liked, and a wound drain that was draining far more, IV fluids and antibiotics, pain medications, etc. I was in his room at least 4 times an hour, or so it seemed. He was a very pleasant gentleman and really quite nice-looking for his age.in another situation I might have given him more than a passing glance. In any case, that night ended in a manner quite unlike most. First, the atypical chronic lunger asked for his anti-nausea pill and yet another cup of coffee, and when I brought them, he said, “I appreciate all y’all do for me.” Then, as I was finishing up in my surgery patient’s room and started to leave, he smiled at me and said, “Thank you for taking such good care of me.” Good heavens, appreciation from not one, but TWO patients? Unheard of.and worth far more than bonus pay.

The next two nights it was back to my own unit, and business as usual. Now I’m coming up on the pre-holiday weekend, and also scheduled to work Christmas Eve. Most places don’t work their travelers on holidays because they have to pay them too much. This place won’t be like that because it basically runs on travelers. In fact, I heard from travelers in my unit who worked Thanksgiving that the hospital put their regular folks on call and yanked the travelers around everywhere. It figures.

Countdown to the end in progress.17 shifts to go.