Jobs

Once I got my MBA, one of the first things I did was to sit down with the director and her assistant. I pointed out to them that nurses who get a master’s degree do so because they don’t want to stay in their current role. The response was that there were no promotions available. They explained that we were budgeted for 10 assistant managers, and we currently have 14. Additionally, five people have been here longer than I have were promised any upcoming promotions. The result of all of this is that I would have to see nine people leave before I would even be considered for an assistant manager role. Assistant manager doesn’t even require a bachelor’s degree, as there are several who only have an associate’s in nursing.

I pointed out that I had more certifications and more education than any of those who were currently in roles over me, as many of those in line ahead of me don’t have a bachelor’s or a single board certification, much less a master’s and multiple board certifications. I am more qualified and certified than any other nurse in the department, including the director herself. That apparently didn’t matter.

My hospital is getting ready to open a free standing ED about 20 minutes down the road, and the staffing for that unit is coming from the staff of my current hospital. I asked them if I could apply to be the director of that facility. She told me that she was planning on running it directly and remotely herself, so there would be no director position to apply for. It’s more cost effective to not hire a new director, don’t you see…

The director then said, “I understand what you are trying to do. Just stick around, because there is a lot of growth planned over the next two years. There will be other opportunities for advancement, and you can apply for one of them.” To me, this was like being placed in the friend zone, where a woman leads you on in order to get you to continue to act like a boyfriend to take her out to dinner, but had no plans of ever letting things go any further.

So I began applying for other jobs. I first tried to get an assistant manager spot at other hospitals within the same company. I was offered one, but at the same pay that I am currently being paid, and I would no longer qualify for some of the incentive pays that I currently receive. In other words, a cut in pay. Topping it off, the position was an hour’s drive away. I turned it down.

So I applied to positions outside of the company. One of the interviews I went to lasted over 2 hours. I found myself saying things like “You hire professionals. They want to succeed and work for a place that is winning. A leader is there to give a team a common vision so they head in the direction that they already want to go, and the result is usually excellence.” They loved me. I was told that I could take a current position as an assistant manager, or I could wait and see if my other application for a more senior position would bear fruit. I elected to go for the higher position.

I then was asked to a second interview with the hospital’s board of directors. I went and got a Brooks Brothers suit for the interview. I got an email on Saturday, and the woman who would be my boss at the new hospital told me that she thought I was a great fit and this second interview was to be on Wednesday.

Then on Sunday, I got an email that the second interview would have to be postponed. Two days later, I was called by HR and told that I was no longer a candidate for either position, because the positions would be eliminated. As of this morning, both positions remain posted on the company’s job board.

I continue to search for a better job. It’s all good, I’ve only had an MBA for 2 weeks, and I have already had 6 job interviews. It will happen.

OPSEC

If we learned anything about the murder of United Healthcare CEO Brian Thompson, it’s that it is dangerous to be in liberal controlled areas, even more so if you don’t practice OPSEC. For that reason, I try to edit out any identifying information or anything that telegraphs my future movements. By the time you read this, I will be home, so security is not an issue for this post.

I have been in Boston at a conference for the past few days. The number of people who knew where I was can be counted on my fingers. We stayed at a nice hotel near Boston Common. We sampled plenty of local restaurants: Saltie Girl Seafood, Lucca Italian, Mike’s Pastries, M.J. O’Connor’s Irish Pub, and others. I spent a day riding the hop on/hop off bus to see some sights, and then it was time to come home.

Some of the things I wanted to see were closed because of the government shutdown: I couldn’t get in to the Bunker Hill memorial, the old Boston Naval Yard, the USS Constitution, or the meeting place of the Sons of Liberty because they were all closed. Shame.

Why

A couple of people made comments to my post on earning my MBA. I did it for a number of reasons-

At nearly 60 years old, I go home at night with a sore back, feet, and legs. I was upset about being forced to take unpaid training, and other things. I am a huge proponent of this:

If you are unhappy with your job, you have two choices: you can improve your worth and get a better job, or you can bitch about it and become miserable.

I decided to do something about it, I thought long and hard about what I wanted, and how I needed to get there. I went back to school to get a master’s degree- a business one. Getting an MSN would not change things, but an MBA would qualify me for management or at least an administrative position.

That’s great advice for anyone- if you don’t like your job, what are you doing to better yourself? How are you going to move forward? You can complain, or you can DO something about it. Which plan is more likely to get you what you want?

Change

Exciting news- As of today, I am an MBA-holding graduate. I have completed my MBA. I have requested a meeting with hospital administration concerning my future with the hospital. Ever since I let it be known that I am looking for work and have an MBA, a BSN, and multiple board certifications, recruiters have been blowing up my email with pitches about why I should work for them. I have agreed to six different meetings with the administrators of other hospitals in the coming two weeks.

I am going into that meeting with my hospital’s admin holding all of the cards. I’m going to attempt to leverage this into a major opportunity. Big changes coming.

Quiet

I’ve been quiet for a few days. The old saying that you can’t fill someone else’s cup if your own well is dry has been true for me this week. Let me explain:

As you all know, I work three days a week. Day one, I had four rooms and a parade of really sick patients in them. One of my patients had leukemia and didn’t know. The doctor and I had to tell her. Still other patients had a host of problems- one guy had a 100% blockage in two cardiac arteries, another had lost so many fluids from a week of diarrhea that his blood pressure was only 70/42. A long day.

The second day saw me treat two coworkers: one a doctor who had a seizure at work. The second, a fellow nurse with SVT and a heart rate of over 200.

The third day was by far the worst. We had a critical incident. Let me explain. EMS brought in a woman who was in cardiac arrest. She was also 38 weeks pregnant, and had been down for about 40 minutes when she came in. I was the team leader.

When you work a cardiac arrest in the emergency department, what we call a “Code,” there are numerous jobs.

  • There is the recorder, whose job it is to write down every single lifesaving act we take, drugs given, etc. That person also is the time keeper. Things like “Two minutes to the next pulse check, three minutes to the next dose of epi,” things like that. This is always an RN.
  • There is at least two compressors. Their job is to perform chest compressions, and there are two so they can switch places when they get tired. Literally anyone who works in the ED can do this job.
  • A Respiratory therapist, who is in charge of ventilating the patient and maintaining the patient’s patent airway.
  • One nurse or paramedic who is in charge of IV access.
  • A doctor, who is in charge of making all decisions.
  • The team leader, who runs the defibrillator and handles all of the drugs. This is always an RN, and usually a well experienced, senior one. They work with the doctor to ensure that the patient gets the proper treatment.

One of the sights that I will never forget is what that lifeless baby looked like when they cut her mother open to rescue her. Another sight that I won’t forget is looking across the patient and seeing the nurse who was the compressor continuing to do her job as tears poured down her face. It was heart wrenching.

In total, we worked on that mother and her baby for over an hour.

We wound up getting mom’s pulse back. We lost the baby. We still had six more hours to go in our shift, and we still had patients to take care of. The most jarring thing about it was that you would walk out of a room where you just spent an hour trying to save a dead baby, only to hear your patient demand a turkey sandwich. Codes involving the death of a child are always hard. In fact, it was one such call years ago that had me seeing a shrink for a couple of years.

Emergency nurses are some of the most jaded people I have ever known. They are used to seeing tragedy on a daily basis. It isn’t unusual for us to work several codes in a shift. What is unusual is to work a code on a child or on a pregnant mother. In fact, we only do that once or twice a year. Add to that, many of our nurses are recent or expecting mothers. Adults dying? That hasn’t bothered me in years, but when a child dies, it’s like a little piece of you dies with them. It’s heart wrenching and it takes weeks to get over it.

For the rest of the day, you would enter a medication room or a storage closet to find a nurse in there crying. Two of the nurses were doing so poorly that they had to be sent home for the day.

Me, I did OK for the remainder of the shift, even though I was on the verge of tears. I held it together and went home. As soon as I saw my wife, that was when it hit me. I sobbed like it was my own child that I had lost, and did so for about 20 minutes. Then I drank some booze and went to bed. I didn’t speak very much to my wife for a couple of days. I didn’t blog, except to post some posts that I had already written and was saving for later. I ate very little.

I feel better now, but you can’t imagine how hard it is to hold a dead baby. I still see that child’s face at night. The only thing that enables me to sleep is the knowledge that we did our job well, and managed to save the mother. I can’t think of a single thing we could have done differently that would have made a difference, and that is what will enable me to go back to work.

Lame

The training was stupid, and the instructor actually admitted that it was designed to absolve the hospital of any liability of a patient were to attack a nurse, because now we can’t sue the hospital for not providing us with training. If a violent event happens, it must be the nurse’s fault for not properly de-escalating the patient’s behavior.

Today’s class was 8 hours long. The first four hours was on how to redirect the patient’s behavior. The training said that all behavior is a form of communication, and the patient is simply trying to tell you that there is some sort of problem that the health care provider needs to address, but doesn’t have the words to be able to express it, so this manifests as “Risk Behavior.” The only proper reply to this “risk behavior” is to safely, and in a non-confrontational way, control and redirect the patient until the patient can realize that what he is doing isn’t productive. It’s called nonviolent crisis intervention, and I think it is bullshit that is designed to cover the employer’s legal ass, and who cares if employees get hurt? Healthcare systems hide behind the workers’ compensation immunity shield, so you can’t sue them if they trained you to avoid violence. They can, however be sued if one of their employees defends themselves from a violent attack using a violent response.

The next hour was all about how employees need to remain detached and not allow the patient that is in crisis to goad or bait you into engaging them.

Then we broke for lunch before returning to learn the practical skills. The first step to each one is to “take a non-threatening stance that is designed to not provoke the patient into engaging in risky behavior.” Then, if the patient tries to hit, grab, bite, or shove you, how to break free and escape to run away and call for help. The key is for the employee to avoid violence.

I was the only male there, so I got to be the one that the instructor kept using for demonstrations. One of the scenarios was how to escape a front chokehold where the patient is facing you and attempts to grab you by the throat. The instructor, was roughly my size, had us watch a 1 minute video on how to escape this and said let me demonstrate, then spun around and grabbed me by the collarbones with both hands. I swear with all of my being that I didn’t do it on purpose. He caught me by surprise because I was zoned out and not really paying attention. What happened was reflex.

I brought both hands up through the middle of his arms, then palmed his face with my left, causing him to lean backwards slightly. Once he was off balance, I stepped into him, put my right leg behind him and shoved. He landed on his ass. The entire class got to hear about how what I did was a violent response, and would get you in a discipline issue of we were ever to do that to a patient.

I don’t give a shit. I will not allow myself to be some crackhead’s punching bag and spend the rest of my life eating through a straw from my wheelchair. A couple of events from Florida this year drive that point home:

A nurse for Palms West Hospital had every bone in her face broken by a patient who attacked her. It was two months before she could walk well enough to go to a rehab center. She is still there, and hasn’t yet returned home, as far as I know. The hospital responded by designating a desk in the ED for the use of a sheriff deputy, to encourage them to hang out there. Also, that makes them a substation, which many hospitals use to declare that they are a police station, so concealed carry is off limits. Most hospitals only use unarmed security, and many times those security guards are unarmed women and old men.

A pair of nurses in Port Charlotte, FL were attacked in March. No one was arrested.

De-escalation

I am having to take de-escalation courses for my employer this week. There is an online component and a classroom component on how to handle patients in a crisis. The online is supposed to take 2 hours and the in-person class is another 8. Sure, I will take 10 hours of overtime. The online class consists of videos that constantly ask for interaction, so you can’t just hit play and walk away. Things like

  • “Click next to continue”
  • Click on each image to read more. You have to click on all of them, or the class won’t go on.
  • and quiz questions on the material to test if you are listening. If you get any of them wrong, you have to start that section over.
  • If the video isn’t the only window open, it stops playing.

So I am sitting here having to let the video play on a laptop while I type this on my desktop.

The way online training works is they tell you how long it should take. In this case, 2 hours. That’s all they will pay you for. I have stopped doing the training, since they aren’t paying me for it. I got talked to last week for that. It seems that they are not happy that I am not completing the required training. I told them that I only do the training that I am paid for.

Back to today: I have been watching this video for an hour and 15 minutes. I haven’t failed one of the 4 built in quizzes that I have taken so far, so I haven’t had to repeat any sections. According to the progress bar, I am only 19% complete. At this rate, it will take me 6 and a half hours to finish. Remember, they will only pay me for 2. For that reason, I am stopping at 2 hours.

I dare them to try to tell me that I need to do more.

I know that many of you are saying that I should just get a different job. The issue is that this is how every health care job that I have ever had is. They demand as much as they can get away with, which is why, in my opinion, there is a shortage of nurses. So I just set clear limits and refuse to do work unless I am paid to do it. I also make sure that I put it off so I can do as much training in a single week as I can get away with, as well as doing it on a weekend. That way as much of it as possible is at time and half and with a weekend differential. If you are going to make me do it, I am going to maximize my pay for doing it.

I Miss

As I write this, I am enjoying the first really cool day that we have had in Central Florida in quite a few months. The windows are open, there is a nice breeze, and a misty sort of rain is falling from a cloudy sky. The temperature is 69 degrees outside, and it’s official: Florida Fall is here. This is the time of year when I put on Youtube videos like this.

A nice, calming sound to play in the background as I do whatever around the house. My memories drift back to when I was a child, the weather the same as it is today, and I watched my mother hang fall decorations like these.

It makes me a bit nostalgic. Now my mother is gone. My father is gone. My innocence is gone, as is my childhood. So is the country that I grew up in.

I miss all of those things. It seems that all is left is an aging guy who is about to become an old man, and a country that seems to be disintegrating. We aren’t coming back from this, are we?

News from the ED

During the past week or two, I had a few notable incidents:

Of the more than 100 nurses who work in my hospital’s Emergency Department, only 9 of them are board certified in Emergency Medicine. Only three of us are board certified in a second specialty. For that reason, I now spend most of my days in the critical care zone.

For starters, this being the tail end of summer/start of fall, there are almost zero cases of Flu/COVID/RSV coming into the ED, but there are quite a few cases of pneumonia and sepsis, mostly in our older population. Of our patients, I would say that the biggest reasons for visits are people who are sick because they are old, abusing intoxicants, homeless, having a mental health crisis, or a combination of those.

One of my patients had come in having some mild stroke symptoms. He had my undivided attention for the first 30 minutes he was there. It turned out, no stroke. It was a complicated migraine. So while we were waiting for further testing and for the migraine cocktail to kick in, we suddenly were inundated with some very sick patients. Four cardiac arrests, and 3 other patients who required intubation in less than a two hour timespan. It happens like that sometimes- things are calm, then it is like a bus full of sick people pulls up. As the only nurse in the critical care zone who is certified to insert IV lines by ultrasound that day, I was busy for that two hours. One case in particular, I had to start an ultrasound line, then stick around to give Etomidate and Succinylcholine for the rapid sequence intubation. After that, I was in a cardiac arrest for another 30 minutes.

In the middle of all of this, the patient with the migraine had pushed his nurse call button. When I was finally able to get to him, he was indignant: “I pushed this button 20 minutes ago. This is ridiculous.”

Me: “I’m sorry for the delay, sir. I was busy with some very sick people. I’m sure that you understand, it’s just how things work in the Emergency room sometimes.”

Him: “Where were you? Are you really that incompetent?”

Me: “Sir, I am sure you heard the announcements. I was literally doing CPR on someone for the past half an hour.”

Him: “I don’t care about that, I called for you and you should come. I am never coming to this shitty hospital again. I want to see your boss, you should be fired.”

My charge nurse enters the room, and the man goes on a rant. The charge tells him what happened, and he still keeps complaining.

All of that. Do you know what he wanted? Some water and a warm blanket.

Working in emergency medicine has convinced me that far too many people have Main character syndrome.

Later, I had another 34 year old patient come in complaining of a severe headache and nausea. He reeked of weed. When I asked him about that, he said “Oh, I have a weed card. It’s medicinal.” He then told me that he smokes 6 or 7 joints a day. We tested him fully, finding nothing. Did I mention that he was covered in tattoos, had green hair, a septum ring, and two lip piercings? He was telling me how he is too poor to afford a ride home, and wanted the hospital to make arrangements to get him home. Uh, you can afford all of that ink, those piercings, and weed, but you can’t afford an Uber? Medical marijuana is bullshit 99% of the time, by the way. It isn’t for medical reasons, they just want to get high. If it were medicinal, wouldn’t there be a prescribed dose and schedule, like with every other medication? What other medication says “take however much you want, as often as you want?”

Anyhow, I now have a few days off.

Damned Squirrels

We were hearing scampering feed over our heads, then the drains and toilets started gurgling when someone was in the shower. I didn’t make the connection until we saw a dead squirrel hanging out of the soffit, with his head stuck.

The pest control guy I called found 12 places where our builder didn’t seal the attic properly against squirrels. He said that most builders don’t, because the code doesn’t require it. The repairs to seal the attic and replace the damage they did is $3 grand. The guy said we are getting off cheap because we caught the infestation early.

That doesn’t feel cheap, but I guess it could have been much worse. Little bastards.