Me

We had our monthly department meeting this morning. There’s nothing like going in to work on your day off so you can be told a bunch of corporate rah-rah garbage that easily could have been an email. One of the things that they did was hired a bunch of nurses, techs, and a couple of doctors. One of the nurses that they hired is from the mid-east. As in, the UAE. She has never been a nurse in the US before, and her US license is brand new. Her English is pretty good.

That’s what confused me. So I told you last month that I ran into the HR director at a job fair, and they tried to recruit me because they didn’t even recognize me. Then, once I told them what I was being offered by other hospitals, told me that they couldn’t come close to matching it. The UAE nurse? They are paying her $1.00 per hour more than I was asking for. I don’t think it was personal, because the HR director didn’t even know my name when she told me that there was no way I could get that much.

I don’t understand why they would rather bring in people from other countries than pay the employees that they already have enough to get them to stay. I guess it doesn’t matter- I am out of there. My last day is less than 6 weeks away, and I haven’t even told them yet. I don’t know if I want to give much notice. That decision is day to day.

I went to a job fair yesterday. Who do I see there, other than the HR director from my hospital. Let’s call them Hospital A. She approached me and asked if I have considered a job with her hospital, you know, the one I currently work for. I responded with, “I already do. I have offers from Hospital X. I would love to stay where I am, though. After all, I have been here for two years.”

She asks me how much I am being offered. I tell her, and ask if there is any thought of matching it. She says, “Oooh. There is someone I would like to introduce you to.”

She walks me over to the next table and introduces me to the HR director for Hospital Y. The one I interviewed with last week, who had already offered me a job. As soon as my HR director walked off, hospital Y HR director says, “Let’s at least steal some of the cupcakes that they are giving away.” So we ate some of Hospital A’s cupcakes and had a laugh.

There’s my answer. I now know that I cannot stay where I am. The other hospitals have good pay and benefits. Mine has cupcakes.

I will finish out the May schedule and then take a couple of weeks off before starting my new job at Hospital X. In other news, I am also thinking about starting work on my Masters Degree in the fall.

I spent my latest shift in triage. There are two triage positions in the emergency room- one prioritizes the patients arriving by ambulance. The charge nurse usually does this. The second triage position is where patients who walk in are prioritized and sometimes treated. It was a slow day by ED standards, as we had less than 200 patients for the 12 hour shift.

The interesting patients of the day were a guy who ran his hand into a table saw, removing the tips of two fingers, a woman who came here from Canada seeking treatment that she had been unsuccessfully seeking for over a year in her home country, and a fentanyl overdose who came back to us after only being discharged 90 minutes earlier (that particular patient came to us by ambulance). The nurse who wound up treating him and I agreed that this guy obviously didn’t care about his own health and just wanted to get high, and that society would be improved if hospitals simply stopped handing out Narcan to every junkie on a constant basis. Sorry, but this guy has been in our hospital more than a dozen times in the past month. I can’t see how we benefit as a society by indulging in this behavior.

I had to teach one of our new nurses how to splint. She had to do a sugar tong splint on one of her patients for a wrist fracture, but didn’t know how. I went back and had to show her how to do it. Then a second came and asked me if D5W had sodium in it. (D5W literally means 5% dextrose in water. Why would there be sodium in that?) What are these nurses learning in school?

The worst part of the shift was the screensavers on the computers. They show a nurse I work with getting an award for saving a patient back in December. Good for her, except she got the award for what I did. A patient had come in complaining of passing out several times. No one could find anything wrong with him, even after the man had been in the ED for 2 days so they were about to discharge him. I went into the ECG server and reviewed the last 2 days of his heart activity and found that his heart occasionally went into a third degree AV block. He would then spend the next couple of minutes in a ventricular escape rhythm, and his heart rate would drop into the 20’s. There’s your problem, and I can’t believe cardiology missed it. I printed the ECG strips and gave them to his nurse, who forwarded them to cardiology. The man got a pacemaker and was sent home. The nurse got an award. I didn’t do it for accolades, but it still sucks that someone else got credit for my brilliant detective work.

Everything that follows is a “me, me, me” story, so if you aren’t interested, the post can end here.

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I got another offer for a job this week, this time for $11 an hour more than I make now. Even though the money isn’t as good as the offer I received a month ago, the benefits are much better. Still, I’m not interested, as that particular hospital is about 45 minutes away from where I live and I don’t feel like driving that far. Still, the jobs are there.

Perhaps the attitude about druggies is the reason why, when I had a conversation with my manager about my coming departure, he didn’t seem to care a whole lot. It went like this, “You know that hospitals around here are aggressively recruiting nurses? Did you also know that this hospital is paying more than $10 an hour less than all of the others in the area?”

He says, “Yeah, I’ve heard.”

Me: “To be honest, I have offers from two other hospitals in the area. Both are for significantly more than I make now. I want to stay here, if possible. My evals are good, above average, in fact. You say you want me to stay and value me as an employee, so what kind of a raise are you willing to give me?”

Manager: “I really can’t have this conversation right now. There are a lot of things going on, and it would be better if you came back in two weeks, and we can talk about it then. My plate is just full, and I really do want to help you, but this just isn’t the time.”

Me: “That’s what you said three weeks ago, and a month before that.”

Him: “I know. Sorry, this just isn’t the time.”

It sounds like they really DON’T value me as an employee. I can’t see any manager who cares about retaining employees saying things like that to one who is making noises like they are looking to go. I do know that they have recently (in the past three months) hired half a dozen new nurses, all fresh out of school. They aren’t hurting for nurses as badly as they were a year ago, even though we are still woefully understaffed, it’s my belief that they WANT to be understaffed. It’s cheaper that way, I guess, even if patient care suffers and nursing ratios stay at 8:1 on the floor, with 30 or 40 ED holds.

So I am going to assume that I have just gotten my answer in the form of a “pocket veto.” If they really respected and wanted me to stay, we would have had the conversation about pay and retention by now. I have done everything but put in my notice, and the manager doesn’t seem to care.

So I have decided that my last day will be in 6 weeks. In three weeks, I will put in my notice.

I had some issues with the local services.

Issue 1: So a car hit a telephone pole somewhere in the area, and we lost power for about an hour. That isn’t the bad part. The bad part is that the electrical surge that came along with it fried some electronics in the house. I wonder what a whole house surge protector costs. It seems like we are constantly losing electronics here because of power surges, although they are usually lightning related. It’s pretty much an annual event.

Issue #2: In preparing to move, we were getting rid of some bulk items. We called to have the garbage people come get them, then put them out on the curb for pickup day. No one showed, they remain out there. So we call the garbage folks on our bill, and they can find no record of our house. I ask “Well, if I stop paying my bill, who will call me?” They say, “You must be covered by our contractor” and transfer the call. Company two says, nope. We have no record of your house having an account. Call company number three. So we do. Company three says that they aren’t servicing our neighborhood. So back to the number on our bill. They say that company two is definitely the one, and transfer us to Company 2’s manager. Voice mail, leave a message. Total time on phone: 75 minutes.

You guessed it. No call back. So we call again the next day and play phone tag for another hour, getting nowhere. I snap a picture of the garbage truck while it was picking up our garbage, and it has the name of Company 2 on the side in foot tall letters. So we call them.

Company 2 drone: “Sure, I can place an order to get your bulk items. What is your address and the name of your neighborhood?” We give them, and she says: “That neighborhood isn’t in our reporting system. Do you have the correct name?”

We reply, “That is the only name. We have lived here for 15 years, and we are sure that’s the name.”

Drone: “Well, that one isn’t in the system, and I can’t put in the work order without one. The computer has a drop down menu with neighborhood names, and unless we put it in, it won’t let us go any farther.”

Can we speak to a manager?

Drone: “I can transfer you to their voicemail, and they will call you.”

I can’t drive it to the dump myself, because the closest dump is in a different county and won’t accept out of county drop offs. I think what I am going to do is load the items up over the weekend, and dump them in front of the garbage people’s business office and let them figure out what to do with it.

Issue #3: My storage locker had been costing me $68 a month. A new company bought out the Mom and Pop that was running it, consolidated it with three other facilities, and then doubled rates. That was back in November. When February came, they raised them again. Now it’s nearly $200 a month for storage. So I spent three days emptying that 10×10 storage unit into my garage. Now I can’t park in it, and I lost my little workshop I had set up in there. That’s OK, since we are moving in less than a year, and we are getting a larger garage in the new place. I will probably build a storage barn in the back of the new place. I can get a 10×16 that looks like the one below for about $4,900, delivered.

When I went in to tell them that I had moved out, I noticed that the security cameras were no longer hooked up, and I had noticed that the electric gate securing the property has been disconnected. So this place was bought out by a large company, the on site managers are gone, the security gate is gone, and the security cameras no longer work. And rates are now 285% higher than they were just four months ago. What the hell are those higher rates paying for? Don’t know, don’t care. I vacated the place.

Shooting at the range with one of my 80% homemade ARs. This one is a gorgeous rifle. Anyhow, this rando comes over and asks to see it. Not unusual, so I show it off. Then he asks me to sell it to him.

Uh, it’s a homemade rifle with no serial number. Not for sale.

He keeps trying to pressure me. I finally had to get firm with him.

My paranoid side says “Fed” or possibly “informant.”

As I said last month, we are searching for a new location to be closer to my wife’s job. I am also tired of things where I work:

• I was suspended without pay for a week because of a pending investigation when a delusional patient accused me of trying to kill him.
• An incident just after New Year’s day where a patient threatened violence.
• Three different incidents in January where patients either attacked or threatened to attack me.
• My hospital claims to want 4 to 1 nurse to patient ratios* in the ED. That is rare. Now it’s usually 6 to 1. On one recent shift, I had 5 patients, but 2 of them were on ventilators. One of the other three was a sepsis patient who went into cardiac arrest just after EMS brought him in. The work load there is just too high.

So I also want to change jobs. Career specialists say that you should change every 2 to 3 years, so I think now is a good time to do so. I think we are close to answers on both.

We found a builder that will build us a 5 bedroom, 4 bath, 2900 square foot house for less than $190 a square foot. The place is gorgeous. Here are a couple of pictures from the model:

Construction should take a bit. In the meantime, my wife’s job is moving in the fall, so if the house isn’t done by then, she will have a 45 minute commute. We are negotiating terms now.

On the job front, I just negotiated with a potential new employer. I spoke with people I know who work there, and they say it’s a good place. It looks good:

• Patient to nurse ratios in the ED of 3:1, with occasional jumps to 4:1. I confirmed with friends that they aren’t blowing smoke with this claim.
• Better neighborhood, so less of the violent psych and druggie patients.
• A $12 per hour raise over what I am making now
• Getting a $10,000 recruitment bonus for a 2 year contract doesn’t hurt (payable in 4 semi annual installments)

The downsides are twofold:

• Because this hospital is properly staffed, there are no shift bonuses for pulling extra shifts. Of course, my hospital stopped paying them in September, so no real loss.
• I can’t be PRN at the new place. I have to work full time for the time being. That’s OK, this will enable us to pay for this new house in 8 years and still keep the one we live in now as a rental.

The new hospital has sent the offer, and I have conditionally accepted for an August start date. (when the wife’s new job location starts) I should get the actual contract to look over some time in the next week. If it looks good, I will sign on. Hey, closer to the new place, less workload, and more money.

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Explanation of the importance of patient/nurse ratios:

For those who don’t know, each patient needs to be assessed at intervals, plus needs medications, tests, and other related things coordinated. For “routine” patients on a medical floor, a nurse can handle as many as 6 or 7 patients at a time. The more things that are wrong with the patient, the more time it takes to care for them, so task loading becomes an issue- a nurse can only do so much without increasing the risk that they will miss something important, or make a mistake because they are pressed for time and rushing high risk tasks like selecting and dosing medications. For this reason, the sicker the patients, the fewer that a single nurse can effectively handle.

Some patients are so sick that they take up all of your time. A patient on a ventilator is one of those. In general, having two patients on a ventilator is all a nurse can handle, because those patients are also usually receiving a list of medications that are high risk, and this combination means spending a lot of time with that patient. This is why the more acute the unit, the lower the ratios need to be. In the ED, patients in general shouldn’t be more than 4:1 to the nurses, unless you want to compromise patient safety by not monitoring the patients closely enough. For that reason, the ICU is usually 2:1, the “step down” unit is normally 3 or 4 to 1, and so on.

This is why the ED usually has a unit called “fast track” where patients are less sick with things like toothaches or broken fingers. In fast track, you will see ratios of 6:1 because the patients require far less of the nurse’s time. Fast track is usually a separate subunit within the ED, usually staffed with a nurse or two and a midlevel practitioner (a PA or a nurse practitioner), and the goal there is to clear out as many low acuity patients in as short a time as possible, thus leaving the sicker patients (who take up more time and resources) for the doctors and the nurses with lower ratios.

My wife’s job is moving. She will be working about 30 minutes farther away from the house than she is now. She wants to move closer to her new work location. I have been working on changing hospitals. If I want to do that, it would be easier if we move. If we move about 30 minutes south of where we are now, it would put us closer to my wife’s work and would make it easier for me to find a new hospital.

So we have been looking at houses. We had a few must haves, and some wants.

• We want a one story house.
• We need at least three bedrooms and three baths. This is so we have room to care for an aging parent if it comes to that, plus room for a guest.
• I would like natural gas service
• We would like a pool.
• We need more storage space. Either a bonus room, a large garage, or room to build a storage structure on the property.

So we began looking.

The first community we looked at wanted $400k for a 2000 square foot house. Hidden costs included a $45,000 bond. A bond is an invention here in Florida that requires each owner of a residential property to pay for roads, fire stations, and other infrastructure costs that are not part of the property. In other words, it is a cost of building a neighborhood that is passed on from the builder to the buyers of the homes. This raised the cost of the house to $455k, or about $225 a square foot.

The second and third builders did not have houses and floor plans that we liked. We went to a late lunch out in the country. While we were there, I happened to see a nearby community that looked interesting, so we headed out there. They had 2950 square foot home plan that they think we can get built with custom options for $525k, and no bond. That brings the cost to $178 a square foot. Admittedly, it’s at the upper limit of what we wanted to spend, but it’s a really nice house with a large kitchen. The best part is that it is within a 30 minute drive of 5 different hospitals, which gives me a lot of flexibility in changing hospitals. It’s one of those small Florida towns that only have a population of about 2,000 people, but still have stuff nearby.

The only real catch is the current lead time for construction is 12 months, meaning that we will be in late 2023 or early 2024 before we can move. We are looking at all of the numbers and facts, but we will likely be paying earnest money within a week or two. That means when the school year starts next fall, my wife will have to commute a bit. It also means that I can start looking for new work, expecting to start somewhere in July or August. There is a hospital that is only 15 minutes from the house we are looking at that is a good place to work and is offering a $10,000 bonus to work there. By all reports, the pay is good and I hear lots of good things about them. There are other hospitals that offer larger bonuses, but there is a reason for that.

So change is coming. It will be easier working where I am, knowing that my days there are numbered.