Coming to Work Sick: The CYA Culture

I see it everyday in the hospital—staff coming to work with cooties because to not come may be career-suicide.  

There are let’s just say…unwritten policies (and punishments)…when it comes to calling out sick—especially in the hospital environment.

First, now you’re on your managers’/charge nurses’ radar (and not in a good way) because it’s an inconveniece—depending on how much notice you’ve given them they now have to scramble to find someone to fill your slot. Then there’s the fear of being given a write-up for an unexcused or unscheduled absence—which could come back to bite you in the arse during your performance reviews. And now that you’re on management’s proverbial sh*t list you now run of the risk being snubbed, given “harder” assignments or a heavier load than others (and being left to flounder), or other forms of horizontal hostility—even possibly being passed over for promotions and perks.  

So now staff just come to work sick. If you’re sick enough according to managements’ standards (which may mean damn near dying) then they’ll have to send you home. And if management sends you home, you’ll avoid a write-up, be seen as a devoted staff member willing to “take one for the team” coming to work come hell or highwater—plus you’ll still get paid for the day/night. So staff now cover their @sses by putting the ball in managements’ court.

But at what cost? Not only are you not at your best (which can be a recipe for disaster in patient care), but it creates the potential for others to get whatever the hell cootie it is that YOU have! And oftentimes, for whatever reason (*hint, hint* staffing), management may not send you home! They may decide (with the plethora of licensed bodies in a hospital qualified to assess you) that you do in fact “look okay” to stay and work. Big. Fat. Fail. Now what?

This call-out taboo is even brainwashed into nursing students. To call out from clinical is to shoot yourself financially in the foot—students are sometimes threatened with having to personally pay the clinical instructor ($50/hr I have heard quoted) to come in on a non-scheduled clinical day to oversee your make up. As if. Or sometimes they’ll give you an ungodly amount of ridiculous busy work to do to make up the hours. And so students just come to clinical sick hoping they can just make it through the eight- (sometimes twelve-) hour shift. We are breeding the next generation of nurses with cover-your-ass-itis.

I was sick a few months ago. And I don’t get sick often, but I really felt like death warmed over. I went to my primary, who gave me a note stating that I needed to stay home (his exact words were “you shouldn’t be in anyone’s ICU like this”). I called the big cheese to let him know (and way before the two hours notice we’re required to give when we call out—I wanted to give him as much notice as possible to find someone else to come in).  I was told that even though I had a doctor’s note it would still be “an incident.” I stayed home anyway.

Would you???

For more insight on the subject, check out Terri Polick’s post, Presenteeism: Why Nurses Don’t Call Out Sick and @TorontoEmerg‘s How Hospitals Punish Nurses for Being Sick.

Insights in Nursing Podcast, Episode 14

Yet again we have more doctors voicing their “concerns” about the apparently very intimidating “Doctor Nurses” (*enter scary music*). Le sigh. I plan to eventually pursue my DNP. Do I plan to have my patients address me as “Dr. IsntSheLovlei?”—absolutely not. I am however, likely to display my shiny new credentials on my letterhead, my lab coat that I’ll sling over the back of my chair (as if I would ever really wear one of those things), or perhaps even on a paperweight on my desk.

I honestly think some our doctor-friends are hiding behind this whole “you’re going to confuse the patients” excuse as to why they are so against nurses with doctorates. What is the problem really? Afraid of a little friendly competition? Think an increasing number of patients will be drawn (if they are not already) to the more holistic model of care that nurses provide? But it’s not like we’ll be taking food out of your mouths—there’s actually a shortage of primary care physicians. Advanced practice nurses are willing and more than capable of helping to fill that void. As far as confusing the patients—I think that patients are less concerned with the alphabet soup behind your name and more so with the excellent (or not so excellent) care that you provide. JMHO.

Check out our discussion of this topic and more on the latest episode of Insights in Nursing with Cora Vizcarra from the Infusion Nurse Blog, host Jamie Davis also of the Nursing Show and MedicCast, and of course—yours truly.

Insights in Nursing Podcast, Episode 13

Has the whole autism-vaccine controversy finally been put to rest? With the internet and so much bad information (and bad publicity by pearly-teethed former Playboy playmates) so readily accessible to people nowadays, will fears now begin to subside? 

Colorado, will now not only be known for its rocky mountains, but for their rocky viewpoint as well (though I guess everyone’s entitled to their opinions…). Apparently, a group of anesthesiologists in Colorado have their panties all in a twist at the thought of nurses, not doctors, making “life-and-death medical decisions” for patients (the gall!!).  I’m not even a nurse yet, and I was personally offended. Can’t we all just get along?… Le sigh. 

And last, an Australian nursing school unveiled an awesome “Women Who Shaped Nursing” display for History Week. Truly a beautiful thing. I’m all about honoring those that paved the way. But what about our male nurses? What about the men who helped pave the way for the military to allow male nurses in the service?  James Derham, who worked as a nurse to buy his freedom? Most people don’t even know that Walt Whitman was a nurse—only that he was a writer and poet. There are many men in the history of nursing—but few people know anything about them because we only talk about the women in nursing. Check out our discussion of these topics and more on the latest episode of Insights in Nursing with Kim from the Emergiblog, host and jack of all trades Jamie Davis, and a scratchy-throat-catching-a-cold yours truly.

Insights in Nursing Podcast, Episode 11

Can you believe that a patient who’d just had a C-section two days prior was actually asked to “tidy up” her hospital room before she was discharged? One of the midwifes (allegedly) described the task as “those bits that we don’t have time for.” Wow. Just wow. Maybe that equal access, government-funded health care isn’t all it’s cracked up to be… And what about nurses with doctorates??—Are they doctors? Are they nurses? What do we call them? Paging Dr. Nurse? Check out these topics and more on the latest episode of Insights in Nursing with Kim from the Emergiblog, Terri over at Nurse Ratched’s Place, host and jack of all trades Jamie Davis, and yours truly.

My First Podcast!!

Check me out on Insights in Nursing hosted by Jamie Davis as we discuss nursing school, the nursing shortage *enter scary music*, and the job outlook for soon-to-be grad nurses.

And back to the books it is for me…finals and a HESI next week and then I can officially call myself a SENIOR nursing student!! The countdown to the end of nursing school is on—503 days, 16 hours, 23 minutes, and 10, 9, 8, 7…

I Just Didn’t…

Clinical this past Sunday was a little more interesting than last week—but not much. I did a newborn assessment, and charted a little in the paper and computer charts. Oh, and I got to help make a couple of beds—exciting stuff for a student nurse thirsty for hands-on patient care right? I did not get to do a postpartum assessment on mom (her regular nurse completed it when I whisked the baby off to the nursery). I did not get to see a birth (vaginal nor c-section). I did not get to pass meds. I did not pass go and I did not collect $200.

It was a little strange at first handling “normal” newborns. I’m used to my NICU babies who have various catheters and such attached to them; these babies were so….free—bundled up like little burritos. Mom was still kind of out of it and preferred that I fed her daughter so I did. It just felt weird being able to scoop up the little peanut from her bassinet and stroll over to the rocking chair with no IV poles or monitors to navigate around. Sitting there with that 7lb bundle of joy made me think back to when my own children were that small (and before they learned to say words such as “no” and “mine”). My lecture instructor said in class that someone always gets pregnant during this rotation—uh, no thanks, I’m retired from that line of work. I already have three strikes, so I’m out of that game.

Sadly, most of the nurses weren’t any better (read: nicer) than the ones we had last semester. I thought (or hoped) that since these nurses cared for hormonal women and babies their demeanor would be a little more accommodating—guess not. No one was outright hostile like my dear Nurse Nasty from last semester, but they did tend to make you feel like some colossal inconvenience. I still don’t quite get that whole “nurses eat their young” thing…

No clinical next weekend since it falls on Easter. Good thing too since I could really use a solid weekend to catch up on some much-needed reading.

Spring Break!!

Health Assessment is over. Finished. Finito. We took our final exam last night and now have to wait 48 long hours for our grades (probably even longer for our final course grades). I actually didn’t think the test was that bad. And since I made benchmark on the HESI I already have an extra 10-point cushion. There were a lot of questions that looked let’s just say “familiar” and I found myself thinking “ooh! I know that!” throughout most of the exam. There were 70 questions total and I was done in about 35 minutes. My professor hesitantly took my scantron—“Are you sure???” I just smiled and shrugged. You know my motto—“Either you know it or you don’t.” I have never been one to sit and stare at test questions as if the answers are going to magically pop out all of a sudden. I have also made it my policy to never change my answers on exams. Most of the time when people change their answers they had it right the first time.

My interview for the nurse extern program was today—I think it went pretty well. It was initially a group info session and then we broke out to tour and interview with the managers of our preferred units. They received almost 600 applications for the program and can only take 32-34 externs so my fingers are crossed—matter of fact while we’re at it, cross yours too! My only concern is the scheduling of it all. They would like for you to work as an extern fulltime—which of course I can’t do or I’ll lose my benefits. So I would have to work my extern schedule around dropping down to a 0.5 FTE at my “real job” (*smirk*), plus my lectures and clinicals since my nursing program runs all year round. Not an easy task, but it can be done!

And so spring break it is—sadly there will not be any sandy beaches in my forecast. I will say it is starting to warm up a little since that record-breaking snow we got but it’s still probably only about 45 degrees on a good day. But at least I’ll get to go to sleep at a normal hour for a few days…

Buh-bye Health Assessment

Health Assessment is just about coming to a close—thank goodness. For a minute there I thought I wasn’t going to make it–my hair even started falling out again. But I’m still here, balding and all lol. We had our clinical final exam/check-offs this past Saturday. You have to do an assessment of one major system (Neurological, Thorax & Lungs, or Abdominal) and two minor systems (CN 1-6, CN 7-12, Cardiac & Peripheral Vascular, or Head/Neck/Face/Ears)—which you basically pick out of a hat. Since you don’t know which ones you’re going to get until that morning you have to know ALL of them perfectly—or at least sufficiently well as clinical is pass/fail. With so many minor details within each system I must have studied for it for a week straight—I even slept with my notes the night before. Instead of visions of sugar-plums dancing in my head I was having nightmares about cranial nerves, diaphragmatic expansion, and liver spans. But it actually turned out ok. My major system was abdominal—which of course was one of my least favorites. I’m just not comfortable with the percussion aspect of it. Liver spans, splenic dullness, tympany over the gastric bubble—most of the time it all sounds like the same ol’ shit to me. And how many nurses really percuss in their daily practice? I am almost 29-years-old and I don’t remember ever being percussed. For my minor systems I had Head/Face/Neck/Ears (and I remembered to hold the otoscope upside down!) and Cranial Nerves 7-12—piece of cake.

We still have to take the HESI tomorrow night and our final exam on Thursday. If we make benchmark on the HESI (we’ll see how that goes), we get 10 points added to our final exam grade. Now I wouldn’t mind that at all…

Up next, Maternity/OB. But first, spring break here I come! Of course it won’t be a full week of pure unproductive bliss since we’re expected to have read the first five chapters in our maternity textbook for the first day of class—oy!

In other exciting news, I have an interview scheduled for the 2010 Nurse Extern Program at the #1 pediatric hospital in the nation! Go me! And from what I’ve heard, due to the economy they’ve had to cut the number of spots in the program in half, so I would just about pee myself if I actually get a spot. It is such a great opportunity—clinicals are such a tease to me at this point! If I’m selected I’ll get to do more hands-on direct care, and in peds at that! For those of you looking for a similar opportunity check out the 2010 U.S. Summer Externship and Opportunity Resource Guide. UPenn puts this out every year; it was recently updated so it should be pretty accurate. Good luck!

Slow and Steady Wins The Race!

So it’s a wrap! At times I wasn’t sure that I would be able to do it (or that I even wanted to anymore), but I made it through my first semester of nursing school! I also got my first B in about eight years—damn philosophy/ethics! It was a high B at that—like an 88.5—so close and yet not close enough. But I’m actually okay with it. My primary focus was on nursing and I did extremely well. Finals were not as bad as I expected them to be; neither was the dreaded HESI. For anyone planning/needing to take it, what I found to be really helpful were the case studies and practice quizzes/tests on Evolve. I also liked that they gave you the rationales for the correct and incorrect answers—it really helps you learn to critically think through the scenarios. I’m not saying the HESI was a breeze because it wasn’t, but it was manageable. Some of my classmates may not agree with me seeing as though the class average on the exam was a 613. But I got a 1033—not too shabby. So I’m feeling pretty good—and it was comforting to know that all of the stress, the meltdowns, and the hair loss were actually turning out to be worth it.

But now when I get home from work I find myself totally stupefied. No chapters to read, no care plans or concept maps to develop, no exams to study for—what in the world am I supposed to do with myself for an entire month? And has cable always been this crappy?—there isn’t anything good to watch that I haven’t seen enough times to be able to recite the script on my own. I will get to spend more quality time with my family though. It gets so hectic during the semester that sometimes I feel like I’m just a family member visiting from out of town. Even my son has said a couple times—“it seems like I haven’t seen you for three days!” Between getting up at the butt crack of dawn to go to work, not getting home from class until after they’re asleep, and then tiptoeing out to clinical like a thief in the night on the weekends—sadly, sometimes that’s almost true. In order to pull this off everyone is making a few sacrifices—not just me.

During the break I’ll also have a little time to work on a few scholarship applications (times is hard, lol)—I know for one the deadline for the FNSNA scholarship is coming up in mid-January. Join me for a little friendly competition?  

But before I know it I’ll be bored out of my mind and ready to go back to school (and back to bedlam). Spring semester I’ll be taking Health Assessment and Maternity—maybe I’ll get to catch a baby or something 🙂

Happy Holidays and New Year to all—I’ll see you in 2010!

Not Just a Pretty Face: The Ugly Side of Nursing School

Clinicals are officially over the semester—praise Flo (Florence Nightingale, that is)! I can retire that mix-matched blue thing of a uniform until late January—shoes too. Of course the last day dragged like hell, and as my luck would have it, I was assigned to one of Nurse Nasty’s patients. She was just as evil as before, except she wasn’t wearing her red scrubs today—still had her horns though. I started to object, but figured that we were only doing a half day and I could put up with her for that long. So I took a deep breath, went into the room where they were giving report and said good morning Nurse Nasty, I’m assigned to your patient, Ms. X today. “WHO?!?” she asks, looking at me as if I had a third eye. Silly me, I must have forgotten that she only recognizes her patients by room number. “Your patient in room 123,” I corrected myself. “Oh.” She then turns her back to me and proceeded to ignore me. I just went about my business; I didn’t have time for her crap. I wasn’t assigned to give meds that day and my patient was on dialysis for four out of the five hours I was there so I basically stayed in the patient’s room trying to keep her comfortable and learning a few things about dialysis from the tech that was running her treatment (in between the tech clipping her coupons of course).

In other news, one of my fellow students made a comment labeling me as “anal.” WTF was that about? I laughed it off at the time, but obviously, days later, I was still bothered by it otherwise I would not be tainting my blog with it. Wikipedia defines anal (retentive) as “a person with such attention to detail that the obsession becomes an annoyance to others…” Nice right? However, in the world of academia, we know that professors hate Wikipedia so I’ll try another source to see if it gets any better. Dictionary.com, defines anal-retentive as “indicating personality traits, such as meticulousness, avarice, and obstinacy, originating in habits, attitudes, or values associated with infantile pleasure in retention of feces.” Wow, all that? Well I’m glad she let me know what she really thinks of me. Thank you Mrs. Freud.  

I’m sure she’s not the only one who feels that way. But what’s interesting is that other students don’t really seem to mind my anal-ness when they’re emailing me with questions about upcoming exams, quizzes, and papers—“I need to talk to you ASAP…call me.” And I wonder if I was being anal when I was out with my family and a student in my clinical group called, completely out of care plans (and we had two due the next morning), and I stopped at her house on my way home to bring her some more? Was that anal too? Though I’m sure only the most anal of nursing students ride around with extra care plans in their trunk… 🙂

I will admit to having a reputation for being a bit “extra” at times. I color-code my note cards and invested in Unbound Medicine’s Nursing Central (HIGHLY recommend!) for my iPhone 3G, though not required, so that I would have a good drug guide (among other resources) at my fingertips while at clinical—meanwhile they’re all scrambling for the one ancient drug book on the unit. I have a coworker who calls me “The Professor” and another student that has nicknamed me “Supa Dupa Student Nurse”—but I know it’s all in fun. Calling me anal though, I interpret a little differently. Over the years I have really gotten sick of taking other people’s shit for doing well and getting good grades. Contrary to popular belief, I bust my ass just like everyone else—I don’t just wake up in the morning with a 4.0 on my transcript. I have everything in the world counting against me and I’m still here, doing the damn thing. There’s nothing wrong with striving to be the best. Who wants a half-ass nurse anyway?

However, I did succumb to my Piscean sensitivity and emotionality and unfriended this person on Facebook. I didn’t do it in an elementary “you’re not my friend anymore!” type of way—because hey, we’re not kids in the sandbox. But my friends on Facebook are my “real” friends and family (on Myspace however, I only know about 2% of my 1400 friends—they’re mostly mob/mafia members for my apps!). I am sharing my real life and my journey through my updates on FB (and Twitter) and I don’t need negative energy or potential trolls in my circle. So I’m sorry if my “attention to detail” annoys you—but as I always like to say “I am who I am—your approval is neither desired nor required.”

UPDATE: My fellow nursing student and I have talked and worked things out. Gotta love the high-intensity stressed-out environment of nursing school where miscommunication runs rampant.