"Hey, Flo! You're getting a new admit in 206-1," says Mel, the charge nurse. "ETOH, admitted for detox, alert and oriented times 1-2. He's got an IV but ER says it won't last long the way he's picking at it. He's coming up in five minutes---they've gotta get him outta there 'cause he's stinkin' up the place."
Flo, of course, has her hands full with six patients---three of whom are total care, two of whom are high-maintenance types who can't reach the water pitcher without an RN's help, and the other is merely a little needy. She explains this to Mel, who asks her friend Alice (with only five patients) to take the admit, while she runs off down the hall to see what 204-2 wants.....again.
"What'll you have, Mrs. A?" she asks in as cheerful a tone as she can manage. "It's about time for some pain meds, isn't it?"
"You're an hour late," growls the patient, a lady of indeterminate middle age with a bad dye job and an even worse attitude. "I want Dilaudid, right now!"
Flo scans the eMAR, finds only orders for Tylenol, ibuprofen, and Norco, and informs Mrs. A. "I'm sorry, ma'am, I can only give you one of those three. Which one would you like?"
"I said I want Dilaudid," insists Mrs. A, becoming somewhat agitated. "Now go get it, or I'll call someone who will!"
"Sorry, I don't have any to give you," Flo replies. "If you want Dilaudid, we have to ask the doctor for it. In the meantime, would you like Tylenol, ibuprofen, or Norco?" In a snit, Mrs. A refuses all three and tells Flo to get out of her room. Flo heads down the hall to her next patient, a COPD frequent flyer who is at least as endearing as he is annoying. "Hi there, Pete," she says cheerfully. "How are you doing today?"
He proceeds to give her a lengthy---and exquisitely detailed---description of the quality and character of his most recent sputum as she assesses him with a practiced eye. She's dealt with fellows like him all her working life, and she's as familiar with what really ails him as he is: it's loneliness. Right now, however, he needs nothing more than a cup of hot coffee and a breathing treatment, which she provides with a smile and a few kind words before she has to be on her way to her next "customer".
Before Flo knows it, it's time for her lunch break, and she asks Mel to cover her hall while she's in the lounge. It's crazy out there, as it is on every day shift, but the teamwork is good and she never has to worry about whether her patients are being taken care of. Unlike her previous hospital, the charge nurses here don't take patients, allowing them to cover for breaks and lunches as well as emergencies; this ensures that the nurses actually get time to eat (and even PEE---what a concept).
By the time she gets back, Mel has medicated everyone and even handled the brittle diabetic in 202 who'd cursed at her and the CNA earlier that morning about the "lousy service". As a matter of fact, he kicked the matter upstairs to Charlie, the department manager, who had promptly informed the patient that his behavior was unacceptable and he would be discharged if it continued.
"Charlie just handed him the AMA papers and showed him where to sign," says Mel, grinning. "He told the guy that this is a HOSPITAL, not a Shilo Inn, and said he was free to check into St. Elsewhere across town if he wants better 'service'. Charlie's got our backs---nobody gets to treat us like that and get away with it!"
Back on the floor, Flo and the aide turn and change two of their three total cares before Mrs. A's light comes on. This time, she tells Flo that she herself spoke to the doctor, and he'd ordered Dilaudid. Flo searches the computer records for the order, and of course, finds none. It's time for a little reality check.....but instead of taking it all on herself and risking a big ugly confrontation, Flo pages Dr. Awesomesauce to the floor.
He has to come from the ICU, but eventually he does get there and Flo can't resist the temptation to listen to the conversation from behind the door. Sure enough, he orders the Dilaudid, but not before he discontinues the Norco AND gives Mrs. A a little speech on how medication orders are carried out. "The nurses are the ones with the keys to the med dispenser," he reminds her, "and they check every order to make sure that it's right before they give a medication. It's in your best interests NOT to lie to them, or make them wish they didn't have to come in here."
(Remember, this is a fantasy!)
Eventually, the shift ends and Flo gives report to the oncoming nurse, a part-timer substituting for the regular night nurse who's ill with bronchitis and not allowed to come to work. (Administration doesn't like the bad PR that results when the staff make the "customers" sicker than they were when they came in.) As she drives home to her comfy apartment, she sighs with satisfaction, for although it's been a long, hard twelve hours she can sleep tonight knowing that she's done a good job, made people smile.......and earned some pretty decent money while doing it.
And tomorrow, she gets to wake up at 0500 and do it all over again. Some things NEVER change!
