More Reasons NOT To Take a Vacation---The Sequel

**VivaLasViejas**, ASN, RN

If you've ever seen the movie "The Mask of Zorro", you may remember a character called Three-Fingered Jack, who's in cahoots with a pair of petty thieves to enrich himself by turning them in to the law and collecting the bounty on them, then busting 'em out of jail and going off to the next town (and the next scam). "I am the holy guts of this gang," he shouts happily in one scene as he clutches cash to his bosom on the way out of one little burg. "Without me, the whole dang opera falls apart!"

That pretty much sums up the way I felt upon my return to work Monday morning, after a delicious ten days off. I knew it would happen, but still, the shock was there as I surveyed the damage: squabbles between staff members which had disrupted two shifts. Money borrowed between employees and not paid back. Grumpy residents who'd run out of their antidepressants. Two residents in the hospital, one due to a CVA and the other a formerly independent woman whose legs evidently decided to give up the ghost and not support her any longer. One death under surprising circumstances. And three move-ins who hadn't been assessed yet, one of whom is a brittle diabetic with leg ulcers that went untreated for over a WEEK because my staff couldn't get their heads out of their hindquarters long enough to ask her doctor for wound care orders.

On top of that, we had caregivers defying dietary orders and giving our 94-year-old with a severe esophageal stricture regular-textured foods, and no fewer than twelve---TWELVE---residents were diagnosed with new urinary-tract infections. I've been asking staff for months to get rid of their long artificial nails........and now not only did the usual suspects have them on, even some of the older girls were wearing them. Of course, artificial nails are one of the biggest witches' brew of infectious material around. Can anyone else say, "The inmates are now running the asylum"?

And people wonder why I never take vacations......

Look, I'm under no illusions about being indispensable (no matter what I said in the article summary). My facility was looking for a nurse when I arrived on the scene, and managed the day-to-day operations for over two months with NO nurse at all; it's not like they can't possibly live without me. They just don't seem to do a very good job of it.

Employee: "Marla, what's that lump in Thelma's armpit?"

Me: "What lump?" (I'd been in the building approximately two minutes.) "Which armpit? Who found it? When?"

Employee: "I dunno, the shower aide said last week that she had a big lump under her arm."

Me: "Hmmmm......I'd better take a look at that." What I'm thinking is, Thelma has a loooooong history of lymphoma that's been in remission, this sounds very suspicious for a recurrence, and WHYTHEHELLDIDN'TSOMEBODYCALLHER DOCTOR?! I run up to the room for a quick assessment and find not only the lump in her axilla, but another one in her neck and two more in her other armpit. Family is notified and appointment made with oncologist.

Care manager: "Marla, I need you to help me whip the aides into shape. They've been fighting like a batch of kindergarteners over where they're assigned, who does what, who showers whom, and I'm about ready to make 'em take time-outs instead of smoke breaks!"

Me (silently snickering at mental pictures of staff lying on mats with thumbs in their mouths): "Hmglmph." I didn't realize I was a babysitter for a passel of twenty-to-sixty-year-old people who can't get along, but hey, whatever.

Executive director: "Hey, welcome back! Guess what, we've got five admits this week!"

Me: "Great!" (Uhhhh.....dude? I love ya, but I was a week behind the instant I walked in the door this morning, are you freakin' trying to KILL me?) Five new charts are sitting on my desk waiting for me, along with the usual stacks of incident reports to be investigated and orders to be reviewed. Really?? Like I'm the only person in this building who knows how to stuff a chart?

Dietary manager: "You probably should know that Aimee hasn't eaten anything off her trays in weeks."

Me: "Weeks!?" I can't imagine anyone starving themselves for that long without somebody noticing........something smells decidedly fishy here. I check her weight and compare it with the last one, and remind myself that these are caregivers, not CNAs or techs who are trained in observation and documentation. Another call to the MD, who advises keeping her on I & O and then faxing him with results in two weeks.

Administrative Assistant: "Marla, you have phone calls on line 1......and line 2......and line 3......."

Me (beginning to feel steam coming from my ears): "Hello---is there NO ONE in this entire facility who can handle random stupid phone calls while I get some real work done?"

Employee: "Marla, Debbie (other employee) keeps walking all over us and demanding a certain section every day, she yells at us on the walkie-talkies, she won't give showers, and she doesn't bring residents' food trays down to the kitchen. You need to do something about her."

Me: "And all of you need to understand that this is a workplace, not a playground." Images of pacifiers and baby blankets come, unbidden, into my mind's eye.

Employee (miffed): "Hey, maybe you should've taken a little more vacation........."

Fat chance. As I've discovered to my sorrow: without me, the whole dang opera really does fall apart, and with the vacation now squarely in my rear-view mirror, I'm not sure that the time off was worth the effort (to say nothing of the patience) it takes to put things back together!

More Reasons NOT To Take a Vacation---The Sequel

About VivaLasViejas, ASN, RN

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