Nobody Knew I was Coming? Travel Nurse continues

My arrival to my office site in Maine appeared to be unexpected. While it was established that I was due to arrive, the office staff had no clue of whom I was nor my specialty.

They had in fact, assumed I was a Hospice nurse and began to introduce me as such! It wasn't until then that I understood what was happening and corrected the situation.

"But," asked a Hospice nurse eagerly, "You'll do it sometimes, right?"

"No," I gently stated, "That is not what my contract states." The glare she gave me could have melted lead. There was a flurry of confusion, phone calls and discussions, attempting to clear the air regarding whom I was and my expected duties. In the meantime, I had no place which to hang my coat, secure my belongings or sit down. It was q small office, quite active. The folks were generally cordial, but unsure of many things. Staff were scrambling to find supplies, a computer and toilette paper. I had never seen such chaos in Home Health before, especially my first day on assignment. I fought an urge to dive under the desk so as not to get run over.

I heard a voice command me: "Here, follow me." I obeyed. A regular staff person and I were headed for the Charting Area. Although I had not yet been issued a computer, looking around, it was obvious that system issues were in the forefront of the activity I witnessed. The Acting Supervisor was dragged out of retirement to fill in until a new one could be found. Unfortunately for her, she had not used the computer program in 8 months, so felt she had to re-learn it. I understood, but was incredulous that her own company didn't furnish her with someone to help ease her into this. Honestly, she was doing the work of 3 people! In addition, she was living for 8 weeks in a motel, as this position was very far from her home, even though she still lived in Maine. I had questions. She couldn't answer them and others were too busy or stressed to care. I was informed that 5 nurses had quit before I arrived. Had I known this, I would not have taken the assignment. My heart went out to the other Travelers who were there. They were seeing too many clients, and, as they were not getting enough training with the system, they were unable to "complete" their charting.

As a result, if I saw their patients, I couldn't finish my charting, as certain things weren't loaded that should have been there previous. Many times, no diagnosis was listed, nor Nursing Interventions or Clinical Note. Clearly they were flying by the seat of their pants. These things were reported to the Supervisor who appeared over-whelmed and confused, as she had a large list of charts on one nurse, who was having more difficulty with her documentation.

The Supervisor was being pulled in too many directions. The first week I was here, I was issued no computer or cell phone. I shadowed a nurse for 3 days, then she was gone. For another day, I was stuck in the office with nothing to do. No assignment, no computer, nothing. I was told I would "just have to wait until they could find some answers." I asked if perhaps I could shadow another nurse for that day. They allowed that as it was a nurse whose clients I would be following later.

The next day I received my computer. After multiple attempts to find my caseload, I was informed by their I.T. that the cases were not loaded properly, which is why I couldn't find them. The "incomplete" charts issued to me that were not finished by the previous nurse, stared at me from the screen. As other system issues reared their ugly head, I spent my day off trying to find solutions with their tech support. Finally! It was fixed....for now.

I was living in a rental cottage by the sea. Accommodations were scarce as tourist season was over, many rentals had closed down for the coming winter season. The cottage was a 2 story, cape cod with large yard, trees and near the water. There were a few more modern elegant homes surrounding it, but I had quite a bit of privacy. It was quiet. I couldn't help noticing that my mailbox to the property was hanging on its' pole, as if not to stay there long. Folks were putting up their holiday lights and the air was bitterly cold, especially being so near the water. The first week I was living there, I discovered mice droppings in various places, hidden in drawers, under shelves and in the freezer! As the landlady unplugged the appliances when she wasn't using the cottage herself, she unknowingly set it up for the infestation, in addition to the usual spots rodents could appear. I had a call into her and was awaiting reply. Then, I noticed my toilette had clogged. I thought it odd, as I hadn't flushed anything large down there. I took a trip to the local hardware store for a good plunger. Over the weekend, my toilette clogged again. There seemed to be no reason for it. I needed to speak with the Land lady. She was angry when I shared with her my findings.

She stated that she "hadn't had any issues with mice, the broken mailbox hadn't bothered her and the toilette in the past had never been a problem." "I've had other tenants there over 10 months (pals of her son,)and nothing bothered them. I am there in the summer and nothing bothered me. You are the only one who has complained about it."

"Perhaps the other tenants hadn't noticed the mice, being summer, or they didn't care. I do care about your house and my health. As a former homeowner myself, if I had a tenant who discovered something serious in my house, I'd want to know!"

She agreed to get an Exterminator. When she found out how much it would cost to rid her house of the pests she was quite upset. I was the one who had to clean out the mouse droppings, wash all the contents of the kitchen drawers, silverware and cooking utensils by hand. Why on Earth, was she upset?!

She lived in Massachusetts.

Back home in Minnesota, if you have a damaged mailbox, the postman won't deliver the mail. I was worried about that here, which is why I informed her about the broken box. She was angry about that too. I am usually pretty tough and can take abuse from an unruly patient. But where I live, and decompress, is a place that should be both peaceful and clean.Her nastiness to me on the phone left me sad and feeling very alone. It affected me the whole day. I looked out the window, watching a red fox peeking out of a concealed drain pipe in the hill in the yard. He crept out, snatching fallen apples from the grass that rolled down from the hill in the neighbors' yard.

"I'll bet he doesn't have mice," I told myself.

It began to snow again. I looked out to sea. The waves were big, gray and foamy. I felt sorry for the lobster fisherman, still out in the bay. Shivering, I closed the curtain and walked back into the living room. For the next two days, until my Land lady's cousin (her maintenance guy,) showed up to help troubleshoot the toilette clog, I was forced to line the bowl with a trashcan liner and dump it double-bagged in the trash outside. It was to be burned. This was after I purchased a 4 foot plumbing snake and a more powerful plunger from the Home Depot. Still, no success in opening the clog. "So much for the clog just being in the piping," as her cousin had thought. I had an inkling that it was much more serious than that.

It was.

The infestation of the mice, the Exterminator had labeled: SOLID.

The smell of dead and decaying mice began to form. It had gotten unbearable as it was winter, and the windows were frozen shut. I opened the door, and lit some industrial strength de-odorizing candles all over the place. It only helped a little. The mice were trapped in the walls and in the plumbing. I continued to go to work and do my assignments. But I began to have abdominal pain. Within a couple of days of that I was in the E.R. in Bar Harbor feeling incredibly ill, the pain still there. We ended up with a finding of Messenteric Adenopathy. Nope. I've never heard of it either. Apparently it mimics appendicitis, but normally isn't discovered until the surgeon goes in to remove the appendix. Fortunately, the C.T. scan revealed it without me having to be cut open.

I was sent back to my cottage on 2 courses of antibiotics and rest, with an urging from the doctor to "Get out of there!" "Dear Lord," I prayed, "Please don't let me end up with C-Diff with all these antibiotics!"

I picked up the phone to speak with my Recruiter to let him know what had happened. I was desperate to move. They put me in a lovely hotel in the town near my office. I had to give up my stipend of course. Over the next week upon my return to work, my load, per M.D. order, had to be light or I would be too sick and exhausted as my abdominal lymph nodes were still quite swollen and tender. The company to whom I was on loan did not appreciate that I was ill. After all, you are there to work. The fact that you have full medical benefits means nothing since you aren't supposed to take sick time, never mind that you might be genuinely ill. The resentment was evident when I returned to work. They grudgingly followed my physicians orders for me to work.

On patient I had to see for an in-dwelling catheter that I had placed 2 weeks previous. She had raw wounds from urine incontinence and she was bed-ridden total care.

Her skin was so excoriated from the moisture, we persuaded her to allow us to get an order for a Foley in order to give her wounds a chance to heal in addition to wound cares. She agreed. We updated her Care Plan, emphasizing certain dressings to be used and not the ones she was use to using, as they were chemically treated and making her worse. She had a mind of her own, and was known for bullying her caregivers into doing things with her cares that were either unsanitary or unsafe. We all had to be on the same page here. My partner nurse who precepted me on her case, her caregivers, physician, nurse practitioner, family and herself all agreed to the plan. Within a week she was greatly improving, though she complained she didn't like how the ordered dressings felt on her skin. She had no further irritation and she was coming along. So imagine my surprise when doing the P.R.N. Foley visit, when I discovered her wounds looking worse and blood in her catheter. Clearly, something was amiss. I asked how she was being moved during transfers and turning in bed while her catheter was in place and asked them to please show me. Her catheter was being pulled, which explained the blood in the tubing. I reviewed with the caregivers what we discussed previously regarding careful handling of the bag during transfers etc.

"This catheter has been pulled." They gave me hostile look.

"Why did you change your type of dressings that we are using, Clara? (not her real name)" I asked.

"I like these better and I can buy them on Amazon." She retorted back.

It took some time, but I gently and firmly explained how she was causing herself damage, and that the Dr. or the N.P. would need to be brought up to date regarding this. I was genuinely worried about her. Social Services was already involved with her. She wasn't confused. She was being obstinate. I helped to settle her and departed with a heavy heart. When I left, I documented everything and contacted her Physician. He promised in no uncertain terms that he would "definitely have a discussion with her, " as she had done this before, regarding dressings. Unknown to me the client too, had placed a phone call, demanding that I be fired. Of course, no one at the office bothered to ask me about it, they just did what she had asked. It's my guess that the Doc gave her a good talking-to and she took it out on me. It was shared with me by another nurse privately, that this client had other staff fired as well from that Home Care agency. I came to the sad realization the reason Home Care Travelers are needed, is because the permanent staff don't stay. There is constant turmoil and we walk smack into it. Between a Scheduler on a power trip, no proper managerial support from the facility, long term computer issues, fed up nurses with no support, lack of communication, illness, my assignment once again cut short, due to politics, it was time for me to say "Goodbye." Bad fit all around.

It seems that when a Traveler in Home Health tries to do what she needs, what she's been trained to do but has no support, in fact, comes up against resistance, the company declares "war" on the nurse. No wonder my hotel manager upon my leaving sadly stated: "We've had nurses come and work for that company and it always ends badly for the nurse." I contacted my Recruiter and told him what happened. He was sympathetic. The stress wasn't helping my health. It was Christmas. I decided to go home. The weekend before I left for Vermont to visit the elderly couple I met on my first trip to Maine, I spent Christmas Day Brunch at the home of the mother of a hotel staff member. it was such a comfort to be surrounded by happy people, wonderful food, and a sweet orange tabby cat who dozed peacefully on my jacket. There were also two gorgeous golden retrievers who loved retrieving the ball we tossed. The snow had all but melted, as the weather was unseasonably warm for December by then. The sun shone and it felt good to be outdoors. The sweet smoked scent of burning wood from the fireplace filled my heart with peace.

By Sunday I was packed, said my "goodbyes" and rolled out of the hotel parking lot. The snow was beginning to fall. The fog, or "sea smoke," as the locals called it, also began to billow in, reaching with its' willowy soft fingers across the bay, the evergreens and highways.

I still had 325 miles to go.