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last---past---next---now
�2006 Candor Communications


2005-09-13 - 8:41 p.m.

what I do for a living...


and we try another night... tonight I work with Berry and Elpien who are a lot more social than yesterday's co-workers who occupied their time reading... Berry and Elpien chat most of the night and most nights I chat along with them, which is probably the main reason I do not pull out the computer too often since I work with them most of the time... I don't think anyone here at work ever reads this diary, mostly because they do not have internet access, but if they ever do stop by I hope they enjoy themselves here...

Berry is my right arm... without her very little would get done around here and I might consider looking around for another job... but because we work as a team, we get more and better quality work done than any other unit with twice the staff doing less work... I can count on her to do any of the work on the unit and she is the only one I can say that about... in fact, there's no one else I would expect to do any of the work up to our standards... that's the sad commentary on the expectations of management and the quality of the program here... but we make the best of it and do whatever we can to advocate for the patients...

if I didn't explain before, the night shift in a behavioral center hospital reviews all the paperwork (or should... maybe some background is in order)...

when I started here there was no review by anyone until just before auditors were due to visit and then there was a mass forging of signatures and documents that fooled the auditors well)... I was seen as intruding into clinical areas at first when I would point out what was missing from paperwork... techs were used as babysitters and guards, occasionally as teaching assistants... the kids (patients) needed a whole lot more than that from the people who spent the majority of the time with them...

I questioned management's perspective on staff, pointing out repeatedly that there was so much waste in the organization that it's a wonder they are ever in the black (and this is a for-profit hospital) and that the quality of cares was impossible to determine because there were no controls or objective auditing tools to measure anything in the place... eventually they contracted a CBA (certified behavioral analyst) who developed a measurable behavioral program based on a token economy (kids earn points throughout their day for completing tasks, have daily goals, and earn major or minor consequences when they do not follow the program guidelines)... however true to the cart leading the horse (and blind leading the blind) organizational environment, there is minimal training provided for the staff who are expected to implement the behavioral program and the minimal training that is provided is provided by a couple of people who have minimal experience and little understanding of how a behavioral program operates...

so seeing there was a rather desperate need for accountability in the system, I developed an auditing tool that provides a summary of the data (that wasn't considered in their program at first) and a way to identify missing data or inconsistent implementation of the program... at first, mostly because no one understood (or simply did not care) the data, there was general distain for my efforts... eventually the kids themselves were seeking my reports to see how they were doing and that is when management decided they should probably understand the program as much as the kids did...

it's been like pulling teeth, but over the years (with Berry being the only supporter of the ideas I put forth and work I've been doing), management has accepted (or imitated) most of the tools I've developed and gradually wrote them into their policies... as I said in my last work related entry, they still are very reluctant to give me any credit for anything, probably because of their own insecurity as much as their misconception that they should not credit anyone who does not have at least Masters Level credentials (preferably more) after their name... that is the nature of the beast however, in most systems where management are in over their heads clinically, they seek the facade of credentials to validate their programs...

not that having lots of educational credentials is necessarily a bad thing... it's just that anyone who wants a true understanding of anything needs the experience in working directly in their field... and too much academia distances one from the true nitty gritty understanding of the work involved in getting any job done... when it comes to psychiatric work, that is all the more true... all the grand theories will do no patient any good until it is painstakingly put into practice, testing, modified and individualized for the specific patient, and demonstrated to be effective at doing whatever it is theorized to do...

I used to rant with a lot more fervor about the pathetic state of health care, especially the state of mental health care in this country... eventually I approached burn out and retired from the field for a while... it was fun to explore my more creative interests and have minimal responsibilities for a few years... but the call to help people is strong in me and I compromised with myself by returning to the field to provide the care while not returning to the madness of management where meetings seem to be all there is to do and nothing is really accomplished other than passing reports around, patting each other on the back, and reacting with some tentative band aid to problems that, for the most part, could have been prevented...

it's as if management (and government, for that matter), allows problems to develop in order to justify their existence...

anyway, the point of this entry was to introduce my co-workers (oh really?) a bit more than I have through the entries over the years... and simply, Berry and I are on the same page.... that is a blessing in any work environment, to have a partner on the same page, but most especially in a madhouse like this one where the left hand rarely knows what the right hand is doing and organization is just another big word...

an example... in the past year, two of my co-workers changed their phone numbers... they called the personnel person (it's a department of one with secretarial pool assistance as it's a 120 bed hospital) and provided their new telephone numbers... today the staffing coordinator calls me and asks if I can work a few extra hours tomorrow, explaining that he did not have numbers for my co-workers to ask them and asking me to make sure they get their new numbers to him or the secretary who types up the staff telephone number list... so when i ask my co-workers, I'm not surprised when they both tell me they talked to the personnel director and provided their new numbers long ago...

this same personnel director needed fourteen months to get me my health insurance card when i first started working here...

her level of competence, attention to detail, communication and organizational skills are representative of the overall management in this hospital... and if it were not for several overachieving staff continually bailing them out and making the systems work, this place would have folded years ago (as two of the four psychiatric hospitals managed by the parent company already have over the last six years)...

besides Berry, there's two other people I work with on a regular basis (and dozens I work with occasionally, some once a week, some only rarely)... Bert, who's been mentioned before, transferred to another unit a while back and only occasionally picks up an extra shift over here... he does a similar job over on his unit... Bert and Berry live together and (shhhhh, this is a big secret at the moment) are gonna be married in November on an Indian Reservation in the middle of the great swamp (get a map of South Florida and put your finger in the middle point between Ft. Lauderdale and Naples and that's were we'll be camping out for a weekend... and are expecting a baby next Spring... they just found out this weekend and woke me up to tell me and if anybody from work is reading, you'll just have to wait for them to tell you (of course I do not use their real names in this diary)...

the other two people are Elpien and Smiley... now it pretty much defeats the purpose of changing names to try for anonymity when I tell you that Elpien is the nurse... an LPN, actually... would you have guessed?... I know, half of my word play probably never gets caught... but I know some of you out there appreciate the trivia and such... anyway, Elpien and I bumped heads (to understate matters considerably) when she first transferred on to this unit and this shift... she was forced off day shit because, for one thing, she does not get out of her chair... seriously, she will walk through the door and sit down and some nights not get up at all until she leaves in the morning... lately, because Bert and Berry have her on a diet (they prepare all her food and bring it in for her), she gets up at least once a night to walk ten steps to the galley to heat up the food they prepared... and because she started having to cover two units she also walks about twenty steps to the other nurses station once a night, but sits down promptly over there... she wheels herself around the nurses station when she must move and no one is around to get her what she needs... this laziness was a point of contention for me at first, since she is counted in the staffing ratio which means I do her work because she refuses to get up and do it... she's also a person who can not accept being wrong and had a lot to learn about the program (and still could not do most of the job Berry and I do, yet she is technically our supervisor) and for a while Berry did not understand the dynamic as Elpien did her best to undermine me in order to take the focus off her laziness and lack of knowledge... eventually we've come to an understanding... she's accepted me as someone she can learn from (though on her terms) and I ignore the fact that she does not help us much therein leaving us one staff short in doing our work every night... we all pretend that's ok and she'd probably act all offended and deny it if it ever came up... management is well aware of it, which is why she was relegated to night shift in the first place...

Smiley is, on the surface, a very smiley and friendly person... she's so social, in fact, that she forgets to get her work done and when she does her work it's usually sloppy or wrong because her focus is on talking, too loud for the night shift, with others who are not interested in actually doing any work... Berry tells me that on nights when Elpien and I are not there she and other staff talk trash about us and about the kids loud enough to wake the kids and if a kid complains they're told to shut up very disrespectfully and intimidated back to bed... I've mentioned it to a few people, but par for the course, nobody cares... again, she is a staff relegated to the night shift because she could not handle any other shift where there's actually patient interaction...

the rest of the night shift crew mostly work on other units and have various levels of aptitude and concern for their work, but none want to work on this unit because we do way too much, according to them... the shift charge nurse has been the loudest advocate for less work and longer sleep breaks (she's somehow been doing that for fifteen years, so what does that tell you about the overall management)... she belittles the work Berry and I do as unnecessary and was quite upset when she was forced to sit in the training I was asked to give on the very work she loves to call petty... I doubt she could actually implement the behavioral program or audit it, but she at least had to recognize it exists and knows she should no longer publicly downplay the importance of knowing the program or auditing... again, she is typical of the management in this hospital...

and as I said in the previous entry about work, I just do what i do because I know what is right and the patients deserve a consistently implemented program... and if you take nothing else away from this entry, take this:

if your kid ever needs psychiatric care, in patient or out patient, ask a lot of questions often and make them explain the program to you in detail and in depth, including exactly what they do and how what they do is supposed to help your kid... make a list of behaviors your kid presents...make then walk your through a typical day and then ask them exactly what they do if your kid exhibits the behaviors that are leading you to seek help... remember that you are interviewing them to see if you want to use their services... and if the person you talk to can not give you immediate and specific answers, then ask why not and ask to speak with someone who can... if they get defensive or rude, find another place (because they will get even more defensive and rude when dealing with your child)...

better yet, look at your child... watch him or her sleeping... watch him or her eating... watch him or her watching TV... look closely... watch her hands... watch his eyes... see their smile, their frown, their laughter, their tears... take your time...

think about what he or she means to you... why did you have a child?... planned or accident, how did you feel when she was born?... how did you feel when you first help him in your arms?... when you first looked into those eyes... look at your child's eyes...

now... go look...

what do you see?...






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