and it's another night at the old psych ward... the words above a paraphrased from conversations with an seven year old girl who doesn't understand why she can't see her family and why she's talking to strangers about her body parts...

in case your first reaction was to think I was throwing another pity party...

conversations with kids at work make up some of what you'll find in my darker writings (and often I won't mention it's not actually me feeling that way, though I think I might point it out in some places I been... anyway, I hope you don't feel the words less just because the feelings came from someone else because they need the empathy much more than I do and this is a large part of the writing process for me, expressing my sense of how someone else might feel... it feels really great when they look at me with eyes that say, you understand...

this entry started yesterday and continues tonight and will probably bring together a few thoughts related to what I do for money in this world... these work related entries are not actually what I come here to share, but then, I do spend more than forty hours a week on the job so it is a big part of the life in black and white behind the candoor...

and writing is how I vent my frustrations and at the moment I don't want to write about work enough to start a whole new diary (or even continue my worklife rambles from years ago), so we'll just suffer through this because I do care about the world even if I want to escape from it in my ramblings most of the time...

anybody wanna run away with me?...

ok, back to life, back to reality, ready or not, a work rant (though rant overstates this, I think, because the tone is very mild, for me... maybe I am mellowing in my old age... on the other hand, since I am not nearly ready to move into my old age yet, forget that... tolerating an unacceptable situation is not mellowing or even complacency, it is riding the horse to what is hopefully a better place)...

or riding the storm out, perhaps...

oh just insert some sort of metaphor that makes us all feel better about everything and let's get on with the work rambles so we can resolve the frustration that bubbles up at work from now and then and get back to enjoying the crisis in progress...

clever plug, no?...

so here we are at work where one staff sits more than a hundred feet awake behind a thick plexiglass enclosed nurses station paying no attention to the hallway where the kids we are supposed to be monitoring closely sleep restlessly... and another staff stands back there talking to the sitting staff, almost equally oblivious to what is going on down this hallway except for every fifteen minutes when she walks the hallway and fills out a monitoring form that will tell the doctor and anyone who cares that the kids were fast asleep even if they were awake or worse, awake with issues or complaints or doing something they should not be doing, like cutting or trying to hang themselves...

and administration states clearly, when pressed at meetings (usually by me, since fewer and fewer people attend even the mandatory meetings and few staff here more than a few years to continue to bring it up), that unless there is an emergency there should always be two staff in a hallway that extends almost two hundred feet from one end to the other... one hundred twenty five feet of it between the almost sound-proofed nurses station and the farthest bed (the other end of the hallway is galley, office, storage... though we do have some work to do at that end which puts even farther from and out of sight/sound contact with the patients and any staff remaining in the hallway)...

safety first, right?...

the chief administrator, Vice President for Psychiatric Services of this large chain of hospitals that span most of the country, stated for all management staff to hear (just at the last meeting, last Thursday, when I once again brought it up) that it is the night shift supervisor's responsibility to insure the safety of patients and staff and part of that is maintaining the correct staffing ratio in the hallway and one person should not be left alone in the hallway unless it's an emergency...

again...

unfortunately, the night supervisor is the staff sitting behind the nurses station mentioned above... she also happens to be the shift charge for the hospital tonight and most weekends...

now that's not to say she's goofing off completely... to her credit she does find oodles of work to do, or at least to appear to be doing... the thing is, almost all the work can be brought out into the hallway (as I do and all staff are supposed to do so we have no excuse to remain back there all night)...

the shift charge for the night shift on week nights makes rounds to gossip, mostly, and almost never ventures beyond the plexiglass enclosed nurses station, therein missing out on actually making rounds of the patient areas and ignoring the lack of concern with administrative rules or patient/staff safety... she's the one I wrote up more than once, just to put on record that she focuses much more on sleep breaks than patient care, not really expecting much from administration, but at least getting her to stay on her toes and either avoid me or come with at least the appearance of respect)...

so anyway, back to tonight, there behind the virtually sound proof glass more than a hundred feet away sits one of the three staff assigned to this unit, the supervisor charged with the vigilant monitoring of the staff and patients who happen to be eleven to seventeen year old girls who were sexually abused (and most abused in other ways as well), some with night terrors because so often the abuses occured at night, several wish death wishes strong enough to require a doctor order visual observations whenever they are awake (there are two such doctor orders tonight)...

as I've said, for years seniors staff have brought this to administration's attention and it changes nothing... too often there's still just one staff sitting in the hallway (that'd be me) with ears focused completely on the kids and a mind wondering and why people can get so careless, so neglectful, and so self-destructive...

and I was not referring to the patients in that last line...

it can be quite distracting (not to mention disheartening and uncomfortable) when you can not trust the people you work with to consistently follow the program and focus on the job in an environment where safety and even lives are on the line...

the bottom line is that this will probably be one more night where they get away with it because there will most likely be peace here... that is mostly because of the tone set on the night shift on this unit (set by me, since I've been here the longest and am the only one consistently responding to the kids night after night - so much so that notes left by the kids for the night shift are always addressed to me as if there are no other night shift staff)... that tone is: you are safe, you are cared for, your fears or hurts or questions are heard...

so when a kid wakes up and comes to her door, she asks for me and get when she needs most of the time (sometimes what they need is beyond my control or ability to provide, so we talk about it and just knowing she's cared about helps a lot)... Berry has the same rapport, but I only work with Berry three nights a week so two nights a week I have to deal with the carelessness... thank goodness for Berry...

in fact, some other staff are exceptionally rude (yes, to the point of abusive, yes, it's been brought up at meetings, no, administration does nothing because supervisors ignore it because they are not where they need to be so they can continue to claim they don't observe it themselves, therein reducing the credibility of the staff reporting and ultimately, eliminating the would-be whistle-blowers)... some are openly bothered by any kid who wakes for any reason and often create a problem where there would be none without them there...

so the unwritten and seldom spoken reality is that I am trusted to keep the peace on this unit at night because I can... and supervisors and other staff get over because administration doesn't want to get involved in anything unless they have to, especially if it doesn't mean cutting costs...

heck, if we actually provided the quality of care we could provide here then more kids might be helped and therein discharged quicker and that might mean more empty beds and less profit for the corporation... sacrilege... the edict is keep the beds filled, that's the ticket to success in the corporate hospital business...

and I feel much better now (nothing like a bit of a rant to relieve stress or frustration) so on with whatever else might pop into or out of my head tonight...

that was the other night and the entry continued with babble, ultimately becoming an entry of it's own and I added a bit to the ramblings above tonight because thoughts about seemingly irresolvable conundrums clarify a bit after a day or two...

before I can move on in my mind tonight though, a bit more vent...

we have kids here who are suicidal... so the rules state very clearly that sharp objects, strings, hard plastic or anything that can be broken or filed into a sharp edge are not permitted in the bedroom areas unless staff are supervising... and all times considered "sharps" are banned from the residential area overnight...

makes sense, dudnit?...

well each night we make our first rounds and more often than we should we find sharps on counters (who knows what is hidden in their rooms) because staff get lax in collecting when they give out to the kids... last night I found a safety pin, a loose leaf book, a key ring, a pocketbook with metal zipper clasps, and assorted other items on the counter in kid's rooms...

as I believe I mentioned above, we had two kids on self-harm suicide-watch last night and finding all that stuff was not a happy experience... so I wrote a note reminding staff once again (such a note is written by me or the day shift supervisor at least a few times a month) to be more careful about leaving sharps in the bedroom areas...

one of the kids on special observation last night has a long history of attempts of all sorts... over her repeated admissions here I've cut string and torn clothing from around her neck more than once from her limp body and luckily color came back to her purple face each time...

she was on special observation over the weekend because she currently placed a foreign object, apparently a piece of metal, into her arm... this object is currently embedded in her arm and today she refused treatment to have it removed telling the nurse that she would remove it herself before she'd let anyone else remove it... the area is purple, infected, she's on antibiotics, and the hospital has started the legal process to force treatment...

tonight I find a string necklace on her counter...

she could have been dead in bed when we did our first rounds, but luckily she was not quite that careless or suicidal tonight... everybody thinks she does it mostly for attention and I am prone to agree, but the accidental death of an attention-seeking suicidal (actively self-harming) psychiatric patient is far from unheard of... so I check her breathing and breath a sigh of relief and write another note about being more careful...

again...

hopefully I will not have to threaten to report a carelessness like this to outside authorities again to get better vigilance (you see why administration just loves me, aye?), but in the real world nothing happened, the kid is fine (well, except for the purple infection and foreign body in her arm), and it's just too easy (not to mention cost effective) to just brush under the rug and that's what everyone would rather do...

and most staff and supervisors wonder why I want to sit up typing or doing some other work to help stay alert on the night shift...

but (here comes the realist, who many be a bit cynical, but does keep the kids safe and the dream alive) this is the nature of our culture and indicative of the US health care system and I've worked enough hospitals around this country to be able to confirm that from personal experience...

I don't know how health care is on the front lines in the rest of the world...

my experience in Canada was as patient, not as worker, but it was similar, maybe even more complicated in bureaucratic bog, though the people seemed friendlier... of course I was on the brief visit patient end and was also quite in love at the time, so everything in life probably seemed rosier than it might have been...

this place is still better than some of the places I've worked...

and I shall leave this entry now and move along to another entry because I've had enough ranting and wish to spin my mind in other directions... after all, the President's state of the union speech is coming up any day now (when did it stop being on the 20th of January, anyway?) and I want to be quite oblivious when that happens or I might go political on you all again and it's too soon for that...

and besides, I owe three entries to the posterity till and this could well serve as one of them (since the three were lost and I don't seem to be finding time to explore the time stream in my brain and find whatever can be found of them)...

I'll close by urging each one of you to take care of yourselves wherever you are and especially if you ever find yourself in need of a hospital or psychiatric care of any kind... do research, choose wisely, and ask to make surprise visits now and then... there are laws protecting patient privacy that give hospitals the right to refuse you access to some areas and records, but do not hesitate to demand administrative disclosure if you ever suspect you or anyone you care for are not receiving the best care available...

do not assume it will happen... do not think that just because staff smile at you they provide optimal care... do not think that a staff who accepts money from you to give your loved one special attention will provide anything they promised to provide...

do not rely on lawyers or government or the AMA or any bureaucracy, use the system when you can, if you must, but the first and most effective assurance you have that you will not be lost in the health care machine is to advocate for yourself... ask questions... visit... make demands to see more information or other people as necessary...

and thank someone when you see you've gotten satisfaction...

the bottom line is that medical care is a business and you are the customer and no matter how many degrees or laws the hospital has on it's side, you, the customer, still has the right to take your business elsewhere...

and that reminder is the single most powerful tool you have in ensuring you or your loved ones get the attention and care you deserve...

. o O ( NOTES ARE THE NEW HAPPY PILL ) O o .
(just let me know you were here)