anyway, it's one of those nights here at the loony bin (and my calling this place a loony bin has nothing to do with the fact that it is a psychiatric hospital... it's about the way the place is run, not about the people living here) where I take a deep breath and recite the serenity thing, accepting the things I can not change and ignoring the potential problems that could arise in the night... simply, they routinely order extra care or supervision and do not provide the staff required...

tonight there is a patient on visuals while awake because she is supposed to be a potential danger to herself, which means someone has to sit by her door and watch her if she wakes up... since we don't know if she wakes up unless we are looking into her room from her doorway, she could be away up to fifteen minutes before anyone makes a routine round... if the patient wants to hurt herself (or her roommate, for that matter), she can do anything that can be done quietly in about fourteen minutes...

her roommate is up reading right now... I probably wouldn't feel comfortable sleeping in a room where my roommate was on a special watch for dangerous behavior either... of course it could be that they just discontinued one of the awake patient's night-time medications that has her wide awake too... not very logical to do that on the same night we want that room quiet, but then, it's the loony bin, logic does not apply...

did I mention they called off the staff who would have been sitting at the door?... yes, the loonies in charge decided to tell one staff they were not needed tonight (because they probably would not have been needed if there was no special visual observation to be done tonight)... and the evening supervisor could have put the patient on a cot in the day room so we'd know if she woke, but the nurse on the evening shift decided that was not necessary...

so the doctor decides to discontinue a night time medication on the same night the same doctor decides that her roommate requires a quiet room and extra supervision and the nurse decides the patient does not actually need that extra supervision enough to create a situation wherein providing that extra supervision was feasible and administration decides to reduce out unit by one staff, again, on the same night that particular room should have someone sitting at the door at all times...

you'd think this was complicated enough, but it gets even more ridiculous when we check the actual written order and find that the order states the patient is to be on constant visual observation, not visual observation while awake as was reported verbally in the shift report from the nurse... this compounds the potential for problems from patient danger to lawsuits as it amounts to a 1:1 sitting at her door at all times because she was not put in a visual area to sleep and the staff was not provided to follow that order...

this happens at least five or six times a month, kind of like Russian Roulette...

I fill out a incident form most of the time because we can not follow the doctor's order consistently and I know how to cover my ass... the official form lets them know each time and if ever one of the patients does take advantage of the risk management is taking, they will not be able to scapegoat staff directly on the unit... they could scapegoat the supervisors on duty however, because one of them could actually sit by the patient's door and they could arrange staffing so that someone is always at the door, but chatting, eating, and sleep breaks are the priority for them, so the risk is addressed even by an inconvenient patch...

then comes my judgment call... I (not the doctor, administrator, supervisor, nurse, or anyone else), because I care enough not to ignore the situation, decide whether the patient is dangerous or at risk enough to require me to not do any of my other work, not take any breaks, and park myself at her door for the night... so I park myself at her door for a little while to talk to her roommate and get a feel for why she's still awake reading and subtly explore how her roommate behaved according to what she observed... and I come to the crossroad I should not have to be at...

is the risk to the patient severe enough to warrant me bucking my supervisor and creating much tension on the shift (because my parking myself at her door for the night will emphasize to everyone, including administration, that nobody took the doctor's order seriously and nobody took patient care seriously tonight and the tapes of the cameras will be reviewed to find the supervisors and staff chatting and not paying any attention to the patient areas for hours on end)...

or do I decide the patient is not at risk enough and go along with the status quo and ignore the doctor's order and pretend there never was one and hope nothing happens and no auditor happens across the paperwork for this particular night for this particular patient... and the staff on tonight are the staff who like to talk the most (therein distract themselves from even realizing they are on a job, no less paying close attention to patients who they disturb because they talk loud and wake the patients up)...

knowing it is only a matter of time before a patient on special observation is hurt or worse makes the ignore option one most challenging for me... on the other hand, I am not here all the time and sooner or later the lesson will be learned the hard way and management will have to address the mistakes they are making, probably in a multi-million dollar lawsuit... unfortunately, sometimes someone has to die before people take their responsibilities seriously...

but I am here tonight, so I sit by the patient's door and the rest of the staff ignore me and I'll get paid for my lunch break and the incident report will be reviewed and filed and following supervision policies will be on the agenda for the next staff meeting (as it always is) and the tension level will move up one more notch because no matter how well people ignore a danger, they know it exists and I am an unpleasant reminder that they try to forget it...

so it is one of those nights when my tolerance, patience, and energy filters are tested... so I do not become like everyone else... so I can maintain clarity of purpose and be true to myself while those around me live out the hypocrisy of pretending to be good and happy people when their actions and inactions prove they really do not care (and let themselves become unaware) because they are more interested in their own personal interests than in the responsibilities they've chosen to get paid to do (especially when they get loud enough to wake the patient)...

there are so many different ways to say whatever...

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