basric

And so it begins again...this week

A new manager—a mandatory trip to the psychiatrist. HERE

It was three weeks before the informal employee reviews began. I was surprised when she saved me for dessert on her meal of deconstructing the unit. I was forewarned by friends--my name had come up in all their interviews.

Already I was on a slow boil that I promise I worked diligently to keep a lid on. She called for me Wednesday night at the beginning of shift—a tactical mistake on her part. It was my first night of five 12 hour night shifts in a row. . . I was fresh and clear headed.

Before I settled in the chair that faced her across the desk, she fired the opening volley, “The psychiatrist finds you unfit for duty and gauging by”—dramatic pause for what she thought was effect—“These incident reports and the comments from your coworkers I must agree.” She flipped open a thick folder; and sat back to smirk, “I could just fire you right now.”

The lid came off the simmer and a flash fire erupted. “You see that red folder over your shoulder? That’s the policy & procedure Manual of the Medical Center. I assume you haven’t read it because I have and to be able to fire someone, except if they kill a patient leaving them possibly liable for a law suit, you have to give a verbal warning, a written warning, a written final notice and a final warning before you can terminate an employee AND you have to have a just cause—which you don’t.

I would take you to the hospital board, you and your set up psychiatrist. No, don’t bother, you sent her copies of the incident reports without including the resolutions. SO if this is a pitiful attempt to get me to resign—you’ll have to do better than this.”

“Let’s look at a random incident report, “I reached and pulled one from the middle of the stack as she sputtered. “This is a good one. The RN claims I bullied her, hurt her feelings and threatened to fire her. Now, the response, on a routine check of the floor I discover said nurse had put a morphine cartridge instead of a Demerol cartridge into a PCA. The patient was ordered 100 mg of Demerol, upon pushing the button she would have gotten a 100 mg of morphine and not ever Narcan would have saved her from respiratory failure and death. I took said nurse into the break room and I’m sure I was severe. I told her this was the kind of mistake that could cost her not only her job but her license. If she had just learned the lesson taken her licks and moved on she wouldn’t have ended up losing her job over it and reported to the nursing board.” So you are going to have to do better than throw resolved incident reports in my face.”

She was purple with fury and so without thinking; foolishly she fired a imprudent wild shot, “You’re sleeping with the Trauma Attending. The entire floor thinks so.”

I smiled and stood up. She stopped me at the door, “We’re not done here. Sit down, NOW.”

“Not just yet, I’ll be back,” I found him at the Charge nurse’s desk.

“I figured she’d have you in there for hours. Did you leave any skin on her?”

“Oh we are just getting started. I thought you’d like to step in since she’d stated straight out we’re having an affair.”

I have a temper, but Attendings are the supreme power of the hospital. Now, he was in a towering rage and I was glad not to have it aimed toward me. He smiled but it was the smile of a warrior about to slay a dragon. I almost . . . almost felt sorry for her, but slander is slander.

“Wait here.”

He was in her office ten minutes.

“She’ll see you now and you will tell me if she does not apologize.” He grinned, “As many times we have been accused, we ought to just go one and have one.”

“Your wife wouldn’t approve, nor my husband. Anyway you tell your wife everything. You can’t help yourself.” If I were going to have an affair it wouldn’t be with a doctor anyway but I didn’t tell him that.

The new manager was pale when I entered but red crawled up from her neck to her face. I sat.

“That was out of line, I apologize. I still believe you don’t belong on this floor.”

“What are you basing this on? I get it you are right out of school and think to follow you book learning. Remove all the alphas on the floor to protect your position. Well, the strong nurses on this floor don’t desire your job.

You want my job, you can’t do my job. Have you even worked on a floor as a nurse?”

I’ll have you know I worked Med/Surg for a year before I got my Master’s Degree from Vanderbilt.”

“You don’t want to play who has the most education with me, you’ll lose. You might check my resume before you start throwing around initials.

She flipped through the folder and pulled out a sheet of paper. The color leached from her face. Again she sputtered and shot off another volley, “Well, if you didn’t have something wrong with you; they’d have offered you this job.”

“What makes you think they didn’t? I’m a trauma nurse, a damned good one. You know they say, ‘those who can’t handle nursing administrate and those who can’t handle that teach.’ I didn’t want the job.”

My temper had cooled and as I looked across the desk at the 25 year old woman without a clue, put in the position of power she’d never keep without help—I went against my intuition, every instinct screaming to rip her to shreds and walk out—I decided to help her, if she’d let me.

“I am knowledgeable and I am loyal. I put patient advocacy first, the floor second and the Medical Center third. I watched new managers. They come onto a new floor and run off the cream of the staff and replace them with their own. Trauma isn’t like any other floor. You NEED that cream. True, we are arrogant, because –- we know our job. It’s a job few can do and we can make you look good.

You need to learn about your floor. You come and work beside me in triage on Saturday and see for yourself. Get in the trenches and see what it takes to be a trauma manager, watch your nurses, CarePartner and ancillary staff. A manager needs to be able to step in when needed. You work with me on Saturday night and if you feel I’m incompetent to handle it, I will resign.

She straightened up fussed with the papers on her desk. She raised her eyes to mine, “If I feel you aren’t handling triage correctly I will relieve you. You have a problem with that?”

“No,” said the spider to the fly. Saturday night was going to be illuminating. We both ended our meeting feeling the victor. I knew I was. She’d never worked trauma. Much less trauma on a Saturday night when there'd be a full moon. I smiled in anticipation.

The conversation is pretty close to what was said — I edited of course we talked for an hour, but I taped and transcribed it into my journal that morning.