eric135

Employee self scheduling; Jean-Watson Theory; Stocks; Ladykitty and other reasons I don't sleep right...

I've been really busy of late. Several weeks ago, I posted about how our hospital had started to institute layoffs, which has been a bit of an eye opener considering a few months before that, we were all talking about the nursing shortage. So even though I am pretty far up the food chain now, I started to apply my philosphy of "making myself indispensable." Which basically means I have totally over-extended myself.

• I recently found out that our scheduling program (called AtStaff) already has the capability for employees to enter their own schedule requests. For years, we have been told that this was something that would be available "later" but come to find out we've had it for years. Which means I could be just a few weeks away from being able to do the schedule totally on the computer, with employees entering their requests online and balancing themselves (somewhat) online. I'll still have to make the always-unpopular decisions of who to move from the overstaffed shifts to the understaffed ones, but it can all apparently happen on our intranet without the reams of paper I presently use to produce a schedule.
• However, because no one in the hospital knows how to implement this aspect of the program, I am having to learn it on my own with some webinars from our vendor. It has been a lot of time, and I'm at the hospital late or on my days off a lot more than I like.
• After I figure out how to do the program, I have to figure out how to orient my fellow charge nurses and then our 80+ employees on the process.
• I'm still working on the implementation of the Jean Watson Caring Theory of Nursing, but I am at a total standstill. Most of this is because our initial meeting with Jean Watson simply didn't impress very much of us, especially those that are as firmly rooted in the Scientific Method as I am. I've read her material and so I saw this conflict on the horizon, but now our Clinical Directors, Vice Presidents and CEO's are wondering how to get the Jean Watson model up and running when we are also supposedly into Evidenced Based Practice. I'm sure there's a way for both to co-exist, and no one would deny that many of our patients can benefit, but I have not come up with a way to either model the behavior or teach it to others, much less design a way to document that we use the theory.
• The stock market has been in a rally for the past couple of months, which basically gives me another part-time and sometimes full-time job. I run stock screens after each day's close, which I have to spend one or two hours doing research. So when I'm working, I have to get up early to do some printing and research, then when I get back at 7am I finish that, settle on the 3-5 stocks I'll stalk at the opening bell, and then I'm watching the screen on and off until the close. If I'm working, I have to set Stops and hit the sack by 10a or I'm doomed. It's been busy but at least it's also been profitable.
• LadyKitty, our 13-year old tabby, is still getting 150-200cc subcutaneous fluids pretty much every day. That's been going on now for the past 16 months. She has her good days, and her bad days. On her bad days, I put her in the closet in my room so the other cats can't bother her, and sometimes that means I am up two or three hours after I go to sleep to let her out.

Luckily, roomie has pretty much taken over running the apartment, taking care of all the cleaning and cooking.

Star Trek Movie Review... 8 stars out of 5!!

GODS, what a good movie. I mean, I could just write that sentence for the next few paragraphs. Everything about it was great -- the characters, the acting, the action, the special effects, the one-liners, all of it.

If you're a Trekkie concerned about [whatever], just stop all that silly nonsense and go see the movie. [No spoilers until after the jump...]

• They totally explain the subtle (and not-so-subtle) divergence from the Star Trek Canon. At this point, they can do whatever they want with the upcoming movies and it will be ok (trust me).
• Every scene where you are introduced to the original characters is electrifying.
• When the first shot of the Enterprise 1701 came on screen, I shed a tear. She's an important character in the film and story and she's great in a bitch fight. She really gets a chance to clean her claws.
• The action is great. More importantly, it carries the film forward, and never seemed pretentious, extravagant or unnecessary.
• You get to know James Tiberius Kirk, and you know why he's the kind of guy that he is.
• The magical friendship between Spock and Kirk is pure and real and will make your heart ache. The neat thing is that, every once in a while, you can see William Shatner and Leonard Nimoy while watching Chris Pine and Zachary Quinto.

[Spoilers after the jump]

...of the myriad verbal and written reprimands that I have written over the past four years, it turns out that I have written up three times as many male workers as female workers.

I don't know why write-ups are on my mind of late.

One of my co-workers was talking about write-ups on our unit, and she told me that I was "known for being more lenient when disciplining males, but am more knit-picky toward females."

Well, as a leader, I am well aware of the fact that some folks have perceptions that I can't help them with. But this one sort of hit home, because in my business, there are more females than males and I always strive to be fair. So when faced with this criticism, I of course went back and looked it up.

As it turns out, of the myriad verbal and written reprimands that I have written over the past four years, it turns out that I have written up three times as many male workers as female workers.

Which puzzles me even further. I mean, given our demographics, I really should be writing up females about four to five times more often than males, but for whatever reason that isn't happening.

And contrary to the opinion of that coworker I mentioned at the beginning of my post, one of the men I gave a written warning to wrote a letter to the clinical director that I personally had a bad attitude toward him because he was an older male with grey hair (which really shocked me given that I was, even then, 75% grey myself).

What seems to piss me off, possibly on a sexually biased level:

• I obviously don't like foul language. Although I am relatively tolerant of "casual" profanity, I have a peculiar distaste for profanity that is yelled or spoken in anger.

What I seem to discipline evenly across the sexes:

• I don't like it when folks disobey the chain of command (some of my write-ups were for workers from other departments that were rude to my staff instead of coming to me with problems).
• I don't like it when folks make patients feel guilty or bad for being sick (that just gets my gall considering what industry we are in and how we are paid for a living).
• I don't like it when folks go to another charge nurse when I've already told them "no".

Interesting... Something to keep in mind for the next appraisal year...

Maybe knowing what we look like down the sights of loaded shotguns is an ideal way to get to know your boss?

I rarely get written up. No, really, it just doesn't happen very often. Of the handful of times I've gotten a write up, it almost always has been due to by absences (we get in trouble after the 6th absence in any 12-month period, and the trouble gets very serious at 9 absences a year). But having a history of kidney stones, I have always had a straight-forward attitude about my attendance: I do the best that I can, and I try to make up for it by doing other things (I worked a total of 24 extra shifts in 2008, plus a lot of extra "projects" for the unit).

So it came as a surprise when the interim clinical director asked me to meet her in her office.

I had assumed it was to be introduced to the new permanent clinical director, but I realized pretty quickly that the tone of the meeting was serious.

The exact details of the write-up are not all that noteworthy, in that, like almost every other employee I have ever had to write up for this infraction or that, I refuted the factual basis (and even questioned the truthfulness of the interim clinical director). Most of the complaints were that I simply didn't like the interim CD and tended to make that pretty obvious in our daily interactions.

Suffice it to say that I made the decision to live with the write-up and work toward building a relationship with the new clinical director. I decided, after a few days of thought, that it was more important to move on to the bigger problems of two inpatient units that had been through more than a year of hell, and needed to get over all of the conflict and just move on.

It was a good decision, in retrospect. It has been five months since that write-up day, and the new clinical director and I have forged a good professional relationship, despite the fact that we have both, literally, seen each other from the business end of a loaded shotgun (the write up meeting took 90 minutes -- I've never had a write up meeting that lasted that long, with basically me arguing with two clinical directors -- much of the meeting was heated and even mean-spirited, myself included). We've been able to work together on several projects, and I've come to trust her judgment and her sense of fairness and justice.

Maybe that initial meeting -- little ol' me seated on one side of a wide desk with two "bosses" taking turns arguing one point after another -- helped me get to this point faster than my peers. Nurses on my units are amazed at how quickly I "turned around," from considering to resign to becoming a real partner in difficult times. Of all of the charge nurses, I have become the new CD's main supporter.

Maybe knowing what we look like down the sights of loaded shotguns is an ideal way to get to know your boss?

Free At Last

Our friend has finally been released from Jail. The whole process was done logically and timely, and all parties were kept informed of when and where the release would take place   The whole process was FUBAR but we expected as much. We were told that, once the release was a "go", the process would take anywhere from four to eight hours to go through.

Prisoners are not usually released from the Jail they are housed, but rather all releases happen at the Lower Buckeye Jail. The paperwork was on the judge's desk at 9am, our friend heard about his release at 3pm, and he finally walked out the door at 8pm.

There is an airconditioned lobby at the main entrance of the Lower Buckeye Jail, but prisoners are not released there. Instead, they are released on the East side of the building, where there is basically a cement slab with chairs where you can wait out in the elements for the prisoner to be released.

There were no updates about the specific timetable. We could not leave any money for him to use the pay phone. We just had to hang out. This entrance is also used for folks who are self-surrendering. It ain't pretty.

I had to miss a day of work, because there was no way to tell what time things would be done. Foolishly, I had hoped things would be over with by say 11am, but it took far longer.

But, at last, the whole jail experience is now over. I look forward, with relish, to erasing the Maricopa Superior Court parking, the 4th Ave Jail, the Durango Jail and the Lower Buckeye Jail from my Garmin Nuvi GPS. I also look forward to erasing all the Jail and Court information numbers from my cell phone.

Another day at Maricopa County Superior Court... It Ain't No Boston Legal...

Well it was another day spent in the Maricopa County Superior Court system.

I dunno, I guess I thought it would be something like Boston Legal, where the defendant would get to say things, lawyers would get to say things, Alan Shore would make an impassioned speech, and then we all smoke cigars with William Shatner.

It ain't like that.

The 7 or 8 defendants were shackled to their chairs, seated where the jury would normally be. As we walked into the courtroom, a long statement about Your Rights Under the Law was being spoken over a loudspeaker in Spanish. Lawyers (about one per defendant) were milling around. There was no judge at the bench yet. We were told by a voicemail recording to go to courtroom 813. Then just to be sure, we called the main number at the courthouse and was assured it was in courtroom 813.

There ain't no court 813. On the 8th floor, there were courts 801 through 805.

It actually was in Courtroom 1001.

Then the judge came in. We all dutifully came to our feet. Then it was down to business.

About 3/4 of the defendants spoke no English. The Spanish translator acted as go-between.

At one point, one of the Spanish-speaking defendants wailed, "But this is my 4th hearing! I've got rights!!"

To which the judge pithily replied, "yeah, good luck with that... NEXT!!!"

Truly, as nation, at times (no not always), we are fucked.

Visiting the Durango Jail, Maricopa County Arizona

We went to visit our friend at Durango Jail yesterday. This was the first time I myself went back to visit, I've been letting my roomie visit while I sat out in the waiting room or in the car. I just didn't want to go back there. Also, there is a sign on the window where you sign in and they take your driver's license and check to see if there are any Wants or Warrants out for you. For some reason, as ridiculous as it sounds, I had this strange anxiety that they'd run my license and then I'd get arrested. Then, I guess I could get a really up-close-and-personal exposure to the Maricopa Jail experience.

Of course, that didn't happen, I registered for my visit without any problems or surprise arrests.

So after all these weeks, I finally know what happens when you actually visit.

• When you visit, if you don't have someone that can hold your stuff for you, plan to leave everything in the car except for your car key, your ID and 2 quarters.
• You are called by name to the door, where you are reminded that you can't have on any belts, earings, jewelry, hair ties, bracelets, short pants (shorter than your lower thighs), etc. You also can't have any kind of jacket/sweater/coat with a hood or a zipper. No sleeveless shirts or shirts with plunging necklines.
• You are allowed to bring back one single key.
• Everything else has to be locked up in a locker or returned to your car.
• Once you are allowed past the door, you pass through a metal detector.
• Then you go back into a large room with, oh, about 40 tables (about the size as what you would see at a fast food restaurant). Each table has a double-width chair on each side (again, same as you'd find at a fast food restaurant).
• On one side of the table is the prisoner, in striped black-and-white prison garb. His hands are handcuffed at the wrist and attached to the table. His ankles are also chained.
• Across the table is a 4-inch tall wood barrier. Prisoner and visitor(s) are not allowed to reach over the barrier.
• No touching, kissing, hugging, holding of children, passing of any items whatsoever from visitor to prisoner.
• Children can visit with the parent but they can't be running around the place, they have to remain seated and have to behave well enough to be in control during the visit.
• Even though the visits have been for 30 minutes, we notice the guards have let visits last as long as 45 minutes.
• At the end of the visit, a guard comes up and taps the table with his/her fingers and tells you "time's up" and you leave.

Other interesting facts I learned about life in the jail:

• Durango Jail was originally built as a mental institution, and there is currently some litigation going on because the facility is filled with asbestos and lead paint.
• Prisoners are housed in "pods" with 16 prisoners per pod. There are no locked doors or bars separating the pods.
• Prisoners can walk around at their leisure but must be in their cots for "body count" for an hour each night.
• Guards (both male and female) walk around the pods every 12 minutes.
• To use the commissary, prisoners place an order for miscellaneous items on Sunday for the following week.
• Sodas are about $1.50, which I thought was pretty reasonable since I've paid as much as $2.50 in high-priced hotels. However, sodas are warm and they don't have access to ice.
• There is a network where prisoners share their books that they've bought from the commissary.
• There's no way for a prisoner to call a phone number without using a long distance per-minute account. So even if you have a local non-cellular land line, they can't call it without spending about 25 cents/minute.

4th Ave Jail, Durango Jail, Maricopa Superior Court: A How-to Guide

We've had an awful lot of exposure to local law enforcement. To make an incredibly long and sorded story short, one of our friends is in jail, and we've been dealing with the aftermath.

It has been an eye-opening experience. Generally, trying to keep up with someone who is incarcerated can be pretty dehumanizing and even scarey. We started off at the Scottsdale Jail (whose lobby looked like the lobby of a mid-priced hotel, with nice wood flooring, and plenty of brass fixtures and potted plants). But it turns out that prisoners are never kept at that jail, and are summarily transferred to the Maricopa County Jail.

Basically, the Maricopa County Jail facility is, to be indelicate, a shit hole. Located on 4th Ave south of Madison, it is a four-square block of Hell transported on Earth. We didn't know the area well enough to find safe parking, and had to park on the street and feed quarters into the marking meter (which were inexplicably sticky and malfunctioned often).

This is not a happy place, and generally everyone there was pretty mad. We couldn't meet with our friend, and we ended up sitting in the waiting room (where all the seats were bolted into the cement floor, both bathrooms were out of order, and all of the deputies were behind bullet-proof glass) for almost 6 hours. For much of the time, I held a cap-less ball point pen in my fist to use as a weapon.

After three days, our friend (who at this point we had yet to be able to visit) was transferred to the Durango Jail, located off Lower Buckeye Road in south Phoenix. This facility is not nearly as scarey as the 4th Ave Jail, and now that we have been there several times to visit, we've gotten the hang of things and know where to go and where to park (they have a very nice free of charge gated parking deck across the street from the lobby). This place is more family oriented, and there were plenty of regular folks, and even the children were pretty safe.

Some thoughts:

• In the name of the Holy Lord Jesus Christ, you don't want to be arrested and you don't want to go to jail.
• We've made excellent use of our Garmin Nuvi GPS. We've driven to "the nasty part of downtown" several times now and it is almost old hat.
• The best place to park for the Jail is a parking deck located on 4th Ave just north of Madison but we never parked there.
• The best place to park for Maricopa County Superior Court Building 101 W Jefferson is a parking garage on the north side of Jefferson between 4th Ave and 3rd Ave. It's something like $2 per hour with a max of $12 per day. I'm going to start parking here for my Jury Duties. It's a fairly close walk to the 4th Ave Jail.
• When you visit someone at the Jail, no one gives you any instructions, and there are very few signs. For some reason, they just assume you know what to do. 1) Go directly to the window and get a visitation form. 2) Go fill it out. If you don't have the prisoner's booking number, you have to call a number which leads to voicemail hell and it will totally mess you up so try to call before and get the booking number. Once filled out, wait for them to call the number they wrote at the bottom of the form. 3) Once your number is called, go up to the window where you will show your ID. If you are not a US citizen, you have to show an immigration ID. You will also have the opportunity to put cash into the prisoner's cash account. One morning they weren't calling out numbers (but didn't make an announcement) and it was assumed somehow that you would know to just bring the form to the window when you were done. 4) Wait until they call your name. You can only have your ID and a single key. Everything else must be locked up in a little locker that takes (I believe) 2 quarters, similar to the type of lockers they have at bus stations. You can't have any belts, any type of jacket/sweater/coat, no hair bands/clips/ties.
• Interestingly, if you allow your GPS to navigate a straight line from Paradise Valley to the Durango Jail, you go right through the center of downtwon Phoenix, now known to us as Shitsville. Your best move is to get to 35th Ave and head south until you get to Gibson where you can make a left, and the garage is on the left.
• I have really gotten to love Google Maps, especially the Street View. It's been very helpful being able to look up the address and then even get street views so I know what some building looks like from the street. I've heard that Google Maps now downloads to Garmin Nuvi's but the street view gives the approximate street address for anything you find, so I can just enter that into the Nuvi and go.
• I'm still getting over the fact that two of my Favorite Places on my GPS are "Durango Jail" and "Maricopa Superior Court."

A meeting with Jean Watson... 2 stars out of 4...

Jean Watson spoke at our hospital the other day.

I had worked the night before, and my shift ended at about 0630am, but the meeting wasn't scheduled until 8a. So I spent more than an hour sitting in my car, parked in the employee parking deck, watching Rachel Maddow shows on my iPod.

The meeting was packed, with about 50 nurses attending. All of us were either charge nurses or clinical directors with a few clinical educators mixed in.

I think Jean Watson thought all of us were well-versed in her theory, and that everyone in the room was accustomed to the spiritual, metaphysical and existential nature of her work. I don't think she realized that very few of the nurses attending were very familiar with her book. Thus it surprised me when, with very little by way of introduction or preparation, she proceeded with a meditation exercise. She brought out a "singing bowl" very similar to the one pictured here, and she rubbed the rim with the stick which caused the bowl to resonate.

I've never been very good with meditation. I've tried several times to meditate and I just can't do it. So while everone else in the room bowed their heads and closed their eyes, I started to get a serious case of... the giggles.

To stop myself, I started calculating the Fibonacci sequence of numbers in my head.

Not a great beginning.

It's not that I don't believe in the theory. I do think it is important to appreciate our patients as a total, unique, spiritual, significant human being, and not simply a machine. That's something I can get behind.

But I was sort of hoping the meeting would be more of a "hands on" session, with all of us charge nurses discussing how to actually use the theory.

• What specific behaviors would be seen when observing a nurse that is well versed in the theory?
• What sort of verbalizations should be used? In other words, what needs to be said?
• How do you document use of this theory?
• How do you use the theory if your background and comfort zone is more scientific / numerical / logical / empirical?
• As a charge nurse, with scientific background/personality, how can I teach or model this theory for my nurses?

We didn't really go into that at the meeting. In fact, at one point, one of the nurses finally simply asked Jean Watson to go over the 10 Caritas Processes, to which she surprisingly replied, "Wow I'm not sure I can do that, I'm not sure _I_ even know them."

One of the nurses handed her a copy of her book, after which she did give a pretty good review of the basic concepts, but I was still taken aback that she didn't know her own material well enough to cite them from memory (although she did admit that she planned to do a more thorough discussion of the theory in a more general-audience meeting later in the day).

I guess if I had to rate the meeting, I'd have to give it 2 stars out of 4.

Jean Watson: Caring Theory of Nursing... Caritas Processes...

Updated 3/14/2009

   Our hospital network is adopting Jean Watson's Caring Theory of Nursing.

Most nursing theories are based on Nursing as a humane and compassionate application of a scientific method. Jean Watson encourages us to "return to our core values", and recall the "original reason we all went into nursing", things we as nurses tend to forget when carrying out the "clipboard nurse" type of nursing, where we exhaustively collect data in the form of measurements and numbers. Watson asks all of us as nurses to be more "in tune to the moment" when interacting with our patients (she doesn't like the "customer" model of the modern hospital), and realize that our interactions can be more humane, significant, and caring.

Nursing, as the underling of the medical profession, often works to turn the human being into the human body, further breaking him/her down into just a "body", and eventually just a "machine."

Nursing work too often focuses on "doing" rather than "being", and has become too easy to "do something" to a machine, things we would never consider doing to a human being.

Watson describes ten "Caritas Processes". Originally "Carative Factors," she redefines these essential "core values":

Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness

Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared- for";

Cultivation of sensitivity to one's self and to others, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self";

Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring relationship";

Promotion and acceptance of the expression of positive and negative feelings, becomes: "Being present to, and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for";

Systematic use of a creative problem-solving caring process, becomes: "creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices";

Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other's frame of reference";

Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, becomes: "Creating healing environment at all levels, (physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated";

Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials', which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; Allowance for existential-phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care for self and the one-being-care-for.

 

Our new Clinical Director gave all of us Charge Nurses a copy of Watson's book, which I dutifully read and attempted to absorb over a weekend.

It's going to be a challenge for me. I've never been that "spiritual" or "metaphysical", instead relying on my scientific background thoroughly grounded in skepticism and empiricism. A lot of these carative factors / Caritas Processes are difficult for me to understand on anything more than an intellectual basis. In other words, I have been unable to bridge the gap between vocabulary and meaning.

Jean Watson is scheduled to come to our hospital tomorrow, and I'll be meeting with her along with other charge nurses throughout the hospital in a 90-minute presentation.

Links:

Jean Watson's information page from the University of Colorado Denver.

The Watson Caring Science Institute's page.

From RNJournal.com, a good overview.

Search Query Results from PubMed.

A Pragmatic View of Jean Watson's Caring Theory.   A Word document giving a general review of Watson's Theory and a case study of its implementation.  (Viewer).