eric135

Self Scheduling

Flexible scheduling is one of the biggest attractors to hospital work for nurses. It's also a source of problems when people feel they are not getting the schedule they require for things like child care, school, and other personal factors. I'm handling the scheduling again. At The Old Place, it was the first responsibility I gleefully threw back at leadership when I disgustedly gave up my Team Leader position, but I must admit, I have excellent skills where scheduling is concerned, and so I always offer to do this task.

My scheduling process is unique. What I have done is placed everyone's name into Excel with the dates across the top. I print a blank schedule (names down the left side, dates across the top) and everyone just puts down an "N" for the days they wish to work. Every night that I work, I take these sheets and type that "N" into the computer, and I've programmed Excel to, for each day, count the total number of "Ns" in that column. So along the bottom of the sheet, I have a running total of the number of people that have signed up for the shift (each job description has its own sheet).

The trick to this is, as everyone comes in to work on a daily basis, they are supposed to examine this sheet, and as folks add themselves in (with me updating and re-printing the sheets several times a week), they shift their days around so that nurses on the over-staffed days voluntarily shift to one of the under-staffed days for the week.

This goes on continuously for 4 weeks, and I take the sheets up two weeks before the next schedule is to begin. Usually, there are not that many changes to be made, and I keep a list of who I move so that the same person is not moved every time. The final balancing act usually takes me about an hour (that's scheduling for two units, for nurses, nursing assistants, secretaries and monitor techs).

I know, some of you will balk at the idea of entering schedules on a daily basis. But really, it only takes about 5 minutes to put in the changes that get penciled in from one day to the next, and the constantly updated total at the bottom of the sheet really helps folks figure out when they have overstaffed. The constant message is always that it is better they move themselves (or arrange trades), because they all know that my final balancing will, without exception, have the same number of staff on duty each night.

It has worked out really well, but there are still some folks that just don't understand the consequences of their decision to go into nursing, instead of something like banking. I do have my "special children" every month, who get upset because I've moved them. But I always tell them they have had 4 weeks to move themselves, and chose not to do so. That usually settles them down.

The excel function, CountIf(range,value), is easy to use, if you are fluent in Excel.

I was supposed to work tonight, but I had my extra shift canceled due to low census. Of course, I am currently doing the Happy Hula Dance of Glee. It reminds me of that feeling I would get as a grade school student, when snow would fall, and school would get canceled.

God I miss rice. I've decided to just about eliminate it from my diet. White rice really is the equivalent of a Milky Way bar, but we Asians and Pacific Islanders just love it. Whenever I sit down to a dish of meat that comes with some kind of sauce, it feels un-natural to eat it without rice. I've missed the passing of my rice more painfully than any person I have dated, loved and then bitterly lost. It's an ache that never goes away. A flower blooming in the desert. My heart rises and sets in rice. OK that's enough for now.

I read on 43 Folders some great tips on how to schedule meetings:

• Make everyone drink a bottle of water before coming to the meeting.
• Schedule the meeting just before lunch.
• Remove all the chairs from the room.
• Meeting's over when everyone needs to pee.

I love it.

I got on the scales yesterday, and I've lost six pounds. Cool. I've only been back in the gym since June 30 (feels like longer) and I'm already seeing results on the scale. My clothes feel better too. I've been trying on shirts and scrubs that had been too tight, and I can get back into them.

I'm switching to the elipse machine. Tried it for a few minutes after the bike, and it got my heart rate up to the 130's and it didn't hurt my knees at all. I did, however, get this absolutely crazy idea in my head that I could keep up with the skinny girl on the next machine. She's, like, 25 and about 100 pounds. I'm 43 and 160 pounds. The idea of keeping up with her was insanity. My heart rate shot up to about 160 and I decided I had better quit before I coded.

I'm working on Harry Potter and the Half-Blood Prince. I didn't pre-order it. I actually got it at Fry's Grocery. There was a rickety table set up right in the middle of the vegetable section with about 20 copies on it. I figure I probably saved 5-10 bucks on shipping an handling getting it at the store. It cost me 17.50 plus tax.

Monsoon season has officially begun. We've had thunder and lightening every evening for the past several days, and it rained a bit earlier tonight. I just hope it cools us down a bit. In the apartment and at work, of course, we're fine, but there have been heat-related deaths due to the heat. I read about a dog training facility a few miles north of us, where the air handling system failed overnight. 28 dogs dead, all while their owners were out of town on vacation. I can't imagine getting a phone call telling me my pet has suffocated. God how awful.

We went to see Charlie and the Chocolate Factory yesterday. Once again, I was not terribly impressed, but visually, the movie was impressive. Johnny Depp did a great job. Too good -- he played a reclusive single man with a weird attraction to children, who invites children into his home, and offers one boy the chance to live with him in the factory. He has an overbearing and abusive father whom he resents, and an absent mother. He really gets into music. Depp's skin tone was this weird and artificial slightly-green tinge. I'm tellin' ya, it was Michael Jackson all over, and it disturbed me.

The movie took advantage of serious racial stereotypes.

The Oompa-Loompas were all computer-generated from one guy, and he pulls off some impressive dance moves, but he's not exactly a great dancer. More like watching your dad or an older uncle dance disco. And the music was updated. But, again, it was another remake, and I think my fancy returned to the previous version.

I decided to use the stationary bike again this morning, rather than swim. I had pulled out my Polar heart rate monitor, given to me for Christmas last year. I had entered my age and it calculated my target heart rate at 115-150 bpm. Even with the bike resistance set at 1 or 2, I was still able to keep my rate between 105 and 115. I'll have to work myself up to keep it at around 120 for 30 minutes. I'm more interested in how much my knees will tolerate. They didn't hurt any more than usual after yesterday's workout, and they feel fine now. Hopefully, I'll get some additional flexibility. I don't know if they make such a thing, but I really need a bike where you can adjust the pedals, being able to select a smaller circle (shorter range of motion) when needed. Right now, the pedals take me from almost locking out my knees to about 90 degrees. It's a bit much for me.

At work, I am charge for two separate units, a total of 51 beds, all telemetry and med/surg. During the summer months, when the census drops, some units throughout the hospital are closed, and it was our turn to close one of our units. A lot of staff getting canceled. The odd thing about nursing is that, instead of people resenting getting called off, there is always a lot of competition to get canceled. I'll get about a dozen calls throughout the shift, all nurses and other staff wanting to be called off, even when they know full and well I can't cancel anybody until 0430 AM after all of the sick calls come through. I finally had to tell the unit secretary that, for all calls asking for me, she tell them that I'm not canceling anyone until 0430 and only if it's something else, to page me for the call. I find that the general rule for nurses to use is that, the tendency to be canceled is inversely related to the desire to be canceled. The more they wish for it, the less likely it will happen.

The air conditioning was sort of on the fritz. It worked, but didn't keep things as cool as usual, and I think it made the patients more irritable (bitchy would be the politically incorrect but more common term). We're in a bit of a heat wave (even worse than our usual) and it's mid 90-s even at night. We had five patients lose it mentally that night. So we went around and removed extra blankets from the patients that were "on the edge." No more flip-outs that night; no idea if the blanket thing had anything to do with it.

I forgot my swim suit when I went to LA Fitness this morning. I was going to just bag it and go back home, but I had worn stuff that could count as work-out wear. So I decided to look around the place and find something to do. I ended up finding an entire wing that includes an aerobics room, four racquetball courts, and a little bar that sells expensive water and juices. Then I walked up the stairs where all of the machines are. There must have been more than 50 machines -- treadmills, bicycles, elipse, stair-masters.

So I figure, with my bad knees, I'd go for one of the treadmills. I get on it, and, as God is my witness, the control panel on that thing must have been three feet wide and two feet tall. Last time I used a treadmill, it had maybe a 12-inch by 8-inch control panel. This thing could apparently launch our offensive nuclear weapons. I couldn't, for the life of me, get it to turn on.

Near me were a few girls walking on their treadmills. They looked 15 but were actually in their 20's. Skin-tight leotards. Neoprene fanny packs holding mp3 players. Headbands. Scrunchies. The whole bit. Skinny anorexic bitches that probably throw up food after meals. I wasn't going to ask them how to get the thing running.

I decided to move over to the bike. It snapped on once I started pedalling. I spent 30 minutes, between levels 1 and 2 (out of 10), I was afraid of working any harder and messing up my knees. It was actually a nice change in routine.

OK time for breakfast -- a bowl of Special K cereal. No plans to throw it up, though.

We went to see The Fantastic Four yesterday.

• Some guy on Headline News gave it really low ratings due to there being no plot. But there was a plot. The problem was that they spent WAY too much time developing the characters.
• Superhero costumes are getting tighter and tighter. I figure the next superhero movie, when the person in charge of costumes shows up on the set, she'll be carrying a box of different colored spray paint. I almost felt sorry for the actors to have to wear that stuff. Sexy isn't the word. Try Clinical.
• The acting was horrible. The movie totally existed for the special effects.
• The guy that played Doom (the bad guy) looks like the guy on Bravo with the reality show based on hair stylists. In fact, I thought it really was that guy from the reality show.

I watched Chronicles of Riddick on TiVo. That scene where they break out of that prison on Crematoria? that planet where, when the sun came up, it temperature hit 850 degrees? Phoenix is like that these days. Anyway, it was a good movie, and hope they keep making them. The uniforms/armor were better too.

My last night at work was stressful. No, I didn't have any stat ICU transfers, the kind where four of us kick a wobbly bed down the halls against the walls, slamming into things, on the way to the unit.

One of our patients became confused. Not a big deal, but the nurse assigned to her is pregnant, so I went in there to assess whether my nurse was still safe, or if I would have to switch assignments. The patient seemed relatively OK -- knew her name, where she was. Very polite with lots of "please" and "thank you"s. I didn't think anything about it.

Five minutes later, my nurse comes into the office. She's crying.

"She kicked my baby."

Apparently, the patient had allowed the nurse to administer IV medications (Haldol), and when my nurse started to turn away, she reared her leg up and thrust it out and kicked the nurse. Not a glancing blow. It made solid contact.

I sent her to the ER. She was reluctant but she certainly wasn't staying on duty after that, and I really wanted her to get checked out. Four hours later, she's dc'd from the ER with a negative ultrasound.

I couldn't walk into the room for the rest of the night. I checked with her nurse -- I picked a large male nurse this time -- to make sure things were ok. But I couldn't go in there. I was just so angry at her. I know, she's confused, and how could I blame her for her actions? But I did, and that's why I decided I couldn't go in there. I tried to be Maria for an hour, then decided I just couldn't. She was confused, but part of her knew what she was doing. She was GLEEFUL that she had kicked the baby. And I am weak and just can't get my head around that.

Later that night, I'm walking down the hall past the elevators. Our next admit from the ER was arriving, an elderly man in for periodic fainting spells.

What caught my eye were all of the guns. Black metallic guns holstered. Seven guns in all, all attached to the hip of a federal guard. Hmmm, no one mentioned to me my patient was a prisoner.

Each of the guards wore a bullet-proof vest. Black. They matched the guns. Many of the guards held their hand casually on the gun grip. Are they poised for combat? or maybe that's how they always stand?

I checked with the nurse to see if she was aware of the situation, and, God Bless Her, she was totally fine with it. Even the guns didn't throw her off. But the patient care was weird. Two to four guards in the room with the nurse at all times. No privacy. Guards answered all the demographic questions.

Once, the IV pump beeped, and I just sauntered in there to clear the line. I guess I threw the guards off because I just walked in there, like some sort of charge nurse, or something. As I cleared the alarm and checked the patient's arm, I exchanged a few generic pleasantries with the patient -- a jovial friendly man, no blood on his hands. No Hannibal Lechter with the weird face-mask, enjoying someones liver with some farver beans and a nice chianti. Just an old guy with dizzy spells. As I left, I only partially registered the metal chains between his wrists and the bedframe, and between his legs.

As I walked out, I finally took in the four guards, who had slipped into the room behind me. Hands on their holsters. My goodness.

I'm off for three days.

The guy that opens up the club in the morning overslept, or something. About five minutes after 0500, people were banging on the doors. My God, people have been more civil grabbing bags of rice dropped from helicopters in times of famine. I don't know when they get there, but there is a man and woman who clean up. I guess they get there even earlier than the open-up guy does. The poor woman, who I don't think speaks a word of English, got a lot of smart-ass comments once she decided to open the doors just a few minutes late. And who knows, she might even get in trouble for that. What's up with people these days?

Afterwards, I went to Fry's Grocery. I've been eating Special K cereal (compared to Apple Jacks, my childhood favorite, it leaves much to be desired). I was tortuously stuck behind this huge woman buying two carts of groceries. She pulls out her credit card [surely, you can see this coming, can't you?] and the register beeps. A manager comes over. Credit card declined.

"Must be a mistake, try this one," she says. Another card, another beep.

It's 0630 AM. It's the only register open. There's a line of about a dozen people (one slim muscular guy buying Apple Jacks, BTW), all just staring at her.

They opened another line, and the guy let me be the first to be rung up. Out of the corner of my eye, this fellow comes in through the front of the store. He's carrying a beautiful green glass vase completely filled with about $100 bucks worth of pennies. He's walking toward one of those penny counting machines, but he's just casually holding that heavy vase non-challantly with one hand [surely, you know where this is going] and he drops it.

A tremendous crash, as green glass and copper pennies fly everywhere. Right at the front of the store, where the folks enter and exit.

I quickly paid for my box of Special K, gave a mean sneer to the muscle-guy with the box of Apple Jacks, jumped over the pile of broken glass and pennies, and left.

I TiVo'd The Birdcage and have watched it on-and-off the past several days. We have it on DVD but TiVo recorded it off Bravo. During the commercials, they gave out little factoids on the movie. For instance, Robin Williams was originally cast as the drag queen, but felt he would not have been able to give enough of a flambouyant portrayal. I can't imagine that movie with anyone other than Nathan Lane cast as the drag queen.

One of my favorite scenes is the one close to the beginning when Albert is walking down the street, shopping in a farmer's market-type environment. God I'd love to do that, complete with the outrageous vest, that hat, the little bag (I actually have a few of those, now that I mention it), the glasses with the chain, the whole bit. Just walking down the street, amidst all of that color, all of the personalities... the guy with the lobster. Nothing about being gay or straight, male or female. Just the pure enjoyment that the scene so successfully captures.

Always, remember: Men SMEAR... God I love that...

I've been trying to cut down on the carbs in my diet. That means not so much rice. Yes, it's absolutely killing me. But it's starting to pay off. Between the swimming 4-5 times a week, and the changes to my diet, I feel a lot better. I just wish the atmosphere at the fitness club was a tad more friendly. No one talks to anyone there. Not even simple "Good morning". Of course, I don't care, I'm going to say Hello and Good Morning to anyone that comes within a 6-foot radius, even if I do get the Doe-In-Headlights look.

I just feel so sorry for the girls. Men don't talk because of the machismo. But the girls don't talk because they must, at all times, make themselves clearly intolerant of testosterone-induced pick up lines. I rarely say hello to them unless they make eye contact and say something first. I just wonder how much fun working out can be when you have to have your shields up all the time like that.

Sometimes, I really miss one of my first gyms, called Wolfgang's Gym, in Richmond, Virginia. Everybody talked to everybody, and it didn't matter how big or how small you were.

Sunday morning makes my sixth trip to the pool. It was my first Sunday, and unlike during the week, when LA Fitness is open at 0500, on Sundays it doesn't open until 0700, so I was sort of worried the pool would be crowded. Boy was I wrong. When the doors opened, only 4 of us were waiting to get in (unlike the dozen or so during the week), and I had the pool to myself almost the entire time.

I'm getting better at the laps. I can swim for 30 minutes, and after about 4 laps, I start having to take short breaks (down from a couple of minutes to now 10-15 seconds) between lengths. I'm still limiting myself to 30 minutes, while working my laps up, and i'm up to 13-15 laps.

I was a tad distracted today. The sun was high in the sky when I started, and I'm accustomed to start my laps just as the sun comes up. Also, I was spending the time thinking about issues at work (like how I'm going to head that meeting about getting our survey scores up, and hope I don't go off one one of my Monkey Rages at the meeting). I have one nurse (not a new grad but new to us) that is having problems. The consensus is to let such nurses go (they can hurt patients, they can hamper teamwork, they can get us sued, yada yada yada) but my vision has always been that I should do everything I can to keep nurses in nursing for as long as they wish to be there. And if that means giving someone some extra time and coaching, then I'm going to do it.

But nurses can be such bitches. They say we eat our young, but that's just for a snack. We really tend to feed best on the fresh bloody flesh of our peers. So the negativity becomes a leadership challenge.

Oh, and above all that, after my 8th lap, I couldn't get the idea out of my head that I had forgotten to pack a fresh change of clothing for after my workout. I usually come dressed in a swimsuit, T-shirt and shoes. The logistics of getting out of the club sans pants and underwear was a tad distracting (luckily, I did pack a change of clothes -- whew!)