This weekend I got a call from a friend from college. We had a really nice conversation, but I left it feeling old. Her daughter just finished her first year of college. When did I get old enough to have a friend with a kid in college?
Yeh. Over the last 19 years, mush-for-brains.
As we talked, the conversation centered on her kids, her health, and her job. We talked a little about me - I did more listening this time. It was alright with me to do so. I was secretly pleased to hear of her health issues - that's one thing I did better than her! My health is good, hers is not so much. I know, I know...this is terrible of me to admit, and I certainly don't wish ill health on her and she hasn't had an easy life, by any stretch of the imagination. She is closer to the norm of a 40 something female in America at this time - divorced, overweight, single-Mom, lonely and looking for answers, working in an underpaid female dominated industry, and two of her kids are learning disabled. Scraping by in the economy, but rich in relationships. She embodies American society.
In this human form, in our western culture, it is very hard not to compare and compete. I am not the norm. I envy her conformity, in some ways.
It is hard to transition psychologically from being the hope for the future, to being the establishment. From being young to being old. From wishing and dreaming to remembering and sometimes regretting. From having endless possibilities, to living with the consequences of your choices (good and bad).
Nobody teaches you this in a real sense. This life down here is really hard.
Thursday, July 24, 2008
Tuesday, July 15, 2008
Whew!
I had a pretty good day at work yesterday and I would like to write about a few things.
My IV skills are staying about the same. I have been having some bad luck in the last several weeks but yesterday I placed 4 out of 7 attempts successfully. Not bad and I only had to get help once! I still get a thrill on placing an IV successfully - I hope that feeling lasts. And, don't worry, those 7 attempts were on 3 different people and two of them needed 2 IVs. I didn't poke 1 person 7 times!!!
I got all my paperwork done at a reasonable pace. I wasn't pushed too much. My patients were generally pleasant people. It was sunny outside and I got my lunch break on time. I got a couple of breaks. I got to chit chat with some of my favorite colleagues on the job (even one of the doctors). I am a happy woman.
One of my patients was nearly my age - about 6 months older than me. His cardiac cath revealed that he has severe coronary artery disease and he will go for bypass surgery this week. It gives me pause when my contemporaries come in, and have bad disease. You hope they are all false alarms!! He should do very well with the surgery, however, I am not sure he understands how his life will change in the future. I don't know if anyone talks to him about his risks in the future, such as possible heart rhythm changes necessitating a pacemaker, possible restentosis of the bypass grafts requiring a second bypass. If the disease continues, he will be out of options - they can only do bypass twice.
Of course, technology may be very different in 20 years and there may be more options available then.
I don't know what the "right" answer is - in this person's case, without surgery it is very likely he will die young from a massive heart attack. The kind where the person just keels over one day and hopefully doesn't survive...because if he did survive he'd likely have a lousy life remaining. There may be no value in giving him all the information about what is to come after bypass - and it may even be a detriment because it could cause him to delay or cancel the surgery with dire results.
But I digress. I've digressed along these lines before; I think the decision process for surgery is fascinating and complicated.
My point in writing about this patient is that he had two 11 year old children - twin girls - that came to see him. I found those kids insufferable. Yakkity yakkity yak. No seriousness. You'd think they'd have some sense of the situation, that Daddy's in the hospital and he's going to have major surgery. He could die. He could even die before the surgery. Nope.
On the one hand they are ignorant and I suppose their parents did not impress upon them the seriousness of the situation.
On the other hand, they are 11 years old and should have some idea about what a hospital is and why people go there, and such. Maybe no one ever taught them about it.
Maybe Mom and Dad don't appreciate the situation, either.
Broken family. Naturally, Mom and Dad are divorced. Dad's "main family contact" is his ex-wife. I just don't get that. If you need to remove someone as intimate as a spouse from your life, why do you continue to hang around with them? When you have broken the family, why do you continue to act as a family when it's convenient?
My subject for this post refers to how relieved I was that I was turned off by the kids. Yes, I am not parent material after all, and despite my doubts, not being a parent is really the right thing.
My IV skills are staying about the same. I have been having some bad luck in the last several weeks but yesterday I placed 4 out of 7 attempts successfully. Not bad and I only had to get help once! I still get a thrill on placing an IV successfully - I hope that feeling lasts. And, don't worry, those 7 attempts were on 3 different people and two of them needed 2 IVs. I didn't poke 1 person 7 times!!!
I got all my paperwork done at a reasonable pace. I wasn't pushed too much. My patients were generally pleasant people. It was sunny outside and I got my lunch break on time. I got a couple of breaks. I got to chit chat with some of my favorite colleagues on the job (even one of the doctors). I am a happy woman.
One of my patients was nearly my age - about 6 months older than me. His cardiac cath revealed that he has severe coronary artery disease and he will go for bypass surgery this week. It gives me pause when my contemporaries come in, and have bad disease. You hope they are all false alarms!! He should do very well with the surgery, however, I am not sure he understands how his life will change in the future. I don't know if anyone talks to him about his risks in the future, such as possible heart rhythm changes necessitating a pacemaker, possible restentosis of the bypass grafts requiring a second bypass. If the disease continues, he will be out of options - they can only do bypass twice.
Of course, technology may be very different in 20 years and there may be more options available then.
I don't know what the "right" answer is - in this person's case, without surgery it is very likely he will die young from a massive heart attack. The kind where the person just keels over one day and hopefully doesn't survive...because if he did survive he'd likely have a lousy life remaining. There may be no value in giving him all the information about what is to come after bypass - and it may even be a detriment because it could cause him to delay or cancel the surgery with dire results.
But I digress. I've digressed along these lines before; I think the decision process for surgery is fascinating and complicated.
My point in writing about this patient is that he had two 11 year old children - twin girls - that came to see him. I found those kids insufferable. Yakkity yakkity yak. No seriousness. You'd think they'd have some sense of the situation, that Daddy's in the hospital and he's going to have major surgery. He could die. He could even die before the surgery. Nope.
On the one hand they are ignorant and I suppose their parents did not impress upon them the seriousness of the situation.
On the other hand, they are 11 years old and should have some idea about what a hospital is and why people go there, and such. Maybe no one ever taught them about it.
Maybe Mom and Dad don't appreciate the situation, either.
Broken family. Naturally, Mom and Dad are divorced. Dad's "main family contact" is his ex-wife. I just don't get that. If you need to remove someone as intimate as a spouse from your life, why do you continue to hang around with them? When you have broken the family, why do you continue to act as a family when it's convenient?
My subject for this post refers to how relieved I was that I was turned off by the kids. Yes, I am not parent material after all, and despite my doubts, not being a parent is really the right thing.
Saturday, July 12, 2008
The Poker Group
I belong to a poker group. Nothing formal, we get together about every 2 weeks at someone's house and play Texas Hold 'Em, no limit tournament style. A little bit of money is involved. I have learned how to play reasonably well, which makes it that much more fun. Some days the cards go in my favor, some times they don't. Often I get mediocre cards, and the trick is all in how I play them. Much like life.
I think about poker and the differences in how women and men play. As you might guess, as a female, I am in the minority - I'm usually not alone, but last night was pretty typical - 4 men, 2 women. It was an average night of play for me; I was out early in the first game, but took second place in the second game. Taking home some money satisfies me. As long as I play fairly well and get a few good hands, I am happy. Of course I prefer to win, but it's not like the men. They really like to win.
Men like to bluff in a poker game. They like to get the better of someone by bullshitting them, achieving this seems to be a badge of honor. As I thought a bit, I saw similarities in the poker bluff and to men go about pursuing women when dating - they try to bluff their way into seeming just a little bit richer, more clever, luckier, more glib, more socially connected, etc. than they really are. That's all in the game. If the poker bluff fails, they still get admiration from their peers - that was a ballsy move.
I generally don't bluff. Every once in a while I try it and occasionally it works. Sometimes my bluff starts out legitimate, and it falls apart when the flop, turn, and river are revealed. Usually I stop my losses when I see my chances slip away, I'm such a wimp!
Experience has helped. I know what a good hand is and I pretty much know how to bet it. I could learn more about pot odds, reading other players' actions better, modifying my behavior to play the cards I have better. Practice and a little research would help; in fact, I read most of Phil Hellmuth's book on Texas Hold 'Em and it improved my game significantly. It gave me a different way of thinking about the game and the players.
I doubt I'd ever make any real money playing poker. It's fun. It's social. And most importantly, it's something my spouse and I do together. Very valuable.
I think about poker and the differences in how women and men play. As you might guess, as a female, I am in the minority - I'm usually not alone, but last night was pretty typical - 4 men, 2 women. It was an average night of play for me; I was out early in the first game, but took second place in the second game. Taking home some money satisfies me. As long as I play fairly well and get a few good hands, I am happy. Of course I prefer to win, but it's not like the men. They really like to win.
Men like to bluff in a poker game. They like to get the better of someone by bullshitting them, achieving this seems to be a badge of honor. As I thought a bit, I saw similarities in the poker bluff and to men go about pursuing women when dating - they try to bluff their way into seeming just a little bit richer, more clever, luckier, more glib, more socially connected, etc. than they really are. That's all in the game. If the poker bluff fails, they still get admiration from their peers - that was a ballsy move.
I generally don't bluff. Every once in a while I try it and occasionally it works. Sometimes my bluff starts out legitimate, and it falls apart when the flop, turn, and river are revealed. Usually I stop my losses when I see my chances slip away, I'm such a wimp!
Experience has helped. I know what a good hand is and I pretty much know how to bet it. I could learn more about pot odds, reading other players' actions better, modifying my behavior to play the cards I have better. Practice and a little research would help; in fact, I read most of Phil Hellmuth's book on Texas Hold 'Em and it improved my game significantly. It gave me a different way of thinking about the game and the players.
I doubt I'd ever make any real money playing poker. It's fun. It's social. And most importantly, it's something my spouse and I do together. Very valuable.
Monday, July 7, 2008
Saturday, July 5, 2008
Yearning for Adventure
In my quest to become the type of person I admire, I have made some changes in my life. One of the motivations of my career change was to become one of those career changers - I have admired them, and now I am one!
Near the end of my 30s I realized how few places I have been in the world. I admire those young people who put off their careers in order to travel. I admire people who speak more than one language. I want to be like them and I made the resolution to do it. This is one reason why I started to learn Spanish on my own. I figured I was getting older anyway. Might as well learn something and be a little smarter at 48 than I was at 38....
The trip to Japan in October is a result of this desire to become more experienced in international travel. I have only rarely been in a place where I was totally different, where the culture and the environment is so very different. I think it will be good for me to experience some culture shock. See other ways to live.
Once I did go to Israel with a church group. I was eager to get away from the safety of the tour group (when possible) and try to get around on my own. I did. In the market place of Jerusalem, in the old city, the vendors shouted out to me in German. Not English....until I muttered "no, thank you." Then their trinkets cost one dollar, not ein deutchmark.
I am a free woman. I don't have my own family to tie me down. My job is terrific but not something I feel compelled to keep at all costs. I have a house and pets, and I enjoy my activities in my community. Yet, I am free. My friendships are fluid, not binding. My family of origin is not dependent on me. I am not a caregiver (except professionally). No one needs me. I am healthy, and I do have some money.
So why don't I exploit my situation?
I don't know. Why don't I?
A coworker brought to my attention the lifestyle of being a travel nurse to the middle east. Saudi Arabia, to be precise. The pay is outrageous, the money is not taxed in the kingdom, and the lifestyle is supported (housing, transportation, etc.). There's 7 weeks of vacation a year, when I could visit Europe or Africa. There's an active expat community living in specialized housing to insulate me from the middle eastern culture when I would want it.
This coworker is thinking seriously about doing it - she is a free woman as well. How fun it would be to go with her and have a year-long adventure half way around the world, and be much richer in many ways for doing it.
To be honest, the idea has interested me. Could I do it? Would I do it?
Fear keeps me from really thinking about it seriously. I mean, there's so much to arrange. Who will take care of my dear pets? What about the house? My car? My job? What about my parents?
Fear is a lousy excuse. My husband could probably get work there, himself, being in the computer field. And he said that he could be talked into it.
I wonder...
Near the end of my 30s I realized how few places I have been in the world. I admire those young people who put off their careers in order to travel. I admire people who speak more than one language. I want to be like them and I made the resolution to do it. This is one reason why I started to learn Spanish on my own. I figured I was getting older anyway. Might as well learn something and be a little smarter at 48 than I was at 38....
The trip to Japan in October is a result of this desire to become more experienced in international travel. I have only rarely been in a place where I was totally different, where the culture and the environment is so very different. I think it will be good for me to experience some culture shock. See other ways to live.
Once I did go to Israel with a church group. I was eager to get away from the safety of the tour group (when possible) and try to get around on my own. I did. In the market place of Jerusalem, in the old city, the vendors shouted out to me in German. Not English....until I muttered "no, thank you." Then their trinkets cost one dollar, not ein deutchmark.
I am a free woman. I don't have my own family to tie me down. My job is terrific but not something I feel compelled to keep at all costs. I have a house and pets, and I enjoy my activities in my community. Yet, I am free. My friendships are fluid, not binding. My family of origin is not dependent on me. I am not a caregiver (except professionally). No one needs me. I am healthy, and I do have some money.
So why don't I exploit my situation?
I don't know. Why don't I?
A coworker brought to my attention the lifestyle of being a travel nurse to the middle east. Saudi Arabia, to be precise. The pay is outrageous, the money is not taxed in the kingdom, and the lifestyle is supported (housing, transportation, etc.). There's 7 weeks of vacation a year, when I could visit Europe or Africa. There's an active expat community living in specialized housing to insulate me from the middle eastern culture when I would want it.
This coworker is thinking seriously about doing it - she is a free woman as well. How fun it would be to go with her and have a year-long adventure half way around the world, and be much richer in many ways for doing it.
To be honest, the idea has interested me. Could I do it? Would I do it?
Fear keeps me from really thinking about it seriously. I mean, there's so much to arrange. Who will take care of my dear pets? What about the house? My car? My job? What about my parents?
Fear is a lousy excuse. My husband could probably get work there, himself, being in the computer field. And he said that he could be talked into it.
I wonder...
Saturday, June 28, 2008
Griselda in da House
Eleanor Roosevelt called her episodes of depression "Griselda moods." I am experiencing one now, for the past week or so. It is rarely caused by one incident, usually a few downers happen at a time when I am vulnerable. Here I am...if my posts are somewhat melancholy for the next few weeks, this is why.
The following sequence of events caused my downturn. First, I learned that my friend who got me into the Summer Singers told me that she won't be able to sing this year after all. I don't know any one else in the group. Yeah, I know, I can meet people, and I probably will, yet I am disappointed. I skipped a rehearsal last week, and I gave myself some unnecessary guilt over that.
Then, the mediocre charge nurse performance. Then guilt about not getting my stuff done at work and going in on a Saturday. Only to be sent home early on Monday. I mean, really, people.
On Saturday night I went out for dinner with a women's group at my church. I keep hoping that group will be a community for me, but it keeps disappointing me. After a year, I am still the newbie, and the others all have a long history together. They talk about all the fun things they've done with their mutual friends. I do make an effort to change the topic of conversation to something I can participate in, but it doesn't succeed for long. And there's one woman who constantly expounds on how intelligent and insightful her little boy is. He just says and does the most *fascinating* things! Heh. I barely even know the 5 year old and I just don't find that kind of topic all that interesting. It makes me think there's a great disconnect between me and that group. Maybe I need a different group.
At work this week, I went in for my meeting (on my day off, might I add) and only two people showed up. I drove in on a day I didn't want to for the honor of being ignored. Great. At least I got paid.
And they wanted me to be charge nurse again this week, two days in a row. After my previous performance, I was hesitant and anxious about screwing up again. I did it anyway. I did OK - some mistakes, some successes (see my post from yesterday).
During the week, I got an email from an old friend from North Carolina, whom I haven't heard from since December 2007. The email was basically: Hi - how are you - I know I haven't written, but I've been so busy, it's just crazy - can't wait to hear from you again - more later...
I replied with a nice update on my life now. Realistically, I expect to hear from her again sometime about January 2009 after she receives her Christmas Card. Hrmph. At least I was pretty sure this is where his friendship was going to go when we moved.
The latest thing happened last night. We had poker at our house and it was poorly attended. We haven't had a group together in at least 6-8 weeks since the last time we hosted at our house, and we were getting concerned the group was falling apart. It looks like it is....the keystone guy who had kept it running got married last year and now there's a rugrat on the way. He has fallen off the face of the earth. We will probably never hear from him again.
I hate that. I mean, what the fuck? Why to people think they have to do that? They just turn their back on their friends when they become parents, give up their previous life and disappear forever?
But, I know, I know, this is the way life is. This is the way people are. He'll probably pop back into our lives 2 or 3 more times over the next 2 years, and then he'll be gone completely. When the second one is born. Then he'll have his midlife crisis because he whacked out his life and resents it. Then they'll divorce. All that bullshit.
It makes me angry and sad. I do not like to be rejected (who does?). I hear the message that despite earlier evidence to the contrary, I am not important. I also do not like my social calendar messed up - I mean, poker was something my husband and I did together, and I scheduled my calendar around it. I tried not to work on Fridays, specifically for poker. Now it looks like either we (or the one other die-hard) will have to take over the group. It is at high risk of failing.
Now, I feel lonely. Indeed I can (and do) seek others out. I keep busy. I do my strategies as I've described in a previous post. I think this mood is going to be one I will function through but have to wait out.
The following sequence of events caused my downturn. First, I learned that my friend who got me into the Summer Singers told me that she won't be able to sing this year after all. I don't know any one else in the group. Yeah, I know, I can meet people, and I probably will, yet I am disappointed. I skipped a rehearsal last week, and I gave myself some unnecessary guilt over that.
Then, the mediocre charge nurse performance. Then guilt about not getting my stuff done at work and going in on a Saturday. Only to be sent home early on Monday. I mean, really, people.
On Saturday night I went out for dinner with a women's group at my church. I keep hoping that group will be a community for me, but it keeps disappointing me. After a year, I am still the newbie, and the others all have a long history together. They talk about all the fun things they've done with their mutual friends. I do make an effort to change the topic of conversation to something I can participate in, but it doesn't succeed for long. And there's one woman who constantly expounds on how intelligent and insightful her little boy is. He just says and does the most *fascinating* things! Heh. I barely even know the 5 year old and I just don't find that kind of topic all that interesting. It makes me think there's a great disconnect between me and that group. Maybe I need a different group.
At work this week, I went in for my meeting (on my day off, might I add) and only two people showed up. I drove in on a day I didn't want to for the honor of being ignored. Great. At least I got paid.
And they wanted me to be charge nurse again this week, two days in a row. After my previous performance, I was hesitant and anxious about screwing up again. I did it anyway. I did OK - some mistakes, some successes (see my post from yesterday).
During the week, I got an email from an old friend from North Carolina, whom I haven't heard from since December 2007. The email was basically: Hi - how are you - I know I haven't written, but I've been so busy, it's just crazy - can't wait to hear from you again - more later...
I replied with a nice update on my life now. Realistically, I expect to hear from her again sometime about January 2009 after she receives her Christmas Card. Hrmph. At least I was pretty sure this is where his friendship was going to go when we moved.
The latest thing happened last night. We had poker at our house and it was poorly attended. We haven't had a group together in at least 6-8 weeks since the last time we hosted at our house, and we were getting concerned the group was falling apart. It looks like it is....the keystone guy who had kept it running got married last year and now there's a rugrat on the way. He has fallen off the face of the earth. We will probably never hear from him again.
I hate that. I mean, what the fuck? Why to people think they have to do that? They just turn their back on their friends when they become parents, give up their previous life and disappear forever?
But, I know, I know, this is the way life is. This is the way people are. He'll probably pop back into our lives 2 or 3 more times over the next 2 years, and then he'll be gone completely. When the second one is born. Then he'll have his midlife crisis because he whacked out his life and resents it. Then they'll divorce. All that bullshit.
It makes me angry and sad. I do not like to be rejected (who does?). I hear the message that despite earlier evidence to the contrary, I am not important. I also do not like my social calendar messed up - I mean, poker was something my husband and I did together, and I scheduled my calendar around it. I tried not to work on Fridays, specifically for poker. Now it looks like either we (or the one other die-hard) will have to take over the group. It is at high risk of failing.
Now, I feel lonely. Indeed I can (and do) seek others out. I keep busy. I do my strategies as I've described in a previous post. I think this mood is going to be one I will function through but have to wait out.
Friday, June 27, 2008
The charge nurse
Despite having conflicting feelings about being a charge nurse, I did it again this week. Twice.
The charge nurse (or unit coordinator, as we officially call it) is a role where you are responsible for the assignments of the nurses to patients, the influx and outflow of patients from a unit, and the main contact for all things that go on in the unit during your shift. I work in a busy outpatient area so there are lots of comings and goings.
In some ways, it is the management of the bin-packing problem in real life. A little translation for all you computer people out there.
The computer people will also know that the bin-packing problem is NP-complete, meaning it is impossible to solve optimally real time. Nevertheless, life is full of such problems and we have to work within them.
Patients come to us in a pseudo-random fashion with different needs and requirements. We have to put them in a room with a nurse assignment, get them ready for procedure (which is a variable task), and recover them (which is also variable). We have capacities - number of rooms, number of nurses, number of techs, etc. The labs that we supply and receive patients from has a different capacity than we have - they get patients in and out faster than we do. They have fewer rooms, though.
So the task involves the simple numbers game as well as various heuristics - how long do we think we'll have to recover, how much of a prep do we have to do, how many patients does each nurse have, what time of day is it, and more. Experience helps with anticipating how things will go.
Another responsibility of the charge nurse is to keep everyone happy (as much as possible). By "happy" I mean that their needs are met. The doctors, your staff, your peer organizations, your manager, the housekeepers (who clean up the rooms between patients), and indirectly, the patients, all demand attention from the charge nurse. Naturally personalities come into play! Additionally, everyone sees the charge nurse's role a little differently depending on the needs they have. Everyone expects their needs to be served exclusively. Yeah, no kidding.
Personally, I liked the challenge. It touches on those industrial engineering urges I had years ago in undergraduate college - I took one IE/CS course and I thought it was kinda cool. Optimization problems. Efficiency. Math. Neat-o. It's like playing Tetris in real life.
The personality dimension of the job is my challenge. Like I said, everyone sees the charge nurse's actions from their own perspective and prejudice, and not everyone is self-aware enough to consider, even for a moment, that maybe there are other forces that resulted in a particular decision. Some people will assume that "you hate them." Or "you're out to get them." Or you're just looking for a chance to "screw them over" or tell them how "dumb they are," and how much "smarter/ cooler/ powerful you are." Some people will conclude that you're incompetent. Then they react to you angrily. Or, they play the two-faced game in which they act all nice to you, but bitch about it behind your back to their peers. I think that's a typical female tactic, although...I've seen the male doctors do that crap, too. Instead of their peers, they complain to the manager.
These things are, in fact, their own problems, and everyone has a moment now and again. Yet, I am sensitive to this - I try so hard to be fair and equitable... but sometimes, the situation is just difficult. I am a highly conscientious person, and to be perceived as careless or spiteful is vexing!
To be completely honest, of course I have my own problems too which I try to put aside. I am human and prone to react to similar (perceived) assaults on the self.
The nurse that was rehired a few months ago (whom I posted about) knows just how to push my buttons. Last week when I was charge nurse for the first time, she did it. As charge nurse, you really can't just avoid someone, like a floor nurse can, and in trying to act as the charge nurse, I apparently got "in her stuff" too much. Then, two days ago she was also on staff when I was charge nurse. I tried a different strategy - staying out of her stuff, only touching base when necessary. That seemed to work...we'll see if that's a viable tactic in the future. I might need to get some feedback or do some reading on how to deal with difficult people in a management position.
I did like the problem, the communication, the juggling. It was scary and exhilarating when things got really busy mid afternoon yesterday. With practice, I think I'll be able to keep my cool better. Each day I worked as charge nurse, I got a little bit better and I would anticipate that trend to continue.
I wonder if I could create a simulation program to develop a schedule and assignments. I see a number of factors I could encode or represent statistically. For example, the flow of patients through our unit seems to be a true random distribution, not evenly distributed at all. I wonder if there are other distributions that could model behaviors on our unit. I see such a program as a management assistance tool - like initial assignments and a reference as the day progresses.
Eh, just a thought. I'll see if this problem bugs me enough to give it a try.
Maybe this is my million dollar idea???
What is a charge nurse?
The charge nurse (or unit coordinator, as we officially call it) is a role where you are responsible for the assignments of the nurses to patients, the influx and outflow of patients from a unit, and the main contact for all things that go on in the unit during your shift. I work in a busy outpatient area so there are lots of comings and goings.
In some ways, it is the management of the bin-packing problem in real life. A little translation for all you computer people out there.
The computer people will also know that the bin-packing problem is NP-complete, meaning it is impossible to solve optimally real time. Nevertheless, life is full of such problems and we have to work within them.
Patients come to us in a pseudo-random fashion with different needs and requirements. We have to put them in a room with a nurse assignment, get them ready for procedure (which is a variable task), and recover them (which is also variable). We have capacities - number of rooms, number of nurses, number of techs, etc. The labs that we supply and receive patients from has a different capacity than we have - they get patients in and out faster than we do. They have fewer rooms, though.
So the task involves the simple numbers game as well as various heuristics - how long do we think we'll have to recover, how much of a prep do we have to do, how many patients does each nurse have, what time of day is it, and more. Experience helps with anticipating how things will go.
Another responsibility of the charge nurse is to keep everyone happy (as much as possible). By "happy" I mean that their needs are met. The doctors, your staff, your peer organizations, your manager, the housekeepers (who clean up the rooms between patients), and indirectly, the patients, all demand attention from the charge nurse. Naturally personalities come into play! Additionally, everyone sees the charge nurse's role a little differently depending on the needs they have. Everyone expects their needs to be served exclusively. Yeah, no kidding.
My Experience in the Charge Nurse Role
Personally, I liked the challenge. It touches on those industrial engineering urges I had years ago in undergraduate college - I took one IE/CS course and I thought it was kinda cool. Optimization problems. Efficiency. Math. Neat-o. It's like playing Tetris in real life.
The personality dimension of the job is my challenge. Like I said, everyone sees the charge nurse's actions from their own perspective and prejudice, and not everyone is self-aware enough to consider, even for a moment, that maybe there are other forces that resulted in a particular decision. Some people will assume that "you hate them." Or "you're out to get them." Or you're just looking for a chance to "screw them over" or tell them how "dumb they are," and how much "smarter/ cooler/ powerful you are." Some people will conclude that you're incompetent. Then they react to you angrily. Or, they play the two-faced game in which they act all nice to you, but bitch about it behind your back to their peers. I think that's a typical female tactic, although...I've seen the male doctors do that crap, too. Instead of their peers, they complain to the manager.
These things are, in fact, their own problems, and everyone has a moment now and again. Yet, I am sensitive to this - I try so hard to be fair and equitable... but sometimes, the situation is just difficult. I am a highly conscientious person, and to be perceived as careless or spiteful is vexing!
To be completely honest, of course I have my own problems too which I try to put aside. I am human and prone to react to similar (perceived) assaults on the self.
The nurse that was rehired a few months ago (whom I posted about) knows just how to push my buttons. Last week when I was charge nurse for the first time, she did it. As charge nurse, you really can't just avoid someone, like a floor nurse can, and in trying to act as the charge nurse, I apparently got "in her stuff" too much. Then, two days ago she was also on staff when I was charge nurse. I tried a different strategy - staying out of her stuff, only touching base when necessary. That seemed to work...we'll see if that's a viable tactic in the future. I might need to get some feedback or do some reading on how to deal with difficult people in a management position.
I did like the problem, the communication, the juggling. It was scary and exhilarating when things got really busy mid afternoon yesterday. With practice, I think I'll be able to keep my cool better. Each day I worked as charge nurse, I got a little bit better and I would anticipate that trend to continue.
Future
I wonder if I could create a simulation program to develop a schedule and assignments. I see a number of factors I could encode or represent statistically. For example, the flow of patients through our unit seems to be a true random distribution, not evenly distributed at all. I wonder if there are other distributions that could model behaviors on our unit. I see such a program as a management assistance tool - like initial assignments and a reference as the day progresses.
Eh, just a thought. I'll see if this problem bugs me enough to give it a try.
Maybe this is my million dollar idea???
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