Wednesday, March 6, 2013

TING AND I, Home Care - Problems

Ah, you say to yourself, perhaps, this sounds too idyllic. Were there no problems? The biggest ones were the rare but scary infections Tina contracted. She came home from the Critical Care Unit with Pseudomonas and drug-resistant methicillin-resistant Staphylococcus aureus (MRSA), common hospital-acquired infections. Her good general health and the use of antibiotics beat these back, though MRSA remains in her system. For five years there were no bedsores, a major risk in these bedridden patients, and then one developed under unusual circumstances and took many months to conquer, but we did, with added help from a wound-care specialist, Edie Fitzpatrick, RN. During the last seven years there have been a few viral respiratory infections, for which medicine can do little. Fortunately, Tina’s body has fought them off. Still, each day is a minor miracle. I have encouraged the nurses who really rely on this job to get a second one, too, just in case.

Other problems? Young or inexperienced nurses generally did not do well. The 20-year-old I hired as our first overnight nurse fell asleep in her chair and remained asleep as I got up from our bed, got Tina’s medications, and returned to administer them. That was grounds for termination, and I did. (Recall they once shot sentries for sleeping on duty.) During the past seven years, I fired two or three others for being asleep on the overnight shift. One of the two was in her twenties, also. Inexperienced middle-aged nurses tended to be nervous but generally worked out. There often was a willingness to learn that helped offset the lack of experience and a maturity that made them more suitable companions for Tina.

Language Barriers

A different kind of problem arose with nurse Kim, originally from Korea. Very nice, hard-working, caring, careful. Not too good with English, unfortunately. One day she described giving medicine X when it should have been Y. No real harm done, but when she went to take another job–soon after–I was both sorry to see her go and a bit relieved. “Trust, but verify” indeed.

Even native speakers of English have some misunderstandings due to the special jargon of the nursing profession. I’ve kidded those trained in British schools with the witty saying that Britain and America are two countries separated by a common language.

H1N1 Flu Shots

As mentioned above, we lost several nurses over the issue of H1N1 flu shots. One had provoked an argument prior to this that led to her dismissal, but the underlying issue seemed to be her dread of the H1N1 shot. Because the flu could be deadly to Tina, an individual nurse’s desire to avoid possible side effects could not weigh heavily with us. We could not let some skip the shots while requiring the others to get them. Sorry. We lost some capable nurses.

Ms. Take
One nurse’s behavior led me to court. She was a hiring mistake, and I’ll refer to her as Ms. Take. In some senses she was a hardship case. She was married, had five children and now custody of a grandchild. In her interview, Ms. Take acknowledged that she was a smoker, which was usually disqualifying. She promised never to smoke on the job, and I think she kept that promise. She was an LPN, intelligent but not well-educated, with more than a dozen years of appropriate experience. Preferring not to work overnight, she was still available for any shifts we had. That might have been a tip-off. Two of her three references did not call back, another tip-off, but the one who did was favorable toward her. Ms. Take was chubby, sloppily dressed, warm and articulate. I took a chance and hired her.

She started with a half-dozen hours per week. Eventually, she was working more than the threshold necessary to qualify for unemployment benefits. After the requisite six months of this, her performance declined. Then she missed a shift without alerting us, with an excuse that did not sound true. I warned her that she was on probation. A month and a half later, on two consecutive overnight shifts, she failed to initial the numerous boxes that document medications and feedings. I knew she was busy making beaded jewelry to sell, which was acceptable as long as she met her obligations to Tina. The morning of her second night she took home with her the shift report record, the first time anyone had ever done that. I called her, listened to her excuses, and fired her.

When the Department of Labor wanted to give Ms. Take unemployment payments because she claimed that was fired without adequate cause, I appealed. Two Administrative Trial Judge hearings, of about an hour each, followed. In the first, I presented my case, and I felt optimistic. In the second, the same judge seemed leaning toward favoring Ms. Take, who had not disputed my narrative. Subsequently, the judge found in her favor. Reasons were as follows:

–We lacked an instruction book for the nurses (though the forms made it obvious what needed to be done).
–We hadn’t warned her she’d be fired if she took our property (nursing records) home (did not tell her theft was not OK?)
–You aren’t supposed to be fired for a first offense, generally, and this was the first time she had failed to document medications and treatments twice in a row.

We had been warned that such judges tend to favor the employee over the employer. Looked that way. I call her Ms. Take partly because she collected a substantial amount of unemployment money and partly because she had lectured one of our staff on how to maximize child welfare payments from the state. Because we paid well above the usual LPN wage, she could honestly maintain that she could not find a comparable job in her area. Perhaps she had outsmarted us, making herself eligible for unemployment then getting herself fired.

In two or three other cases, we succeeded in appealing unemployment compensation decisions concerning other nurses we fired for good cause.

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