30% More Work for the Same Pay!

There was a memo in my box at work (Hooper Detox) this morning. The first three paragraphs stated something to the effect that management appreciated the hard and good work …bla bla bla… of admiting nurses. Bla bla bla… The fourth paragraph started with a “But -“ (emphasis my own) and went on to say that since auxillary staff were not performing the search/shower procedure satisfactorily, nurses are now expected to search and shower clients. Nurses are also expected to bring clients upstairs and show them to their bed, locker, and give them a tour of the unit. The primary reasons for auxillary staff being relieved of this duty are that they are supposedly less comfortable with naked bodies, are less knowledgeable in body mechanics, and less familiar with the facility and operations and give incorrect information.

Ah, hell no!

Even though I don’t normally work in admitting, I’m angry on behalf of the admitting nurses.

For one, the admit nurses already each go through detailed paperwork with five clients each during a 6-hour period. One hour may seem like a long time to spend on one client, but this is what is expected to happen in one hour:

  • Prepare a 15-page admit packet before seeing client, making sure each page is named, numbered, signed, complete. Sometimes paperwork blanks call for information which must be hunted down in the chart or via co-workers with database access.
  • Two of these pages are very detailed, including an Admission Assessment with the client that can last thirty minutes itself if the client’s answers are less than brief, and a progress note which can take anywhere from five minutes (brief and pointless) to twenty minutes (detailed, valuable, and more legally and professionally legitimate).
  • Provide emergency or urgent care as necessary, as in the case of withdrawal seizure or bleeding abcess
  • Making double-sided photocopies of the Nursing Admission Assessment
  • Taking the client’s vital signs, and charting them four places
  • Assessing the client’s withdrawal symptoms, and medicating if appropriate – chart this four places
  • Educating the client about the withdrawal (medication) protocol corresponding to their drug of choice
  • Educating the client about the ill effects their drug of choice wrecks on their health
  • Actively listening to the client’s story and complaints and providing appropriately encouraging, empathetic (therapeutic) response. Clients regularly break down into states of panic, anger, and despair during admission. Chart as appropriate.
  • Transcribing client medications three places. This can take up to half an hour if a client takes several medications.
  • Creating Medication Administration Records on the computer, and printing these
  • Adminstering a tuberculosis test if necessary, and documenting in three places

This is the kicker: when I was trained in the search/shower procedure today, it involved NO nakedness, NO body mechanics, and the doling of only rudimentary facility-related information. One puts the client in a shower stall, closes the curtain; the client hands their clothes out under the curtain and begins showering. The client dries off and dons scrubs. You walk the client upstairs and show them the phones, the soda machine, the smoke room, the cafeteria, the television, the laundry hamper, the showers, the nurses’ station, their bed, their locker.

The clients are high or in withdrawal. They do not ask doosies of questions. They ask when they can smoke. They ask when they can make a phone call. They ask when they can sleep. Give them much more information and they not only don’t hear, but they don’t listen. It’s ridiculous to think that clients need someone with a four-year degree to search, shower, and orient them. The union’s gonna love this one. Too bad I’m not a union employee. Too bad I’m just a nurse. Too bad I’m young, and a girl. My opinion just won’t count.

Too bad I’m on-call. See if I accept any more shifts in admitting!

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