Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Yet ANOTHER Tale of Public School Wonderfulness!

When She Who Must Be Obeyed, and I, and our family had moved to another school district, we, surprisingly enough, registered our children in that new school district. We were provided a sheaf of paperwork to be completed, and, in leafing through my homework assignment, noticed a physical form for each child.

I examined it, and noted that, at the bottom, it required the signature of a “Licensed Health Professional”.

I pointed this out to SWMBO, and she asked me what I intended to do with this insight.

“Well, I’ll perform physicals on our children, document them, and sign the forms. Save us the hassle of a doctor office visit!”

She protested that I was an RN, and that they meant for a doctor to sign the form. I invited her to point out where, on the form, it so stated.

She turned it this way and that, and, finally, was compelled to admit that it did not so state explicitly, “but that is what they meant!”

“Perhaps, that is what they should have said!”, and I went off to retrieve my stethoscope and children.

I performed all the diagnostic maneuvers required, documented my findings, and, at the bottom, where it called for the “signature of a healthcare professional”, I signed it Reltney McFee RN, BSN.

Several days later I took the kids to school for registration and walked into the office. The woman there told me she needed some documentation of address so I gave her a utility bill. She needed some ID for me, and I provided my driver’s license. She needed a phone number, and I provided it. Next she asked for the School physical forms. She examined them, and asked, “Who is this?”, indicating the signature.

“That’s me!” I said. She asked me if I was a physician, and I replied, “No I’m not. I’m an RN.”

“You cannot sign this form!”, she informed me. I leaned over the counter, pointed at my signature, and observed, “Yet, it certainly appears that I have signed it!”

“But, you have to be a doctor to sign this form!”

“No”, I corrected her, “it requires the signature of a licensed health professional. I am a registered Nurse, and am therefore a licensed health professional. Hell, I’m even licensed by the Bureau of Health Professions!”

Unswayed by my logic, she informed me, “Nurses aren’t health professionals!”

I picked up a phone book. “Oddly enough, the Board of Nursing seems to think that nurses are health professionals. It’s a local call: why don’t you call the Board of Nursing in the state capitol, and straighten them out? I’m sure they’d enjoy having you correct their little misunderstanding!”

And then I smiled.

She stuttered a little bit, looked flustered for a little bit, went into the back office and then came back out and said “We’ll take it this time.”

I smiled and said thank you and went on my merry way. Next year the kids came home from school and had these physical forms that need to be filled out. I looked at them: there at the bottom of them it said “signature of Nurse Practitioner, MD, DO, or Physician Assistant”, none of which I was.

My nursing school instructors would have been so proud of me! I was an agent for change, and the school system had changed their forms at my instigation!

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Fun And Games Off Duty · Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Fun and Games In The Public Schools!

So, my daughter, Brenda, had injured her knee in gym class at middle school.  
We lived about a mile from the school, and, once she had told the teacher about
her knee injury, did that teacher, or any other official of the  school, call her 
mother, the nurse?  To quote Eddie Murphy, in his persona of The Ganga 
Teacher, "No, no, noooo, no!"

Did they phone her father, the nurse?  Again, "No, no, noooo, no!"

Did they have a teacher drive her home, so that she would not have to walk 
home on her injured knee?  As you might have anticipated at this point in my 
rant, "No, no, noooo, no!"

Did they put her on a bus, again, to prevent her walking home on her 
demonstrably injured knee?  If you have read this far, sing along with me:
 "No, no, noooo, no!"

Instead, of course, they sent her home, walking, on her injured knee, around 
a mile from school to her home. 

As you may have guessed at this point, I was not favorably impressed. Nay, 
I was pissed. 

I wrapped her knee, applied ice, elevated it, after identifying no marked 
instability.  It did hurt her with walking (which, of course, the idiots at the school 
had required her to do to get home, since they had NOT called her father, or 
her mother.  But, perhaps, I had already told you that little detail) 

I dosed her with ibuprofen, and put her to bed. I wrote her a no physical 
education note, and retained a copy for myself. I signed it, 
"Reltney McFee, RN, BSN".

In the morning she appeared  improved enough to return to school. Therefore, 
in consultation with She Who Must Be Obeyed, we decided to send her to 
school. We drove her. Ourselves. To make sure that she did not have to walk. 

So, that afternoon  I was surprised to receive a phone call from the phys ed 
teacher.  This worthy told me that he required a note FROM A DOCTOR, in 
order to keep her out of class. I pointed out that he had, in his hand, a suitable 
note, that I had written, directing him to keep my child out of gym class until 
further notice. 

He replied that, absent a note from a physician, he would require my child to 
participate in gym class. 

I gave this a second's thought, and brought him up to speed. "So, let me see if I 
am understanding you.  You have a note, in hard copy, in your physical 
possession, written by me, her father and a Registered Nurse, directing you 
to keep my child out of gym class due to an injury she suffered on school 
property, and notifying you that, should she participate in gym class she may 
sustain additional injury.  You, in your medical judgment, have determined that 
you know more of this sort of thing than I, and will contravene my explicit 
instruction, in my capacity as her father and a registered nurse of 20 years 
experience.  Cool story.  I'm certain that the jury at your lawsuit will be very 
impressed.  Perhaps impressed to the tune of several hundred thousand 
dollars."

He sputtered, "You cannot sue me!"

"Really? Is that what your attorney told you?"

"I do not have a lawyer."

"Well, what do you know?  I DO have a lawyer, and you can, too!  Once my 
lawyer serves you with the papers he will prepare to hold you personally 
responsible for my daughters crippling injury, suffered through your willful 
and wanton negligence, ignoring the specific instruction that I, her father and 
a registered nurse, have provided you. In writing. Right about that point, 
I wager you will find yourself a lawyer!"

He sputtered a while longer, and noted that he would, sooner or later, require 
a note from a physician. I told him that I would obtain one, at my earliest 
convenience. And, I'd provide him a copy. 

The call terminated. 

Once I had my daughter in my vehicle, outside the school, I asked her how 
gym class had gone.  

"Fine, Dad.  They sent me to study hall, and for some reason, the teacher 
seemed pissed about something."

I smiled, and replied, "Well, it might have been something about sending 
you, and our attorney's kid, and his attorney's kid, as well, to a very nice 
college!"

She looked puzzled at that, but, what the hell, I wasn't going to be able to 
put things over on her for very much longer, and I ought to savor the few 
remaining opportunities. 
Fun With Suits! · Sometimes You Get to Think That You Have Accomplished Something!

Teamwork!

This one time, after departing Da City’s employ, I worked for a hospital in Da City. After several adventures as a staff nurse, I was promoted to supervisor.

The way things worked, was the staff nurses attempted to untangle the problems that developed,and then punted the resistant ones to me. So, one evening I received a phone call from one of the floor nurses, relating that Mr. Man was due some coumadin (a blood thinner, used post blood clot, among other indications), and she had none in her medication drawer to administer to him.

Thinking, “This is why I get the big buck!”, I asked her, “Have you looked on the counter, and checked the medication record?”

Yes to both, no accounting for the coumadin either place.

“Did you call pharmacy, and request that they run some up to you?”

Again, yes, she had. Her explanation of why Our Friends In Pharmacy had not delivered the medication, was intriguing. “They said that it had been in the drawer when they swapped them out this morning, and they were not going to send any more up, until tomorrow.”

Puzzled, I asked, “Did they explain how your patient was going to get his medication in that circumstance?”

“Nope, simply said that they would not deliver any more.”

“Let me look around. I’ll be right up!”

I arrived on the floor, and, sure enough, no lonely coumadin on the counter in the med room, nor on the counter in the nursing station.

I called Our Friends in Pharmacy, and asked the pharmacist about the missing coumadin.

“It was there this morning, I’m not gonna send any more. Everybody knows that the nurses take meds from the drawer, I’m tired of it!”

It had been a kind of grueling night for me, and I was not in the mood. “So, let me see if I’m hearing you correctly: you are telling me that you have personal knowledge of nurses diverting medication from patients for personal use, did I hear that right?”

His reply? “Yeah, everybody knows it. It goes on all the time!”

I set my trap. “So, what have you done about this information?”

“Nothing. Everybody knows about it, nobody’s gonna do anything!”

“So, you are telling me that you have personal knowledge of medication diversions, and you have done nothing about this knowledge, did I get that right?”

“Yeah, nobody’s gonna do anything about it, so, yeah, right.”

“What do you suppose the Board of Pharmacy would think of this revelation? Tell you what, why don’t I write them a letter, documenting this conversation, and you can find out, in person, what they think of a pharmacist who has personal knowledge of medication diversion, and takes no action to end it. That ought to be very educational, don’t you think? In fact, if you are here, with the needed coumadin, before I finish that letter, perhaps I will not have to send it at all! Maybe, I could write a letter telling the hospital administrator how wonderful it is to work with pharmacists who are so very, very collegial. Bye-bye, now!”

I asked the nurse, standing next to me, if I could borrow her pen and have a sheet of paper. “What for?”

“Got a letter to write!”

“What sort of letter?”

I told her, “That depends on whether or not we see your favorite pharmacist up here with your coumadin in the next few minutes, or not!”

I heard the pounding of footsteps on the stairs, and heard his wheezing before he even reached the stairway door.

I love it when we all work together to help our patients!

Fun And Games Off Duty · Fun With Suits!

“That’s just the way we do it here! (giggle)”

While I’m regaling one and all (well, you, yeah, YOU! Over there! I see you!) with tales of the school “system”, there is the tale of Allen, Number One Son, and his transition into North Schools and their second grade.

So, in his first grade year, we had lived in another small town, several counties away. I had heard of an opening for an ICU nurse at this hospital, and had applied for, and been accepted for that position. We moved, and the children moved schools, unsurprisingly.

In the previous school, Allen had been in first grade in a Catholic school. He had brought home homework, and his mother and I had worked with him thereon. Therefore, foolishly, once we had moved and he had started second grade, I assumed that there would be homework, again.

Nope.

He came home each day, and I asked him about his homework. “No homework, Dad.”

Was he certain? “Yep, no homework, Dad.”

Did the teacher send anything home with him? “Nope.”

Had there been anything written on the board, such as, oh, I don’t know, HOMEWORK?

“No, Dad!”

This little bonding moment repeated itself day after day, until, a couple of weeks into the school year, there was parent-teacher conferences. Aha! Now was my opportunity to resolve the no-homework dilemma!

So, I arrived at the appointed hour, and introduced myself to the teacher. “I’m Allen’s father. He tells me that he is not getting any homework assigned.”

Cute, young, blond, she smiled, and nodded. “Um-hmm!”

I paused, and, no additional verbal reply forthcoming, I plowed on. “Now, Allen did get homework in first grade, at his previous school.”

Another smile, another “Um-hmm!”

I paused, again. No verbal riposte was forthcoming, and again I plowed forward. “And, I had been of the understanding that homework was important to the teaching process. It seems to me that it provides feedback to the teacher regarding how well the students in general, and each student in particular, is grasping the material.”

Another head nod, another smile, another “Um-hmm!”

I continued. “In addition, I had thought that homework also had the benefit of helping the student generalize the material away from the classroom, promoting retention as well as helping the student incorporate the material into his or her daily life.”

Another nod, another smile, another “Um-hmmm!” I was beginning to suspect that this college graduate teacher was suffering from a poverty of conversational themes. (Sigh!). I wound up my presentation, and went for my closer.

“Therefore, I’m puzzled. Allen is telling me that he is not getting homework assignments, and you appear to be confirming that. I have to confess that I’m puzzled. Can you explain the pedagogical principles that led to this particular plan of instruction, omitting homework?”

Her blonde grin widened, and she tossed her head as if she was still in the sorority house back at Wherever State Teacher’s College. “(giggle) That’s just the way we do it here!”

Outstanding.

I imagined myself, back in Nursing school, answering my clinical instructor, Dr. Smith’s, inquiry, “So, Mr. Stretcher Ape, why did you administer lasix to this patient?”, with the following:

“(giggle!) The Doctor ordered it! (giggle)”

Yeah, about that. Had THAT been my answer, and not revelations about optimizing fluid balance, and the salutary effects of diuresis upon the patient with heart failure, well, I’d still be repeating my FAVORITE! greeting in The Whole World!, which is “(knock, knock, knock!) Fire Department!”

All night long.

Fun And Games Off Duty · Fun With Suits!

CHARLIE AT KINDERGARTEN ROUNDUP

So, a couple of years previous to David’s kindergarten goat rope round up, his older brother Charlie had undergone the same appraisal. I had worked nights the preceding evening, and got off work just in time to drive into town and join the fun.

For those of y’all who HAVE worked nights, you can ignore the next little bit. For the rest of you, pay attention. Night shift workers generally NEVER are fully caught up on sleep. On days after work, they are acutely-on-chronically sleep deprived. As for me, I am NOT at my best, when poorly rested.

So, we rolled in to the cat-rodeo that is kindergarten round up. One of the tasks, among others, is the child has to print his/her name. Our darling little boy had, of course, completed this process, and another earnest young teacher was reviewing the assignments. There was the clock face, and the stick man drawing, and the colors identified. All was at baseline until she came to the print-your-name part.

“Well, you see, he printed his name as S-h-u-r-l-e-y, and that is wrong, you see…”

I couldn’t stop myself. I interjected, “Unless, of course, we had named him Shurley, right?”

The poor woman stopped in her verbal tracks. I could almost see her head spin, and she bent to the package of papers, furiously flipping pages, and examining each one, seeking verification that Charlie’s name was, indeed, Charlie. Or Shurley.

After a minute or so of paper flipping, and eyeball spinning, The Plaintiff, Charlie’s mother, patted the teacher on her arm, and reassured her, “Ma’am? My husband worked all night last night, and he sometimes thinks that he is funny. Charlie’s name is in fact Charlie, and, yes, he misspelled it. Can we continue?”

For years, his siblings teased him about being named Shurley. And in answer to the inevitable question, “Surely, you jest?”

“I’m not kidding, and stop calling me Shirley!”

Fun With Suits! · Pains in my Fifth Point of Contact

Erehwon ER Day Shift Call Off

So, a long, long time ago, in a county far, far away, I was the overnight ER nurse in Erehwon Memorial Hospital (“Both nowhere, AND backwards!”). I’d clock in at 1900, and until 0200, there’d be two of us working the 6 bed cubbyhole that passed for the Emergency Room out here in the suburbs of nowhere. Once 0200 came along, it was me and the Physician Assistant, all to our lonesome.

So, TINS ©, there I was, Fighting Disease and Saving Lives ©, and, long about 0500, I received a phone call from our director of nursing, Beelzebub. She reported that (a) the day shift nurse had called off, and (b) I was going to have to work over.

Now, at this time, we had four children at home, two of whom were toddlers. In addition, Erewhon Memorial Hospital had awful insurance, and expensive into the bargain. Therefore, since my wife made more money than I, and had cheaper and superior insurance, she carried us all as covered family members. That made HER the primary breadwinner, in my book. Our routine was I’d boogie home, and she’d meet me at the door, and traipse off to her Monday through Friday, 9-to-5 office job. I would then watch our children, until she came home, and nap away for a couple of hours until I got to do it all again. Working 12 hours meant a couple of things. First, it made for long, long duty days with that sort of plan. Second, working every other weekend, well, on work weekends I got to sleep the day away. Third, there were 2 days every week where I had to enter the parental “Iron Man” contest, and the rest of the time I was not more challenged than was my baseline.

So, departing from work late was not going to work for me, inasmuch as that would either make my wife late for work (a non starter), or leave the toddlers alone at home while the older kids went to school (another non starter). Alternatively, I could boogie on home, and be the Dad. That was my Plan “A”, and I was reluctant to deviate from it.

Surprisingly, when I presented my reluctance to Beelzebub, she was unimpressed. “You will simply have to work late, until I can find someone to cover for you.”

As was I. “Uh, no. Your problem is NOT covering for ME. I am here, and will be here until the end of my shift at 0730. Your problem is covering for the employee who called off. I am unable to do so.”

“Well, you simply cannot leave. I do not have anybody to cover.”

She did not appear to be listening. “Well, I likely can stay until 0800, but not one minute later. I will not have my wife be late for her job, simply due to your inability to perform yours. Similarly, my children will have a parent at hand this morning, and that parent will be me. I can inconvenience myself a bit on your behalf, but I did not call in, I am not responsible to write, enforce, or amend the sick or tardy policy, and I will not accept that responsibility.”

Still with the not listening. “You can not leave. I will prevent you from leaving!”

That was interesting. “Uh-huh. How, exactly, do you plan to stop me? Simply so you know, I’m an ex-Da City street medic, and I have been threatened by honest-to-God, no shit felons. It will be interesting to see what you bring to the conversation, that they did not. And, if you’re later than 0730, you will miss your chance.”

She was not giving up. “You cannot leave the narcotics unsecured.”

I had thought this through, just a bit. “I understand that. My plan is to secure the narcotics, and count off with whatever nurse you send to relieve me. If you have not done so by 0730, well, then I will secure the narcotics keys someplace I personally know to be safe, and bring them back with me when I return to work next week.”

“If you take them home, then I’ll send the sheriff out to retrieve them.”

This, as well, had been part of my ruminations. “That works for me. Once that deputy has provided me with documentation that he or she is a legitimate recipient, I will provide them to that officer, and require a written receipt.”

She delivered what she evidently thought was her trump card. “If you walk out that door, I’ll bring you up with the Board of Nursing on charges of patient abandonment.”

Me, I had a figurative Ace of Trumps. “That ought to be interesting. Just so you are aware, in that event I’ll bring charges against you, before the Board of Nursing, regarding your neglect of duty. You know folks will call off: you provide sick time. Yet, evidently, your ‘plan’ is to have somebody work as long as 36 hours, because you do not have any sort of real plan. I’m confident that I can argue that any reasonable and prudent administrator, of your background and training would know, or ought to know, that somebody might call off. With that knowledge, comes an affirmative duty to have a real plan to address the dislocations that this sick call will predictably produce. A plan that, evidently, you do not have.”

She did not seem to have a counter. “You cannot bring me before the Board of Nursing!”

I was unconcerned. “I’ll be certain to mention that. In my written complaint. To the Board of Nursing.”

The call terminated at about that point. I called home, and brought my wife up to speed on the entertaining soap opera that was my workplace. She was concerned about the youngest kids, and we game-planned a couple of alternative measures to manage things. We ended the call with a plan of action.

So, long about 0735, one Mark 1, Mod Ø Very Pissed Off Floor Nurse arrived to “take report”. Inasmuch as there was no soul there at all, not on the payroll, that part was quick. Narc count went smoothly, and I danced my happy ass out of the door. I met my wife on the road, part way to her job in the next town, we handed off the kids, and she continued to her job, and we went home.

The Moral Of The Story: Nurses are very, very good at passive aggressive behavior. I had been a nurse at that point for nigh onto 20 years. I would put my passive aggressive against anybody’s.

And, planning for things that are readily foreseeable, might be A Good Thing.

Tee-hee.