Fun With Suits! · Pains in my Fifth Point of Contact · School Fun And Games · Sometimes You Get to Think That You Have Accomplished Something!

Again, with not fitting the mold!

Remember my fun filled interview for Nursing school? So, nearly 30 years later I applied for PA school. Among the requirements was 500 hours of patient contact experience. So, I had worked as an RN for (shockingly enough) 30 years at that point, and had accrued, with overtime, something on the order of 63,000 hours of patient care.

So, I went to interview for the incoming class, and they asked me if I had 500 hours of patient care experience. I had included my resume detailing my schooling and work experience as part of my application, so I assumed that my work history was not a surprise.

I asked, “Do you mean, in the past 3 months? or overall?”

“How about, overall?”

“Well, something like 60,000 plus hours, I guess.”

The reply? “Well, alright then! Let’s move along!”

I succeeded, and so got to deal with the financial aid office.

I filled out the form, complete with the birthdate revealing that I had been born some 50 + years previously. I ignored the part where they sought my parent’s tax forms.

When I turned in my application, the gosling behind the counter reviewed my papers,  and looked my elderly ass right in the eye, saying, “You don’t have your father’s tax form in here!”

She sure was quick! “No, ma’am, I do not.”

She was, albeit, persistent. “You have to include your father’s tax forms.”

“Ma’am, I am not going to submit my father’s tax forms. For one thing, he has not filed in 13 years. ”

“He hasn’t filed in 13 years? He has to!”

“Ma’am, perhaps you could call him up, and let him know that. But, it’s going to be kind of a long distance call. And, when you reach him, please tell him that I love him, and miss him every day.”

Perhaps, she was not so quick. “Huh?”

“Ma’am, my father died over a dozen years ago. You will not be receiving his tax forms.”

Undeterred, she demanded, “Well, we will need your mother’s tax forms!”

I was over this. “Ma’am, you are not going to receive my mother’s tax forms, either. She is pushing 80 years old, I have lived on my own for 30 years, and the only tax forms you will receive are those belonging to my wife and me. Perhaps I should talk to your supervisor?”

After several minutes, an adult appeared. I reviewed my position. “Ma’am, this young lady insists on my providing my parents’ tax forms. That is not going to happen. I have supported my own family for nearly a dozen years. I am not about to provide my parents’ forms, nor have they supported me for longer than this nice young lady has been alive.”

The adult looked at me for a moment. “And, you are Mr. McFee, correct? And, you are the student? Not one of your children?”

“Ma’am, if you look at the applicant’s birthday on the application, you will see that it matches my apparent age.”

This soul indeed perused the applicant’s birthday, and regarded me. “Uh, sir? I think we have everything we need here. You will not be asked again to provide your mother’s tax forms. Thank you, and have a nice day!”

Fun And Games Off Duty · Fun With Suits! · Pre Planning Your Scene · School Fun And Games

Not Fitting The Mold

So, TINS. I decided after several years as a nursing assistant, that I wanted to be an RN when I grew up. By the time that things lined up, I had already started working for EMS in Da City. So, I set to knocking off the pre-requisite classes I had not already collected, and waited for my Nursing school application to be processed.

Now, at this time, there were very, very, very few men in Nursing. The school I applied to, a community college, had a decidedly  problematic academic tendency among the population from which they drew their students.  So, since I had attended Tremendous State University for a couple of years, it seemed that I was a good candidate to handle collegiate level studies. For these reasons, it developed that I was accepted to this school.

In the course of the intake, I had to interview with an admissions officer. We talked about coursework, and finances. She asked me about what financial aid I had lined up. I admitted that I had none, and planned to pay for school through Da City’s tuition reimbursement program, as well as my earnings.

She did not think much of that idea, for some reason. “Mr. McFee, we do not allow our students to work.”

I was surprised. This was, after all, nearly 1980, and I had thought that liberated women, and various movements to remove barriers had changed things. Simply to be certain that I had heard her correctly, I asked her, “Er, ma’am? you do not ‘allow’ your students to work?”

“That’s right, Mr McFee. We do not allow our students to work.”

“Uh, ma’am, you do realize that I am working full time, have a house, and am my own only source of support, right?”

“Mr. McFee, you need to plan for that. We do not allow our students to work while they are in school.”

“Uh, OK. Uh, ma’am, so, where do you live?”

“Why do you ask me that?”

“Well, I support myself and you are telling me that I cannot work. I suppose that means that I’m moving in with you.”

THAT got her attention! “Mr. McFee! You are NOT moving in with me!”

“Hmm. So, how about you document that you have told me that your experience is that students who work while in school do not perform as well as those who do not. You could note that I have acknowledged that warning, and the school’s extensive experience behind that warning. You could write down that I will elect to work while in school, and therefore, any failure on my part will be in spite of your vehement admonitions. Do you think that will work for you? It is a chance that I am willing to take.”

“Uh, Mr. McFee, please sign here, next to my notes to that effect. Thank you. Welcome to Un-Named Community College School of Nursing. You have selected a challenging course of action, both academically as well as because you have chosen to work. Good luck!”

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

“But, what do I do?”

So, TINS, TIWFDASL as a nursing supervisor at The Little Un-Named Hospital In Da City (TLUNHIDC). One night, I received a call from our ICU. The nurse on the other endtold me that she had an order to transfer a patient, from our hospital to The House Of God. She asked me what I wanted her to do.

(Again), I thought, “This! This is why I get the Big Bucks!”. I told her, “In that case, I think you ought to transfer your patient to The House Of God!”

She responded, “But, I don’t know if they have a receiving physician at The House Of God.”

My rejoinder, “Well, then, call the House Of God, talk to the nurse in their ICU, and verify that there is a receiving physician.”

(Henceforth, I’ll dispense with the “He said, She said” business. From now on, any dialog beginning with “But…”, is her. Any other dialog, is me.)

“But, what if their physician hasn’t received report from our physician?”

“Note that fact in your nursing notes of that conversation, call our doctor, and invite him/her to call House Of God’s receiving physician, and remedy that oversight.”

“But, I don’t know if report has been called!”

“You might elect to look in the chart, for a note documenting that report has been called. Or, when you talk to their ICU, ASK!”

“But, what if report has not been called?”

“Well, while you have them on the phone, give them report. And chart that fact.”

“But, I don’t know what ambulance service to call, to transport that patient!”

“Ask the switchboard who is next on the rotation, and call that service.”

“But, I don’t know if the family has been notified.”

“So, the required phone number is in the chart, correct? Once all the other pieces are in place, phone the contact person, bring them up to speed, and document same in your notes.”

“But, what do I do about his property?”

“I suppose that bagging it up, and sending it with him, might be reasonable.”

“But, what about the chart? How am I going to send the chart with him?”

“Most nurses photocopy it, and send the photocopy with the patient. I recommend you do likewise.”

“But, how am I going to get it photocopied?”

“Most charge nurses, have the ward clerk servicing their floor do the photocopying.”

“But, we cannot spare her for that long!”

“You have an eight bed unit, have three vacant beds, haven’t had an admission in 6 hours. If you cannot spare her, right now would be a good time to fill your supervisor in on what catastrophe is unfolding in your unit!”

(her: “stutter…stutter…er…um…uh…”)

(Me) “I’m waiting?”

(Her) “But…But…What do you want me to do?”

“Get a pen and paper.”

(her) “What?”

“Get a pen and paper.”

(her) “Why do you want me to get a pen and paper?”

“Simply do it. Now.”

(her) “I have a pen and paper.”

“Good. Write this down. Call The House Of God, verify that our doctor has reported to their doctor.

If not, call our doctor, and invite him to do so. You give report, and chart same. Call the ambulance service that the switchboard tells you is next up on the call list. Call his family, bag his property. Have your clerk copy the chart, and send that copy with him. Have you written all that down?”

(Her) “Uh, yeah.”

“Do you understand all that?”

(Her) “Uh, yeah.”

“Ok, now Do IT!”

End of call.

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!

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.