Well. A whole lot just happened all at once.


To recap: I work in a critical-care unit that's embedded on a floor that is not critical-care. My immediate managers, the Assistant Manglers,  are not critical-care nurses. They don't have neurological or neurosurgical backgrounds. There are two of them, and both of them have shown a positive disinclination to be trained in the way we take care of critical or acute patients, despite having been told to get that done fourteen months ago. As a result, we folks in the NCCU deal mostly with our Head Big Mangler, who is a critical-care nurse.

(I should mention here that we are the only unit in the wide swath of hospitals that Ginormo Research, Inc. owns that does exactly what we do. If you're in reach of a Ginormo ED, and you have a specific problem, you will end up on my unit.

Four months ago, give or take, Keith showed up. Keith has been nothing but badly-groomed, unhygienic trouble since he showed up. He makes decisions on a weekly basis that, if he were working for Planned Parenthood, would get him fired the same day. . .but because this is a big corporate bureaucracy, have been allowed to accumulate in his file. He endangers patients and makes bone-headed mistakes that are simply inexcusable in somebody who has as many certifications as he does.

I bypassed the Assistant Manglers last week to report a particularly dangerous Keithism, and was written up. I discussed it yesterday with the Head Big Manager, and today got called into her office. Here's what happened:

I presented her with the rebuttal I wrote to the quote-unquote verbal warning I got. She read it, and then cross-referenced it with the writeup that the Assistant Mangler had submitted. I watched as her eyebrows climbed and she made little snorting noises.

Then she said, "I hope you understand that I can't, unilaterally, take this off your file. . . .but I am going to talk to Assistant Mangler about removing it."

I didn't know that using gentle terms like "misunderstanding" rather than the more accurate "I checked this out and it's a baldfaced lie," or "lower-acuity skillset" rather than "this person refused to complete mandated training" would be so effective. But they were.

Head Big Mangler agreed that I had done the right thing by going to the unit coordinator. She agreed that I had done the only thing that was logical, in light of various issues I didn't expand on here. She asked me to pass the word that any future Keithishness be brought to her attention, immediately, even if she weren't physically there.

I heard a distant hum, like large machinery.

And then she said, "So. . . how do we deal with our weakest link?"

The hum grew louder and more distinct, and all I could think of was

But unfortunately that would leave us short-staffed. I said, "Well, we're already manipulating the assignments so that we can keep an eye on Keith's patients as well as our own. . . ." and Manager cut me off. "No," she said, "you guys have enough going on with your own assignments. We need a way to keep an eye on him without burdening you further."

The hum resolved into the singing of a choir of angels, bursting through the Keith-colored clouds that have made my life a misery since March.

End result, TL;DR, was that Manager will be auditing charts and being much more present. She won't delegate this, since there aren't any sub-Manglers that can make good decisions about critical-care patients. And she promised to keep us in the loop. She told me, "I've noticed that people have been calling in rather than work with Keith, and I don't want to lose strong nurses because of one person."

So damn if I didn't get all validated and shit.

And, much more importantly, the entire unit, working as a group, got validated. We saw a problem, we followed the rules in so far as we could follow them rationally, I broke a couple because what the hell am I here for otherwise, and it's all slowly working out.

Now--whether this actually happens is a different deal. Having seen Head Big Manager's face today, though, and learned the meaning of the words "her lips narrowed into a grim line" as she was reading my write-up, I feel a bit more hopeful.