True North Nurse

Had no idea, as a new Tumblr’er, that spam appears in the form of nefarious folks ‘liking’ your posts. Someone whose name linked to a site full of lots of tits and ass liked several of my posts, and I innocently thought I had a new follower until I clicked on their name. Um. No way to guard against that eh?

My retirement outlook became a bit rosier after accepting this position, though I could have gotten a job with many other places in Ontario and still be sitting prettier than I was in New York given the cost of living there. The healthier retirement forecast is due to the fact that hospital employees in Ontario which includes nurses, are members of the Hospital Employees of Ontario Pension Plan (HOOPP) if they work for a participating employer. Participation is mandatory if you’re working for an employer that is a participant but I can’t fathom for the life of me why you wouldn’t want to participate. Here’s how HOOPP works:

1. Yes, you’re required to contribute, but that’s a good thing. You’re saving for retirement and not relying on CPP (Canada Pension Plan) or SSI (Social Security (US)), both of which will send me very modest cheques. The number of people who’ve saved nothing for retirement and are relying solely on Social Security or CPP is staggering.
2. The current contribution rate for employees, (which changes year to year) is a mandatory 6.2% of your annualized earnings, then 9.2% for everything above your annualized earnings once you’ve contributed the initial 6.2%.
3. Here’s the bonus. Each and every paycheck, your employer matches your contribution at the rate of 126%. So, for every $100 you contribute, your employer kicks in $126. You can’t beat that. Just as your contribution is mandatory, your employer’s is too.
4. The contributions you make are tax deductible come tax season. Another win-win!

So your HOOPP balance escalates rather quickly if you’re an RN working full-time. I don’t mind admitting I’ve never been the greatest when it comes to saving for the long-term. Oh sure, when I’ve had 401K or 403B plans in the US, I’d contribute 4 or 5% but that was never getting me anywhere close to what I’d need to retire comfortably. HOOPP really helps in that area by forcing you to contribute a healthy amount for a realistic retirement. Close to 17% is being put in this pension plan on my behalf every pay period. 

Last but not least, the stability of the pension fund. I’m sure that’s one of your questions. You’d be crazy not to worry about a retirement plan that was holding so much of your savings. At the end of 2010, the HOOPP Fund had $35.7 billion in net assets available for benefits, an increase of $4.6 billion over the previous year. At the end of the year, HOOPP was 101 per cent funded. 101%. Over-funded!

So, I feel really fortunate to receive this as a benefit of my position. Everyone knows how hard nurses work. Nurses worldwide should be well-compensated for the lengths most of us go to on a daily basis to take incredible care of our patients. Believe me, there are easier ways to earn the wages most of us earn. We do it because we love it. Helping us achieve a comfortable retirement after we’ve spent 25 or 30 years doing this job is the right thing to do.

This new job I landed soon after arriving back in Toronto is no longer new so I ‘spose a little public reflection is in order. I’m surprised at how quickly I found employment after moving back - 6 weeks. I imagine it could have been much worse. Even with fields such as nursing, where they always blather on about how much of a shortage there is, there are a surprising lack of jobs. I have extensive education in critical care nursing and some decent experience to back it up, yet I got no callbacks until the very day I had already accepted this position after six weeks of wall-papering the GTA with my resume. Oh well. Their loss. I’m rambling but that’s alright. This is supposed to be reflection after all.

In general, I love the job. The work we’re doing, for some of the most vulnerable populations out there, is not without its headaches. However, I come home most nights (or days) more rewarded than at any time previously in my career. The clinic and our “hospital within a clinic” where I’m posted, have a mission that really jives with me. It runs on a harm reduction model which I’m a big advocate for. Given the population we’re working with, many with current or past history of homelessness, they often will also come with some history of substance abuse and/or mental illness. We’re under no illusion that anyone’s going to come to our facility clean and sober if they recently used. Like cigarettes and booze, most other substances are nearly impossible to quit without a herculean effort. As such, if our clients are going to leave the clinic during the day to use, we’d rather they do it as safely as possible and will provide them the necessary education and supplies to ensure a reduced risk for them and ultimately the public at large. Harm reduction could be its own post. Or twenty posts, for that matter but I’ll leave it at that for now.

So back to what I was mentioning about the new gig. We call it the “Infirmary” but it’s basically a mini-hospital within the clinic. A big proportion of clients we accept are discharged from acute care but aren’t quite ready to go home or back to the street or to the shelter, and need a week or two of extra medical care. In this day of messy hospital discharges and kicking patients to the curb often before they’re ready, a unit like this is a huge help. We also accept clients, as an example, who need “respite” care. Perhaps they’ve just started intensive chemotherapy at another facility and need a place to stay for several days where their side effects can be managed by a medical professional. So the types of cases we see really runs the gamut.

The unit is staffed by one charge RN and one CHW (community health worker) per shift. The average patient load is 4-6 but could be as high as 10. I really enjoy the autonomy of the position. There’s a ton of multi-disciplinary collaboration which is a necessity when it’s often the nurse that spends 95% of the time with the client and everyone else as little as a few minuets a day.

During their stay, in addition to the medical care the RN provides, there are social workers to assist with things like housing and benefits if that’s a problem for the client. The physician is also on call during the day and can make themselves available if needed. If the client really goes sour while they’re with us, we can always transfer them to an acute care facility. I guess the point I’m trying to make is that there are supports in place in spite of the fact it might sound like there’s 2 people responsible for caring for 5-10 patients at once.

Now to the title of this little perambulating prose. They chart using the SOAP method here. For those of you like me who haven’t utilised it much (or at all), here’s a quick and dirty rundown on SOAP (no pun intended. Hah. I slay myself. *snort*.) Your progress note is written in the chart as follows:

S - Subjective. Information the patient (or family) reports to you. Quotes are ideal. What the patient’s experiencing in their own words.

O - Objective. Measurable data and other relevant points you observe. Vitals, labs, results of your physical assessment.

A - Assessment. As a nurse, this is usually your nursing diagnosis (when’s the last time you wrote a formal nursing diagnosis??) or more realistically, a condensed list of patient problems, all created using the Subjective and Objective data previously gathered.

P - Plan. What are you going to do immediately, in the short-term and in the long-term to help the patient gain relief from the issues you’ve identified? Include measurable goals whenever feasible.

It really is a very systematic, clean way of interacting with the patient and documenting said interaction. Yet I haven’t used that method other than a few practice exercises during the first semester of nursing school. None of my previous employers have required it. So it’s taken a few weeks to really get my charting up to their standard. Earlier this evening, I reviewed some of the first chart entries I wrote when I arrived and they read like a wet-behind-the-ears 18 yr old nursing student two months out of high school.

Alright, I’ve rambled enough for one post. There are one or two other things I wanted to write about but I’ll save them for later tonight, time willing.

I was reminded tonight of my days before nursing. Of my previous life as a software engineer working for Geocities. For those of you too young to remember them, think of them as the Tumblr or MySpace of their day.

Anyhow, we used to hire these men and women to sort of foster the particular community on Geocities they were interested in. E.g, cars, tropical fish or dog grooming. Some of the, took their jobs as “Community Manager” a little too seriously. They’d start asking us to ban someone who somehow crossed them, or didn’t apologise to a mutual friend they insulted, etc. The reason didn’t matter. What mattered was that we had these people who probably lived in their parents’ basement with four cats, running their communities for a free Geocities account and a few hundred bucks a month taking their roles waaaay too seriously.

Not unlike the individual on Twitter this eve who felt I owed my followers an apology for an inadvertent error I’d made. After searching my stream and not seeing an apology, the individual pointed this out. I apologized. Again. To which they replied “good! All sorted out then!”

Ya know what you little pain in the ass? Go f*ck yourself. Who made you Mom of the Internet? I have a Mom and she doesn’t go around advising complete strangers about netiquette. Neither should you. Now can I go back to my real job nursing sick people back to some modicum of health?

So they heavy-handedly arrest the former IMF chief. They give him punitive bail (compared to most celebrities). He sits in Rikers Island far more than any other government official or celebrity would - as if the police had something to prove and were going to stick it to this “Frenchie” - their term, not mine.

…prosecutors said the victim “offered a compelling and unwavering story” and that the proof against Mr. Strauss-Kahn was “continuing to grow every day.”- NY times

This morning, we find a a whole boatload of incosistencies in the accuser’s story.

Prosecutors disclosed that the woman had admitted lying in her application for asylum from Guinea; according to the letter, she “fabricated the statement with the assistance of a male who provided her with a cassette recording” that she memorized. She also admitted that her claim that she had been the victim of a gang rape in Guinea was also a lie.

The woman also admitted to the prosecutors that she had misrepresented her income to qualify for her housing, and had declared a friend’s child — in addition to her own daughter — as a dependent on tax returns to increase her tax refund.

The housekeeper admitted that she lied about what happened after the episode on the 28th floor of the hotel. She had initially said that after being attacked, she had waited in a hallway until Mr. Strauss-Kahn left the room; she now admits that after the episode, she cleaned a nearby room, then returned to Mr. Strauss-Kahn’s suite to clean there. Only after that did she report to her supervisor that she had been attacked.- NY Times

So, she lies about what happens after the “rape”. She’s lied about past rapes even occurring in order to get into the US under an asylum program - a program that is overwhelmed with legitimate claims all the time. She’s lied to the IRS for years about a non-existent child in order to lower her income tax bill. She lied about her income to get cheaper housing.

Now, I’m not for a minute suggesting sex did not occur. Strauss-Kahn has a reputation for the ladies. It’s well documented. His wife knows. The media in France knows. It’s nothing new. Charges of rape are, however, new. But how are we to believe this accuser when she has a string of falsehoods in her past. How are we to determine when she’s telling the truth and when she isn’t. DNA evidence isn’t enough. Strauss-Kahn has already admitted they had sex and it was consensual. The accuser WALKED AWAY and cleaned another room and then cleaned up the crime scene! WTF?!?

This man has lost his job. His reputation has been probably irreparable harmed. How does he get his life back. Yes he’s got plenty of money. That doesn’t repair the character assassination that’s happened for weeks in the media. That doesn’t get him his job back. The New York County DA should be revisiting its procedures and the NY Police Department better start reviewing its treatment of defendants. Last I checked, people were innocent until proven guilty. This man’s been treated as guilty from day one.  Not cool.