Sunday, February 26, 2012

The inside scoop on Hospitals in Mexico

First of all I have to remind you I'm by no means and expert on this considering this is the first hospital I have worked in. But I do ask our new nurses where they worked before and what it was like. It seems to me that we are the norm as far as private hospitals go. The only place that is more standardized like I am use to is the IMSS.  The other thing about the nursing jobs here is that the pay is so very low. Most nurses get no more than 4-5,000p a month. I am getting more than that because I entered at a supervisor level. The nurses at the IMSS get 7,000 a pay check and only work three twelve hour  shifts per week. Which is way more money and way less hours than me. My plan is to go sign up for a job at an IMSS but apparently it takes years to get accepted into one of the positions.
Basically when you walk into my hospital it is beautiful. It reminds you of a hotel but with nurses stations. The nurses are well educated in school but once they are out the hospitals do not maintain a proper continuing education program. This is something I have been pushing for since I got into the hospital. No one seems to understand the importance of it. Or like many people have told me the higher ups are just afraid to give to much education to the lower positions. This is not only in the hospitals but pretty much is the rule in the work force here. To be honest the only personal experience I have in the states is in Hospitals and the last one was a teaching hospital so this totally rubs me the wrong way. Im going to do my best to keep this post objective and not go into my rants. So here I wont explain how utterly important it is for continuing education in health care.

Since October I have tried to encourage changes such as continued education, starting an orientation program for new nurses, placing resources for the nurses at the nursing stating (drug books, references on processes, an easier and safer documentation practice, etc.) And everything I try to implement gets denied. I am basically not being allowed to do what they told me they hired me for. Finally I asked for a job description because my position was completely made up. I was getting sick of wasting my time trying to plan and implement things when I was always held up and denied at the last min. I had no idea what the heck they wanted me to do from day to day. Now I am a Supervisor B, with basically administrative duties. To explain it best Im doing all the crappy paperwork that the head nurse doesn't have time to do.

The worse part about all of this is that the things they do focus on are so silly. They are insane about the dress code. For example I have gotten "talked to" like three times for my presentation. The first time was because apparently I wasn't using enough bleach on my uniforms. Then it was that I don't paint my shoes enough and the looked dirty. They were clean but scuffed, here you have to wear the old school leather white nursing shoes. Can I hear a Blech from any nurses out there. This last time I was told that my little fly always were to messy and I need to start putting gel in my hair. And don't get me started on my tregas earrings. Basically the supervisor in charge of checking this sort of thing was ticked off because I explained to her that she was doing something illegal and when she argued with me about it I brought it to the head nurse. What was she doing  you might ask. Well in health care we write with pen only in the charts. This is so that nothing can ever be erased. If you make a mistake here you are suppose to put (parenthesis) around it and rewrite what you wanted. One day I found some nurses taking pieces of tape and ripping off what they had written and writing over it. I very nicely explained to them that this is the same as using white out and is illegal. A short time later one of them told me that the Supervisor does it all the time. YIKES!!! So the same nurse who walks around sending people home for scuffed shoes and fly aways thinks its ok to falsefi documents as long as you cant tell. Yes that is what she told me when I confronted her about it. That the nurses shouldn't do it because when they do it its ugly but when she does it it looks nice and you cant even tell she did it. Sigh!!!!!!!!!!!

To be honest a lot of the problems within the private hospitals here (and yes I have asked around) is the chain of command or lack of use of it. For example the above mentioned Supervisor is no more than a supervisor. But many of the changes I have wanted to make the head nurse thought were valid and could work. This of course was when I as alone in her office with her. But when we would bring it to the Supervisor meetings I would be immediately shut down by this supervisor. And worst of all the head nurse would immediately agree her. Basically if it comes out of my mouth they quickly scruntch up their lips and shake their heads no.

Also the horrible communication. They are giving us a course on Lean Healthcare which is a system of organization and communication from Japan. We used this system at the last hospital I worked at in the states and it was great. But to be honest with the way things are here its next to impossible to implement any of it. We have no intranet, all the supervisors of nursing and the head nurse use the same email address, there is no calender of events or meetings. You usually don't know about a meeting until like 10min before hand. Mind you most of this kind of thing doesn't really reach the patient but turns out to be a horrible working environment. And happy nurses make happy patients.

The few suggestions of mine that have been put into place they are sure to wait a few weeks after I suggest it and then suggest it as if it were their idea. This also is very common in all the workforce down here. There is no since of encouragement to employees who do have good ideas. They are to afraid you will raise up above them. Again this is so hard for me to swallow because the hospital I came from encouraged growth. I never push this kind of thing or try to make sure everyone knows the idea came from me. This is because I know they all know and there really isnt any point anyway. I have finally given up on giving any ideas for the betterment of anything. I realize that if I do they will just get turned down. I have resigned to just doing what they ask of me and no more. My husband made it very clear that this is what is expected here. And Im finding its true. The supervisor I mentioned above has back off quite a bit. This all makes me so sad because I have so much to offer and instead Im organizing the charts of discharged patients and doing secretary work.

Actually I may even look into another teaching job next week that will be the same pay but half the hours. I'm pretty sure I wont get seguro or Infonavit and because of this I have to discuss it more with my husband. But as excited as I was to put my nursing uniform on I think its not where I should be. I haven't even touched a stethoscope in over a month. Athough I hate the job hopping, I guess its ok because Im still learning so much about the work force here in Mexico which is nothing like where I grew up. I had one job from the time I was 16-18 at a nursing home (thats a long time for a teenager). Then another job from the time I was 18-21 at a hospital until I moved to St. Louis to go to school.Thats when I worked at Barns and had that job from the time I was 21-28 when I moved to Mexico. I have almost had more jobs in two years than I did in over ten years of working in the states. I know there isn't a perfect job and the grass isn't always greener, but I think its time to start being a realist and accept that maybe nursing isn't what I should be doing down here right now anyway. I do want to apply at the IMS and maybe even in Tepa. But for now if I can make the same amount of money but have more time with my kids maybe I should be teaching.

Friday, February 24, 2012

Love letter to my girls

So an old friend of the family created this really cute site for moms. I haven't had as much time as Id like to read on it but what I have had time for I have loved. I felt so  privileged when she asked me to write a love letter to my girls for her to post during her Feb postings. So here is the link. I think that lots of  my mommy readers will really enjoy this encouraging page.

Thursday, February 2, 2012

Experiencing IMS in the city

Yesterday was my first real experience with the free public health system here in the city. Let me tell you its much worse here than in the small town of Tepatitlan. For my job I have to have a carta justificante when I miss work for an illness. And the letter must come from the IMS not from a private doctor. So although it was obvious that my girls had the pox and I couldn't bring them to the daycare I still had to go to the IMS clinic. I was there from 9-12 waiting. Basically they didn't explain everything to me well and even with my probing questions they were reluctant to fill me in on the whole process. By the grace of God the director of our day care showed up (hoping to get vaccinated against the pox) and she got the full information for me. Here is how it works. We are part of the evening shift appointments. People can start showing up at any time for these slots. The appointments don't actually start until 2pm. But if you wait till then to go there may be so many people already that you wont get an appointment that day. But we were there at 15 min till 9am and the lady seriously thought I would wait from then until 2pm. That is virtually impossible with three kids. Not only that by the time I got fed up and left at 1200 there were only two people there for the evening shift appointments. So I'm thinking if we ever do have to get something from that doctor again (for work, or day care) then we will show up at like one and have to wait until 3 or 330 for our appointment.  During the time we waited we managed to see the dentist who spoke English to my girls and confirmed we have no cavities. YEAH for that one. We will be visiting the dentist in another 6months for the fluoride application. The only thing I felt was missing there was education. Maybe they didn't do it because I still had my work uniform on. Usually the IMS clinic is better about educating the patient. The dentist is not as full and basically you just show up and they check you out. They actually came over to me and asked me if I wanted the check up from them while I waited for the other office.  We almost got the babies flu vaccine but I gave up waiting before that happened. I'm kinda pinching myself for that one. But after three hours there with three girls I was done and so were the girls. We ended up going through the ER and getting Tylenol and my letter from there. I have since lost that letter which I'm also kicking myself for. We also ended up getting an Antibiotic because the oldest on has infections in lesions. The whole experience was pretty horrible and I'm pretty sure we will never use the doctor there unless its absolutely necessary. I'm still glad we have Seguro in case we ever need hospitalization because there is no way we can afford a private hospital. And also the ER was pretty quick and we got free care and medication. Right now the girls are playing well and so far the baby hasn't shown any signs of contracting it from them. I hope if she is going to get it that she gets it soon. I feel like Im leaving something out of the informative part of this post so as always if there are any questions Id be happy to answer them.