Liz picked up her lab coat and stared at her reflection in the full-length mirror. Though she looked calm, she felt inches from panic. Monday had arrived. In fifty-five minutes, she had to leave for work. Her stomach clenched. Her shoulder muscles knotted. She searched for courage and found doubts swirling like gnats at the beach.
She hated first days, but until she faced today, there could be no second or third. How different could things be from the pressures she'd faced at the hospital in the city? What if she hated being nurse manager at Eastlake Community?
Eric had called the position a challenge. Megan had said the unit was a disaster and the doctors disgruntled. Jenessa had spoken of the need for organization. Alex had shrugged. He seldom had patients on the unit, unless he was called for a medical consultation.
had tried to be encouraging. Laurel
When she'd asked about the acting nurse manager, Jenessa had changed the subject. Did this Mrs. Forbes resent not receiving the position? Was the woman working on the unit? Would she be on duty today? Liz felt as if she was walking into a game where she didn't know the rules.
I'll deal with this. She had to or opt out the way the four previous holders had. Had they decided to resign or had someone forced them out?
With a new worry added to the swarm of gnats, she left the bedroom. Before going downstairs, she paused in the doorway of her sons' room. She smiled. Justin sprawled on the top bunk. One foot hung over the edge. Thank heavens she'd insisted the side rail remain in place.
was curled into a
ball in the center of the lower bunk. Brandon
They looked so innocent. Would they lose the hard and defiant edge they'd cultivated in the city? She prayed they wouldn't give their grandfather trouble. All weekend they'd hung around the house, even refusing to go shopping and exploring with her. They'd spent all of Sunday on the porch waiting for the neighbors to return. Bedtime had arrived before Delores and Chet had come home.
In the kitchen, the aroma of fresh-brewed coffee did little to stir her appetite, but she had to eat something. She opened the refrigerator and took out the juice.
Pop stepped into the room. "Want me to scramble some eggs for you?"
The thought of food made her stomach lurch. "I can't eat."
"You got the jitters again?" He patted her shoulder. "This move's a good one for you and the boys. Nice town. Nice people."
His optimism cheered her a bit. "Thanks. You're great. Make sure the boys clean their room and mow the lawn. I think they can handle the hand mower. Tell them not to blow what's left of last week's allowance."
He chuckled. "Bran won't. Money slides through Jus's fingers like water. They're good boys. Once they get used to being here, they'll settle down." He poured two cups of coffee and sat across the table from her.
She swallowed a mouthful of orange juice and wished she hadn't. She pushed the glass away and looked at the clock. If she left now, she'd be forty-five minutes early, and she'd have too much stewing time. Why hadn't she agreed to start today at nine and let Eric introduce her to the staff?
"Been thinking about
again," Pop said. Florida
Liz looked up. She'd thought his talk had been nothing more than a dream. "What have you decided?"
"Depends. George and Pete have found a house we can share, especially if Al decides to come along. Not far from
. You and the boys
can come for visits on their school vacations, and I could come back summers to
ride herd on them." Orlando
A lump formed in her throat. He'd been so much a part of their lives since Derek's death. This meant another change, but one she knew was right for him. She'd miss him. So would the boys. "When do you plan to leave?"
"Don't fret. Won't be 'til after school starts. Boys will be old enough to stay alone for the short time from when school lets out and you come home from the hospital. It's not like they're babies."
He was right, they weren't. There might be some kind of after school program for them. The problem was that Pop was the man in the twins' lives. How could she replace him? She thought of the things she couldn't teach them. Her friends called her athletically challenged. They were right. She couldn't think of a sport she enjoyed or was marginally adept at playing. She wanted to beg Pop to stay, but he'd given up a lot for her and the boys. "Why did you wait until this morning to tell me?"
"Figured I'd divert you from the jitters."
"Didn't work." She sighed. "Go for it . . . . I'll miss you."
He patted her hand. "I'm not abandoning you."
"I know." She believed him, but that's what it felt like. He was the boys' only relative. Her parents and his wife were dead. She and Derek had been only children.
"About time you got on with your life. My being around keeps you from looking for someone. I know you loved Derek, but you can't mourn him forever."
Why not, she wondered. Clinging to those memories was safe.
"I worry you think I won't approve if you find love again," he said. "I'd be happy to give the bride away."
"When do I have time to look?"
"Could find time if you wanted." He refilled his cup. "Boys are getting too much for an old man. Made mistakes with Derek. Don't want to repeat them with my grandsons."
"You didn't make mistakes. Derek was a good husband. He died a hero."
"In a foolish way. Dashed into that house with no thought for what would happen to you and the boys. Wasn't the first time he took a chance with his life."
She felt tears forming. Her husband had run into a burning house where three children were trapped. He'd saved two, but the third had died in his arms. "Don't blame yourself. Derek wanted to be a hero to everyone." She rose. "Time for me to head to the hospital."
"Smile. It's not your doom."
"Feels like it."
Ten minutes later, she pulled into the parking lot, found a space, and watched nurses and other staff members walk to the red brick building. Her heart hammered, and she tried to tell herself how foolish it was for a woman who'd just had her fortieth birthday to feel like a six-year-old on the first day of school.
She left the car and followed several women in white uniforms to the elevator. Were any of them part of her staff? She stood at the rear of the car and tried to smile. Her lips felt stiff, and her hands were blocks of ice. A dozen scenarios, all centered on failure, ran through her thoughts.
On four, she strode down the hall to the ortho/neuro unit. She glanced into the office that would be hers and saw Delores. Liz paused with her hand on the door. Why hadn't her neighbor mentioned she was the acting nurse manager?
Delores looked up. "Be out of your way in a jiff." She shoved papers into a box. "Just clearing my junk out."
"You don't have to rush."
"You are the new broom, and you know what they say." The blonde's smile failed to reach her eyes. "Should have cleared out on Friday, but I had to take the last of my comp time before I lost it. I'm not about to give them a penny more than they deserve."
Bitterness tinged Delores' words. Liz prayed she wouldn't be buried beneath the overflow. Still, she didn't blame the other nurse for being upset that someone else had been given the job she wanted. "Leave the box until you go off duty."
"I'll shove it in my locker. Won't take more than five minutes. Then I'll show you around." She grabbed the box and hurried toward the locker room.
Liz slumped in the chair behind the gray metal desk. This day was off to a great start. How would this twist effect the friendship between the twins and Delores' son? Maybe the other woman would be the one to say no. Liz reached for the papers in the wire basket on the corner of the desk and began to sort them.
Delores cleared her throat. "All set. Good thing I didn't give myself an assignment this morning. I'm free to show you around. Actually, I thought you'd be in later."
"Is the unit well-staffed?"
"Yes and no." Delores made a face. "There's a big turnover so most days we work with floats. Got two today so the nursing office must have thought you needed an easy intro."
"Will you stay on the unit?"
"I'm not sure how you'll feel when people come to me with questions instead of you."
"Why should that bother me?" Liz asked.
Delores shrugged. "I have . . . . Never mind."
She had what, Liz wondered. Delores' rigid posture made Liz uncomfortable. Was the other nurse friend or foe? Was her resentment toward the administration or on a personal level? "I wish I'd known you worked here. We could have driven together."
"Didn't Mr. Bradshaw tell you about me?"
"He called you Mrs. Forbes. I never heard your last name when we met."
"Guess I was in a rush to get away. Had to drop my son with his father so I could spend some time with my friend." Her smile was sly.
"What about driving in together?"
Delores shook her head. "Most days I don't go straight home. I have a . . . arrangement. Having a social life is complicated when you have an impressionable son. I'm sure you understand what I mean."
Liz walked to the door. "Let's sit in on report and then make walking rounds."
"Your choice." Delores led the way down the hall.
"How long were you acting nurse manager?" Liz asked. "You weren't here when I interviewed."
A spark of anger lit the other nurse's pale brown eyes. "I was on vacation. Didn't know I wouldn't have the job until I returned. Guess I don't know the right people. Sure hope you do. If not, prepare for a short stay."
Liz wondered what Delores meant. Who were the right people? Megan had encouraged the application for the position, and Laurel and Jenessa had added their voices. Liz wanted to believe her experience had led to the hiring. Did Delores have some vague promise that she'd be offered the job if she proved herself during the interim? Does she think I stole her job? Don't jump to conclusions.
"Have you always worked on this unit?" Liz asked.
Delores shook her head. "CCU, but when the opening here came up, I figured I'd give it a try. No one else offered. This unit has a reputation for spitting out nurse managers."
Before they reached the nurses' station, she halted. "Look, I don't blame you. You applied and evidently were more qualified than I am. Put it down to hospital politics and the mechanizations of certain doctors."
Which doctors? Before Liz could ask, the night nurse began report. Liz noted the nurses who took notes and those who seemed bored. Once report ended, Liz introduced herself. "I'll be speaking with all of you in the next few days."
As she and Delores walked the unit, Liz made mental notes about the location of supplies and the types of patients presently on the unit. In one of the rooms, she watched a young nurse begin pin care on a patient whose shattered left leg was being stabilized before it could be set.
Liz motioned the young nurse into the hall. "Ever do this before?" She glanced at the name tag.
Penny shook her head. "I read the procedure book, but this is my first time."
"Did you ask anyone for assistance?"
Penny shrugged. "Everyone's busy with their own patients, and they think I should have learned how in school. We spent three weeks of clinical here, and I never had a patient with this kind of procedure."
"Let me show you. Once you see, you'll have no problems." Liz introduced herself to the patient. "I'll do your pin care this morning." She quickly demonstrated the procedure while Penny watched. "If you have any questions, come to me." When Liz stepped into the hall, she turned to Delores. "What kind of orientation do the new grads receive?"
"Evidently, not a good one," Delores said. "They spend the first two weeks with staff, learning how we do things here. If they don't know what they're doing, blame our administrators."
Why, Liz wondered. Each unit had its own demands. "Do you mean there's no orientation specific to the unit?"
"They spend a day or two learning where things are kept. What's to learn? They should have been taught during their schooling."
Delores frowned. “I went straight to CCU after I graduated and had to take a course."
Did Delores know much about orthopedic and neurological nursing? Liz added a specialty course to her list. Right after computers.
"Delores, phone," the unit clerk called.
When the other nurse headed to the station, Liz stepped into one of the patient rooms on the neuro side. An older nurse with graying hair stood with her hands on her hips. "You need to get to the chair, and, no, I'm not going to use the lift."
Liz stepped to the bedside. "This your first time?" she asked the patient.
, I'm Edna." The nurse smiled.
"About his tenth, and it's time for him to try on his own. Doesn't think
I'm strong enough." Jordan
Liz smiled at the large-boned woman. "I'm sure you are, but let me try." She glanced at the name on the headboard. "Mr. Greene, I'm Liz Jordan, the nurse manager. Let me show you how you can help yourself. I'm sure you don't want to stay in bed forever."
"What if I fall?"
"Edna and I won't let you. She's going to hold the chair. Now, use the trapeze and slide to the edge of the bed. Bring your hips toward me and put your feet on the floor. Now stand and pivot."
The patient followed her directions and looked up with surprise. "I did it."
Liz smiled. "Next time, Edna will help."
The older nurse laughed. "And I'm a tad bit bigger than she is. Good to have you aboard, Mrs.
Liz continued rounds on her own, and then walked to the nurses' station. Delores sat on a corner of the doctor's desk. "Here she is now."
Two doctors introduced themselves. Liz noted their names and connected them to the patients. Once they left, she sent Delores to assist with patient care. "I'll be in my office."
"Don't you want me to pick up these orders?" Delores asked.
"Sure, but they're used to me taking care of it."
"I think you'd better pass the word that the patient's nurse is expected to transcribe the orders. Before long all they’ll have to do is check since this unit will soon have computers." Liz said.
Edna made a vee sign. "If she doesn't, I will."
“Computers here. Maybe next year.” Delores glared at the older woman, and then turned to Liz. "I haven't finished your tour. I'm sure policies are different here than wherever you worked before."
"Probably, but I've read the policy and procedure manuals. Mr. Bradshaw gave me copies. I need to make notes on some changes I'm considering."
Delores fisted her hands on her hips. "What things and what changes?"
"The ones I was hired to make."
Delores laughed. "Go ahead and plan. You won't get any backing from the Nursing Office, the union, or the Board. When Bradshaw took over from the former director, someone I considered to be a brilliant leader, there were going to be great changes. Haven't seen any. Things were better before. People were promoted on seniority, not education."
Liz shook her head. Was there a way to rid herself of this thorn? Arguing wouldn't work. Eric was slowly making changes. Unfortunately, the union had to be convinced any new system would benefit the nurses and the patients. Liz thought about Penny. Putting a new grad on a unit with minimum amounts of orientation was asking for a law suit. Did the fault lie with the administration or with the person who had been acting nurse manager?
She sat at the desk and made a sketch of the department. The nurses' station was built as a triangle. The medication room and the doctors' desk filled the base. The desks for the nurses and the unit clerk formed the sides. One of the patient wings held patients who'd had orthopedic or neurosurgery and the other those with neurological and medical problems.
Once the drawing was finished, she made notes for a proper orientation and began a list of teaching modules to be included. She reached for the phone and placed a call to
to make an appointment to speak to the dean of the Nursing Department. There
was no reason the program couldn't give the staff nurses credits toward a
bachelor's degree. Grantley College
Someone tapped on the door. She looked up and saw Megan. "Thought we were meeting for lunch?"
"Is it that late?"
"Nearly one. I waited for you to call, and then worried something had gone wrong. You okay?"
"Just immersed in plans." Liz put the papers in the center drawer of the desk.
"Then climb out of the pool. I'm starved."
They found a table in a corner of the nearly deserted cafeteria and unloaded their trays. Liz's appetite had returned. While she ate soup and a sandwich, she listened to Megan's chatter about her love life. Liz chuckled over her friend's inability to choose one man.
"You're fickle," Liz said.
"Or a coward." Megan raised her glass. "More likely it's a reaction to Dad's single-minded clinging to a habit of avoiding women and commitment."
"There's nothing wrong with not wanting a second marriage."
"I'd forgotten that you're as fixed in the past as Dad." Megan finished the tea. "So what do you think of your unit?"
"There's a lot of room for improvement. Part of the reason for the frequent requests for transfers is the way the place has been run. I don't blame new grads for leaving. They're thrown into the fire and left to burn."
Liz frowned. "Maybe not. She accepted a job she wasn't prepared to handle. She doesn't have a degree. She's a CCU nurse with little experience with the types of patients on the unit."
"Why are you defending her?"
"She's good with the patients."
"Is she, or does she try to charm them? Delores doesn't like to work."
"You could be right."
"How are you going to handle the problems?"
Megan laughed. "You jest."
Liz shook her head. "Not really. I'm designing a plan, and, by the end of the week, I'll see how to implement it. I need to talk to Eric about the four new grads. They've been on the unit two months, and they're still floundering." She looked up. "When are you moving to administration?"
"When the nurse recruiter retires or resigns. She won't share her territory."
Liz rose. "I'd better head back. I'm sure other doctors will be making rounds, and I need to meet them all."
Megan frowned. "The orthopods usually come by in the morning."
"I met two. Delores must have waylaid the others."
"Don't let her go with Dad. His partner doesn't mind."
Liz gathered her dishes. "Why not?"
"She tried to dig her claws into Dad. He ran fast, but she took a few strips. According to her, they were a hot item."
"And you're protecting him?"
Megan shook her head. "He's too wary to be trapped, but she's spreading some nasty gossip."
Liz carried her tray to the disposal area. Gossip and rumors, she thought. Let's hope I can avoid them.
When she reached the nurses' station, she halted abruptly. Jeff Carter, the man who'd resided in her daydreams for years, stood at the unit clerk's desk. "Where's the new nurse manager?"
"Here," Liz said. "I'm Liz Jordan, and you are?"
"Dr. Jeff Carter, not to be confused with my son." He smiled.
Liz grasped the edge of the counter. "Since I know Alex, there'll be no confusion. Is there a problem?"
He nodded. "On Friday, there was a medication error involving one of my patients. I was told the incident report was in your office. I want to see it."
She frowned. She'd looked through all the papers that were in the basket and hadn't seen any incident report. "Let me look."
"Don't you think incident reports are important?"
"I didn't find one on my desk, but I'll check the drawers."
As they strode down the hall, he told her what he'd learned. "Someone on this unit is responsible. I spoke to the pharmacist on duty. He said a nurse had insisted she'd spoken to me, and I'd ordered penicillin on a patient who's allergic to that medicine. No one called my office. I want to know who's behind this."
"So do I." Liz checked the papers on her desk and searched the drawers. "Not here. Maybe Delores put it with the things she removed from the office."
"Find her." Ice coated his voice.
"On my way."
"One thing you'd better make clear to your entire staff. Any time there's a question about one of my orders, I expect a phone call."
Liz turned. "That's standard practice. Who signed off the order and sent it to the pharmacy?"
He shrugged. "Writing's on a par with mine."
Liz smiled. “Won’t be a problem when the computers arrive.”
“Not you, too. Find that incident report.”
Liz found Delores in the lounge. "Dr. Carter would like to see the incident report from Friday. It wasn't in my office."
Delores smiled. "Maybe I accidentally put it with my things. I'll check my locker and bring it to you."
"Thanks. He's a tense man."
Delores laughed. "Maybe he should be."
Ten minutes after Liz reached the nurses' station, Delores arrived. "Found it. Dr. Carter, I understand your patient was fortunate."
Jeff Carter's mouth formed a taut line. "Weren't you in charge Friday? Where were you when the incident occurred?"
The blonde rested one hand on her hip. "Taking some comp time. I'm sure I told the clerk to call your office."
The thin woman wheeled in her chair. "You never."
"Then I must have told the patient's nurse. These new grads let everything fluster them."
By the time the stories were checked, Liz had no idea what had happened. The incident report was no help. She frowned. Delores had signed the report, yet she denied being on the unit when the wrong medicine was given. "How could you sign a report when you weren't here?"
Delores opened a drawer. "Pre-signed forms. The nurse manager only needs to sign that the nurse made it out."
Liz lifted the forms from the drawer. "This won't happen again."
"Better not." Jeff picked up a stack of charts. "Mrs.
I'll speak with you after I've seen my patients and talked to their
Liz watched him walk away. She would rather hide, but she couldn't. She returned to her office and added more items to her growing list. How could one person sort out chaos?
His deep voice sent chills along her skin. "Dr. Carter, come in."
He closed the door. "I know it's your first day, but do you have any idea when you'll have a smooth operation here?"
She wanted to laugh, but that would be the wrong approach. "I've a list of areas where improvements are needed and some ideas of how they can be accomplished. But to give you a date, sorry."
"I wish you luck."
"Thanks. I'll be speaking to all the doctors and asking for suggestions. Do you have any?"
He smiled. "A few hundred. We should name a time and place for a meeting."
"I'd like that." She mentally ran through a list of those who should be included.
"How about joining me for dinner on Friday?"
"Sure. No, wait . . . ." She'd answered before she thought, before she remembered this was real and not part of a fantasy. She shook her head. "Not dinner."
"We can meet here, or you could tell me now." Did he hear the panic in her voice?
"Can't today. I've office hours, and I need to organize my ideas. Not here either. Too many curious eyes."
She frowned. "Why would anyone be curious about a meeting in this office?"
"Let me talk to Eric. I'm sure we can use the conference room and ask the other doctors to come."
"Friday. I'll pick you up at seven."
"Tell me where, and I'll meet you." She'd also ask Eric and Jenessa to join them.
"You're new in town."
"Not that new. I went to Grantley with Megan." She chewed on her lower lip. Why had she reminded him? Evidently, he didn't remember how she'd made a fool of herself. Liz stared at her desk. This was the moment she'd dreamed of for years. Dreamed was the key word. Reality wasn't safe.
"We'll go somewhere so we can talk."
"You don't know where I live."
house." He walked to the door. Laurel
She shook her head. What had she done? Business. The dinner was to be a business meeting.