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. Laurel had tried to be encouraging.
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. Brandon was curled into a
ball in the center of the lower bunk.
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 Florida again," Pop said.
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 Orlando. You and the boys
can come for visits on their school vacations, and I could come back summers to
ride herd on them."
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."
"Were you?"
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.
"Mrs. Jordan, 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."
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. Jordan."
"That's Liz."
"Good enough."
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 Grantley College
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.
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."
"Delores Forbes."
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?"
"With stealth."
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. Jordan,
I'll speak with you after I've seen my patients and talked to their
nurses."
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?
"Mrs. Jordan."
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."
"Strictly business."
"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?"
"Don't ask."
"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."
"Laurel's
house." He walked to the door.
She shook her head. What had she done?
Business. The dinner was to be a business meeting.
