January 16, 2014

Per Diem

One thing about working per diem is that unless you have a long-term assignment--which in the per diem world means going to the same unit more than two days in a row--you don't really get to know the patients.  You see them for a shift, maybe two.  You might do their admission, or their discharge, but rarely will you do both.  You don't get to see the patient's recovery evolve during their stay.  Instead, you step in during the middle of a play scene:  you don't get to see what happened before, nor do you see how their story ends.  You're just there for Act 2, Scene 1 and then it's exit nurse, stage left.

So you don't really get to know the patients.  You don't know their progress, their plans, their goals.  You don't know their background.  You don't know their little quirks.  You don't know how well they play with others.  You don't know exactly how they behaved yesterday so you can anticipate that sort of behavior today.

OK, through the miracle that is known as documentation, you can at least read up on the patient and learn what they were like before you got there.  But what you read on paper and what you see in the flesh can be two very different things.  And documentation doesn't always cover the little things.  You may learn from the chart that they received the HAB cocktail (Haldol, Ativan and Benadryl), but you may not know exactly what the precipitating events were, or how they felt afterwards.

On the other hand, an advantage of being per diem is that you are a fresh set of eyes.  You're not going in there with the presumptions about the patient's history or behavior, and so you're not going to be as quick to draw conclusions.  You may catch things that other nurses may miss because they're so used to the patient.  You may be more objective about things, whereas those nurses who are more familiar with the patient may be more subjective.

Per diem nurses have to be able to adapt to an ever-changing patient population.  You do not have the luxury and comfort of getting the same patient assignments each day.  Instead, you go in there never knowing what--or who--to expect each time.

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