Yesterday Elias had his occupational therapy. He has a new therapist now which is really not that big of a deal since it seems like every time we get going with the sessions he ends up back in the hospital. Hopefully, that trend is behind us and there are better days ahead. She spent the day kind of evaluating what he can do and what his needs are. She was very pleased with many things that he is able to do right now. She was telling us that he is actually doing some of the typically more challenging activities that children with his "delay due to hospitalization" have a difficult time with. She was telling us that is a huge plus for him because these are the activities therapist have the most frustration with. Things like blowing the raspberries with his mouth and all the facial expressions he has, social interaction (which we already know he loves people) skills, is audible responses/interactions and his response to overall oral motor stimulation. She was just very impressed overall and while she did not come right out and say it (probably because she can't) she was insinuating that his developmental chart does not serve him justice. Again something we all know, but it is wonderful to hear a professional reaffirm that thought. We were so very proud of him yesterday. She really wore him out too, as he took a very long nap afterward.
Unfortunately, the positive karma did not carry through the night as we had to dismiss our nurse in the middle of the shift, about 3am. I had awakened to use the restroom in the middle of the night. I do not mind this usually because it gives me the opportunity to peak in on Elias in the during the night. The nurse was one who had not worked very many shifts, this was only her fourth because she only works one day a week and is the back up nurse. I noticed that she was sitting on the couch that is right by the door to his nursery. We intentionally keep items on this to keep the nurses from sitting there, it is too comfortable. There is a desk for them to chart and do their notes along with the obvious desk chair for them to sit. For some reason she chose to move the items off the couch and sit there. She has done this in the prior shifts as well, but always places the things back on the seat as she found them. I did not really think much of it. I took notice of how she was sitting as I walked past his room to the restroom. While in there his Cardiac/respiratory monitor alarm sounded for a very brief period. We have become accustom to this happening at times simply because Elias gets in such a deep sleep it does not always pick up the breath movement enough. When I was on my way back to the bedroom I peered in again and noticed she was in the exact same position, legs and arms crossed everything. This was maybe 2 minutes after the alarm had sounded, so I did not expect to see her sitting there. I stood at the gate, which is literally arm length away from where she was sitting and she was still. She did not turn or move as I stood there watching for several minutes. I even walked away in to the living room and back again, stood there again for another moment with no movement from her. I could not see her face so I was not certain, but I suspected she was asleep. I quietly opened the gate to the nursery, which has an audible click and creak when it swings. She did not even flinch, let alone turn to look. Human instinct makes us look when we feel a presence, and you do usually sense someone standing and staring when they are less that 3 feet from you. I actually took 2 steps into the room and still no movement. It was not until I started to bend and swing around trying to get a look at her eyes that she gasped and looked at me. I asked her point blank if she had fallen asleep, but she denied that. She even spoke of the alarm which had just gone off, but I asked why she was sitting in the exact same position both before and after I went to the restroom and she never turned to acknowledge me while standing there for several minutes right on top of her. We had a bit of a debate that was just spirited enough to wake Katharine. While I conceded that I was unable to prove that she had fallen asleep I was not going to make that accusation as reason for dismissal. I did inform her that I no longer had confidence in her to be alert enough to watch Elias. We discussed her telling me about working several days of double nursing shifts and basically needing money so she was working as much as possible. This was a few weeks ago. I spoke with the agency about this and her ability to be available for back up purposes just 2 days before. They did not foresee any issues but was not aware until I informed them she was getting work for up to 5 agencies, which is perfectly legal. She told me that she does not work any other places when she works with Elias, but last night was a fill-in day not her regular day. Again I am not going to say she did or did not do something if I do not know for 100%. I had been concerned that she is working so many hours that even if she did not work before Elias shift, it would be that she was so tired from the previous 6 days that compounded into her being tired while on his assignment. While I did inform the agency of my suspicion I told them I did not have enough evidence, but my observations, experience during that time and my gut told me that was what had happened. So based on that I was dismissing her from the case based on lack of confidence and being uncomfortable in her care for Elias. Like I told the agency, her nursing skills were fine. I just felt she was working very long hours, while for just reason, for Elias' sake I simply cannot be comfortable with that knowledge and the risk of her being too tired to be alert enough as he needs. Not that I have to provide just reason to get rid of a nurse, but I feel morally obligated to have a significant and sound reason to do so. This is the second nurse this week we have had to dismiss. The other was just a simple issue of her and Elias not being able to work well together. He was always very irritable with her and not so with others and would always sleep much more the next day following her shifts than normal. We think she was simply stimulating him too much when he was trying to sleep and would of course become cranky, fuss and cry, so she would stimulate/play some more to try and calm him. This was something we had been noticing for a little while, but as I mentioned before...we feel the moral obligation to provide sound just reason before dismissing. So we are interviewing nurses again this weekend and the beginning of the week. At least, while these incidents are close together, it is for minor reasons and more expected (aside from sleep, but again I cannot prove it for 100%) and typical in the home nursing world. For that we are thankful.