Qualified to Work in the United States

I’m angry after continual shifts where the aids I'm working with are trying to get away with things that are unsafe for our patients.  I start to wonder what requirements exist for the aid positions. They don’t call them aids, they call them, “Mental Health Workers.” But in starting the job I thought they were CNA’s, certified nursing assistants, but that's not adding up.

We’re still short-staffed, I figure there are job listings, so I give it a Google.

The job title reads, “Mental Health Worker” and under qualifications reads, “Qualified to work in the United States.”

That was two years ago now, and since I worked at that hospital the state partially shut them down, taking away their right to take patients who are on holds. The only patients they can take into their care now are those who come to them voluntarily.

They are trying to get their accreditation back. There are still job listings for mental health workers but it now also includes high school diploma, CPR, and ability to read and write English, under qualifications to apply. 

My last week working at the inpatient hospital, the last week before I quit, I was working with a mental health worker who informed me, “in this unit, mental health workers can come and go when they want without checking in with the nurse.”

I said, “Not while I’m on shift.  I need to know if there are eyes on the unit or not.”

She said, “Well, I know you don’t normally work up here, but these people aren’t as sick so it’s not as big of a deal.  It’s not like working in the other building.”

Inside, I call bullshit so clearly there is no point continuing this conversation, but I need to get through the shift with her and that is going to go better if she is somewhat on my side.  I can see that’s not likely to happen since she’s already trying to fuck with me, but here we are.

I say, “Look, I’m sorry if this is not what you are used to, and I do know the more you work with someone a flow and expectations are established.  I know this is our first time working together and I do need to know if you are on the floor with the patients or somewhere else.”

I have a patient that shift who is limping and when I ask about it she tells me she is supposed to wear a boot but they took it from her on admission saying there were metal buckles that were unsafe.

This is something they do when they are short-staffed.  We're not supposed to take it away, but a patient with a medical device that has the potential to pose a threat does need to be monitored 1:1 or every 5 minutes depending on the potential risks.  

I look through her paperwork and see the doctor’s orders for the boot and crutches. We don’t get to take boots and crutches away from patients with healing leg fractures.  Whoever took her things away replaced one risk factor with another and I am too un-surprised to be mad about it in the moment.  I ask the mental health worker if she can go grab this patient’s boot from her belongings from the shed outside.  It’s 10 am when I ask this, and I’m slammed with work.  At 2 pm I notice she still doesn’t have it and check in with my co-worker.

“Couldn't find it.” She says. I ask if she can take another look and without leaving the building she tells me she checked again half an hour later and still can’t find it.

I am the only nurse up here and am not supposed to leave the building.  I make my rounds and leave anyway to find the boot in the shed with other patient belongings, front and center. 

I share some concerns with the oncoming shift about this mental health worker as I am leaving for the day and am told, “Oh her?  She was a patient in the adolescent unit six months ago.”

“What?” I ask, “How old is she?”

“She’s 18 now. We’ve had a lot of issues with her, she flirts with the male patients and we kept finding her in their rooms alone. I guess she had her shirt off one time and they didn’t let her back on this unit till that guy was discharged.”

I schedule an appointment with the chief nursing officer the next day.

Among other things, I discuss this with the Chief Nursing Officer at our meeting.

I say, “I do my best with our staff to patient ratios, but it is not possible for me to be safe if I can’t trust the staff I work with and need to be concerned for their safety too.”

We discuss this girl, I’m calling her a girl. I am assured those issues have been addressed.  

I say, “Well, they haven’t, because she’s still working here and given her behavior and recent stay here as a patient she is decidedly too vulnerable to be in this position.”

CNO, “No, we do a very thorough background on all of our employees.  Those issues have been resolved.”

I wonder if the Chief Nursing Officer is a robot coded by a lawyer to only engage in conversation like she’s being interviewed by a reporter.  But, I know that she’s not.  She’s just a woman who has decided to keep a job and a paycheck that requires her to put vulnerable lives at unnecessary risk.

I decide I don’t want to become a robot, and take a paycheck in exchange for being OK with how things are run, and email my notice as soon as I get home.

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Review

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This story is searing, incisive, and deeply unsettling, offering a powerful critique of systemic negligence and ethical decay in psychiatric care facilities. It reads as both a personal reckoning and a scathing indictment of institutional complacency, highlighting how underqualified staff, bureaucratic apathy, and profit-driven priorities place vulnerable patients—and ethical healthcare workers—at risk.

The central theme revolves around the ethical collapse of institutional care. The narrative lays bare how systemic failures undermine patient safety, exploit vulnerable staff, and demoralize those trying to uphold professional standards. The CNO embodies how corporate structures prioritize liability avoidance over genuine care. There’s an unwavering commitment to patient safety and professional ethics that serves as the emotional backbone of the narrative. The slow erosion of faith in the system, leading to a powerful and necessary decision to leave before becoming complicit exemplifies healthcare burnout. The decision to leave does not read as a victory, but a surrender.

The narrator does an exceptional job of balancing personal disillusionment with sharp social commentary. It not only captures the emotional exhaustion of working in a broken system but also reveals the subtle, insidious ways that such systems force caregivers to either compromise their ethics or walk away entirely.