The welcome mat's always out...

Many thanks to all of the Change of Shift folks stopping by lately. I really appreciate your visits.

Come over anytime and visit some of the other folks noted on the sidebar to the right. DisappearingJohn and Dr. Wes have sent me a whole bunch of folks in the last couple of days, so if you haven't visited them already, go click on their links and visit.

More goodies later...gotta run!

Rest after Thanksgiving...or TGIF

After a day and a half where I got to play the roles of wife, mother, cook and galley slave, I was happy, happy, happy to go back to work where the only dishes I saw belonged to patients and I did not have to wash them. Hooray!

I got one of the same patients (a/k/a Mr. Easy--he gave himself that name) and one I haven't taken care of in a while, Mr. I'm Going Home in a Week (if my family actually comes for training). He's a sweet old man and as usual, he's getting anxious about leaving the hotel. Who wants to leave after a year plus of 24/7 staffing to scratch your nose when you'll have to go with your family who won't like it when you ring for them 20 times in two hours? No one really does.

Overall, Mr. IGHIW was in a reasonably good mood with only a couple of bouts of anxiety. I got him in his chair and out of his room for about two hours, so that worked for him. He was tired when he got back.

Mr. Easy ate too much yesterday so he vegged all day in bed, even when his wife came. He ate a little lunch and just slept all day. No fuss, no muss.

I got to do some paperwork and talk to our big boss about getting my certifications next year. I'm still working out the details, but I know for sure I will get at least one, depending on what the official regulations are. Both are attractive, since we get a bonus and pay grade advancements for getting them, but if there are technicalities, I want to know about those ahead of time.

Now, the weekend is here, so now I get to pay the bills and go on about my other fun weekend duties.

More later. Enjoy your weekend, wherever you are!

Change of Shift: November 27, 2008 Volume Three - Number Eleven

Welcome to the November 27, 2008 edition of Change of Shift. Many, many thanks to Kim from Emergiblog for letting me host this edition. Look around and if you like what you see, feel free to come on back!

Happy Thanksgiving to all of our US readers. As you're working on your unit or basting the turkey like me, have a look at all the submissions for this edition. You won't be disappointed by our cornucopia of submissions.

General

Nancy Miller presents Here’s to a Long and Healthy Life! posted at Photography Colleges.

Alvaro Fernandez presents Brain Fitness 2: Sight & Sound, at PBS posted at SharpBrains, saying, "PBS just announced the second installment of their popular Brain Fitness Program show: "Join host Peter Coyote in "Brain Fitness 2: Sight & Sound," the follow-up to "The Brain Fitness Program," as he explores the brain's ability to change and grow, even as we age, helping us maintain and improve our vision and hearing.""

Erika Collin presents 50 Awesome Video Games for Physical Therapy and Rehab posted at U.S. PharmD. Since I'm a rehab Wii-kind of gal, check it out! There's nothing like getting that problem patient boxing away to warm up those muscles!

While muscle strains and pulled ligaments are not very serious injuries, they can be extremely painful. With this in mind, Dean Moyer of The Back Pain Blog shares some thoughts on Neck Pain Relief That's Quick and Easy. Dean, we need you on my unit!

Nurses

Hueina Su presents Best of Both Worlds posted at Intensive Care for the Nurturer's Soul.
and Rx for Balance: Keynote at Northeast Regional Oncology Nursing (NERON) Conference posted at Intensive Care for the Nurturer's Soul.

Kathy Quan presents The Nursing Site Blog: Share Your Ideas with Nurses in Congress posted at The Nursing Site Blog, saying, "Health care and the nursing shortage are on the top hot topics for the next administration and Congress to discuss. Nurses can begin to get comfortable "talking" to legislators who speak the same language. There are 3 nurses in Congress this term. Let's start sharing ideas."

DisappearingJohn presents Dealing with a decision made... posted at DisappearingJohn RN, saying, "A new and exciting job awaits me" Good luck John!

Jeff Long presents Travel nursing pay day. How important is it for you? posted at Travel Nursing Blog.

Nurse Laura, Oncology RN from NurseConnect.com blogs about Rapid Response Team to the Rescue! Nurse Kathy, Clinical Manager, RN from NurseConnect.com blogs about "Self Talk."

MojitoGirl at Sunburned Paradise gives us a close up view of Key West roosters in a post you have to read to believe. Ay carumba, mi amiga! Oy!

NurseExec has some great insight for all of the nursing students out there who want an RN to tell them how it is. Check out her On Nursing post for her first-person account.

Strong One presents Act the Part and You Will Become the Part posted at My Strong Medicine.

Nursing students

Sarah Scrafford presents Forget Facebook: 50 Social Sites for the Serious Student and Job Seeker posted at Career Overview.

MachoNurse describes his first week in clinical in Week One post.

That concludes this edition. Thanks for stopping by RehabRN. Come back anytime!

Submit your blog article to the next edition of change of shift using our carnival submission form or check out Nurses Notes, the next host site.

Past posts and future hosts can be found on our blog carnival index page.

Thankful

Although my co-workers and I kvetch, whine and moan about the least little things, today, I have put aside the slights of some of them and I am thankful. We stopped b(^t$%ing about the people we can't change.



I am most thankful that I work at the Hotel Madison. Many of my classmates this holiday season have to take low census (from their vacation if they want to get paid) or get docked because their hospitals need to save a buck. Thank you Uncle Sam for that no low census thing! I can use my vacation for what it was intended...actual vacation...when I want it!



I am thankful I woke up today. It sure beats pushing up daisies as I told K., one of my coworkers. It's been a little depressing seeing some of my old patients in the obituary section of the newspaper lately, but I'm getting used to it, not numb necessarily, but more aware.


Today was a pleasant day. One patient went home to see his family for the weekend and the other was very laid-back and relaxed. No admissions and no time stress today.

I'm off tomorrow, so check out Change of Shift. Back to prepping for Thanksgiving dinner! Stay tuned...

What happened?

I wonder this often when I work and when I see things such as....

...the urine bags that are always full.
On our unit, everyone is assigned patients, including the nursing assistants. In many places in our grand state, those assistants could be delegated to by folks such as the LPNs and RNs. Our assistants regularly refuse delegation, and often neglect their own tasks, such as this, that seem too "demeaning" or "boring". Or my personal favorite...they'll only do the task for you if they "like" the patient.

One of my patients was assigned to the escapist assistant I mentioned before in this blog. Again, his Foley bag was getting ready to explode. If only the boss paid attention...maybe I can ask Santa for that for Christmas.

...a new patient assessment that is not done at 2345.
This patient arrived around 1130AM and said nurse supposedly did all his documentation. It's not unusual for some of the paperwork to be floating around on people who arrive at 1500 or later, because our daytime people leave not long after that, so we on evenings, finish up whatever they don't do. This nurse didn't do much. We had two lowly notes for the patient: one the H & P from the admitting doc and the generic "patient arrived at xx time" one for the admitting nurse. Not a nice surprise!

...that someone who refused a shot got one.
This is what one of our elderly patients told C. tonight that the med nurse (same as the admitting one mentioned above) gave him a vaccination that he did not want. I guess she missed that class on assault and battery in nursing school.

My trainwreck came back from dialysis in a happy mood. He barely rung his call light all night.

Off I go for off-day errands...back later!

Happy Monday!

Reasons I'm happy:

1. It's my last evening shift this week...today! Hopefully, when I get back later in the week, I'll get some new people. I've had a doozy this week, but it's not his fault. When you're a trainwreck, you're gonna have issues.

Thank goodness for therapeutic communication (and some very understanding coworkers) or I'd have jumped out the lunch room window by now.

2. My turkey is thawing. I'll be cooking for my family Thursday, which means Wednesday night will be a late one prepping, chopping and baking some stuff.

3. I am feeling good. So many people I work with are getting colds, etc., and feeling crappy. I went back to sleep this morning and I feel much better. It's amazing how sleeping works!

4. I'll be hosting CoS (Change of Shift) also on Thanksgiving. Another reason to stay up late on Wednesday.

5. Finally, if you're feeling ambushed, check out Jo's latest post at Head Nurse. It made me laugh so hard. My, how people infer things from these blogs!

More later, stay tuned and stay well!

Nuggets for November 22

I should be thankful that things are not worse, but it's been busy at work lately. Fall is turning to winter and that means we're heading into pneumonia season. We've got a couple of cases all ready. Lots and lots of coughing going on! Chest PT for everyone!

Now for something completely different....here are a few tidbits of interest I've run across in the blogs this week.

This penis reconstruction story makes me think of Fournier's gangrene again. (from Highly Trained Monkey)

What's wrong with nursing (from My 2 Cents)
One of these days...

Sometimes the best therapy is a long-drawn out rant (from Spook RN)

An ingenious Christmas gift you gotta see (I found this thanks to ER RN)

Thinking of going back to school? Some of those professors will be talking about YOU if you aren't very nice...I really loved the "who's the geekiest" post recently.

Field trip!

Bubba is on one today at school, and if I had time to hang out, I'd take this to my nearest Wal-Mart just for fun. Many thanks to mylife1060 at Hell on White Clogs for this little gem. Enjoy!

The holidays are coming...

And, as usual, I never feel like I'm ready! I've been busy shopping for Thanksgiving dinner and cleaning out cabinets and freezers. After that, I'll get to clean some more in between working.

On top of it this year, I'll be fluffing and buffing around here as I get ready to host the Thanksgiving edition of Change of Shift. The submissions are trickling in, so if you're so inclined, get going on yours and send it in!

You know it's the holidays on our unit because food is appearing everywhere. It's tough to be a nurse or hospital employee when wherever you look (in only JCAHO-approved places, of course) there's food--candy, cookies, you name it. A few people have dropped hints to families that no nurse can deny a good piece of chocolate. I'll second that, thank you. Bring it on! I'll just have to do a few more laps around the Hotel to burn off that candy!

More later! Send those posts in...I'll be waiting!

It's that time again...

for Change of Shift, and crzegrl and Zippy are hosting there, so head on over.

As I mentioned before, RehabRN (that's me...pinching self) will be hosting the Thanksgiving version of CoS, so submit away!

Happy Friday all! More goodies to come...

New favorite on the floor?

I've been shopping and I found these new comfy shoes...heaven! Guess I need more socks!

Nuggets for November 12

Here are a few of the latest posts of interest I've encountered from the blogosphere.

Nurse William enlightens the masses on the duties of the triage nurse in the ER. Don't miss it!
http://nursewilliam.blogspot.com/2008/11/er-stuff-you-need-to-know-part-1-triage.html

The MERCI project helps recycle medical supplies that might be thrown away to help developing countries.
http://nurseattorney.blogspot.com/2008/10/merci-project.html

Dust in the wind tells us what it's like to go from nurse to triage patient
http://dustitwind.blogspot.com/2008/10/waiting-room-watching.html

Being on call from donorcycle
http://donorcycle.blogspot.com/2008/10/its-still-exciting-to-be-on-call.html

In case you missed it like I did, Nurse Ratched was featured last week in Colin Son's Medscape article in the Pre-Rounds section. Even though, the election is over, go read it.

Move it continued...

Since I'm cleaning the house for the move, I've also decided to get some work done on this blog. There are some amazing people out there who help bloggers out there and I've sought them out (you know who you are!). I've got a lot of ideas and I'm pretty excited.

Please pardon the mess while you're here, but everything will look pretty when it's all done!

I like to move it, move it...

And we'll be doing a bunch more of that at our house soon, both literally and figuratively.

There's always plusses and minuses to moving, but I'll be glad to do it, since Dahey's heading to a new assignment. I love the current Hotel Madison, but they all understand. My shopping buddy, A., will miss me, but now she says, she'll have another place out of town to hang out. My boss and other folks were sad, too, but understanding.

As a result, I'm going to have to figure out which way RehabRN the blog will go. I'm working on some stuff for that, too. I met a lot of neat people at the conference. It was such fun.

More later...

For the soldier...

...the sailor, the airman,
the officer,
the XO,
the COB,
the submariner,
the SEAL,
the parachutist,
the Green Beret,
the lowly KP potato peeler,
today we honor you all.

For the young men and women in the prime of life,
for the husbands, fathers, brothers,
wives, sisters and friends.
And the aunts, the uncles, the cousins.

For the combat nurses, the docs and the corpsmen in the field.

For the young and the old,
Injured and healthy,
Strong and frail.

For the wounded,
I am proud to be your nurse,
To just listen,
Or tell your story.

For the fallen,
Who left everything to fight--
Families, fortunes and friends,
And never returned.
You, truly, gave all.

May we remember, not just today, but every day.
That freedom has a price;
Paid in blood, sweat and tears,
In toil and tribulation,
On battlefields of the past, present and future.

Thank you veterans, one and all.

Wild and fun

The wild part:

In the middle of the day, I let our dog out on the front porch. He likes to bark at everything, but I noticed he had an unusual bark at something today. I looked out and a very large red fox was running around in the yard across the street. In our neck of the woods, it's not an uncommon site in the early morning hours, but at mid-morning, it was strange. WildDog decided to come inside, since I would not let him run over and chase the red fox across our street.

The fun part:

Work has actually been pretty pleasant. We are experiencing low census right now and most of the folks are in good moods. Things are getting along swimmingly. I somehow (holding breath) am not working Thanksgiving Day.

I can't wait to get up and bake away. I really love the cooking part of Thanksgiving. This year, I'm also very, very honored to be hosting Change of Shift right here at RehabRN on November 27.

For more information, check out Kim's page on CoS at http://www.emergiblog.com/.

Finally, a major Happy Birthday shout-out to my bro-in-law the major and professor. I hope you enjoy your blast from the past we sent!

The roles of the rehab nurse

This is a series of occasional articles geared toward new nurses entering rehab. If you've been around the nursing world for ages and you have some comments, feel free to throw them out there.

Recently, I attended a conference about multiple sclerosis and one of the presenters talked about how important the roles of a rehab nurse is to patients and the vaunted interdisciplinary team. Here are a few roles you play that may not have been so obvious.

1. Scheduler
Rehab nurses get schedules thrown at them by PT, OT and whomever else can think of something for them to do. We get to coordinate how people get from A to B and sometimes, we even get to say, "No way. You're not taking my people." Knowing how to work the schedule is a very important thing, for your sanity and the sanity of your patients and the rest of the rehab team.

2. Cheerleader
Rehab nurses cheer on patients, to be adherent to medication regimes ("That sounds nicer that 'compliant' "--actual quote by a presenter), to get out of bed and do therapy, and also to look at the sunnier side of life. Yes, some days suck, but you just have to deal with whatever gets in your way and motivate your people. I do not use pompoms, although, I have been known to use Diet Pepsi (or patient's drink of choice) as a motivator. Sometimes, as they say, you gotta fake it 'til you make it.

3. Marketer
Yes, this plays into the previous role of cheerleader. I have to "sell the program" as I always tell people. The program is, you will get out of bed, you will get your life going and you will have a routine. You can be sick and tired, but you have to at least try. Sometimes the best sales pitch is the one where the patient derives it from himself.

4. Therapist
Sometimes, all you may do is to listen therapeutically. You don't get the alphabet soup after your name like those therapists, but you get an earful. Think about how you can use that rant, rave or entreaty to help that patient. If you need help, ask for it, from your charge nurse, manager or your psychology staff. I couldn't live without ours.

Whirlwind trip is over

After way too much fun and excitement on United Airlines last night, I finally made it home. Since there was no coffee on the plane, I drank some Coke and was awake enough to get home in one piece without falling asleep. It was tempting but I just don't sleep well on planes.

I enjoyed the seminar with my partner-in-crime, A. We got a lot of shopping and walking done in between sessions and it was fun. I met a lot of interesting people and the organizers plan on keeping in touch with us, to see how we're doing. Since we all work for the same place, I'm not surprised that they're doing this....it'll probably end up as a research project or something!

Today so far has been busy, and tomorrow I'll be back to work after a week away. I'm as ready as I'm going to get right now. Back to housework...stay tuned.

Conference all day

Well, it's looking pretty official out here in the Emerald City...my package is on its way home, filled with smoked salmon, salted caramels and souvenirs for family and pens and all sorts of freebies to take to work.

I got lots and lots of pens and stuff. They had all sorts of medication branded stuff--even blue liquid soap. (I passed on that, since that doesn't ship well, nor would it pass the TSA 3-1-1 rule.) A, my cohort, packed her own box, then E, one of the other RNs from Texas who we met, came along with us shopping and then to the Post Office, so we could ship the goodies.

Tomorrow, we go to another class and to a tour of the local unit. Stay tuned!

Sleepless in Seattle

I'm busy messing with the wifi in the room on my Palm with keyboard.

So far, so good.

I voted already, have you? If you haven't, go vote!

More later from the Emerald City...

Test post from Palm

This is a test. This is only a test

Whew! Another week over!

It was busy going from evenings to days. Thankfully, when it got really hairy, I was not working evenings.

One nurse was off this week, since a family member recently passed away and she headed out of town for the memorial services. One night in particular was crazy without her. I heard about it on Friday. I'm glad I was not working evenings. I would have just gone crazy!

My time back on the day shift was not bad, just busy. I got to pass meds a couple of days, then just take care of people on Friday. That was lovely, even though I felt like all I did was draw labs and run back and forth. For some reason, labs pulled from PICC lines on our unit always get screwed up. I don't mean sometimes, but most of the time. We get screwy results from the PICC, so then the doc orders a redraw from a vein, which usually drives the patients crazy. I had to do this with one of my patients. He was getting persnickety, so I tried an easy vein, but it didn't work, so I had to use one in the hand for his blood draw. While I'm not the best IV sticker, I can get blood out of hands and arms pretty good. I also like to think that I keep people from getting all bruised up, too, which I normally do. This draw, happily, went as usual.

The same patient needed a Vancomycin trough, so I drew that from the PICC. He was not going to let me get it any other way. I looked up the protocol and followed it to the letter, so I knew
I would not mess it up! I did a lot of fluffing and buffing, so I was happy to be finished.

Today, while I was perusing the paper, I found out one of my favorite patients died. Mr. B., the crazy plumber I took care of at Saintarama died this past week. The obit showed a photo of him that I recognized. It was from a photo with his family that he had in his room. He tried but never succeeded in getting rid of the trach after his illness. I will miss him. He was so funny.

I'm getting up early, early, early Monday morning to drive to the airport. We're taking off to our Pacific Northwest conference. The weather says rain, rain, rain, but at least, we'll be away from Madison. It should be fun. I'm going to have to tinker with mobile Blogger and see how that goes.

Have a great weekend all....more next time!

CoS

Is up at crazymiracle...head on over if you haven't already!