Dysfunctional families at work

It's not just the patients at the Hotel who have dysfunctional families, but the employees act like a dysfunctional family, too.

Your boss decides to tell your office mate he/she is a "downer and never has anything good to say". Said nurse is always doing more than expected, unlike a large portion of the staff we work with. Said nurse is also stressed by an HR department that "forgot" his/her promotion (which means no more money on the payroll as promised, which is nice during the holidays or any season) and who is genuinely feeling awful. I finally convinced Neighbor to see the new PCP at the Hotel after failed attempts with one in another system who never returned calls. Neighbor has some scary symptoms that don't warrant a hospital stay, but are concerning nevertheless. Crossing my fingers that a specialist appointment (or two) is on his/her appointment list soon.

I had the distinct pleasure of participating in a facility-wide job fair. It's a good thing they rented out hotel space because we were mobbed. I participated in over a dozen interviews for nursing staff. It was amazing the amount of people we got to show up. I hope the nursing recruiter  has learned: be prepared for CNAs. They seem to always be looking for a job and freebies. A few were exceptional, a couple were good, but only about half were recommended for hire. It would have been nice to have another group to interview these folks, because we had so many people show up, it took FOREVER.

My partner was another nurse from our department who I don't see a lot. She is Ms. Right as in "I'm always right"and is well-known for spending most of our staff meetings fighting with the boss. She has years of experience, but sometimes doesn't act like it. She thinks what she thinks is more important than following policy, procedure or even, evidence-based practice. She came from another high-intensity area and sometimes, she needs to go straight back. She's gotten comfortable, though, in her role, so short of a egregious error of judgment, she'll never leave before she gets her advanced degree. I really wish her graduation date was soon...

The good thing: some of our staff scheduled appointments for me. This meant I had to show up, so I spend the last hours of my day taking care of them, reviewing what happened this week and it was pretty darned good. We had one of the best weeks ever for SU encounters. It was a bright spot to this Supermoon crazy kind of week. I'll take it.

May your weekend be full of joy. Don't let the turkeys (or Ms. Rights) get you down!

'Til next time...

Torn...

The dilemmas I've faced this week.

The first one was the dreaded certification renewal (one of them, anyway).

Getting a nursing certification is a little like qualifying for an equestrian event: lots of jumping over obstacles and looking perfectly put together.

After months of combing all my files for CE certificates to put in the application, making sure my membership was updated, then filling in the rest of the application and credit card info, I sent it off. A few hours later, I got the "we're reviewing it" e-mail.

Today, I got the all clear. I'm renewed for another five years. The hamster wheel starts again...

The last couple of days, not throttling some of my coworkers about the US presidential election has been another dilemma.

For those of you not in the know, we not only elected a new president this week, we will, on Bubba's birthday, January 20th, inaugurate the nation's first reality TV star, thrice divorced president married to only the second non-US citizen First Lady. Some of my coworkers want to talk about it all the time.

I'm not one of those people. We give out blood pressure meds for a reason at the Hotel. We're not supposed to be inducing conditions that will send people into rehab.

However, I'm looking forward to the weekend. I'm celebrating my favorite US veteran, Dahey.

Happy Veterans' Day to all of you who have served!

A little this, a little that

I've been escaped from the office and I've been busy. Dahey and I got Bubba from camp and took him on a road trip.

We're not the Griswolds, but we had a similar adventure on this trip. I inadvertently only read some reviews of the Hotel Hell we stayed at. I missed the good ones that said "Don't ever stay here."

It was really, really hot where we were. I packed lots of drinks in the truckster just in case.

The first clue we were in Hotel Hell was the neighborhood once we got off the highway ramp. It was sketchy. The lobby of HH looked decent, but I'm always a little concerned if they have doors to the outside, especially if the neighborhood is not so good. When you have to ring the doorbell to get into the lobby at night, it's not good.

Next, we got a non-smoking room with cigarette burns in the comforter. And if that wasn't enough, crumbs were on the floor (between the beds).

The room had a slightly musty odor and the air conditioning wasn't on. We turned it on, I inspected some more. There were no bedbugs or any other visible bugs and the in-room fridge looked new and was COLD. I got the extra strength Febreeze out and sprayed the room. I knew it would come in handy someday (have carried it, but never used it). I figured it would get better. It didn't.

All night we heard noise from the AC the room temp never went below 85 degrees. It was horrible. On top of that, there was a lot of noise from the parking lot. When that got quiet, the trains came by.

I probably slept about 4 hours all night. Needless to say, once the boys fell asleep, I booked another room in a nearby town for the second night. In the morning, I told the hotelier we were checking out.

We went off to see the sights and had fun. We even saw a movie while we waited for the check-in at the new hotel.

Our new hotel was an oasis. I checked everything then took a nice shower, so I could go out into the heat and sit at a baseball game.

It didn't matter. With more air conditioning and a clean room (and bathroom) I could tolerate anything.  Even a 110 degree heat index!

Now, it's back to staycation.  It's going to be fun.

Stay tuned!

He WAS a hard working man

We always liked having R. around our place at the Hotel. No matter the task, whether visiting M., his wife (and our RN coworker) on the unit or fixing something broken, he was happy and smiling.

He was a good old boy who had a whole bushel basket of gifts. He was courteous, kind, and a whiz in the machine shop. Our volunteers were stunned when he fixed one of their pieces of equipment and got his staff to bring it back to life. It wasn't just better. It was amazing. In fact, they thought they got a new one.

Today I heard R. left us. He passed away too soon. Being retired for almost two years, he was doing fun stuff until he got sick.

I thought of him when I heard this song.  And we at the Hotel mourn with his wife and family today. Yes, indeed, he was a hard working man.

RIP R., because you earned it.

Snow day

Bubba was out of school. On the same day he became a teenager. Alone in a house with cupcakes, which made for some interesting text message conversations, complete with photos.

Alas, since nurses don't get snow days or much downtime (most of us, anyway), I went to work. It was quiet. By 0800, when the clinics are busiest, we barely had two people show up. Thank you RehabLand Snow Removal folks. You cleaned, but people forget how to drive when temperatures are low and the pavement refreezes. Slip and slide accidents were everywhere.

I kept busy. I had a few folks who couldn't come in call me, so I helped them with what I could over the phone. I stocked my rooms, I visited patients in their rooms. I did training, since it's that time of year for competency renewal.

After lunch, we started seeing more people in the Hotel. It never got to the usual levels, but a little variation in our routine was nice.

Hope you have time to breathe (and maybe even think) in your day today, wherever you are.

More later.

Changes

Yes, it's January, and everything changes, if you're on  a calendar year cycle.

Health insurance changes for many people. I saw the first few people in my office looking for the department that handles that this week. How they get that deviated  (we're not even close to the office they need to go to) is crazy.

One of my friends from my master's program received a pink slip right before Christmas. His/Her health care organization needed to stop spending money, so they just laid off everyone in his/her unit. The equation seems to be: if the company loses millions, the employees have to suffer.

I have thought about changing jobs at the Hotel for the last year or so, but I think, I've finally decided to give up on most anything posted on our jobs site. Our HR department may or may not be run by actual humans, because every job post I've responded to and gone to interviews (two so far)  have not been anything like the job posted online. This job mentioned working from home and flexible hours. The first things they mentioned was that neither of those were true. Big red flags flew up and continued flapping in the breeze as my other favorite thing was uttered, "Oh, well, this isn't just a 40 hour a week job." To me, it sounds like a whole bunch of mandated overtime. Funny, that's what I thought it was, so thanks for clarifying that little detail.

As a result, I think if I want a new job, it will be outside the Hotel, and with a company that actually posts accurate job listings as not to waste my time and theirs (in this last interview, I spoke to the chief executive of that area, who had to make time for me) in my interview. When I think of the waste this was, I'm mad. Not just for me, but for him/her.

Happy weekend all! I'm going to enjoy it. Hope you do too, wherever you are.

Timeless truth

You can observe a lot by just watching. ~ Yogi Berra

We got an e-mail recently saying the Hotel (and Washington and Madison) was becoming a "smoke free campus".

Supposedly, there was a campaign (not run by our crack public affairs officials) about this big news. I found out about it in a meeting earlier this month, and the nurse executive said, "This shouldn't be the first time you are hearing about this."

Sadly, it was. While I don't smoke myself, it does make things challenging for our patients that do.

Miraculously, someone got Ye Old (stress on old and clueless) Public Affairs person(s) to post this information for patients on our website and social media. It starts January 1.

The grumblings are loud and rowdy at the Hotel because our patients did not get a designated smoking area, nor did our employees. The nearest one is in the building next door, which is a long walk.

The best quote on social media, however, was truth.

"The last time I checked, no one could smoke inside Washington or Madison, so how is it that you weren't a 'smoke free campus' already?'

I'll just keep watching...stay tuned.

Technical difficulties, please stand by

This is the story of my life. Had I not lived one already in tech, I'd be crying every night. One step forward, two steps back. This place isn't the 'market leader' it used to be...at least not at the Hotel.

Contemplating a different sort of rehab spot for the future if this doesn't get any better. I tell myself everyday I'll give our new boss one year in the job before I move, but at the rate it's going, I may just move early (like him/her, hate the BS).

To be continued...

Dear Social Media Darling

Dear SMD:

It's nice of you to come back to the Hotel after your last momentous visit when you yelled, threw punches and screamed at a large contingent of staff.  It really is hard to expect a Hotel, because after all, we are really a hospital.

Posting your latest set of grievances on social media won't help.

We will be professional and do our jobs, but if you're looking for warm and fuzzy, there are plenty of pets available down the street at the local animal shelter.

Here's hoping this visit is more pleasant than everyone is expecting.

Yours professionally,

RehabRN

Ah, memories!

I was reading online and found a link to these NCLEX questions. The scenarios are the "what would you do" management ones. I love those.

For fun I decided to read them, and see how they'd be answered at the Hotel. The selected questions are located at this link: http://www.rnpedia.com/practice-exams/nclex-exam/nclex-practice-exam-management-care

Here's what would happen (or has happened) at the Hotel for the ones I selected. See if your place of employment is the same.

Remember nursing students: you have to answer as if you work at NCLEX Hospital, not at the Hotel or your current hospital. Your mileage may vary, but you'll get the answer right.

1. RE: substance abuse/unfit to work We've had our share of people who shouldn't come to work for a number of reasons. Frankly, I'm all about sending them home if they don't need to be there. Unfortunately, some of my coworkers, do not feel the same way, and contribute to everyone else doing double work so someone else isn't "found out".

Can you say "dysfunctional family"? I knew you could.

7. RE: abuse complaints. Please, please, please don't call the police FIRST, young'uns. I've seen this one in person and the manager ended up leaving and one of our students was basically run off the unit, because he/she did not use common sense.

Assess, mitigate, and notify your chain of command first.

8. RE: dates and patients. Yes, I do tell them it's inappropriate to ask me, a married woman, out on a date, psych or not. I'm here doing a job, which does not include interviewing the next Bachelor/Bachelorette candidates.

9. RE: client calling out asking for help all the time. This is great information, but good luck implementing it, if you don't have a cooperative crew. I remember many a night when some of my evening characters constantly badgered me (and often the rest of the staff) no matter what I told them.

Just remember: dementia and sundowner folks will keep you hopping on evening shift, kids. Don't forget: evenings do get quiet and dark, and that's when things like to fall apart.

11. RE: the surgeon and the chart. Remember: just say no. If he's on your facility medical provider list, he can look for himself. If he chooses to do so (which violates hospital policy in a great many places), it will be logged and he'll have some 'splainin' to do as Ricky Ricardo used to say.

15. RE: visiting hours. Here again, is another example of using common sense. If your family is quiet, calm and respectful, it makes this easier. Model it and they'll do it, too.

Don't be a Nurse Ratched. Taking care of the patient and his/her family (and well-being) really IS your job, no matter when visiting hours are.

On retirement of a dear friend

Dear Bette:

I'm so happy you're retiring. I know you are, too, even though you say it's bittersweet. Much of life often is, to remind us to be thankful. You've been through a lot the last few years, but you always smiled, even though, being sick often sucks. You were a trouper. It was my pleasure to work with you.

I'll miss you coming up to get coffee in the mornings and discussing all the interesting patients we'd see at the Hotel. You have the uncanny ability for people to trust you and tell you EVERYTHING, even things we didn't really want to know.

You made us realize that our folks are multidimensional people, and to only look at them from one side, was doing them a terrible disservice. Thank you. I know my practice changed from the time I spent working with you.

I will never forget your pioneering spirit, embracing new projects and treatment methods, and I'm sure the rest of the Hotel won't, either. (I promise I won't give your phone number out when some of those providers ask what you really think of those treatment methods, since you are an expert).

You hopefully, will be healthy and stress-free very soon, too, as you leave the hallowed Hotel halls soon for retirement.

I will miss you terribly, but I will never forget you. You are braver than any other person I know, and have given so much to me, our staff, and our patients with your presence.

Godspeed on the rest of your journey.

With warmest regards,

RehabRN

Just another Monday

Still Nurses' Week..YES! The psychology staff are celebrating on Florence Nightingale's birthday at the Hotel, but they have to send an e-mail every day so people don't forget.

I celebrated today by having lots of technical difficulties in my clinic. Now I have to find a creative way to get a gift basket of coffee, Mountain Dew, chocolate and other terribly fattening things to my favorite support technicians. Yes, it's been that kind of week and this is only Monday. We have a "special notes" section of our intranet, so I recognized two of the folks today. I had to...those two saved my derriere so much already.

Bubba got out of school early today and is counting the days when school ends here in RehabLand. Since his school had no snow days (we had a school boss from Minnesota who wasn't scared one icy day) this year, they'll actually finish on the day they said. Bubba, however, may notice those last days are different. For the first time ever, he has final exams. Should get him ready for high school!

Now Bubba is at his friend Jorge's house, helping him get some of the music homework done before the big party this week at the last band class. If Jorge gets the magic number, he'll be in. Bubba, his partner in crime, wants to provide moral support so it happens.

Stay tuned...one more day of Nurses' Week left. Enjoy every moment. You deserve it!

Dodging bullets

Dahey dodged one on Monday. He was not selected for layoff (or furlough) at his job. What's the reason? Working without a contract, the firm on his job site finally ran out of money. It closed one location. Federal contracting isn't all it's cracked up to be if the government can't decide.

I didn't dodge a bullet, but I missed one thing. My chance to get out of the Hotel is dashed for now. I just need to look at a few things, then decide when to try again. I told someone if they talked about it too much, it might not come true. (From years of experience, I keep my mouth shut). It was only a transfer opportunity, but after four years of this, I feel like moving on.

I hate it when I'm right.

More to come...

Blowin' in the wind

Yes, it does seem like answers lately ARE doing that. It's been extremely windy here in RehabLand lately. From the "dirty fronts" to the Alberta Clipper, the winds are blowing.

The winds of change are also coming soon to RehabLand. We know it because it's leaking out of the management suite slowly, but surely. Our manglement finally GETS what I do in the SU, and they know realize how woefully executed my programs are (due to lack of cooperation from manglement, staff, etc.)

Some folks are even seeing cryptic messages in the media. They are slow on some things, but may be smart on others.

I'm having flashbacks to my other life before nursing. And some of them ain't pretty.

How to tell when change is in the wind (my $0.02)

1. Headquarters hires a new boss from outside who has a reputation for "cleaning house" in a Fortune 500 company. 

Some of our armchair pundits at the Hotel may have missed the hint when he/she said, "Some folks won't be with us on the journey." in that welcome e-mail.

Translation: If we can fire you, we will. If we can downsize/rightsize or RIF (reduction in force) you, we will.

2. Said head honcho gets permission to bring in a bunch of high-powered consultants with whom you can sit in a meeting (where you're supposed to be asked about your job) and they will grill you like your at Nuremberg. 

The grilling will have very little relevance in relation to you or your job or the reason why they (Manglement) asked you to come in the first place.

My favorite part: watching one of the old doctors (not a consultant, but an "expert") nod off during your session. The runner up was the grilling they gave the education chief. Best description: deer in the headlights. This was scary.

Translation: We're already paid for our time, so this is just a foregone conclusion, but we're trying to figure out how we can get more work "analyzing" your organization.

3. Head honcho publishes a "manifesto for change".

Believe it or not, the Hotel is in it. People like that at work because it makes them feel "safe".

Translation: You'd better believe the Hotel is going to change. Don't feel too comfortable just yet.

Should be interesting to see what happens...

My patient gig is up...for now

Recently, I got to go on the other side of the fence. I had a sleep study in a sleep lab, after my two home studies looked funny.

I got basic prep over the phone, but I still had to call to make sure it was okay to take my meds in advance, etc. Preparing Dahey and Bubba was fun, too. They are always wanting instant communication when I am gone, so I had to let them know I was going to spend most of my time there sleeping. Translation: Don't call and send me a bunch of text messages. 

To keep the environment quiet, I had to turn off my cell phone and all my electronic devices since I was going to be wired up in bed. They budget 45 minutes to do this. My tech was great. I got wires on my head, which seemed to involve sandpaper, to make sure the electrodes and the goop got a good seal. I also got belts around my chest and waist. For good measure, I even had some leg electrodes with weights (kind of like those used when fishing). All the leg ones were attached with a good amount of goop and sealed with Medipore tape.

My room looked just like a hotel: heavenly bed type setup with a million pillows, flat screen TV and there was even a very nice leather recliner. Since I hadn't had any caffeine all day, I was ready to go to sleep when I got there.

Lights out were at 9PM for me. It took me about another hour to fall asleep. Then the fun started. My cannulas came off, not once, but twice. My room got hot, so the tech had to come in and cool it down. She warned me of this earlier, because if you sweat, the electrodes can come loose. (No way I was going to do this one twice!) Finally, the room got cooler (I think the duvet and the pillow top on the bed made me hot, but not sure.) I slept, but it was not quality sleep. I could hear trucks going down the road outside.

Miraculously, I woke up and it was nearly the wake up time we discussed when I started. I had to take all the wires in the bathroom with me, but when I got back, she took them all off. Relief!

The PhD who interprets the labs was in before I left, so I got a report. Yes, I have periods of apnea, but since none was severe enough for CPAP during the night, I probably won't get one. (My best sleep is on my side, so he recommended that). I just missed the score for a CPAP (barely). What does this mean? I will have to discuss with my doctor and see what he can wrangle with the insurance company.

As Dr. X, the pulmonologist told me, the PhD said he'd just put me on one, too. A borderline score shouldn't be an eliminator, but since insurance companies look at the almighty dollar, it is. CMS even has guidelines on this for Medicare. There are alternatives which I will have to check.

Now, I just have to wait until my next appointment to see what the verdict is.

It's Tuesday

However, for some folks, it's Friday. Forever. One of our retirees came in for the last time and left today. Sadness.

Tuesday for me means patient appointments (if someone doesn't cancel them at the last minute) and meetings. Fun meetings where people who insist that it start at one time (0800) casually stroll in at 0815 and throw off the folks who have to come in at 0830 from another site for a short report.

Our coordinator called some of them on it. I don't really think it will stick or embarrass anyone enough to show up on time. It's the Hotel way, and they (the Hotel "team") aren't going to change for anyone. Even if it is terribly inconvenient and they are the first people who think the meeting is going too slowly.

I'm all for locking the doors and deducting the time from their pay, but unfortunately, management doesn't feel the same. We should ALL suffer together.

Just another reason why I hate team building exercises. A few divas always screw it up.

'Tis the season...to retire

Not me (I wish!) but certainly a lot of people around the Hotel are retiring. More than a few messages have appeared in my mailbox for parties for people leaving at the beginning or the end of the month.

It's even happening at the Hotel. A couple of our folks are retiring. They are looking forward to lives where THEY dictate what the schedule looks like. I can't say that I blame them. Others, such as one of our NPs, can't wait to be a grandma (any minute really!).  What perfect timing...retire and spend as much time as you want with your grandchild. Another is working on his/her golf game and the travel associated with it.

Our boss really wants to retire, but since we can't find a replacement, he/she will have to set a date and retire and let the Manglement of the Hotel figure it all out. Waiting for years (yes, it's true) is really not fun.

It's too bad the Hotel only does lip service to succession planning. It might make the transition easier.

One of these days, they'll wake up...and someone will figure it out.

But I'm not sure if that will happen before I retire (many years down the road).

More to come...

Only in my dreams

Only in my dreams could we get a Hotel Rehab as "smart" and "accessible" as this new one going up in Nebraska.

I'm kind of worried about those gestures turning on and off appliances, lights, etc.

What do I do with the guy who has spasms whenever we turn him (or whenever he tilts just right in his wheelchair)?

It could get REALLY interesting.

Just sayin'...stay tuned. (I'd love to be there when it opens!)

It's HOT!

Dear Summer:

I know it's not Labor Day yet, and the kids are back in school, but this 100+ degree temperature thing needs to go.

I finally got used to not freezing to death at the Hotel. Now my space is so cold I have to either 1) talk to patients in the hallway, if it's possible or 2) turn the air off and sweat while I talk to patients.

All this stuff about designing rooms for patients is nice, but once in a while, couldn't we get a universal design that works for EVERYONE?

I know I'll be waiting for the remodeling (that may never come) in my end of the Hotel. Here's hoping the HVAC folks can get it right.

Sincerely (only if you fix climate control),

RehabRN

The gift horse (aka "I ain't got time...}

Heard at the Hotel (or relayed by stunned observers).

1. When our nurse manager (who now does quality review) asked one nurse about his/her documentation and lack of a shift assessment, the answer was "I don't have time for that".

Really? So what is it we hire an RN for...assessment skills? Maybe you need to take one of our open CNA positions.

2. One nurse got a chance (was selected) by the Hotel to go all-expenses paid to a national conference because he/she has gone for years on his/her own dime. The catch: since we have a new chief nurse at our location, she told him/her that he/she would have to do a presentation to the unit staff when he/she returns.

After lots of paperwork, discussion, permission from umpteen people (because  you can't just GO to a conference anymore at the Hotel....) he/she comes to my office and says, "Oh, I'm going to call and let them know that I'm going to go on my own. I don't have time to do a presentation."

3.  One (actually several) of our professional staff notes that patients request information, etc., via  e-mail or text message. This is even in their notes.

Will he/she/they even contemplate using the Hotel's patient portal, with secure e-mail included (it even writes your notes for you)?

Nope. It requires one training class (about 30 minutes) and you have to teach your patients (most of whom already use the portal) to contact you that way.

I just wonder what everyone is doing with all that extra time...