On the cusp

Yes, months have passed since I've been here. It's been busy. The year has been monumental.

Since the solar eclipse, I've been busy getting my program at the Hotel ready for inspection. In October, the inspectors came. They came to see my program, because Washington doesn't have one, and if they didn't see mine, we'd get written up.

Three words: Blew them away. When I started this gig, the regional boss always glossed over what I did. Since said boss left, and we're still awaiting a replacement, the local Manglement decided that maybe, just maybe I might be able to show them how we do what we do in the Hotel. We did.

We came. We saw. We kicked some serious butt. The Hotel crew stepped up to help me get the stages set (because we have issues, but they are in process), clean, prep and know what to expect. I briefed staff so they'd know the basics of what the inspectors might ask them. Then I showed them a good time (and a marketing package unlike any other). I got patients involved (because they are part of the inspection, too) and all my people shined.

We got kudos in the official report, which, to me, validated the work. It validated why we have to work as a team. It validated that we care about patients and always want to do more.

I sent lots of thank you notes. My entire team got one. My nurse compatriots in other departments got their own special kudos. Why? Because they need it. They are new and they need to know they are doing a good job. My patients got thanks, too.  You have to remember who helps you, and acknowledge it regularly.

In October, we finished our official year, and it was the best ever (no kidding). We saw more patients in the SU than ever.

Last month, I finished my gig on my rehab committee. I had fun. I wasn't nervous any more talking to thousands. It does get easier, even with a script.

Today, I'm awaiting my next adventure. I'm going to leave rehab sometime soon, but it will never leave me. I carry a song in my heart, and lots of memories of the Hotel and all the characters along the way.

May your New Year be filled with health and happiness, wherever life's journeys take you.

Until next time, I bid you adieu....

Frights aren't just for Halloween

It's been scary in the Hotel Rehab lately, and it's not because of ghosts or Halloween. We've seen a lot of our folks get sick and go out on leave. Our latest one is the building greeter. Believe it or not, having a greeter is part of the overall improving patient and employee satisfaction.

M. our greeter, shows people where to go, gets wheelchairs, makes phone calls and does all sorts of stuff that I often don't have time to do for patients and visitors.

M's boss told us that he's getting surgery and may not be back for at least two months. I will certainly miss him and so will our patients. Some have even gotten grumbly when I can't do stuff for them because they were so used to having him around. Maybe this news will improve their behavior.

Our nurse practitioners had a major job analysis done throughout the hospital system. For some, the changes that will happen mean they'll have to go back to school. Ours are lucky, they shouldn't have to do that, but the work they can do will change. Not sure if our medical staff are really aware of what all they do. They will be aware soon.

Finally, I'm constantly reminded that not everyone who's in rehab is totally well. They do get sick, again, and they do die. It's sad and yes, sometimes frightening. Some cases are sudden and some are not. I'm really glad we have many options for hospice for our patients. One of my SU patients recently decided it was what he/she wanted.

A whole lot of interventions doesn't always equal quality of life.

I've got to stop here. The frog singing outside is making me crazy...and I'm tired.

More later...

Sometimes you have to go with your gut

New nurses: this one's for you.

We take care of a lot of people at the Hotel Rehab, and it's normal for us to see a variety of society strolling through the front doors. Sometimes we are given plenty of information to do our jobs accordingly. Other times, we aren't.

Since I work with all of the folks who complete rehab, as a specialty nurse, I have to understand how to use my assessment skills. When something seems strange, it usually is. Police come and go in the Hotel for a variety of reasons, and it's always for something.

I took care of one of our folks in the SU. Said patient did well in his/her rehab stay, and would seem like a good fit for our aftercare program that I manage. While I do chart reviews of all of the patients to determine eligibility, and this one passed all of my normal reviews, something still wasn't right.

Said patient was getting ready to discharge. Since he/she was not exactly confident about this program when I discussed it, I didn't worry about it. I do not push patients to participate, because it's voluntary. In one of our discharge planning meetings, another consulting staff member, who I greatly admire, voiced concerns over this patient's "legal issues." In rehab, this, too is not uncommon, as many people may be in rehab due to accidents and may be managed by legal or worker's comp case managers from outside.

When I looked at my credit monitoring service e-mail recently, I found out why Officer Friendly was pacing through the unit. It wasn't because we have staff parking scofflaws, it was because my SU patient was a registered sex offender. His/her pending litigation might end up in a prison sentence. This, consequently, disqualifies SU patient from my program.

So for all you new folks: what does this mean? This means you tailor your care to the specific patient, and remember, no matter what to be professional. This article mentions a number of things you can do to make this happen, as a floor nurse, and discusses things your risk manager may ask you.

In my decade of practice, I've seen nurses act like fools and discuss these patients  loudly and use computers visible at the nurses' station. My advice: don't do it. You will look stupid, and you may be disciplined. You should discuss this with your nurse manager in your area in a private location to make sure you ensure the safety of staff, visitors, as well as the patients on the unit.

Finally, all of those things you learned about therapeutic communication and ethics come to the forefront in these situations. Yes, you can take care of these folks and be honest and direct. I often tell students this is why you don't overshare in ways that may make your patients uncomfortable or create other issues. Seek help from other team members, such as psychology and your chaplains, so you can make your care plan appropriate for your patient.

Happy New Year...sort of

Yes, it's 2017, the New Year's festivities are over.

It's cold, we have a new president and I have a surly teenager.

Still getting used to it all and letting it all sink in. I haven't forgotten you, dear folks. I've been swamped at work and when I come home (when I don't have some viral mess that's going around the Hotel) I rest.

My biggest goal this week, is to put the Christmas decorations away. No, I am not an Orthodox Christian. I am a late packer.

Even though it may seem apocalyptic at the moment, I won't have YUGE news, a la our Cheeto-in- Chief, but at least it will be real.



More to come. Stay tuned.

Thank goodness

It's almost time for vacation again. Surprisingly, I'm partaking of a little office escaping for one week for not one, not two, but THREE months in a row. In the computer, it's not vacation (I'm actually going out on the road for conferences, etc.) but to me, any day outside of the Hotel is freedom. I'll take it! Traveling partner and I get to have a reunion, too, which is even better.  Look out folks, as we shop and eat in interesting places in our off time (plans are underway...)

This week was a full moon. Somehow, I didn't realize this until I was driving home one night from an event. The sky was hazy but relatively cloudless. There it was: the big monster sturgeon moon right up there. It explained the craziness that was this week.

I work with technology that helps patients see their providers from home, so in theory, I shouldn't have people not show up. In a week with a full moon, don't count on it. One patient couldn't make it (we always call to check) because he had last minute visitors, or patients (he/she's also a healthcare professional). This happened last week, too, but that patient is a sweetheart and invited his/her guests to see us and talk to us before he/she completed our assessment. We dispensed with the usual formality, got the visit done post haste and wished them all well until the next visit.

Besides the fun at work, I'm doing plenty of work in advance for a committee that audits nurses' training and continuing education. What does this mean? I look at a lot of CEU certificates. My favorite one this week was a CE class on humor in healthcare. It is worth 20 CEUs. I thought to myself: if I could market a 20 CEU experience here in the Hotel, I'd bet I could make some money too. If that's too expensive for you, however, the author does belong to this group you can check out for free.

Now that Bubba is being a typical teenager, it's driving me nuts. Pray we survive...

Stay tuned...

What happens when...

A patient comes up missing in your hospital? Do you call security? Do you knock on the door of the bathrooms or your rehab training room? Even at the Hotel, you're not supposed to lose patients.

No, you just complain about said patient because he/she never came out of the room. My office mate told me this story recently.

"Hmm." I told him/her. "I heard a story on the radio and I figured Patient R was discharged."

"What?" he/she says.

"Patient R was interviewed by a reporter at his/her house. Apparently, some nice neighbors did some stuff for him/her and they ended up on the 'Feel good news' segment on RehabLand's WXYZ's news."

Too bad no one had that channel turned on at the Hotel. It got lots of airplay recently. Must have been a slow news day.

Yesterday, I saw Patient R come back with the key to the training room. He/she apologized.

I just smiled.

Never a dull moment. Stay tuned for more interesting returns.

Head banging or TGIF hurry up

Maybe it's because it's a long weekend. Maybe it's because I've had more than my share of head banging needed recently. If I were a pitcher, my ERA would be terrible. Two patients scheduled no-showed or refused to cooperate. Very frustrating.

Some of the people you work with have amnesia and screw stuff up no matter how many times you tell them something.Asking these same people to think is a dangerous thing. "Oh you mean I was supposed to answer when so-and-so called on the teleconferencing unit to discuss x patient." Yes, Dumbelina, you sure were supposed to answer. Even a master's degree in your discipline is of no use.

I think of the article I read about doctors not wanting to use stethoscopes in the 19th century because, "Why do that when I can just put my ear to someone's chest?" I want to yell the same thing about the technology at the Hotel, with which they do the same thing.

Thank goodness I already bought all the beverages I'll need for this weekend. I will be partaking of some nice cold ones as soon as it's feasible Friday.

Stay tuned and hope you enjoy your Friday.

Great blog post on nursing

I don't regularly follow NPR, but I came upon this blog post because of a therapist I work with at the Hotel. It speaks volumes.

Don't miss it! BTW see the movie if you get the chance. Kids or no kids, it's a good one.

Happy weekend wherever you are. You deserve it.

I call it a Hotel (jokingly)

However, the Hotel I work in, does not, and will never resemble the hotels (or hospitals) pictured in this NY Times article, "Is this a hospital or a hotel?"

Also, I did not pass. I guess I'm a bad judge of hotels, due to my lack of experience. (I only scored a 50%)

Forget the nail spa, after some shifts I've worked, a nice massage would be a great substitute!

Stay tuned...

Ah, paradise

Just when I thought the Hotel had some of the most delusional folks in the world, I came upon Amy from Amy's Baking Company (thanks to HuffPost).

Thanking my lucky stars that she doesn't work with me.

We could use  a hospital version of Gordon, though.

Stay tuned...

A loss in the family

Some times, they say you spend so much time at work it's like your second home. And yes, sometimes that home is inhabited by some pretty dysfunctional family members.

But there are others who remind you of what working together is all about.

I should be finishing one of my very last grad school papers tonight, but I can't. We lost a member of our work family and frankly, I still can't believe it.

Eddy was a nurse who had worked at the Hotel (and Washington, our sister hospital) here in RehabLand for over 10 years. Eddy started out at the Hotel, and just thought he wasn't learning enough, so he transferred to Washington and worked in the ICU. He came back to the Hotel a couple of years ago, when he moved to the same neighborhood.

He had a grand old time there with those ICU patients and was known for having a easy, laid back humor. He could get riled up, but it was rare. If he were freaking out inside over a code or anything, he never showed it. He worked with a nurse in our clinic, K. and he always gave the two of us trouble when we were together. He'd say, "One of these days, I'm going to get my BSN and get a cushy job like you guys have." K. always said, "Eddy, come on down. I'll show you what this 'cushy' job looks like."

Eddy died today. He was on leave with his wife, since she had recently had a baby--their second. We threw a big shower for them days before she went into the hospital to be induced. They brought their older girl and we had a grand old time on the unit. We said, "See you when you get back...before the holidays" and meant it.

When I was in charge (I just like saying that, I'd joke to Eddy) with him on my crew, I never worried. Even though I had less experience, Eddy would ask for my advice. This floored me. "Eddy, why on earth are you asking me, you old ICU nurse?" He would also go home at lunch or dinner time to see his wife (they lived right near the hospital) or she'd bring his dinner to work.

Eddy would just say, "RehabRN, you know a lot, and I ask you to get the real dope on stuff." Guess that made me the "real dope dealer". (Eddy was fond of bad jokes!)

We're still waiting to find out for sure, but they suspect Eddy had some kind of cardiac issue, not unlike many of the patients he had cared for in the ICU. Eddy was reasonably young, didn't smoke, and wasn't overweight.

It's still hard to believe on such a beautiful clear, crisp day, on the cusp of the holidays, he was snatched away from us and his little family to meet his eternal destiny.

May the angels come to greet you, even though we mourn you who were taken away from us too soon. It was a pleasure to know you for the time we had been given.

Godspeed, friend.