Recovery

It's been a nice evening enjoying escaping work.

I had dinner with a friend and had a nice summery lager.

A great way to forget there are two more days left his week...ugh!

Irony or Day two of the JC

Yes, one of the executive secretary's must get a "communication" bonus, because we're getting a recap every day (with emoticons and gifs...I wish I were kidding) that the Joint Commission is at our hospital.

Kinder, friendlier hospital? I don't think so.

But after another day of digging, sorting, and moving things around in the files for another upcoming audit, I discovered some very interesting things.

1. Some people think they can BS their way through everything. Including three months of work, where they didn't really do much.

That should be an interesting conference for the slimy critter whose nose is tilted so high that she'd drown in a rainstorm.

Have fun 'splaining,  honey. It was nice knowing you.

2. Some data is really a mess. I'm so glad it's not mine. I did the best I could with it, and passed it along.
 
3. Don't mess with a big Army veteran in a red truck. Thanks D for keeping that guy from running me over in the parking lot! (Quitting time is scary in our neck of the woods some days!)

4. Read something light and fluffy to destress when you get home. My favorite today was the classic blog, Fmylife. Just when you think your work day blows, you read about someone else's craziness.

My favorites today involve lack of anatomical knowledge and the good old general crazy character.

Ahh! I feel better already. Back to the iTunes and going through the years.

Enjoy your moments wherever you are. At least, JC can't visit EVERYONE this week.

Stay tuned...

They have arrived

Joint Commission. Nice. Don't you just love Mondays?


So, it's a great reason to leave my door closed today and not answer, since I'm busy getting ready for another grandiose biennial inspection in a mere 21 days.

I really need a vacation soon.

That is all.

In the news, part 2

Amid all the fun and excitement running errands, keeping a little boy out of trouble and working on homework, I checked out some health-related goodies today on the internet. Hope you enjoy!

Disabled?
If you are, please don't get caught doing lots of heavy, manual labor like these folks. (courtesy of our friends at www.bbc.co.uk)

I guess JCAHO is messing with tradition...
Yes, doctor slang is rapidly disappearing according to this article.(also from our friends at the BBC)

Hungry?
If you need a snack and are getting tired of all these folks telling you what to eat, check out the latest hearty muffin recipes. (courtesy www.nytimes.com)

The second coming?

No, it wasn't the second coming, but JC (aka the Joint Commission) was in the Hotel recently. Somehow, we were lucky enough to have them come on the unit when it wasn't absolute bedlam.

I read all the prep materials Madison had printed for us and it was helpful, but of course, our surveyors asked for something completely different. If you have never been through a Joint Commission inspection, it is an experience.

What was my job, you ask?  I was the lucky nurse who was chosen by the nurse manager to demonstrate how we take care of our patients, how we dress wounds and how we keep them safe. I also had to take the surveyor to therapy.

You know it's going to be a little stressful when...

1. Surveyor asks if you are causing never events. This led to a chat about what we actually do. Surveyor was happy with the explanation, especially, when we put it on his/her level.
2. You ask one of your patients if he/she would mind talking to the surveyor and he/she says no.
3. You ask the second patient, patient agrees, interview is fine, but surveyor does not like how therapy is doing certain things. Several other departments get involved. Surveyor does not come back in timely manner.
4. You're waiting for surveyor, patient gets fidgety, so you start AM care. 
5 Surveyor finally arrives and is accompanied by CNO's right hand nurse and another executive office nurse. You are sweating...not because of the audience, but because the room is so hot.
6. Mr. P. your fidgety patient, see this as his moment in the sun, so he tells surveyor how he doesn't like our other hospital. With all the bigwigs in room. Happily, Mr. P. tells surveyor he loves us because we know what we are doing.
7. Mr. P. did so well that he's chosen as the tracer patient in meeting with surveyor and boss.

I did get a compliment from the boss that the surveyor was impressed with our work. (whew!) I just hope those good things appear in the report.

So what would I say was helpful?
1. Know your facility's policies and be able to talk about them, especially those odd ones. Be prepared to find them, too, since they may want a printout.
2. The boss blanketed the unit to let everyone know the surveyor was on the unit, but we also shared this information with our visitors. No one complained, either.
3.Be friendly, smile and give them exactly what they ask for. Surveyors grade you on your disposition just as much as they grade your knowledge of policy and procedures. If you're a good poker player who bluffs well,  you'll have an edge.
4. And if you can, never let them see you sweat. You are okay, though, if the room is hot.

Psychosocial Insecurity

Our little unit is an open-door haven that former patients visit regularly. Even when they're visiting other folks in our building, they tend to wander by the unit, to see the staff and to see if they know anyone who's staying with us. It may seem unusual to some, but not to us.

Then again, some of the people who stay with us a long time (and they probably make up at least half of the unit) don't want to leave. They enjoy the security of knowing they'll have help whenever they need it, or twenty-four seven room service we like to call it.

Right now, we have a couple of folks ready to leave us and they are suddenly getting jitters. "Oh, I feel sick." "Oh, I can't do this (or that.)" "I don't have any help lined up yet." Surprise, surprise. If we got out our Carpenitos for nursing diagnoses, we'd surely have a lot of these psychosocial diagnoses: Ineffective coping, relocation stress syndrome and my personal favorite, ineffective denial.

Despite the best intentions of getting sick at the last moment to postpone discharge, our first discharge guy left. He not only left, he waited all day to do it. He couldn't rush, because his help wouldn't be there right away. As when many people leave, some people count down to the next time we'll have someone back...as a long-term customer again. Those maudlin thoughts just creep up, even if office pools are forbidden.

One guy keeps leaving and coming back, because we keep discharging him for medical issues too acute to be handled on a rehab floor. I wonder how long it will take before he doesn't bounce back again. Age and infirmity can do that to a person. While I was off this weekend, he was back for one day and returned to acute. He didn't even make it 24 hours on our unit. I guess our idea of stable is a little different than the acute hospital's idea of stable. Not breathing and cyanosis just are not good things.

If the internal excitement is not enough, we have prowlers looking for privacy violators. Yes, it's all because of the good ol' JC. They're on the loose so this is practice...just like those quarterly fire drills. The boss just about had a fit when I gave a chart to a doctor. I had to prove I saw his badge and look him up in the computer. Good thing he's a psychiatrist with a sense of humor!

All this and H1N1, too. It's going to be a rocking end of this year. I'm just crossing my fingers!

More to come...

Life and death

I've been lucky this week. Things finally calmed down. My first couple of days were pretty exciting.

There is always a hustle and bustle on one particular day of the week, because it's this day that we get the most patients admitted to the unit. This day also is the day I work my evening shift after a day of rest. Sometimes, I have time to get rolling and other times, I have no time at all and that was the case.

I got in and one of my patients needed blood after the first two hours of the shift. Only no one got his consent, which means I had to track down our doc, who was long gone and out of pager range, then call the local on call doc to get him/her to come over to do the MD portion of the paperwork. Said patient was a little perturbed because his favorite MD never told him he might need blood. Happily, he got over that, and I got the blood started before the end of my shift and even led one of the new nurses in the process so he/she would get some practice, since we don't give too much blood at night. All was good.

The next day, everyone's happy and I'm actually getting into my rooms right after report. In one room I smell something funny. I look and see my quad patient has bursted his colostomy. Get goodies and clean him up. I think the wafer is intact, so I get ready to put the new bag on, and discover it's not. Get all stuff set up and put on new wafer. Three sides are taped with pink tape (because he needs it) and all of a sudden I see a geyser. Thankfully, I caught it with the nearby towel. (Nursing students: never change a colostomy bag without one...if you do, do so at your own risk!) Finish cleaning, finish taping and I kept praying all night he wouldn't do that number again.

Another patient recently asked me about last rites and whether he got them when he was very ill. Since we have an active chaplain service, it was really easy to check the chart. Besides, I told him, spiritual care is also mandated by JCAHO.

One day, I came in to the news that one of our recently discharged patients had died. It was shocking, because, he/she was young and in a way, it wasn't. This patient always denied suicidal ideation, but something about him/her caused a faraway look on their face that made you think they would not be around for a long time. We often talked about ghosts and somewhat about death, because our unit has a reputation for being haunted. Said patient even stated that he/she saw something in one of the rooms he was in that lead him/her to believe that the stories were true--curtains jiggling at night, and a reflection in the mirror when no one was around. He/she wasn't worried, because he/she hoped his/her roommate, who died during his/her time was the ghost hanging out in that room, because it was comforting.

And so the week of work is ending, and the sturgeon moon is on the way. We'll just wait and see how it goes. More to come...stay tuned!