It's the truth

Thank you KevinMD for this one. I need it.

I'm at a point in my life that I'm tired of putting up with bullshit. I entrenched myself at the Hotel to succeed at my goals: getting more education and getting a good job. But the view from here right now is annoying.



via GIPHY

In 2011, the Robert Wood Johnson Foundation called upon nurses to participate in their publication, Transforming Leadership: Leading Change, Advancing Health:

“Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors.”

I need a couple more doctors who listen to nurses in my life right now. There just aren't enough at the Hotel.

Stay tuned...

I'm not hiding

I'm just dealing with fallout. Fallout related to the end of our hospital's fiscal year.

Some of the fun  meetings I've been subjected to:

1. Year end recap
Actually, I'll be forced to do that next month. Boss didn't show for this month's meeting (that's really a waste of time).

2. Meetings with my boss, coworkers and a provider who was forced to be there.
An hour of telling people what I do, what I am allowed to do, and why you telling me what to do isn't a good idea.

NOTE: my boss sat on the sidelines watching this car crash. He/she knows better.

I had fun by pointing out how I know what you know, and when I knew it, even though I'm not supposed to do your job.

3. "Scut work"
Said provider in #2 said he/she isn't going to do the work that other providers in our system do, because he/she can delegate that "scut work" to the NP.  BTW none of the scut work mentioned here is even done by an MD in our system.

NOTE: this "scut work" requires a physician or licensed independent provider to write an order. Our MDs are really "busy" not writing as many orders as they can, especially at odd hours.

My favorite excuse: "just blame the computer". This wreaks havoc for the nurses, especially when your facility supposedly "disciplines" providers for too many verbal or telephone orders.

I really wanted to ask what he/she normally does when not goofing off, but I bit my tongue.

The train is coming, so off I go. Enjoy your day wherever you are!

Sometimes I wonder

Why do specialists forget the basics? Wouldn't you expect your doctor to know the basics about flu, even if he/she were not an internist or primary care provider?

I really did want to bang my head into the large conference table as I explained to a patient (who was being evaluated for a specialty rehab program) the basics of caring for someone (grandchild) with the flu.

Said MD walked in and acted as if he/she was clueless to any of the guidelines. It's very handy that the Nursing department makes us do an in-service on flu EVERY year here at the Hotel.

I thought it was a little overkill, but having enough knowledge to explain to patients seems like something an MD might be able to do, too.

I'm just adding this to the crazy day list at the Hotel.

More later...

Amazing!

I read this in a note written by one of our critical care fellows for a patient who was transferred due to hypoxia. I'm sure all the pharmacists out there will be absolutely surprised by this new use for this drug (or maybe it's an off-label thing, since we are a teaching hospital).

metronidazole currently, added for hypoxia

And if that wasn't amazing enough, I'm not the only "mad as hell" person at the Hotel. Apparently, the good folks at Gallup are getting an earful in their polls, especially this one: Congress' job approval falls to 11%. It's about time.

But, I have to thank my old buddy, Steve, who found this jolly video below that every rehab nurse will love. If only all the toilets in the Hotel could have a bottle of this to kill the smell from some bowel programs.

Enjoy!

Crazy day x 2

Not mean crazy today. Just regular crazy.

Crazy MD still thinks he knows everything. My other MDs are fighting over a patient (which is not a bad thing.)

The inn is full, and all the naysayers are still on vacation. Hallelujah!

The week will go on, and I will survive.

That is all. More later...

Battered and bullied...

No matter what I did, it was not enough for that crazy MD I worked with today.

So glad Monday is over!

No way!

"I can't deny the fact that you like me, right now, you like me!" --Sally Field

Thanks Doc C for inviting me to Public U to read my submission to your poetry journal.

I know it's really because you did your internship here in RehabLand, and if someone decent comes along, you just invite him/her.

Shucks, now I'm just gonna have to tell the boss I have a reading date at PubU that day.

More to come.

Demotivating employees

Ah, spring is in the air (for the moment) here in RehabLand, and the hospital administrators (aka PHBs) have emerged from their coccoons, er lounge chairs, to start rabble rousing the troops and demotivating away.

How can they do that you say? Well, here are some stories (I wish they weren't true) on how they do this.

NOTE: the names of all parties and sexes, etc., have been centrifuged to protect the guilty and the innocent, since I don't want the HIPAA police to come carry me away.

1. Medical personnel are allowed $xxxx per year for continuing education. (Not nurses, though). But, good luck, Ms. Overworked MD trying to use yours. You're not properly certified yet, so your slug compatriot MD gets your share. Call HR and file a complaint.

2. Allied health person gets invited to a national conference to speak. Your boss, who's been at the place forever, fills out all your appropriate paperwork. In the meantime, you sign up to present and pay your conference fee, hotel and airfare.

You get an e-mail that you've been disapproved, but when your boss tries to appeal to the higher-ups, he doesn't get the dignity of a response. Nice. So much for having seniority. You can't even take off unless someone with more seniority lets you have the time. Go file an EEOC complaint.

And my personal favorite...

3.  Become an advance practice nurse, get certified, speak at a national conference, and then submit your request for one lousy conference (subsidized by a private foundation) because you need more education to take care of new patients we have on the unit. All you want to get are your days off as official absence.

Get rejected because the "man with the plan" says we "can't afford to give you days off to learn" at the premier (and also free, since you got it paid for) conference in the world.

Reminds me of this Dilbert scenario...stay tuned for more to come!

PHB: You may have heard that our company has been accused of unethical business practices.
Alice: Is it the falsified product safety reports?
Wally: Is it the false stories planted in the media about our competitors?
Dilbert: Is it the crime family connections?
PHB: What?! Are you saying those are considered unethical too?!? Good God, this thing is just snowballing!

Benefits of being a student

1. You get to read lots of magazines that have absolutely nothing to do with nursing, but are interesting when studying the US healthcare system.

This FastCompany article on Medicare fraud was very enlightening.

2. You get an international perspective from more than just your classmates on privacy issues, whether it's HIPAA or some other national protocol.

Word to staff: Don't try this one, even if she is cute.

3. Another plus: idiots exist wherever you go, just like the MD and her husband in this article.

Thank you Vince Ciotti for posting these links via HIStalk. You make being a student very interesting, indeed. Keep up the good work!

Off I go to work. More later...

A note to all the civilians out there

Yes, your friends in the medical or healthcare industry may scare you.

I went out a while ago with some friends from high school. You could almost part the room by who's in a healthcare job and who is not or is not familiar with the healthcare industry.

Some interesting observations:

1. People with boys tend to know a lot about emergency rooms. One of my friends has several and rarely blanches when he tells the stories of Kid X running into the fancy glass table at the department store and getting a cut on his head or when Kid Y goes and has a compound arm fracture after some skateboarding stunt gone awry.

I just thank my lucky stars I don't work in the pediatric ER.

2. Allied health professionals often have their own interesting stories about doctors. One friend has a doctor she works with who asks her to call the special back office line so he can take care of whatever she needs for his patients right away. She can also tell you what doctors have the best staff in town.

3. Another one of my friends still works the night shift after several kids and 18+ years. I never cease to be amazed at how well she functions. I just shudder at the thought of 18 hours on the night shift, let alone 18 years! She works at a major teaching hospital, so she always has some funny stories about dazed and confused people on nights, especially the residents.

Sometimes I think she should have been a nurse. She'd be one kicka$s patient advocate. She is kind and pleasant and takes no crap from anyone.

4. One of my friends is a doc. I always think about this before I get really annoyed. Friend A has some great stories and some real heartbreakers, so I know the line Dr. K. told me a long time ago is really is true: "I have some patients I will never forget."

5. I am always surprised that these same healthcare professionals, who have years of experience tell me that they're amazed at what I do, and here I am, a newbie nurse. And no, I didn't pay them to say that. They work 24/7 just like we do. They've paid their dues and they've put on the flak jackets when some crazed MD or patient screams at them for no reason.

It reminds me that in many environments, nurses are on the front lines of healthcare. We are in the hospital trenches with patients. First, when things get down and dirty, we have to go and get whomever cleaned up and out of there. We're a little like infantry in that regard; a little like MPs, since we have to keep our guard up and watch out for trouble.

Finally, it gives me hope to know that these good people, doing their jobs in the other healthcare disciplines, are out there watching my back, too, even if they're not next to me in the trenches.

Before dawn, darkness

The last few days, I've been feeling pretty terrible. The virus-of-the-month in December worked me over good enough, that I've succumbed to one or two more in the interim. I felt so terrible working on Sunday night that I finally surrendered today. It's been sinus hell and coughing for too many days, thank you very much!

I called the MD to see if I needed to come in or if something could be sent out. Apparently, I'm not the only person sick, so I got my prescription. My day today has been, first, take Bubba to school. Next, go back to bed. Wake up a couple of hours later, and call MD.

In the interim, I called in sick to work. Note: this only takes 7 (yes, seven) phone calls to actually reach a live person. What little voice I had left disappeared by the time I finally got my manager, so I creaked that I had called the MD and was not coming for my regular shift today. Manager sounded a little annoyed (no surprise), but nevertheless accepted. (At least I gave enough time to get a replacement!)

Next, I waited an hour after MD office called and confirmed that a script was sent to my local pharmacy. I got to the pharmacy and I waited, because, they, too were inundated with lots and lots of emergencies. No problem, I found a seat in the empty waiting area and sat with my coffee and a magazine. Got meds, and scurried home to take the first dose of my seven days of huge capsules. Then, it was back to bed again, to sleep a few more hours, before Hubby calls to check to make certain I'm still around...and yes, I was in the same spot...in bed!

The weather's improved markedly in our neck of the woods, but there is a bit of winter gloom still hanging around. One person I know went in for surgery and had complications that have changed her life. She's handling it well, thankfully, but when you look at the grand scheme of things, you wonder. Last year this time, one day her husband was alive, the next he had a cold, the following, he was dead.

I'm still wondering about our cancer patient. He's set for staging soon, and some days, he just won't get up. I've taken his meds to him on my med passes recently and I keep the mood light, just as I always have done, and he laughs. But, I worry for him. Hanging out in bed in a dark room in winter is just so depressing. I wish there was more I could do.

Finally, I read an interesting thing in my ANA Smart Brief today, which I get via e-mail daily. I've posted it verbatim below. I think it tells a story people don't really realize now.

Enrollment in nursing programs nationwide has increased every year for almost a decade and the worsening economy is making the profession even more popular. However, some experts say a lack of available spots in nursing schools and the hard work and dedication required of nurses could be barriers for some aspiring RNs. "Yes, it's a route to some form of job security, but you really have to want to be a nurse," said Frances LaFauci, associate dean of nursing for Suffolk County Community College, adding, "You have to be tough, physically and mentally."

Nursing is not for the faint of heart, or the paycheck. I totally agree with the toughness factor. In a way, I feel like a nurse has a lot in common with many tradesmen. I had to apprentice and learn and then go out as a journeyman (or person as you wish) and ply my trade. Everything I learn colors what I do, and I don't look at things the same anymore.

Builders build and/or maintain infrastructure that last far beyond the scope of their lifetimes. Some never see a completed project because it's so huge. What we do as nurses is immediate and visible in our practice and the lives of our patients, even if we don't see it directly. This is why I really enjoy rehab, since we see this happen literally right before our eyes.

Things change, but we adapt them and integrate them into our practice, and the life-changing component remains. And at this point in time, I can't imagine doing anything else.