Sick day

When you absolutely, positively need a break before the end of the week? You call in sick (or in my case, exhausted).

The last straw? The doctor who almost no showed my last patient appointment of the day, then shows up in the last 10 minutes. What does this mean? My patient is taken care of but, I miss my important diagnostic that my PCP had ordered, but I couldn't do at lunch time. More unpaid OT...not fun.

Never fear, however. This nurse case manager found out that Saintarama urgent care can indeed do the tests that Dr. H. put in electronically. The outpatient area was closed when I left work.

"Come on over" the lady in the urgent care said. "We'll take care of you. We're here until 8."

Happily, no pneumonia, but a nasty, nasty case of viral bronchitis. The only thing I didn't have was some codeine cough syrup.

Problem now solved...and I stopped barking and coughing a while ago.

Back to work tomorrow, then excitement with Bubba who starts spring break.

Never a dull moment at the Hotel or at home. 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...

It's really Monday

It may be a holiday (banks are closed, Bubba's out of school) but it's still a Monday.

I told the nurse at my appointment this afternoon that there were several, telltale Monday signs. One, if it can go wrong, it will. Luckily, all my odd things that happened weren't life-threatening. Two, the doctor was late for my late afternoon appointment. No big deal...he's nice and doesn't short change you on your moments.Three, the parking lot was full. My favorite comment by one lady coming into the office, "There must be a lot of sick people here today."

Lady, if you only realized what you just said. I heard nary a cough (except for one cough out of a little boy on the far side of the room) while I was there.

Thank goodness they don't run late with the sick folks.

More to come...the week is still young.

In the bus station

I read this article today about psychiatrists with a heavy heart. Pushing people through an office every 15 minutes just to give them pills and ship them out is not going to solve their problems.

How many people will have to kill themselves or be hospitalized for long periods for insurance companies to figure this out?

Just sayin'...

Flying solo

So far, the sky has not fallen. My first day was pleasant, even if some of our administrative staff were not. Most of our patients arrived on time, and one was even early.

We will see how the rest of the week goes...more later.

Heard on the unit...

Aw, it's been forever since I've had enough goodies for this segment! But when patients speak, sometimes we just bite our tongues and run as fast as we can to our lunch break, so we can share with the rest of the folks on the unit and with the audience at home.

Situation 1

RN is educating patient about the proper way to use an incentive spirometer. After demonstrating proper technique, patient says, "Oh, that's just like what I do at home with my bong." RN listens as patient describes how marijuana "relaxes my legs so I can get into my chair."

Sorry, remember that non-smoking thing you signed to come here for rehab? Yep, it applies to Mary Jane, too.

Situation 2

RN is talking to patient re: helping himself (He's a lower level thoracic paraplegic, so he can do it) by dressing and turning himself. "Oh, I'm not going to do that (turning) at home. I'll just wake her up." (implying whatever woman happens to be in his bed.)

Nice. My reply, "So since Babe #1 is not here, could you just move the pillows and turn yourself, please?"

Situation 3

From patient who is not really observant about following his intermittent catheterization rules or fluid restrictions.

"Where's my nurse? I missed my appointment." says Mr. Drinks-A-Lot.
"What appointment?" I asked.
"My catheter appointment. I've got a headache."
"Yes," I replied, "and you realize this is a sign of dysreflexia, correct?"
Patient shakes head.

If only Tom and Ray were here to do this...more to come...eventually!

Nuggets for March 3

I'm off today, so I went in for my now yearly appointment today. The tech was nice and surprised I could handle it. (I was going to that happy place, I tell you on a couple of films!)

Anywho...WildDog is outside lollygagging in the breeze, waiting for the mailman, so I'm busy surfing away here. Here are a few items I've found today. Enjoy!

I'm really tempted to print this out and hang it on my locker. I know jo featured it once on her blog, the appropriately titled magicbulletsaway.blogspot.com.

The nurse attorneys are at it again...check out a couple items below:

• Taralynn Mackay has an article about jobs for nurses and board actions.
  
• LaTonia Denise Wright reminds us of the 24/7 nature of nursing. Oh, if you only knew how much I think about pummelling idiots...think is always the key word.

And finally, from my ANA daily newsletter...the 83-year-old ER nurse in Syracuse, NY comes in whites and cap two shifts a week in a local ER, when not tending her garden. If I have half that energy at 83, I'll be good!

More to come...stay tuned.

It never happens...usually.

That was my day today. Even though, I'm coming down with another cold (I'll be happy to get rid of them once and for all!), my day went along smoothly.

Surprisingly, since it usually never happens, I had some of the same patients I had on my evening gig. I told them I was just as surprised as they were. I got both of them rolling quickly and it was great. I had to check the computer for orders, and that went well, too. One patient got up in his chair, rolled around and checked things out. It was a beautiful, sunny day, and the temperature even started creeping up to pleasant January levels.

My boss told me I got my permanent appointment. He was a bit taken aback which kind of makes me wonder about him. I think that four hour meeting he was in today fried his brain a bit.

Happily, the census is down for the moment. Hopefully, it will stay that way for a while. I know we'll enjoy the reasonable quiet.

More to come...stay tuned.

Another day...until the weekend

I got some good news this week. I may actually get my permanent appointment soon. The paperwork is in...hooray! This document tells a little bit about classification and nurses in the VA. You can cure insomnia if you read all of Title 38, just like you can with economics readings as I mentioned to one of my coworkers today.

One of my patients was up and out right away to an appointment. One was out at 1030, so all I had to do was get him ready and he was gone the rest of the shift. The other one stayed in bed until after lunch and then he got up in his chair and rolled around. He was with us when I started this spring, so it was nice to see him come back and everything went well.

More goodies tomorrow!

Fun Friday

This happens when one, the census is down, two, both of your patients have doctor's appointments at the same time and three, you are not working the weekend. Oh, what joy!

That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)

Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.

Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.

The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.

All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).

Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.

I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.

Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!