Monday again

Surprisingly, I did not have hundreds of e-mails when I returned to the office. I had about a dozen.  One of these days, the crazy admin who works for us will figure out that we ALL really don't need to receive a 9MB attachment on every e-mail she sends. (I bounced this request to the tech people today).

I worked with a patient (Mr. X) who always seems to show up in my office. Some therapists need to be working with him, but they're off doing other things, so I think of things for him to do. I allot about 30 minutes a day on this. I wish I could bill for my time in a clinic visit like the therapists do.

Meanwhile, Mr. X thought he was evading the medical staff on rounds by hiding out in an area near the remodeling being done in our part of the Hotel. Nope. They saw him. I managed to coax him out of the corner so he could talk to his doc. Once she arrived, I was out of there.

I also got a referral to one of our docs today. Patient found us on a website, made a phone call, and ended up in my voice mail. Before I could call, he called me. Mr. Persistent wants a second opinion with a specialist who works with us. He has a disease that requires a choice between two medications that will keep his disease at bay, but one, if he's got certain conditions, could actually kill him. Once specialist is back from his family jaunt across the country, he'll be on his consult list.

One patient made my Monday melancholy. Mr. E. has been coming to our place for a few years. His wife has never really coped with his issues very well. The caregiver stress they talk about in nursing school is starting to show. Mr. E. came in to a clinic visit with a week old beard. This is highly unusual for him, since he tends to shave every other day. Mrs. E. didn't come in with him, either, which is unusual.  She told us he had some issues and that she thought he was sick. She was correct. He got admitted.

Staff are getting bend out of shape about Mr. E. not being cared for. He's not the only one. I think Mrs. E. has finally broken. The strain of caring for her loving husband, who was once a tall, strong, highly educated man is killing her. Her back is strained from the weight. The role of loving wife and partner has been permanently replaced with caregiver. It's not what she signed up for. She doesn't say it, but the vacant look in her eyes tells you. The folks who promised to help just aren't doing it anymore.

The burden has fallen to us to carry at the Hotel,  as we wait to see how the rest of the questions in our minds will be answered.

Stay tuned...

The fugitive

I feel like a fugitive from the law of averages.  ~William H. Mauldin

That's the story of my life lately. Everything that can go wrong will, or at least it seemed that way on a recent shift.

I have the misfortune of having oddball things happen when I am the charge nurse. I've been in charge for a while (but too frequently) and things have been getting progressively weirder. Last time, some of the staff drove me so crazy I don't even want to talk to them anymore, because to ask them to do something is a burden. Eye rolls, heavy sighs, and flat out "no" on occasion gets my blood boiling. To top it all, these same people want to talk about teamwork....hello? I'm the captain of the team and I'd like you to, at the very least do your own work!

And if that's not enough, invite people in from outside and have them critique your work. I was this close (imagine index finger and thumb close together) to calling the ambulance supervisor for the crew who took one of our patients out. DweedleDee and DweedleDum complained about the patient, complained about the necessary items he/she had to take along, then complained "Why didn't the doc send this patient out sooner?"

I just asked them to get him/her out of the Hotel, but in the back of my mind, I really just wanted to blow it all and ask them when they got their MDs. Funny, I only saw EMT on their shirts. I'm no MD, nor would I presume to know everything about this guy. This was the second pain in the arse crew on our unit and if it were up to me, I would lodge a formal complaint. Your job is to get Patient X from us to point B that's it. Medical treatment philosophy is not my business.

Thankfully, both these people were out quickly. Acute situations are inappropriate for rehab for obvious safety reasons. Sure, I love giving blood out as much as the next guy, but if you're gonna need unit after unit, and potential surgical intervention, you need to go somewhere else.

Enough venting for me...off to vegetate until it's time to be Homework Taskmaster with Bubba before all the sports....stay tuned.

The greatest nurse

I've only been a nurse for a little while compared to the people I've worked with, but I've noticed a few traits to consider if you want to be the "greatest nurse."

1. Roll with it, baby. My preceptor and confidant, G., instilled that in me in my orientation at Saintarama. Life happens while you're making other plans, as the song says, so always go with the flow and use plan B if you have to do it!

2. Have a sense of humor. As a kid, I hated shots. One of my favorite nurses, Mitzi, always found a way to get me to take them without them hurting so much. I use her line, "Dangle that arm like a dishrag and relax." a whole lot. Her counterpart, Rita, used to do a Bickersons routine every time she saw my mom, which usually sent the office folks away laughing.

3. Appearances can be deceiving, so use it to your advantage. Moral of the story: never mess with a 4 foot eleven inch former Navy nurse. MMB taught me that a good nurse can be tough and tender at the same time....and that nurses who work with moms and babies will take you out in a heartbeat if you mess with either. (Said nurse had to diffuse a momma/baby daddy situation before security came on one clinical.) She managed to do it without force. Whew!

4. Do what you have to do to get done, but get a break wherever you can. You're not going to be a very good nurse if you're crabby, have to pee, or have six phone calls to make . Prioritize accordingly. It may not solve every problem, but your bladder will thank you.

5. Sleep. Get enough sleep so you can deal with the tasks of the day. Many of your coworkers will slack off or work too much overtime, so someone needs to be paying attention.

6. Old school's not always so bad. Don't knock primary nursing. You may end up with less patients. My professor gave me the greatest compliment when I told her I was going to be a rehab nurse on a primary care unit. "That's what nursing is all about!"

7. Vent and get it out, but treat everyone you can with dignity. Yes, we get frustrated, but if we do nothing about it, it bubbles up and takes over. Find ways to relieve stress in a constructive manner, both at home and at work.

Heard on the unit...

Today's installment, actually from yesterday, is mostly patient quotes. I would have had them up sooner but I was just too tired.

One of my patients is a retired high school math teacher. Fr. V. is also hard of hearing, so this makes conversations really interesting.

Me: "Father, I heard you were a teacher, what did you teach?"
Fr. V. "Idiots."
Me: "Weren't you a math teacher, Father."
Fr. V.: "Yes, I was. I only taught the idiots. The smart ones learned all by themselves."

Even funnier thing...one of his likely students (Mr. G.--he left on Tuesday) was about two doors away. Now I'll never know if Mr. G. fell into the smart ones or the idiots on his initial high school math classes.

Fr. V. also had some spiritual distress, once I got him thinking about tests. Neuropsych had sent one of their students to do an assessment on him and he could not hear her well. As a result, I had to call the neuropsychologist on his behalf to see if they'd let him retake his exam. It should be interesting.

"That night nurse really doesn't like her job, does she?"

Mr. R. mentioned this to me as I was assessing him. He told me this nurse makes him feel very much like an inconvenience and that he's just trouble. Sure, Mr. R. gets up at 0500 to watch the news and drink his coffee, so it's not as convenient as staying in bed. Now, I make sure he has his coffee in his room whenever I get on the unit. If he doesn't, I make him some. He's fallen twice since he came to us, and he's staying until he can get his new cervical decompression next week, so we have to keep him out of trouble.

This is a sore subject for me. I hate dissing my coworkers, but some patients are very observant, and now I know why some of them actually ask their docs if I can be their nurse while they are on our unit. I never actually say anything about the coworkers, so I just let the patients vent and get their feedback. Most are very positive.

More later...gotta warm up the car and go to work. Mr. R. probably needs his coffee by now!