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...

Meeting agenda and assorted paperwork

Today's meeting agenda was like a ransom note but lacking a weapon. The list of demands was long, but the list of assurances was short.

I know I'll never forget this moment. I tell myself that I'm keeping that e-mail forever because it's going in my book. The book I'll write about the Hotel (and some of my crazy coworkers) that will be called Is this a bad business case or reality? You decide (working title).  If that title isn't snappy enough, we'll get another.

Some of the agenda items were crazy:

1. First of all, when the boss asks each attendee for a meeting agenda item, it does not mean 10 from one person. (not kidding).  He/she is running the meeting, not you.

2. The need to define our "communication terms". Last time I checked, you had a company-provided cell phone, a desk phone, a laptop and a desktop PC. If you can't communicate with that, I don't know what to tell you.

3. Asking the boss for prizes. Don't you need an extra trinket for nurses' week? Maybe I'm just weird because I don't.

My assorted paperwork continues. Paperwork for the siblings, paperwork for this agency and my all encompassing travel paperwork that will probably get rejected on the first round.

I feel like a hamster in a wheel...stay tuned.

Fun things to argue about at work

1. What exactly happens when someone coughs up a nasty trach plug? Is it sputum or gastric contents?

2. If you can't tell the difference in #1, should they let you graduate as a nurse practitioner? I probably p*$s% off our NP student, but last time I checked, lungs should not (regularly) contain gastric contents.

3. What does no really mean in any language (pick several, but we're all speaking English--American, anyway--here)? When you refuse to see my patients (or in our local speak: decline) and say no, I take it to mean, NO you will not see them. Yes, there is a communication gap here.

Sorry if you don't like what your boss says to you after that when I tell him/her. Not exactly my problem. If I could write orders for what the patient wanted, I'd be practicing medicine, not being a nurse.

The color of the sky, football teams, and crabby patients are all up next. We'll see how the week progresses.

Stay tuned.

Frustration

The name of the game for this short week. Oh, what fun!

Stay tuned.

Yes, it's coming!

Whatever you want to call this month's full moon, it's here.I should have known it when I got to work and my day started off smoothly.

The rest of it, got wild and crazy.

First, I got a lot of strange requests, and those were just from the people who came to my door. We had orientation in our conference room, so we always have those lost souls looking for the conference room.

Next, our doc had his clinic in the SU. One of his characters, after a procedure, decided to sit outside my office and say, "I don't feel so hot. Can you get me some candy?" He thought his blood sugar was low so one of the nurses took his blood sugar, then another got him candy. He bounced up, and our clinic RN checked him out.

Why didn't I do this? I was managing a few other fires:

1. A meeting for one of our patients was abruptly cancelled when one of the interdisciplinary team members didn't show up for work. No one knew until the last minute. It's always a joy rearranging schedules for people eight hours driving distance from you who won't answer phone or e-mail messages before you leave.

2. Another patient thought he had an appointment, while our sugar guy lounged on the chairs in the lobby. Nope, I told the therapist, I'll have to talk to him later.

3. Finally, a few minutes later, when I thought all was finally quieted down, I had to take a family over to another unit, because they were picking up a discharged family member. They had just driven in from far away and their relative was wondering if they ditched him because they ended up in our end of the Hotel, instead of his.

All went well after that. One of the nurses I know from one of our other clinics came to see me. We had a nice chat and I showed her all the stuff. She enjoyed it.

I was so happy to leave. Now I just have to wait for the full moon to be over...more to come!

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...

Teamwork...not!

How's this for teamwork....

1. Boss tells you, "I'll handle that." and proceeds not to do what you ask him (communicate).

2. So, doing the job your boss asked you to do, you send an e-mail to all the affected parties for further feedback and updates on the plan Boss asked you to implement.

3. One of the teams sends a very inappropriate e-mail with feedback, then demands your presence at their next team meeting.

4. Boss also mentions that he/she will go with you to meeting.

5. Since you thought this was a team project all along, you invite some of the other folks who helped you work on the plan.

6. Said team (who wants you at the meeting) says, "Why do they have to come?"

7. You kindly reply that you thought an interdisciplinary team was just that...an interdisciplinary team.

And pray, that your boss will actually show up for said meeting since you think he'll just ditch everyone and leave you out in the cold.

We shall see...so much for team cohesiveness in RehabLand.

Just lovin' it

Yes, in a mere three days I'll be done with the latest installment of my graduate education. And I have to say, I learned a lot. I learned that some people are just a pain in the arse. Yes, they are.

I thought we only hired non-professionals at the Hotel. No, kids, the non-profs are everywhere. What distinguishes them?

1. When you're supposed to function as a team and communicate with members who can't show up for meetings, you take minutes and post them before the next meeting.

2. You act like an adult.

3. You actually show up, and do some work.

and finally,

4. When you're assigned to be the leader, you lead. You don't goof off hiking in the woods when you're supposed to be responsible for an assignment (I wish that wasn't a real excuse...).

Now, I'm going to finish what I started, just like I said I would. And when I'm done, I'm gonna pray that we get a passing grade out of this one. I don't have a really good feeling.

Should make doing evaluations really interesting.

More on the way!

There but for...

The grace of God go I...the old saying goes.

I absolutely loved the following line in one of KevinMD's posts entitled, What this doctor learned when he was a patient.

Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.

Sometimes we nurses say the same thing...about everything I just mentioned. Thanks KevinMD having such a great guest post. It's a great story.

What a difference

Yes, a day does make a difference. I did not feel as if I was running around like a chicken with my head cut off.  Same patients (minus the admit), but more quiet and getting things done. I felt as if I accomplished something.

There always is something lacking in communication, though. One of my patients was crabby, because I took his wheelchair from his favorite spot and moved it. This was for a number of safety reasons, but he was pouting  all day, according to our NP. I did a couple of treatments and he slept most of the day.

My other patient is a rehab nurse's worst nightmare or trainwreck. Imagine a non-compliant diabetic who has survived major, major surgery (and has the scars to prove it), a G-tube among other tubes, and is just plain flighty. One minute, he/she can't get up, then family comes, poof! All's well. We push him/her to do therapy and sometimes it works, sometimes not. If we were a CMS supported rehab, he/she'd have been out on the streets long ago. 

At the end of the day, I went to a meeting. I was horribly unprepared because the nurse who actually attends our regularly scheduled department meeting just forgot to tell me about it. I was supposed to report nursing's views on a patient I've seen, but barely know. Guess I'll be busy learning about him/her for the next meeting!

Now, Bubba has enlisted me to hang the hummingbird feeder. We'll see how that goes...more to come.

In the dark

It's been interesting lately. It always is when you work the evening and night shift. Most of your life actually happens in the dark.

First, you confide in your coworker who's sitting just outside in the darkened hallway of what you see around you. She's been a nurse forever (since dirt, she likes to say) so she tells you about life in other places, and it ain't like the soap opera of the Hotel, either! Yes, sistah!

Next, you eventually turn down the lights in the rooms so people drift off to sleep. Sometimes, they don't drift too quickly. They fear the dark, sleep apnea, and the doctor showing up tomorrow. They vent in the dark--"Why didn't Dr. X tell me why I had to have so many blood draws?", "How come I have this IV?" or "No one told me I had xx bug."

One of my patients confided a lot of firsts to me recently. First person he knew to become injured. First person in his family to have cancer. First one in his family who controlled his type II diabetes effectively. First one in his family not to have a heart attack. Now his cancer has caused his recent mayhem. He's going back and forth on a pendulum he did not choose--surgery here, treatment there, back to us, and the cycle swings back again.

He does have a little consolation. His siblings bought him a computer. While the internet's not working yet for him, he does play games, which keeps him occupied. One of these days, he says, he'll beat that computer in chess.

And off I go in the dark, for the next round of confidences and consolations.

More to come...

Ironies

There are just some things that are very ironic in my job.

First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.

I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).

Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.

Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.

Stay tuned. More merriment to come...

There is a light...

At the end of every tunnel, if you really look hard. Sometimes, you have to dig through a lot of dirt and excrement to get to it, but you get there.

I had a really crazy last few days. I realize that some of the people I work with really don't work as a team if certain people aren't there to influence them to do so. It really pisses me off, but I can't do anything about it.

So what do you do? You find the people who'll work with you, and you work with them. You help them and they help you. And if you need the other ones, you have to put on the RN hat and delegate. I don't like pushing people, but I'm getting sick of this crap. If they only knew that I don't ask them for help because I get really perturbed about their followup comments, "Oh, she's not very efficient," "Oh, she does it different than I do, " or my favorite, "Why does she talk to the patient before we turn them?"

One of my patients, who is a lot sharper than he looks told me last night, "I noticed a lot of people make you do stuff on their schedule, and if you don't they get mad." Surprise, surprise. I have found that if I give people options and tell them I have to do other things, too, 95% of them will make a choice when given two options. That other 5% is another story, but even they can often be convinced to cooperate.

A lot of people think therapeutic communication is hooey, but I look at it more as negotiation. Some people we work with need control, because so much of their lives are out of control. This establishes some for them, and saves me some time in the process. It may not be old school "my way or the highway", but they can't say I didn't give them a chance.

My day, although I missed a little sleep, has been delightful. Dahey and Bubba took me to brunch and gave me lovely little presents...just what I wanted! We went out to eat and let someone else cook and do dishes. I came home, did a little shopping and now I'm getting ready for day 4 of 5. I'll deal with it as I go.

My light is the fact that after this week, I won't be at work much for the rest of the month, due to vacation days and conferences. When I looked at the new schedule with this on it, my heart leapt for joy.

Plenty of days to recharge ahead...and lots of light at the end of the tunnel.

Happy Mother's Day to all of you out there, wherever you are, wherever your momma is, here or gone. Mom's responsible for this missive today! :-)

Nightmares

Yes, I'm hearing about these, and in some respect, I'm living them.

I'm doing paperwork for the nightmare patient. This is the patient who refuses to take responsibility for his/her actions and blames everyone else, including me, for any trials and tribulations on the unit surrounding his/her pleasure. Same patient refuses to elaborate with me on any rehab goals as are needed regularly since he/she is a rehab patient.

I'm really ready to wake up and ask for a different patient. This one sucks. If one more neuropsychologist tells me to use motivational interviewing, I may vomit.

Recently, we had a patient code on the floor. Said patient had lots and lots of problems but the biggest one was with patient's MD. MD just would not listen to the nurses. We voiced concerns about the patient for days. I'm still very angry about this. I went and discussed this with a third party and the help and rationale was sound, but I still have misgivings. Thank goodness the third party didn't gloss over it. All those years of hospital experience are handy!

While I'm happy I CYA'd myself, I'm just not happy that I couldn't do anything about getting said patient the care needed. I feel like a failure. I know it's not my fault. I'm going to spend a lot of time on my days off vegging out, so I can forget what an a*& this MD is.

I will content myself with the fact that said patient told his/her family, who visited rather frequently, that our place was the best..."especially the nurses."

This week at Madison

Here are a few of the interesting topics I've encountered dealing with my patients this week. Links to appropriate resources are also included for more information.

Before I headed back to the evening shift, I got to admit a fellow from a far western state. Our unit may be the red-headed stepchild of the SCI system, but we have a reputation for healing people with wounds that can't get healed anywhere else. (It also helps that our boss has friends in a major research hospital in town, too.)

The new guy, Mr. C., got a room with a fellow (Mr. W.) who's also had step one of the same type of surgery he's being evaluated for--girdlestone surgery. Said patient is pretty nice, but physically, mentally and emotionally, he's been a trainwreck. Patient was a victim of violence. Patient has several health problems now directly related to the incident: short gut syndrome, and a whole bunch of other things. The dietician has put him on an FAA diet (free amino acid) with a different type of formula--Vivonex. It's really amazing that he's as positive as he is.

Mr. K., our elderly gentleman who's just about to hit one year at our place (on and off, with trips to acute at Washington) came back yesterday from Washington. He had some mental status changes (possibly medication related) and also mastoiditis. Some of the staff were a little upset with him because he told the folks at Washington that there were "drug problems" at Madison. (One of his previous roommates was discharged due to drug issues.) While Mr. K. is a little off sometimes, more often than not, he's very astute to things. As a consequence, he's very upset that he's back in his old room, and he told us if he could get up he'd probably slug his roommate. Nice. It should be interesting to see what the boss decides to do with him, since we're running at full capacity and getting four new people next week. There aren't enough rooms to make another room isolation right now...

Nuggets
Here are a few other goodies to check out this week, if you haven't already.

I found this cancer article in the NY Times this week, along with another article about doctors and condolences.

MonkeyGirl's Rehab post was just a riot. Head on over and read it for a good laugh.

RehabRN book club items
I recently finished reading Best care anywhere by Phillip Longman. Even if you don't work at the VA, this is a fascinating book.

I'm still working on From Silence to Voice by Suzanne Gordon and Bernice Buresh about nurses and communicating to the public.

On a non-nursing note, I finished Elizabeth Berg's The day I ate whatever I wanted. This was a great book. I really loved the apple pie recipe story near the back.

BTW visitor 5000 showed up here on 8/12/08 at 11:42:55PM from beautiful, downtown Chicago, IL via www.nurseratchedsplace.com. Thanks for your visit!

More later...stay tuned.