Sometimes you have to go with your gut

New nurses: this one's for you.

We take care of a lot of people at the Hotel Rehab, and it's normal for us to see a variety of society strolling through the front doors. Sometimes we are given plenty of information to do our jobs accordingly. Other times, we aren't.

Since I work with all of the folks who complete rehab, as a specialty nurse, I have to understand how to use my assessment skills. When something seems strange, it usually is. Police come and go in the Hotel for a variety of reasons, and it's always for something.

I took care of one of our folks in the SU. Said patient did well in his/her rehab stay, and would seem like a good fit for our aftercare program that I manage. While I do chart reviews of all of the patients to determine eligibility, and this one passed all of my normal reviews, something still wasn't right.

Said patient was getting ready to discharge. Since he/she was not exactly confident about this program when I discussed it, I didn't worry about it. I do not push patients to participate, because it's voluntary. In one of our discharge planning meetings, another consulting staff member, who I greatly admire, voiced concerns over this patient's "legal issues." In rehab, this, too is not uncommon, as many people may be in rehab due to accidents and may be managed by legal or worker's comp case managers from outside.

When I looked at my credit monitoring service e-mail recently, I found out why Officer Friendly was pacing through the unit. It wasn't because we have staff parking scofflaws, it was because my SU patient was a registered sex offender. His/her pending litigation might end up in a prison sentence. This, consequently, disqualifies SU patient from my program.

So for all you new folks: what does this mean? This means you tailor your care to the specific patient, and remember, no matter what to be professional. This article mentions a number of things you can do to make this happen, as a floor nurse, and discusses things your risk manager may ask you.

In my decade of practice, I've seen nurses act like fools and discuss these patients  loudly and use computers visible at the nurses' station. My advice: don't do it. You will look stupid, and you may be disciplined. You should discuss this with your nurse manager in your area in a private location to make sure you ensure the safety of staff, visitors, as well as the patients on the unit.

Finally, all of those things you learned about therapeutic communication and ethics come to the forefront in these situations. Yes, you can take care of these folks and be honest and direct. I often tell students this is why you don't overshare in ways that may make your patients uncomfortable or create other issues. Seek help from other team members, such as psychology and your chaplains, so you can make your care plan appropriate for your patient.

Transitions, part 1

How hard is it? Plenty, when you're dealing with Manglement at the Hotel.

Here's my transition plan as of this week:

1. Get e-mail from Second-in-command Assistant Chief Nurse Mangler:
Go right ahead and see X, since she's been running the clinic while we've been waiting for you to get hired. We'll let you know when your start date is later, because we're waiting for people to come back from sick leave and the new hires to start.

2. I discuss specifics with my department Nurse Mangler.
NM: "Sure. Set up time with X and let me know what's going on."

3. I call X, set up appointment, come in on day off. I have to do this since NM can't possibly let me leave for a minute to go up two floors to see X for one hour, even though some of his/her favorites park in the cafeteria three blocks away while on duty for longer time periods than that.

NM is okay with this plan and it's confirmed via e-mail and verbally by conversation in hall with several witnesses present.

4. Meet X on my day off and get items I need to set up for a learning plan in the Hotels' Learning System. Total time for this, including printout of manual: two hours. As a result of this meeting, also advise NM that I have to attend another quarterly department meeting this week before I work an evening shift.

NM: Fine, just get to work on time.

5. Now after investing this much time in meetings, learning plan setup, etc., NM tells me I will not be compensated for my time to attend meetings, etc., until I start in the new position (which is the same department, but a different "cost center" per accounting.) Otherwise, "if I let you off for comp time, you're stealing time from this unit." (yes, this was a direct quote)

6. WTF?! Express "concern about lack of compensation" with a straight face and proceed to assemble everything for HR.

7. Notify X that I will have to start training later, which sets off its own cascade of idiocy all the way up to the boss of the center.

8. Get call from center boss. Center boss says "hold tight and we'll straighten this out. You won't lose anything"

And they wonder why people are so frustrated! If this was not my dream job, I'd run straight out the door.

Stay tuned for the continuing saga, because drama at the Hotel is new everyday.