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...

The little people

We finally found out where the VIP entourage went while they were touring Washington recently, and we were patiently waiting on the floor for them to stop by on our unit. The VIPs stood us up.

Since everything our hospital system does is now posted on Facebook, the photos told us where they went.

I'm used to being "cut" from the A list in my area all the time. Nurses are used to it. My bosses, he and she, are not.

It's not fun finding out you are the "little people" after you come to work when you really could be doing something better.

Life is full of small victories. Enjoy every minute.

More to come.

Reality check

How many of you go to work sick? Raise your hands.

If I had a 100% rate, I would not be surprised. Nurses often come to work with illnesses for a variety of reasons. This article has one of the best arguments I've seen for a long time.

I have gone to work because I'm a master at assessment. I've had chronic health issues (nothing major) for years. My body is good at telling me what's wrong.

These are my rules:

1. If I have a fever and will be in regular contact with patients, I'm not going to work. Plain and simple. If I can't do paperwork that day and hide to avoid breathing on anyone, I'm out. I had nursing instructors beat this into me, I mean, reinforce this vigorously on my clinical rotations. As I know from my work in the SU, if you have a fever, you probably are infected with something. This red light is one you should not ignore.

Do everyone a favor. Don't share and stay home. This health system actually publishes an algorithm.

2. Diarrhea will also keep me home. If they only knew how busy our staff bathrooms are (and many times, it's not just staff using them).

3. If you have any other symptoms that are not normal or normal for you, i.e. vision or balance disturbances, you probably need to see what's going on first before coming to work.

My managers always love the "migraine with vertigo" call in (I've used it), but I don't care. You should like being able to keep affordable car insurance. If walking is a problem, driving will be, too.

Also, never take any open wounds (even paper cuts) for granted. If you can't cover them effectively, you need to consider staying home until you can.

I like my doctors. They know I won't bug them unless I think it's an issue for me and my patients. Be sure to have a PCP, so when you need them, you have them. I love mine because she likes nurses and always has our back (she has no problem talking to pesky nurse managers if needed).

To sum it up, if you're sick, don't buck it up. Take care of yourself so you can take care of your patients (and not contaminate your coworkers). You deserve to be well, and so do your patients and coworkers.

More later.

RehabRN reading continues...

It's so nice that Bubba's been feeling like reading, so Dahey and I take him regularly to RehabLand's public library (which is pretty darned good).

Here's a couple of things on the burner right now.

1. Child, please by Ylanda Gault Caveness. This author works the parenting sites and has lots of interesting perspectives as the mother of three kids.

While my childhood deviated on many planes from hers, due to ethnicity, etc., there were more than a few common sayings mentioned in the book that I heard in our house among my parents.

I chuckled to myself more than a few times reading this book, and frankly, there are some hilarious moments that will make you laugh out loud. (and even disturb your neighbors sitting nearby).

Little book with a whole lot of parenting wisdom. I highly recommend it.

2. Shrinks: The untold story of psychiatry by Jeffery Lieberman I just started this one, and the intro is just right. It sets you up in a patient story, and draws you in. The stress, anxiety and the ambivalence of the general public to consider the benefits of a medical psychiatric workup.

I can't wait to continue down the road of this story penned by the former president of the American Psychiatric Association.

Stay tuned!

Some luck

One of our doctors is doing a case review for the Hotel peer review group. He/she worked all weekend gathering information, which included printing some records. Since this was done remotely, it doesn't necessarily print in the right spot. Happily, I managed to figure out where they went and get them to him/her. Some luck!

A friend of one of my relatives just had an adorable baby boy with a cleft palate and other issues. The friend did everything right and still had this happen.

The weatherman says we'll have a warm, breezy day as we just start to see tree pollen on the weather reports. I hope Bubba has lots of luck with his allergy medicine. It won't be pretty otherwise.

Stay tuned...

If only I could say this...

I have had many therapeutic conversations with my friend, the Pharmacist out Yonder. We have always had some interesting stories from work.

As usual, she tops me again, even when I told her about her old neighbor's not-really-a-surprise-party-anymore surprise party my traveling partner's been planning. (Drat!)

She had to call a doctor recently to get a prior authorization for a certain antipsychotic med dose. She clarified the prescription, found out it needed the prior authorization, and called the insurance company.

The (not so) nice people at the insurance company gave her some information, but told her the MD had to call them back.

She calls the MD to explain the situation, and he says, "I'm not really in the mood to call the insurance company for that."

Really? I said. How can he NOT be in the mood?

I think I'd promptly be in the mood to find another doctor.

That is all...hope you enjoy your day wherever you are.

In the news

Since I'm taking a break, I thought I'd have a look at the latest health news.

Here are a few that caught my eye. Hope you enjoy.

What not to say (from www.cnn.com)
Um, yes, some things really ARE important enough to not be busy for, Mr. Professional Basketball Player. Cancer doesn't give a rat's (fill in your favorite anatomical part) who you are.

A hypoglycemia dilemma (from www.nytimes.com)
This interested me, because I often feel hypoglycemic. Think you can figure out this dilemma? Check it out.

A different type of dilemma if you have back pain (from webmd.com)
Steroid injections may help some folks with back pain...or not. Read more here to learn more about a recent study.

Just another reason (also webmd.com)
Please be careful with supplements! Bee pollen for weight loss could cause other potentially life-threatening conditions, even if it sounds like a good solution for you.

If it sounds too good to be true, it probably is.

Happy weekend all!

Things not to do, part 77

It really seems like it. It's so very easy to find things folks should not do.

1. Don't wear jewelry to CPR class.
Especially, if it is a long necklace and is going to get tangled up in the AED simulator. Shock anyone?

2. Diss the nurses.
Not my patient, but even my doctor relatives know this is not a good thing.

3. Stick a q-tip up your nose.
Because it really, really is a bad thing if you break off the long wooden stick, and the rest of it stays in your nose. We will have to send you for an extraction.

Stay tuned!

A cautionary tale

I read this KevinMD article today just because I liked the title: The toxicity of Medicaid.

Some of you may say, "This is a doctor writing this. Boo hoo."

Boys and girls, we should be up in arms, too. The patients described here don't just need nursing care, they DESPERATELY need it. (yes, I'm shouting again.)

The system has engendered dangerously bad habits in people. As nurses on the front lines, I'm sure our friends in the ED could tell us about how many patients might easily be triaged to lower levels of care...if they existed in their area and took Medicaid.

In rehab, we coordinate care regularly between specialties and help people get things they need, even if they are indeed expensive. We need to do more of this for Medicaid patients to keep them out of the ED.

Unfortunately, the EDs of America sit there like the vaunted Motel 6...we'll leave the light on for you. The light is on, but it is unfortunate that many folks miss the most important thing about the ED.

This place is for emergencies only. It's not for a one stop shop to get all your doctors' appointments done right now, so you don't have to get up in the morning, and (gasp) go to more than one place. It's not so you can avoid your copay. It's for emergencies.

Because one day, if you have a heart attack, stroke, or car accident, you may want them to be ready and waiting with the light on, for you.

TGIF Meeting hijack

I usually don't have a lot of meetings at the end of the week, but this week was unusual.

One meeting was short and sweet. The doc took notes, assigned the tasks, and away it went. Elapsed time: 20 minutes.

The next one, the token MD at our other hospital, Washington, decided to hijack a pressure ulcer prevention meeting by talking about getting all of our patients these items and getting "some good publicity finally." in the local media.

Ahem, the dander was standing on my neck. The dander was standing up on almost everyone else's neck. I told the doc (since I was only a meeting interloper anyway), "It may not be appropriate for everyone. Come on down to Madison. We can show you this exoskeleton in person (assuming one of our patients is in a trial)."

What I really wanted to say (and everyone else did, too, but didn't) was STFU. Hijacking the meeting for purposes other than what you're supposed to be there for is decidedly rude.

Happily, I did get to escape for a bit. Bubba had one of these ceremonies today at school.  I just wish I could have stayed for the cookies afterward.

TGIF all! Enjoy your weekend (long for some of you) wherever you are.

I love the internet (or this week's Nuggets)

Which is where I ran into these articles, thanks to my favorite publications, as well as some fellow bloggers.

Hope you enjoy!

Mistakes
Frankly, since I've started working at the Hotel, I've been mistaken at odd times for a doctor, a nurse assistant, a sales person, a stripper and a random person in scrubs. I have never been offended by these descriptions because I take them at face value: the patient was delirious, delusional, demented or just plain oversexed (sorry couldn't think of a D adjective for that last one).

I ran into this KevinMD op-ed (which I highly enjoyed the angst because of the Nerdy Nurse) of this obviously almost 30 something year old woman who is mistaken for a nurse, when she has those coveted MD letters on her white coat.

All I have to say is, if you had the demented character who said you reminded him of a stripper, you'd have thanked your lucky stars he called you a nurse instead. Far worse has happened...

An innocent abroad

All I have to say is, I'm not going to say to much, or I'll have to plead the Fifth, but this is a very interesting article if you are a little technologically inclined. It's just the tip of the iceberg, and I thank my lucky stars that my only cultural barriers right now are between hospital departments.

If you only read the first two sentences...

You may very well see your own career trajectory right before your very eyes. The words that struck me:
"hospitals need to create a patient-centered culture founded in principles of compassion, service and high quality"

You got it, Sabrina. Indeed.

Don't let the door...part 2

Not my favorite vintage of whine, but nothing new...

RPIA Doctor: "You mean I have to do the paperwork for that appointment?" (audible, loud, obnoxious 14 year old sigh).
RehabRN: "Yes you do. I'll get you some help." (calls tech support)
Dept. Tech: (shows RPIA what to do with in-person demo) "Okay, well I guess I can do it." (RPIA walks away)

Dept. Tech and I banged our heads into the nearby desks. Ugh!

Some people just don't get that bad four letter word...work! Technology is a means to get it done, don't you know?

Don't let the door hit you on the way out...

Quote from one of our docs who's leaving to 1) go to greener pastures or 2) is having a late mid-life crisis.

When I asked him/her if Mr. Z. one of our patients who saw a specialist could get an order printed for his nursing home printed out, he said,


"Oh, I don't believe in using that stuff like Dr. S. I think it's hocus pocus, so I'm not going to write that order for the nursing home."

Said doc is patient's primary care provider at the Hotel, but I don't think he/she gets the EBP part.

Good riddance.

The tales of woe

The word of my day was woe.

"Woe is me." I heard from the specialist who's complaining that the other specialist at X Hospital is bad mouthing him to our patients. Who tells specialist this tale? The patient. Specialist has taken care of patient forever, before he/she ever even went to X Hospital in our system. Patient told Specialist the truth, and he decided to tell me.

Kids, haven't you ever heard that maxim, "If you can't say anything nice, don't say anything at all."? "No surprise" I told our Specialist. "He (and his hospital) have done weirder things lately." Frankly, I'm surprised upper management isn't reigning them in yet.

It was woe for our staff, too. I couldn't believe it when I saw our home health nurse doing assessment documentation on a newly arrived patient. She's usually out on the road somewhere, but for some reason, she got called into an admission that should have been completed by the floor nurse.  Not sure why the boss let that happen, but I'm so glad it wasn't me!

There was woe for one of our patients' families. Said patient died over the weekend. We really liked him (at least most of us did). Rudy was a very opinionated character who almost made it to his speed limit birthday, but he had a heart attack and never regained consciousness. He and I got along very well. I was the person who set up his Fritos whenever he was on our unit (he was a Frito maniac).

Rudy told me he wasn't afraid to die because, during one of his many spates of illness, he had had a near death experience. "Heaven is beautiful", he told me. "I saw it and I really wanted to stay, but they told me I had to go back. I saw the Devil, too."

"Really?" I asked. "How did you know it was the Devil?"

"He looked just like the pictures...and he had a bottle of Jack Daniels, trying to get me to go with him."

"No way!" I said. He just shook his head yes.

So from then on, it was our inside joke about Jack Daniels. I told him one night when he spiked a temp late in the shift, "Rudy, I know Heaven was nice, but could you just wait to go there until my shift is over? And whatever you do, don't take the Jack Daniels." Rudy eventually recovered and we laughed about it.

Happily, all of Rudy's last year wasn't a tale of woe. Rudy got to see his grandchildren born and he was so proud. I saw him from time to time and I always gave him trouble. On his last visit to the unit, I told him he had the most seniority (as in he'd been coming to our unit for so long) on the unit, so he'd better help us train our new staff.

"And Rudy," I told him, "if they say you're mean and quit, I'm gonna call you up."

He just smiled. I opened the last bag of Fritos I ever gave him during that stay while his family looked on bemused. Sure we spoiled him sometimes, but he was like our family. I figured out in the last couple of years, I'd spent more time on the unit with Rudy than I have with my own family.

Rudy was a Marine through and through. He loved the Corps and educated me that the Marines wear scarlet not red.

And like the old Marine saying goes, I send it out today to Rudy, not Chesty this time: "Goodnight Rudy, wherever you are." I'm praying you're in Heaven where it's beautiful and not with the Devil and Jack Daniels.

Godspeed, dear friend. I'll miss you and all your Fritos, too.

The gift

Recently, I was talking to a friend while I was tooling around for my birthday. I had not seen her in a long time. I found out a physician I worked with (a friend of her family's due to a hereditary neurological disease) had asked her mother to donate tissue upon her death.

D. is  from a large family (over 10 children) in a rural middle of the country state. Mom is still doing her own thing at nearly 90. She does, however, have several of her children as her healthcare POAs. D. was unsure about Mom and the donation.

Since I know D. has the same disease as Mom, we talked about Dr. S. and the research in her lab and the family dynamic. D's elder sister (who is one of only two children who live near her mom) is absolutely against any donation for scientific purposes.

I listened and D. asked what she should do. I simply told her, "D, you need to talk to mom and if necessary, have Dr. S. do the same. She has already put a name and a face on this disorder you have through her cooperation with the global research team Dr. S. works with. It is her choice, but she needs to know that when she dies she can leave you and the rest of your family a gift. The gift of material for researchers to work with in their labs. Someday, your grandchildren may one day get a vaccine that would assure the great-grandchildren and their children never suffer what you do because of Mom."

I know it is hard, but I hope she will understand. It is a gift that no one else can possibly give in the near future.

Unfortunately, for D., one sibling thinks this will delay the funeral, cause them to not have an open casket and be upsetting to the other children. This sibling also "thinks doctors are all quacks." To add insult to injury, D's sibling did not inherit the disorder she and four of her other siblings have.

I'm just hoping this holiday season, Mom comes to realize, through my friend, Dr. S., or through one of her other children and grandchildren the potential of the gift.

You know it's Monday when...

"It's a cruel, crazy, beautiful world./Every day you wake up/I hope it's a blue, blue sky." --Johnny Clegg

1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.

And in between all that, I had 1) other patients and 2) lots of documentation to do.

So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!

Stay tuned...

Just because

Just because I could...

I got one nurse's assignment changed, even though I wanted to him/her suffer, since the lazy a$% is off the next two days. Why? Because I like the patient, and he asked nicely. Slacker Nurse was really a pain over the last few days, and even though he/she had a lower acuity assignment, he/she was perturbed about not texting friends every 10 minutes or so per usual.

I helped one of our students (Student 1) find some research articles related to a patient. And yes, kids, this is considered business-related use of the internet at the Hotel. Student 1 said, "I always feel weird doing that. What if a call light rings?"

"Go answer it and come back to your research when you have time, " I said. Simple. Patients always come before any research. Period. Besides, most of those happy patients didn't ring the light much the last night when I worked with you.

I got Student 2 some networking info from a nurse I never met in another state. Connection? A national  nursing organization and Facebook. Since the job market is so crappy, I don't mind paying back the help I got myself when I was a Almost Done Nursing Student. (Thankfully, the market was great way back then!)

I got one of our patients his/her favorite snack. I brought it in myself.

I got everyone's care done in a timely matter one night recently. Why? I wasn't herding cats that night, i.e. dealing with primadonna doctors and nurses, as well as crabby patients.

Just because, I like to do the unexpected. It really messes some folks up. At least, it keeps them on their toes.

Stay tuned...

In the news, part 2

Amid all the fun and excitement running errands, keeping a little boy out of trouble and working on homework, I checked out some health-related goodies today on the internet. Hope you enjoy!

Disabled?
If you are, please don't get caught doing lots of heavy, manual labor like these folks. (courtesy of our friends at www.bbc.co.uk)

I guess JCAHO is messing with tradition...
Yes, doctor slang is rapidly disappearing according to this article.(also from our friends at the BBC)

Hungry?
If you need a snack and are getting tired of all these folks telling you what to eat, check out the latest hearty muffin recipes. (courtesy www.nytimes.com)

In the news...

I found this article intriguing, and I'm sure a few other nurses out there might, too.
Gotta go? You may make the best decisions with a full bladder (from www.yahoo.com)

So does that mean most of my coworkers, when we're on a busy shift, should have tip-top decision skills? If only it were that easy...

Another fave (I love it when they count...)
Five secrets women shouldn't keep from their doctors (also www.yahoo.com)

And finally, because I just woke up from a nap and I can agree...
One in three adults sleep less than 7 hours a night 

Stay tuned...now I'm awake, you never know what's gonna happen! Enjoy your day wherever you are.

Sunday Monday Tuesday

One patient yesterday told me it was a nice Sunday. No Mr. R., it was actually Monday. It surely seemed like Sunday on the unit when I got there.

It quickly turned to Monday, however, since our doc on call started ordering labs here, there and everywhere, on healthy and sick patients.

So now it really is Tuesday...and I'm taking a breather. More later, so stay tuned.