Heard on the unit

Call it the Chronic absurdity version of Heard on the unit. Guess which one(s) is(are) true?

1. So and So just lets his/her blood pressure get high to get attention.
2. I think X is paranoid and has a list of people to investigate if anything happens to him.
3. Did I get "any"? How could I get "any" in here?
4. Where is Mr. Z? I haven't seen him in a long time, so is he sick?

Answers: all true.

So is the Hotel Rehab really a crazy place? Well, some folks (like me) say rehab is a little psych and a little med-surg, so who'd be surprised with what patients (and some staff) say.

The first one shocked me because this is what one staff member said about another. I think she needs a vacation very badly and/or we have a whole lot of Munchausen Syndrome going on at the Hotel. There are some people who even suspect one of our insulin dependent diabetic staffers is overdosing on insulin for attention.

Hello, neuropsych! Can you help US? We need a real EAP folks. I'm going to go to HR and find out if they have one yet. Or I'm getting a poster of a beach in the tropics so people can chill out while eating lunch.

Surprisingly, the same person who noted this diabetic fact also noticed that since "X has become paranoid, there have been no hypoglycemic incidents." Hmm...

Number three was my fault. Never assume that patients understand pronouns or articles refer back to something you've already discussed when their minds are obviously somewhere completely different. The reply noted was when I had asked Mr. X, who keeps refusing to let the lab draw his blood (or let us draw his labs). I had asked if he had had any blood draws recently, and repeated, since he's quite deaf, "So have you had any...blood draws?" Of course, Mr. X missed the last part. Oops!

Mr. X was also startled to discover that RNs have magical "selective hearing" when necessary. Mr. X. had been dropping double entendres left and right and wondered why I was not playing along. I had to put on the RehabRN Old School Nursing Cap (which I had to borrow from F, my mentor) and lay it out, chapter and verse, according to Hotel policy, which meant, no, I cannot and will not discuss certain things at work with you. End of story. If you want Viagra, you have to talk to the psychologists, who then refer you to the appropriate medical team member for evaluation.

And finally, yes, Mr. Z. hasn't been around recently. He had a psychotic episode while apparently high/drunk/stoned on something on our unit. Security has been advised by the hospital legal staff that he cannot come back until he proves he has completed his substance abuse treatment program and meets other conditions.

Yet another thing I gloss over with a blank, "You know, I don't really know."

Stay tuned. You never know what I'll hear next.

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...

Mental health

With an interdisciplinary team in rehab settings, patients get the full spectrum of assistance to accomplish their goals and achieve a better quality of life following illness or injury.

Nurses, however, don't always use similar, available resources. How many times has your hospital's Employee Assistance Program sent out cards with phone numbers on them and have folks discussed the benefits? Probably a few times.

I found this interesting article on www.nurse.com called "Nurses With Depression Need Peer Support." It addresses a lot of issues, particularly this fact:

"Some 9.6% of full-time healthcare practitioners between the ages of 18 and 64 suffered a major depressive episode in the year before an October 2007 report published by the U.S. Substance Abuse and Mental Health Services Administration compared with 7% among all full-time workers."