Back to business

Working always makes things interesting. From my space near the front door of the Hotel, I see a lot.

This week, I've had a lot of visitors. Folks looking to learn stuff I can teach them, families learning about when and where they'll go when they go home. I've even gotten to plan some projects and pitch new ones that need resources. I feel like I'm going somewhere, even though I'm running.

My regular characters come see me. One rolls in and it's obvious he needs help. His leg is dangling. He's slumped a little more than usual. He tells me the new wheelchair is having issues. His headrest is messed up and his foot pad won't stay on the chair, so we have to carry it upstairs.

Thankfully, he didn't have one of those spasms, that to the uninitiated, look as if he could just fly right out of the wheelchair. If I had a dollar for every time he's frightened new staff, I'd be rich.

Nevertheless, I fix what I can, empty his leg bag, and get him to the motor pool, otherwise known as therapy, so the wheelchair specialists can fix him up, literally, and figuratively. One smiles and tells him she knows where the "real tools" are.

He follows along, and I leave, knowing I've done my warm handoff to the next discipline.

Now for more fun...FIM certification!

Stay tuned.

Critical thinking

Is critical thinking in nursing really dead?

Sometimes, I wonder if it died recently, because many of the nurses who work at the Hotel tell strange stories.

What would you think of a rehab unit where...

1. Nursing staff don't want to get patients up to therapy after lunch? They went all morning, they say.

2. Nurses want scheduled pain medications because (I'm quoting because they actually said this) "He has to ask for prn meds and he never does, so we can't give it to him."

Pain is a part of rehab, but not taking care of it, especially in folks with addiction history, is criminal. Nursing is about alleviating suffering and promoting wellness.

Hmmm...wonder what part of the pain assessment they missed? How about the first part where the nurse actually talks to the patient. If Mr. Z. tells me is pain in his legs is a 10 after his first rehab session, even though he's got his long-acting on board, guess what I'm doing?

That's right...looking for PRNs. If those aren't appropriate, how about ordered adjuvants like cremes, gels or patches? Or my personal favorite: doing the interdisciplinary thing and calling your PTs (or whoever has them) and getting some warm packs if this might help (since we don't have a towel warmer like Saintarama).

If his pain isn't resolved, then we should consult the pain specialist group that is right down the way. They do take consults.

My $0.02 on this rainy night.

Dear Manglement

Yes, it is rough when no one wants to do your job. With guaranteed bonuses taken away because your performance sucked last year, yes, I really do feel for you.

It's terrible to come into work and be coddled with free snacks, coffee, etc., and your own reserved parking space at our multiple locations. I'm not really surprised with your recent actions of not notifying the campus here at Madison regarding security events, since you have a stellar track record to uphold.

Even though, RPIA, our former chief nurse, (and the rest of you who are still left) knew we were under a bomb threat at our Washington location one beautiful March day, you didn't "bother" anyone to pass that info along, because, "You know, the police will handle it." It was nice of you all to evacuate the building, just in case with RPIA.

Yesterday, we figured something was up when our retired veteran air traffic controller patient noticed an odd helicopter pattern down the street near a strip mall after therapy. He and Mr. Z., another patient who is a retired police officer made a few phone calls. As usual, no one bothered to notify us peons at the Hotel that a strong armed robbery occurred just a few blocks away and the helicopter pattern was due to the police tracking the suspect.

Just remember...we take care of those who take care of us. You might not like the next patient satisfaction (or employee) survey.

Sincerely not,

RehabRN

Ah, memories!

I was reading online and found a link to these NCLEX questions. The scenarios are the "what would you do" management ones. I love those.

For fun I decided to read them, and see how they'd be answered at the Hotel. The selected questions are located at this link: http://www.rnpedia.com/practice-exams/nclex-exam/nclex-practice-exam-management-care

Here's what would happen (or has happened) at the Hotel for the ones I selected. See if your place of employment is the same.

Remember nursing students: you have to answer as if you work at NCLEX Hospital, not at the Hotel or your current hospital. Your mileage may vary, but you'll get the answer right.

1. RE: substance abuse/unfit to work We've had our share of people who shouldn't come to work for a number of reasons. Frankly, I'm all about sending them home if they don't need to be there. Unfortunately, some of my coworkers, do not feel the same way, and contribute to everyone else doing double work so someone else isn't "found out".

Can you say "dysfunctional family"? I knew you could.

7. RE: abuse complaints. Please, please, please don't call the police FIRST, young'uns. I've seen this one in person and the manager ended up leaving and one of our students was basically run off the unit, because he/she did not use common sense.

Assess, mitigate, and notify your chain of command first.

8. RE: dates and patients. Yes, I do tell them it's inappropriate to ask me, a married woman, out on a date, psych or not. I'm here doing a job, which does not include interviewing the next Bachelor/Bachelorette candidates.

9. RE: client calling out asking for help all the time. This is great information, but good luck implementing it, if you don't have a cooperative crew. I remember many a night when some of my evening characters constantly badgered me (and often the rest of the staff) no matter what I told them.

Just remember: dementia and sundowner folks will keep you hopping on evening shift, kids. Don't forget: evenings do get quiet and dark, and that's when things like to fall apart.

11. RE: the surgeon and the chart. Remember: just say no. If he's on your facility medical provider list, he can look for himself. If he chooses to do so (which violates hospital policy in a great many places), it will be logged and he'll have some 'splainin' to do as Ricky Ricardo used to say.

15. RE: visiting hours. Here again, is another example of using common sense. If your family is quiet, calm and respectful, it makes this easier. Model it and they'll do it, too.

Don't be a Nurse Ratched. Taking care of the patient and his/her family (and well-being) really IS your job, no matter when visiting hours are.

You can survive

I tell myself this every day. I can survive.

Why? Because, yes, I can survive sitting in a conference for 2-4 hours per day this week, because this conference is talking about where we are going. I'm hoping with a little nudge, we can get people to make the push to see it happen.

I stop what I'm doing because people need me. I'm not turning someone away because I'm in the middle of this. If they bothered to knock, they needed something. I can survive five minutes of missing presentation time.

One of our old timers came by to tell me his wife is getting frail and he needs help. Finding the people who can get that help to him is important. The help will assure that he survives.

I just wish my arm would stop hurting. I pulled something in it doing my exercises tonight. I will survive and hopefully, it will feel better tomorrow.

Kickboxing awaits.

Stay tuned.

Learning every day

I tell my patients and other nurses that I learn something new every day. Lately, it's been very true. So many things in my life, at home and at work are precipitating the changes. I'm hoping they are all for the better.

While I'll never become a maternal/child nurse, I learned about STABLE the other day from one of my e-mail groups I belong to related to technology. This course is provided virtually for those nurses who are in rural areas who cannot attend in person, due to time or expense.

I'm learning more than I ever wanted to know about some new technologies. Just because it's expensive, doesn't always mean it will work. A long, arduous task was made harder. However, I shouldn't complain. I have a technical guy with a lot of history, who can figure out just about anything. I am extremely lucky.

I have to remind myself of that very fact, too. I am lucky to be able to learn so much.

More later...

Every little bit

 Not all of us can do great things. But we can do small things with great love.― Mother Teresa

I came across this blog last year when I read about it on BBC. One woman talks about raising her child as a single parent and subsisting on very little.

Now she's been blogging over a year, and talks about doing little things to make life better for others.

Important thing to ponder...

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...

Weekend recap

Yes, I'm in a stupor from all the weekend excitement, but I think it has more to do with the hours I work. (Sorry, I'm just a diurnal kind of person...)

Thankfully, the weekend was quiet. We never say the "q" word at work, but now the weekend is over, we can. It's fine and dandy when you sit and work in relatively equal proportions.

This was handy, since I was asked got stuck to train people on how to use the new payroll system. Why? Since I can read and am "good with computers." We're going green just like Saintarama did years ago and Madison will not print your paycheck stubs anymore. You can via the internet. Great idea in practice, but when a government organization runs anything, there are lots of caveats.

One big bugaboo is that SuperGiganto Payroll people sent e-mails with passwords that expired pretty much after they left the mail server. Which means I had to teach people a) how to get their e-mail (some know how and some don't) and b) how to get through the maze that is SuperGiganto Payroll.  As a former author of help documentation, there was way too much of it. One of our nurses totally violated the "green" part of getting into her payroll account by printing the help file, which had to be at least 100 pages. This task, in between call lights and actual work, took about two days.

I also had to complete the paperwork for some folks who missed our yearly competency reviews. The caveat: the forms said they all had to be reviewed by the nurse manager, so only about 20% of the competency could actually be completed over the weekend. Sorry, boss. I tried to help out...you'll just have to do the rest. You'd think our very own education nurse could work on this, but lately, the only thing she's working on is vacation and sitting in her office. I heard more than once that maybe I should be doing her job instead of her. Not a chance. Said nurse has more experience than I do and probably will never set foot back on the floor again.

Since I had some free time, I found a great free review for my next grad school class. I'll be looking at that in my spare time, since classes won't start for a couple of weeks.

Overall, it wasn't a bad weekend. We have more bookings coming up today at the Hotel, so we'll see how it goes.

Stay tuned. It's never a dull moment.

No going lightly...

It was a non-stop day. I didn't wake up late, but it seemed like it. After I got up, I had to get Bubba up and ready and he was in no mood to get moving. Finally, we were on our way about 15 minutes later than usual.

I got to work and realized I needed to run some errands this afternoon. I talked to the boss before report and he let me use my "get out one hour early card" today to achieve all my backed-up errands.

Then, it was to the trenches. I got one guy up and in his chair so he could go off to therapy. I set up his roommate to get ready. Then I went to the third patient and found out no one had given him his GoLytely. Arrgh! I went to the med nurse, got it mixed up and I started getting patient #3 ready.

It's not much fun getting a big guy cleaned up, only to mess him up later with GoLytely. Here's how I did it. First, I brought the gallon in and explained he'd have to drink it all. Much moaning and groaning proceeded...so I told him, "You can drink some, we'll stop, get one thing done, then you can drink some more and we'll keep rotating." It worked. Patient drinks a pitcher. RN shaves patient. Patient drinks another, and on and on until we got the entire gallon down and all the AM care done. Elapsed time: 1 hour and 20 minutes.

Thankfully, his dressing survived the onslaught, based on it's location, so I changed it later in the day when we had to roll him to do cleanups. I had to find a willing participant, each time I cleaned him up. Nobody, of course, wants to help, but you can guilt trip them into it if sweet-talking doesn't work.

Lunch was the clear liquid diet. This afternoon, the bisacodyl tabs. Tomorrow, if he lets me, another gallon of GoLytely.

And yes, if you're asking, it really does roll downhill in this bed. Thank goodness we have extra absorbent pads!