And so I rise...again

I rise again, because the crazy patient leaving Washington missed hitting me in the crosswalk. I really thought I was going to go down for the count. I had the right of way, but the hurried patient was turning right on red. No harm, but I did notify our local PD (took a photo while he waited at a stoplight nearby), in case Mr. Hurry-Yup decided to run down any students down the street at Private U.

I'm not sure why I decided to become a stair climber. I think it had something to do with running up and down all the flights of stairs at Saintarama to the rehab gym to take patients their pain meds. Ah, the days before bar coded medication administration! Pull the meds, mark the MAR, and give the pills. It wasn't perfect, but we made do.

This weekend, I'm going on my next stair climbing journey. It's the same set of stairs in the same skyscraper. However, I'm older, wiser, and a tad out of shape, but a promise is a promise.

I figure this old asthmatic nurse ought to do something right? I have been so lucky that my asthma is well-controlled. I drove my sainted mother crazy with my asthma attacks as a kid. We were on a first name basis with most of the Saintarama Childrens Hospital ER staff due to our regular visits.

My friend, a grade school teacher, had to tell her class that one of their classmates passed away on spring break. P. was a kid with asthma for years. This time was different: it got so bad he was put on a ventilator, then he crashed. They couldn't bring him back.

So I will rise, and as I go up all 865 steps, I'll think of P., and the 3,630 other folks who died last year due to asthma. Otherwise, the firefighting crews who race after me will just have to pick me up and take me the rest of the way to the finish.

Stay tuned...

Pills, possibilities and picadillos

Ah, what a week it's been. Starting off with Pi Day on Monday, I feel as if I've been sprinting everywhere. Spouting might have been correct, though. After I had my lunch and ordered a new computer (which was absolutely crazy--for both the discount and the credit card hold), I showed my friend K. the new office, since she's rarely over anymore. I look up, and there it is: a huge leak on one of the ceiling tiles.

Since my office is in an older part of the Hotel, leaks are not that uncommon. After three days, moving from this room to that room, they finally finished the search for the leak. They found it in one of the radiator lines upstairs. I was ecstatic that the leak was repaired and I didn't have to wonder if the tile would come crashing down while a person was visiting me.

The CDC also published guidelines this week about opioid prescriptions. Our folks in the SU hope it works. They had another unruly customer in the building who required a two person assist, I mean escort out of the building by security. On top of that, we have a very troublesome patient, who's behavior is escalating. It's making things difficult for the staff.

For picadillos, Google says I must remind all of my European visitors that we use cookies here on Blogger. I don't use the data, so I hope you don't mind.

Despite all the mess, today is St. Patrick's Day. I celebrated by wearing my green and eating corned beef and cabbage at the lunch one organization had for the staff  and patients at the Hotel. I remember that without those Irish ancestors (or some like these) I probably wouldn't be here today.

More to come...

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.

The wait is over...

Yes, as this nurse suspected, it was salmonellosis (and confirmed by the lab today).

Now that Dahey has had more symptoms (and he ate at the same place Bubba did), I get to play nurse coordinator and get him some medical advice, too.

Joy!

Hope your weekend is a little less exciting than mine. Stay tuned!

No I wasn't up all night

Celebrating, just awake with a hacking cough. Thank goodness I finally found some cough medicine which helped me to get back to sleep only took an hour, but at 0200, when you think you may go to the 24 hour drug store...it was a LIFE SAVER!

And to all our folks up north, hope you enjoyed your Canada Day. I was thinking about you and several of my old pals up in Winterpeg and Montreal yesterday.

Miss you guys lots!

More (cough) later...

The first day of Spring

Yes, it's spring on the calendar, but you can't tell in RehabLand. It's freezing!

I went to the allergist for the first time in a LONG time. (my personal rite of spring). Discovered that I really do need to change up my meds so I can be less stuffy, or at least have a less stuffy nose.

Even though it was cold, I stood outside waiting by PrivateU to get lunch from a food truck. Not just any food truck but an exceptional Asian fusion one. To top it off, a pink cupcake truck was parked nearby.

Life really is sweet...and lunch was surely wonderful today.

Stay tuned...more to come.

Charge of the Light Brigade

I got a lot of requests when I was on rounds as the charge nurse recently. Lots of emergency calls on the call light: "Could someone come over here and turn off these lights?" Yes, even the charge nurse runs around turning off lights when all the fun stuff comes on TV. It's only an emergency if it puts a glare on your TV.

The charge nurse brigade just got some new tasks since the boss is away training. The evening charges get to make the assignment, because the daytime charges (doing boss's job while he/she is away) refuse to do it. "I don't want people mad at me!" said Daytime Charge Nurses. I'm having flashbacks to Saintarama. Fortunately, I didn't have anyone changing it when I wasn't looking, as happened there.

I did have one very passive-aggressive 12 hour person, who I'll call D (for Diva) who wasn't too excited with  her assignment. I gave D, a nurse assistant, the same assignment as the night before (plus one person) and she stood around for the first hour of the shift in our patient lounge, far in the back, kvetching away with one of the nurses. Perhaps she  was perturbed that she didn't get a light assignment, since she thought she deserved one. The other nurse she talked to had a lighter assignment than D because she can pass meds, which D cannot. Everyone else had 3-4 people (one of my better nurses had 5 until a 12 hour person came in to pick up part of the assignment) and so did D. Somehow, I don't see how that's so tragic. No one else complained.

To top it all, one of her patients, Mr. X., who was pretty much self-care, said she only came in the room once during the four hours she was supposed to be taking care of him. Thankfully, one of my other nurse assistants (who had a patient  in the same room) saved the day by helping Mr. X out. Since Mr. X. was a new admit, his new nurse (D's replacement) and I straightened the rest of his paperwork out by the end of the shift.

Despite everything, we did have a good shift. K. the charge on the night shift came in early and ran a very special errand. She got goodies so the night shift could celebrate with Mr. A. on the morning of his birthday. Mr. A. has been on our unit for nearly a year. The night crew all went to his room and sang Happy Birthday when the breakfast trays showed up. His nurse on evenings bought him a present he'll really enjoy: Milky Way minis.

All in all, between drama and sugar in all forms, it wasn't a bad night.Stay tuned. More to come...

What is it...

That makes some of the people I work with not give pain meds? What makes them the judge and jury on pain when a patient who had major (and I mean major, serious, as in World Renown Hospital screws up royally on a simple slam dunk procedure) abdominal surgery asks for a pain med?

To top it off...no history of abuse. Another thing...what's with telling them they can't have their PRN med when they ask for it (which, by the way, was within the time parameters).

I just want to scream sometimes. Thankfully, I have more creative outlets.

Stay tuned...it's always a blast at the Hotel, even without fireworks!

Robots?

One of my patients recently asked me when we were going to get robots to hand out the meds like they did in another hospital he visited. They've been in the media a few times, so you just never know....

I can think of a few uses for a robot right now at the Hotel.

1. Monitoring one-to-one patients. If we equipped one with Taser turned on a low setting, maybe we could keep one particular character from ripping off his/her dressings all the time.

2. Entertainment. When someone wants to talk for ages, we'd send in our friend, the robot. "Gotta run, but BOB the robot will be glad to talk to you for a while." Or you could play a video game on BOB's screen.

3. Send the robot on emergency call lights runs for things like ice, water, and blankets. Now if we could add an ice maker to said robot...ooh!

But finally, I don't think we'll be doing this with our robot: marrying folks on the unit. I just don't think Giacomo and the other chaplains would go for it!

More later...stay tuned!

Good cop, bad cop

That was my day yesterday. Instead of playing good cop like I usually do, I had to play bad cop. One of our folks violated one of the rules he agreed to and I had to go to the big man (our director) to have him play the heavy. (It was helpful that he was strolling around on the floor...I didn't feel so bad about it...and he wrote up the note, too.) Nothing is more annoying than a patient who gets mad at you in the middle of the shift.

Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.

One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).

I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.

Bubba is off school today...so we'll be playing and working in the snow. More later!

Out of order

Everything functioned pretty well today, but the order of our day was a little off with all the excitement.

One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)

I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.

At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.

My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.

He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.

One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!

Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.

One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.

I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...

Every good turn deserves another

I have had a wonderful three days at work, even though I feel like all I've done is run. I was taking care of the meds on one hall and I took care of two guys at the other end of the hall. I hadn't taken care of those guys in a while, and it was really fun.

There's been a few posts I've seen regarding Phil Baumann's Eight Ways to Become a Better Nurse.

Here are my own ways (I also posted them in his comments)

1. Improve one thing you do every day. There may be a lot of things you need to do, but work on it by choosing one thing every day.

2. Leave work at work. Unload before you leave the door. Your family will appreciate it.

3. Find outlets for creativity in your work.

4. Make patients smile.

5. Be kind, especially to those in need, whether they're your patients, someone else's patients or your coworkers.

6. Take care of yourself.

7. Keep your eyes on the horizon. Look out for trouble that may be coming.

8. Say please and thank you to everyone...and mean it.

I'm off this weekend, so I'll be working on all sorts of stuff, here, there and everywhere. Stay tuned!