I wonder if...

The moon is changing. Lots of weirdness going on in this neck of the woods in RehabLand.

1. I was doing a patient visit today and I thought I was going to hear a sad tale of woe. Said patient got one of those "grandkids need money to stay out of jail" scammer calls. He almost fell for it, but his daughter called some of my friends (yes, I do have some) at ReallySwankySuburb PD and they told her not to do anything, since it's a scam.  It's a very good one, too, with multiple phone calls, etc. The patient was pretty proud that it was Senior 1, Scammer 0, and so was I.

2. The boys at home are crabby. All day, every day. Bubba forgot his lacrosse stick and missed his last game. Puberty is driving everyone nuts.

3. My equipment I wished for is messed up. Hopefully, our guy in safety can get it fixed. Hurry up and wait for the specialty mechanics.

Will Friday get her sooner? If only...

Stay tuned.

What a wonderful Monday

If you call getting prepped for the upcoming full moon wonderful. Sure!

My day in a nutshell:

1. Go to do your first rounds and they're looking for Dr. X. I go to the clinic Dr. X is usually in, and they say, no, Dr. X is off today.

2. Get on the elevator to go to your next part of rounds (your unit) and Dr. X. sends me a text saying "I'm here, where's the patient."

3. Call the cavalry, explain Dr. X. really is here now, so go find the patient. Cavalry is successful.

4. Run down several flights of stairs, find Dr. X and then see the patient coming in. Whew!

5. Return back to the ranch to figure out what is going on with a pending problem. No one is around. Finally get answers after two text messages and three phone calls. Problem not resolved until tomorrow.

6. Find out person you have worked with for five years is leaving her current job.

7. Find out people are retiring in droves due to pressure, illness and just plain ready. Sad on some, not on others.

8. Try to fix a patient's problem, but the help for that is not working today.

There were some good things, though.

1. The day was beautiful.

2. I went home for lunch and made a BLT. It was good, even though I set off the smoke detector.

3. I saw an incredible Buckeye butterfly today. It stopped long enough for me to snap a photo and send to my dear husband Dahey who collected butterflies as a child.

4. My friend's husband is getting stronger. He will also be getting a longer course of treatment. Neuro wanted five more doses, nephro wanted no more. They decided to meet (almost) in the middle: two.

Sure beats watching a neurologist and a nephrologist duke it out in his room.

I'm resting up hoping tomorrow is even better. Stay tuned.

Resources I wished I had

This article for my patient who was so very unhappy with her ex-husband's last name. If the former Mrs. U. comes in, I'll print it out.

More often than not, I'd like opportunities like this one to volunteer. Some of my coworkers need rejuvenation more than others.

After a wild, blood moon kind of week, I am so happy it's the weekend!

TGIF all wherever you may be!

New moon craziness

Well, according to the calendar, it's not a full moon. I would have thought otherwise recently, though.

People (patients and staff) acting funny at the Hotel made me go and check the calendar.

A few oddities here and there to keep up busy. Among them...

1. A death (not unexpected) in the acute wing. 

2. A seminar (also at the acute wing). Just another occasion to hang out and sell the program (mixed results on that ). The major plus: walking to the parking garage (it was a glorious day and no, I did not rush one bit!).

3. Balky people everywhere. I love reactionaries! Sometimes, we just don't plan in advance, so we're standing there waiting when we could be doing work that will be of benefit later.

The rest of the week awaits...so off I go!

I'm beginning to wonder

If this is really true.

If some folks who work with personal health records actually have a clue what user testing means. I don't think they actually invited users to do the tests.

If the moon is changing. Why yes it is! Now I know why some of our staff are particularly surly.

Never a dull moment at the Hotel.

Stay tuned...you never know what will happen.

It's almost a full moon...

However, the calendar says we're a week early.

You would have thought it was with the sophomoric antics of some of our supposed "professional", long tenured staff.

I am starting to think that the best and the brightest leave because this guy's book title is indeed true. Why be exceptional when mediocre will do just fine?

Might as well give up and bay at the moon early.

Stay tuned.

A weekend scene at the Hotel

Full house (with a couple of empty beds 'cause no one else can go in that room...).
Nothing going on for entertainment (That happened Friday).
Beautiful weather. (Translation: everyone who can be will be outside smoking, since they froze the last few weeks).

And I'm stuck at the Hotel when I could be washing the thick crystals of salt and grit off my car with the millions of other people thinking the same thing....priceless.

I'm so glad it's not a full moon. Maybe someone will get discharged soon, so we can have some quiet.

Stay tuned!

Stormy weekend? Perhaps not...

So maybe we won't have a stormy moon at our place this weekend...why you ask?

Let me count the ways...

1. We lost some patients. Spring has sprung and they'll do anything to get discharged or go on pass for the weekend. I love that part of spring!

2. The supervisors are not micromanaging at the moment. It helps that a few just got back from vacations in the tropics watching baseball and getting a tan. Want to divert them from looking at your drink at the nurses' station? Just ask them about spring training and who they saw.

3. Some of the drama mamas won't be working this weekend due to illness or vacation. At least they can go nuts at home with their families, and not with us!

I'd say the q-word, but I'm not going to jinx it....stay tuned!

A night out with the big men

No, I'm not going out with Dahey and Bubba, nor am I partaking in that festival of festivals called the NCAA tournament. (although a few of my patients will be glued to the TV). No, I'm working at the Hotel again. People come in, and people go out, and when I get in, we'll see who's left.

Lately, it's been placid, but that tends to change when 1) the moon does (the Storm Moon is coming Monday) and 2) the drama mamas come to work.

I'll just hang with the big men, thank you very much!

Stay tuned!

So glad it's Monday...

And the crazy full moon weekend is over. Being in charge ain't all it's cracked up to be!

My shift in the hot seat included:

1. Assigning all the patients. The Slug was in charge before me on the previous shifts, and lo and behold, one patient went unassigned. Granted, said patient is easy to care for (little to do on our shift) but it really looks bad if you forget to give him/her a nurse.

2. Avoiding mutiny in the ranks. Another installment of "he said, she said, I wanted OT and didn't get it." My advice: communicate. Said nurses could have and would have avoided the whole drama thing if they just would have talked to the people they needed to.

No, it's just too easy to be passive aggressive and yell at your co-workers...

3. Dealing with a patient who thought chest pain is no big deal. The joy of all the tests, time spent on the phone, with the on-call doc, with the patient's regular doc, the supervisor, the pharmacy. I really miss my phone headset on those days.

4. Blood pressure issues and a patient who doesn't want to go home. He/she is mad at the world and I was the lucky target. Finally, we got everything under control...at least for the oncoming shift.

And blissfully, every single person showed up before I was ready to leave the building, so I was not forced to stay and work a double. I am always so, so happy to go home.

More to come...

Nuggets for December 30

The last version of Nuggets for 2009 (aka the Golden Nugget version). I'm always mining for the best of the rest of the blogosphere and beyond.

If you're on a break and will be toasting with non-alcoholic sparkly stuff because you're working New Year's Eve, this version's for you! I'll be doing the same thing at the Hotel Rehab, looking for the Blue Moon. (Yes, this once in a blue moon--full moon twice in a month-- is New Year's Eve).

Hope you enjoy!

The gifts that keep on giving
Christmas is over, but the spirit lives, before and after in this story of giving in Philadelphia. (from www.nbcphiladelphia.com)

The fmylife.com folks have stories of woe all the time. Another site, using the same script (sorry, the nerd in me comes out occasionally...), is called Gives Me Hope. Check out the equally interesting stories there, when you need a lift and proof there really are good folks out there.

Science non-fiction

A Dissection Project in California Aims to Create A Search Engine of the Brain (from www.nytimes.com) Henry Molaison, known worldwide as H. M., an amnesic who collaborated on hundreds of studies of memory died last year at age 82. His brain will be used for this project.

Resolutions

Yes, the New Year is upon us, so make a difference. Check out this article from Dr. Oz at www.nytimes.com called Realistic Resolutions, about resolutions to get healthy.

The Goals Guy, Gary Ryan Blair has a whole section of his website devoted to New Year's Resolutions. Check it out!

Bed-lam

Yes, I'm being silly after my most recent evening shift because I can. I feel fortunate that I left with my mind reasonably intact to drive home.

It's not even a full moon, but the crazies are out. We must be running a special, and while we're not a polytrauma unit, we keep getting TBI patients, who just came off one-to-one status. We don't have enough regular staff, nor PRN agency staffing, like the mothership, but they can send us people and suddenly, they don't need that one-on-one anymore. Hmm, must be a lot of miracles going on these days at Madison. The only miracle I see is the patient leaving one place for another (our little unit).

The crazies aren't actually the TBI people. Happily, they've been quiet. The crazies are our regular, crochety characters who really need to go home. They're bored, so they create problems to get attention diverted to them from other patients.

One regular decided his bed was too hard. (Remind you of someone...maybe Goldilocks?) We called the bed vendor. They check out fancy low air loss mattress on the bed. Bed works based on all their requirements. Patient waits until bed vendor is gone. Patient goes crazy, rings lights, spews expletives and acts all sorts of silly, just below the level where we can call security and get him some nice Haldol (a spray can of that would have been a delight). Charge nurse had to get one of our regular beds and plop Crochety on it, so he'd finally be quiet, for a moment. He continued to be a regal pain all night, for one reason or another. Sometimes, I think this patient did this because he was genuinely bored and it is truly a control issue.

My patients were reasonably good, but I always wonder why the boss gives me the assignment I get. It never ceases to amaze me that I get an assignment to give out pills to half the unit and try to feed two people at once.

Besides Mr. Crochety, we had a guy get unstable on us, so he took an ambulance trip. He was diverted from the hospital we intended to send him to, so the charge had fun getting with the ambulance crew to find out where indeed he was, since she had no idea to whom to give report. Turns out this patient verbalized chest pain and they pulled off and got him to the closest hospital en route instead of trying to get him to Madison.

I ended the night by finally doing all of my charting. I usually chart as I go, but there was no way to do that on that shift. Finishing with my faculties intact was enough relief for me.

Stay tuned...who knows what wild and crazy stuff the weekend will bring!

Life and death

I've been lucky this week. Things finally calmed down. My first couple of days were pretty exciting.

There is always a hustle and bustle on one particular day of the week, because it's this day that we get the most patients admitted to the unit. This day also is the day I work my evening shift after a day of rest. Sometimes, I have time to get rolling and other times, I have no time at all and that was the case.

I got in and one of my patients needed blood after the first two hours of the shift. Only no one got his consent, which means I had to track down our doc, who was long gone and out of pager range, then call the local on call doc to get him/her to come over to do the MD portion of the paperwork. Said patient was a little perturbed because his favorite MD never told him he might need blood. Happily, he got over that, and I got the blood started before the end of my shift and even led one of the new nurses in the process so he/she would get some practice, since we don't give too much blood at night. All was good.

The next day, everyone's happy and I'm actually getting into my rooms right after report. In one room I smell something funny. I look and see my quad patient has bursted his colostomy. Get goodies and clean him up. I think the wafer is intact, so I get ready to put the new bag on, and discover it's not. Get all stuff set up and put on new wafer. Three sides are taped with pink tape (because he needs it) and all of a sudden I see a geyser. Thankfully, I caught it with the nearby towel. (Nursing students: never change a colostomy bag without one...if you do, do so at your own risk!) Finish cleaning, finish taping and I kept praying all night he wouldn't do that number again.

Another patient recently asked me about last rites and whether he got them when he was very ill. Since we have an active chaplain service, it was really easy to check the chart. Besides, I told him, spiritual care is also mandated by JCAHO.

One day, I came in to the news that one of our recently discharged patients had died. It was shocking, because, he/she was young and in a way, it wasn't. This patient always denied suicidal ideation, but something about him/her caused a faraway look on their face that made you think they would not be around for a long time. We often talked about ghosts and somewhat about death, because our unit has a reputation for being haunted. Said patient even stated that he/she saw something in one of the rooms he was in that lead him/her to believe that the stories were true--curtains jiggling at night, and a reflection in the mirror when no one was around. He/she wasn't worried, because he/she hoped his/her roommate, who died during his/her time was the ghost hanging out in that room, because it was comforting.

And so the week of work is ending, and the sturgeon moon is on the way. We'll just wait and see how it goes. More to come...stay tuned!

Taming the monsters

Yes, the full moon is coming, so you always know things will get exciting...crabby patients and even the occasional homicidal one. Well, at least the docs will enjoy talking about that this week.

My particular monster is the paperwork monster. Last week, I finally filled out my loan benefit forms, so we'll see if the almighty out-of-state (OOS) office approves of them. I calmed down my own homocidal tendencies re: this, since different person is in charge of submissions for this benefit. New person told me OOS office aware of idiot who caused all the work in the first place, so I will be crossing my fingers.

I'm finishing the rest of the grad paperwork and checking out more financial resources. At least, all my computer time is not in vain if I can get some funding somewhere. One large resource site with a huge chunk of cash will have submissions in August. Hooray!

Besides the paperwork, work has been interesting. The first night we got to send out one of our regulars due to possible MI. My other patients were really pretty easy, even if one or two was slightly demented. You know it will be an interesting evening when your patient rings the call light, then says, "I forgot why I called." Repeat 25 times and you have my shift the other day. Thankfully, I figured a way around that. I made sure I rounded on someone very regularly and got him/her comfy while I was in the room each time. The next shift...hardly any calls.

In my free time, I started looking at the CRRN material again. Happily, this exam is in December, so I have some time to study before it. It's not a requirement for employment at my job, but since I started in rehab nursing, it's been my goal. It also helps that work wants more certified people, particularly to maintain our CARF certification and to eventually get Magnet status for our hospital.

So since I have some free time coming up, I'm going to get some work done around here. More to come...

Another full moon

Yes, today, folks, we'll finally see it...if the storms blowing through don't cloud the sky this evening.

On our unit, we've known it was coming for days, since all of the patients start acting up in a variety of ways. The full moon will do that to some folks, I guess...

I've been encountering a lot of interesting stuff lately. I took care of a patient who had this listed on his diagnosis chart: Hypermetropia. Since I must have been snoozing during that part of the opthamology section in pathophysiology, I decided to look it up, and alas, it's simply farsightedness. I did find a really cool page on WebMD called How to read your eyeglass prescription which tells you why it's written the way it is. Very interesting...even if I don't need anything for my eyes just yet! I'll be ready for a family prescription to come my way.

One thing I was getting confused on was an SGPT result. Turns out it's just the same as an ALT, which I was looking at somewhere else.

Next, I ran into a diagnosis for mitral valve insufficiency and aortic valve stenosis. While it's not heavily clinical, I found a great set of heart articles on this very subject from the Texas Heart Institute in Houston. If you have to explain this diagnosis to a patient, go check them out. Note: they also have a special section for professionals, as well.

We had an interesting situation recently. One patient with generalized swelling was a difficult stick for a blood draw. When you missed the vein, you got fluid. Anasarca is a very challenging condition to deal with, especially when doing blood pressures or any other procedure that may put pressure on the skin. Just putting a stethescope on to do a blood pressure left a mark on this patient.

Finally, be careful how you use OTC medications. This information about ibuprofen is very good from www.rxlist.com. Remember, there's a reason why they say, "All things in moderation."

Ahh...the weekend!

Just what I needed! It's been a thrilling week and I was glad to be spending my weekend at home, thank you very much. The full moon and the crazy people at work were enough for me! I'm feeling better, since those meds kicked in my doc finally sent me. Hooray!

I left late Friday because I volunteered to take a patient to Washington for a scan. The tech left early, so when we got there, we had to wait for the on-call to show up. "He'll be here in 15 minutes" actually took over an hour. Thankfully, this was not an emergent scan, although it was ordered stat. The scan took 5 minutes and I got a whole lot more OT. Said patient wasn't too crazy except for when the "people" came back on the ride back to Madison. Oh, hooray! More documentation for the boss for me.

My days were pretty decent, even though I ran and ran and ran. My day seemed like this for a while: Do AM care, dressings, etc., get patient in chair. Feed or set up for lunch, let patient sit in chair some more (or go to therapy) then put to bed before end of shift. Heaving three guys around (even not big ones) with a lift, still is taxing. I did not have to do meds at all on day shift, which was a welcome change.

One of our long-time people decided to become a DNR this week after much discussion with the medical staff. We'll see what happens next.

An observation: all of our rooms, except one, are isolation now. You name the isolation, we've got it: MRSA, MRSA/VRE, MRSA/AB, and MRSA/VRE/AB. MRSA's just so popular in our neck of the woods that we have multiple rooms with people on this isolation. One coherent patient was so funny. He was calling MRSA "Mercedes", as in, "I've heard a lot about that Mercedes bug on TV."

The temps have been ricocheting around (one day 10 degrees, the next 50) so it makes you really sweat with the isolation gown and gloves on. I was in the non-isolation room one day with just gloves on for five minutes and my hands looked as if I had had them in water for 10-15 minutes straight. Ahh, you just gotta love the heating and cooling system when the weather does gymnastics.

More goodies to come...I went to some great CE seminars last week, so I'll post a little bit about what I learned in some Nuggets.

Enjoy the rest of your weekend, wherever you are!

Nuggets for January 15

Well, it's back to work today, and I still have a bunch of stuff to do before I go. Here are a few things I've found while traversing the internet and various blogs.

My Own Woman has a great post for new nurses. Read it and live it. (I'm not brand new, but I'm still new at nursing and it really made me think.)

Tex from Weird Nursing Tales always has a great sing-a-long on his site. The latest, describes what I get to deal with on evening shift.

As a student nurse, I really enjoyed my trips to OR land at PrivateU's hospital. I almost considered going that route after getting my degree. If you're interested in the jobs of the OR nurse, check out UnsinkableMB's post on life as an OR nurse.

Jeepgirl has one of the reasons why I'm happy there's no full moon this weekend. Some of our people will just be crazy, anyway. All I can hope for is that a few more of them make it out by Friday, so the census comes down a bit before the weekend!

So many posts...

...so little time. I can't believe 400 have flown by this fast! Whew.

Work is crazy lately, even though it's not the full moon this weekend. I am so tired. Not sure if it's the hours I'm keeping lately or the virus-of-the-month the doc tells me is going around. We have two people scheduled to go home tomorrow and three arrivals on Tuesday. (I'm so glad I'm off!)

More later...back to decorating before work.

How to know the moon is full

Listen up, all you nursing students, although you may have thought meteorology has nothing to do with nursing outside of being listed before it in the class schedule, the full moon can make a difference on your unit.

In my short time as a student and so far as a nurse, I've heard from psych to labor and delivery to LTC nurses that the change in the phases of the moon brings out the strange and unusual more than you'd think.

Well, since yesterday was the full moon, here's a few of the fun things that happened at Madison.

1. The crazy people get crazier. Yes, lil' ol' Mr. K. keeps forgetting he's a quad, even when he's reoriented, and in between, he even acts lucid. Last night's installment: he kept wanting to put on his pants and get up, so he kept ringing his call light. Not even the two Pepsis (he loves Pepsi so much they could use him in ads) I brought in as a bribe kept him quiet.

I'm starting to like the idea of aerosolized Haldol for not just patients, but some of my coworkers.

2. Your coworkers get edgy. When I asked about Mr. K. and his light buzzing, I remarked, "Wow, has he been quiet all night?" since Mr. K. did not buzz once while I was sitting at the nurses' station (which was not long). The Slug, true to her pain in the backside self replied, "You've been smoking crack."

Nevertheless, I blew her off, since I spent most of my night actually on the floor with patients, while she sat by the phone and played secretary in between her med passes. It's actually better for her to sit by the phone because whenever you work with her, because you'll get about 20-25 calls a night and 99% will be for her. It's just a whole lot easier not being at the desk so you don't have to be her secretary.

3. The normally quiet people decide they need something...now! Mr. H. decided to do this last night before the end of shift. I guess he got tired of me going into his room and always giving his roomies their PRN pain meds. I've delivered meds on his hall for a while and this was the first time I've ever given him a pain med.

One of his roommates is a basket case. He's taking every psych drug, pain pill, and sleeping pill we'll give him. That's what happens when you can't deal with the life you've created on the outside. The roomie is having problems with his wife and infidelity again. The story gets better and better--he was with the other woman when he was injured and she is having his baby. Other Woman decided to let the wife know once he was injured. Said wife was really perturbed when he visited Labor Day weekend.

With real-life stories like this, who needs to watch a soap?

4. Although it's not related to the full moon here in our neck of the woods, the weather's been crazy. Ike's remnants flew through the midwestern US and left us with a whole bunch of water. Lots of low-lying areas around here that don't normally flood filled up really fast. We had fun taking not one but two detours to get to a family reunion yesterday. After the second one, I told Dahey to just go back home and take the route closest to our house, since that doesn't normally flood and it worked out well. I just wish we could have stayed longer at the reunion. It stunk having to leave and go to work.

One more evening, then back to days. Stay tuned for all the excitement.