Meeting agenda and assorted paperwork

Today's meeting agenda was like a ransom note but lacking a weapon. The list of demands was long, but the list of assurances was short.

I know I'll never forget this moment. I tell myself that I'm keeping that e-mail forever because it's going in my book. The book I'll write about the Hotel (and some of my crazy coworkers) that will be called Is this a bad business case or reality? You decide (working title).  If that title isn't snappy enough, we'll get another.

Some of the agenda items were crazy:

1. First of all, when the boss asks each attendee for a meeting agenda item, it does not mean 10 from one person. (not kidding).  He/she is running the meeting, not you.

2. The need to define our "communication terms". Last time I checked, you had a company-provided cell phone, a desk phone, a laptop and a desktop PC. If you can't communicate with that, I don't know what to tell you.

3. Asking the boss for prizes. Don't you need an extra trinket for nurses' week? Maybe I'm just weird because I don't.

My assorted paperwork continues. Paperwork for the siblings, paperwork for this agency and my all encompassing travel paperwork that will probably get rejected on the first round.

I feel like a hamster in a wheel...stay tuned.

The range of topics is endless

No, folks, but it surely seems that way.

How my day went today:

1. Took Bubba to school again today since it's still below freezing. Guess he's just spoiled, even if his walk to school is short.

I don't want Children/Family Services getting my license for frostbite, if you know what I mean!

2. Went to work and Dahey actually called in the AM

It is a miracle. He's forgotten his phone every day but today. Somehow, he never forgets his lunch.

3.  Sat down at my desk to do "paperwork" (aka trees we kill in the name of a "paperless work environment".) Realized it was time to get up almost three hours later.

Wow! I do get a ton of work done when I shut my door. Unfortunately, some paperwork is not as redemptive as others.

4. Heard this argument multiple times from very unhappy people (aka  my travelling NP buddy) who had to create a discharge summary on a patient who was at the Hotel with a long, complex course. The curses at copy/paste  in the medical record went on and on.

5. Found out that one of my favorite internet sites scooped a big story in health care. Whoa!

Makes me wonder if the Hotel operations will be a take over target.

Stay tuned...

The things you find

Since I've been on vacation this week, I've been trying to get my end of the year stuff done. Dahey has some financial stuff to take care of that he finally got around to today. 

It was a lovely day in RehabLand, so we took Bubba outside and taught him about how you can quickly clean up piles of leaves from the old oak, which, of course, never sheds them all until you have a lot of wind (or snow) in winter. We put leaves in cans, we put leaves in bags, so we will be ready the next time they come by to pick them all up. Bubba was tired by the time we were done.

I filed some paperwork. I thought I was only filing this year's stuff. Well, 2013 must have been really crazy, because most of the paperwork was still unfiled for that year. Luckily, this was easily fixed (by sorting it out and filing it). 

Besides filing, and giving away old stuff, I found some new stuff. I put a DVD player a relative didn't want in the closet.

I figured I might as well get it out and start using it to get my exercise program back on track. Each year, I write down my top 10 goals for the year. I only accomplished 3 of the ten this past year.

The appointments that needed to be made were made with all the folks who were still in their offices this week. The rest will wait until next year. A couple of resolutions written down, and hopefully the start of many more successful ones.

More to come...

The gift horse (aka "I ain't got time...}

Heard at the Hotel (or relayed by stunned observers).

1. When our nurse manager (who now does quality review) asked one nurse about his/her documentation and lack of a shift assessment, the answer was "I don't have time for that".

Really? So what is it we hire an RN for...assessment skills? Maybe you need to take one of our open CNA positions.

2. One nurse got a chance (was selected) by the Hotel to go all-expenses paid to a national conference because he/she has gone for years on his/her own dime. The catch: since we have a new chief nurse at our location, she told him/her that he/she would have to do a presentation to the unit staff when he/she returns.

After lots of paperwork, discussion, permission from umpteen people (because  you can't just GO to a conference anymore at the Hotel....) he/she comes to my office and says, "Oh, I'm going to call and let them know that I'm going to go on my own. I don't have time to do a presentation."

3.  One (actually several) of our professional staff notes that patients request information, etc., via  e-mail or text message. This is even in their notes.

Will he/she/they even contemplate using the Hotel's patient portal, with secure e-mail included (it even writes your notes for you)?

Nope. It requires one training class (about 30 minutes) and you have to teach your patients (most of whom already use the portal) to contact you that way.

I just wonder what everyone is doing with all that extra time...

Finding the lost

That was a lot of my job recently. Because our office is right off the beaten path, the lost seem to show up there a lot.

People come to our area by mistake. This week the clinic they missed the most was...(drum roll, please) the wheelchair clinic. Oh, I was calling our friend Ralph over there, a few times to say "I've got another one for you." Ralph, being the nice man that he is, was waiting down the way with the door open whenever he could. You just look down the hall, and there you go, I said, about 30 times it seemed like one day.

Some lost souls make me sad. The little guy with hemiparesis in his wheelchair who came all the way from Faraway at 0300 to make his appointment at the Hotel. He got dropped off right next to the elevator, but couldn't get on it. That's where I found him. I got him on it, took him to the clinic he needed to go to, got him his paperwork, helped him get it done, then I handed him off to the clinic nurse who was free. M. our clerk, even stuck around to get his paperwork.

A little later, I met an elderly band leader who was wandering through our building. He was with his wife. He was a little confused on where to go, but I got the two of them on their way, too.

It's not really my job to lead people around the building. We have transporters for that. I tell all the students, though, that it is my job to take care of patients.

If that's the only care I get to give them some days, I figure some care to get them to their appointments on time and happy, is the best care I can give.

Stay tuned...

I think I'll call...

Grumpy made me think of a phrase we hear often at the Hotel. Amongst the rabble, er, employees at the Hotel, we say it in jest. However, the patients take it seriously.

"I'm going to call my Congressman(woman or Senator)!"

While I was doing a follow-up call with one of our folks, he/she was really close to uttering that famous line. I was fortunate that I was able to resolve the problem thanks to one of my office pals.

What happened to a consult for an AFO that was submitted electronically? It went everywhere internally it could go. Things got messed up when it went to the vendor on paper (who'll actually make this one). Somehow the paperwork from the vendor never ended up where it should have.

That's not all...when  Patient X called right around Christmas to see what happened with his/her paperwork, someone (of course they don't have a name) told Patient X, "Well, you know, I'm sorry. We've been busy since So and So retired." Customer service? I don't think so.

Pal enlightened me. "Nobody retired over here, RehabRN. Don't worry, Mike, the assistant chief will call Patient X."

And he did. And Patient X was happy. And so was the Congressman/woman and the Senator.

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?

Developing a good reputation...

Takes more time and effort than a bad one. Working hard daily with your patients to develop a system that works really is work, even though Manglement may not reward you for it.

So, you have to go out and motivate yourself, even if no one else will.

Per Hotel policy and procedure, I had to fill out extra paperwork for a free CE thing I'm doing, but I figured while I was at it, I may as well let the boss's boss know what I'm up to. Yes, I am getting my master's degree. Yes, I am a certified specialty nurse, and yes, I need to do these CE things (including out-of-town ones that I get scholarships to attend).

Stepping outside of my little box on my little unit at the Hotel helps me to do that...and see the country.

And I take pride in developing a good reputation, even if it's a little inconvenient on occasion. My patients deserve it.

Thanks so much Mr. I. for saying I was your "number one nurse" while you stayed with us when I packed you up ready to go. I work hard to earn that reputation from you, and all my patients.

How to tell if your boss is an idiot, part 2

Or how to tell if your boss and his/her boss are not getting along.

Since Madison requires that nurses transferring to the clinic I'm going to be oriented and trained by our crack corporate training staff (Employee Edu-mucation), I told my boss once I found out what the training schedule was, as this needs to be completed soon.

1.Send e-mail to boss. Boss says "Sure, go right ahead." (which is totally unusual, since Boss doesn't usually act like he/she cares about anything right away.

2. Read this e-mail. All is good. Will talk to admin person (who coordinates all the details) in morning.


3. No, boss comes out and says "Read your e-mail." His/her boss says, "No way are you just going to that training. You have to submit Form X to Committee Y and get approval from Director Z before you can even think about going to that."

And the final line (after Boss's boss CC's  the corporate training director, chief nurse and other minions -- 4 in all).

4. Boss's boss says, "Please fill out form X and send in ASAP so we can get this done."

5. Needless to say, once I looked down from the computer, I noticed it was time to go home. And so I left this paper for another day...

Stay tuned ...

Change up

Here I thought, at the beginning of the week that I would have to work day shift for a while and lo and behold the boss switches my schedule around.

So working half in one shift, and half in another, I got to see some crazy stuff I don't normally see.

We occasionally have discharging patients who don't want to go home. We had one this week. This patient tried to think up every excuse in the book. It doesn't help it if the patient also has psychiatric issues and is not only anxious, but getting manic.

Psychiatrist, psychologist, and MD get patient a nice dose of something especially calming for the road. Nevertheless, the patient gets halfway home and calls to say, "I need to come back." MD tells transportation to take patient to nearest emergency room if things get crazy.

Another patient gets  in his wheelchair with snacks and a soda and proceeds to roll his chair off a wheelchair ramp in front of the Hotel, into the curb and somehow flip the chair. Thankfully, he couldn't go too far away. We have no idea why or how he did it. Called our docs, called the on-call doc, called the super. Patient gets the all clear. Lots and lots of fun paperwork to do for the charge nurse.

Another anxiety attack was averted when Mr. Z's nurse finally found his soda and snacks in his room. I don't think he could handle losing those items, which would have been worse than breaking his leg!

Stay tuned...we'll see what shift I work next!

LRR part 2

If you read the last installment, you'll understand why I abbreviated the title above.

Yes, it did certainly seem a bit like Groundhog Day at the Hotel, with a twist. Mr. J. ended up sick, then sent to our lovely sister hospital for a workup before the holiday starts. Yes, keeping an acutely ill rehab patient on a unit staffed with skeleton crew for the first major holiday of the season is NOT a good thing. Thank you Dr. F. for finally figuring out this important fact.

Mr. J. wasn't thrilled, but since he'd like to possibly make it back in time for his son-in-law to bring his favorite barbeque this weekend, he thought it was a good idea. Amen!

Thankfully, Mr. J. was still being evaluated by the time I left, so I was not required to fill out all of his discharge paperwork. Hooray!

In the grand scheme of things, repetition can be a good thing.

Stay tuned!

If you're bored...

And you're on our unit, you just might...

1. Cut your G-tube end off, because it was way too short anyway. What does Mr. Snip win, Vanna? Why a free trip to the ED, Pat!

Yes, it really is not RN scope of practice to float in a Foley instead, Mr. GI intern. That's your job to do it...or not, since you are on call for that specialty service.

2. Fall out of your wheelchair and require stitches. Yes, another trip to the ED and lots of incident report paperwork.

3. Tell your nurse on the daily health and welfare search, that yes, you do not have any more of a particular substance because you ate it. And no, you did not have any brownie crumbs on your tray.

It's not a full moon yet, but  it seems like it is! Stay tuned for more fun updates from the luxurious Hotel Rehab.

I had to do it...

I broke down and bought a clipboard, so I could keep my paperwork arranged when seeing patients.
Guess you can call my a clipboard nurse now.

At least, I'll never lose my pens and paper again!

Training down...now more

Yes, it's the end of my first week of training in the sister unit, and surprisingly, things are going well. The day was not jam-packed today, so I was able to get some extra work done.

First, I came in and worked with a trainer for the position I'll be doing. She's really good and I think I got notes on just about everything. I'm going to transcribe everything, so I get it done and so she can review it prior to my start.

Next, I got an hour of orientation from one of the main staffers. My job is to support him/her and several programs the SU runs. I understand the materials, but the actual process of getting people in and out is a bit different. It's rehab, but mainly similar to something you'd see in a mental health setting.

I'm really happy I'm a rehab nurse, or this would have all blown me out of the water by now. I also got the call today that I'm being featured in a nursing newsletter soon, and I've been appointed to a committee due to my  "leadership skills." I had a chuckle about that....I never feel like I'm leading anything but the poop cleanup parade. It's nice to feel wanted.

After that, it was a slow afternoon, so we did follow-up calls and paperwork. All in all, not a bad week at all. I will get to learn new skills, and hopefully, wow all the inspectors who'll be coming around in my first month. My boss will let me continue training on a regular basis until my start date. The grumblers on the floor are finally quieting down. I shouldn't take their grumblings personally, but I get really irritated when they direct their angry comments at me.

As Dahey says, expressing displeasure at the treatment I get is not a bad thing and needs to be done right away. Guess I've been used to being the whipping-boy, er, girl for too long.

And off I go into the weekend. There's plenty to do here at the ranch. Stay tuned!

Day 1 in the Land of Oz

Spent the day hanging with the crew from the SU (sister unit) where I'll be spending my time answering calls, writing notes and assisting the MDs with whatever procedures come in during my stay.

Lots of admin stuff today and not too many procedures. A note here, a note there, vitals here and there and a whole lot of note taking for me. I figure I'll just alter my colors in the notes to keep things interesting.

I have a checkoff to complete before my week is over. One item's been removed, since it's no longer appropriate, and another's been added for the accreditation and compliance folks.

Tomorrow should be busy with lots of docs, patients and procedures. We'll see how it goes. 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.

Nuggets for March 11

Oh, there's been so many items of note lately, I can't believe it.

Social networking (a la Facebook)

It's been a big hairy deal at our place, since one of our coworkers was disciplined for Facebook use.

Think your thoughts on Facebook are private? Think again. In fact, some insurance companies want access to your Facebook account. according to an article on ZDnet recently.

Misuse of social networking sites may have ethical implications according to this ONS article.

If you're not sure what to do and not to do on Facebook, check out this article from
www.pcworld.com.

Preaching to the choir

Nurses spend most of their time on paperwork according to a recent study from Healthcare IT News.

You want what?
I couldn't believe my eyes when I saw this story on Reuters tonight: Netherlands: Nurses' union: care does not include sex.

Oh. My. Freaking. Heavens. (clutching chest). Makes me want to go back to karate class again!

Get healthy!

You gotta love those multipurpose exercises...I sure do.

The start of something big

Yes, the big ol' week, that is. Thankfully, it's been more entertaining than irritating so far.

It's always nice to come back after a vacation of any sort. I was discussing this with one of my coworkers today and she mentioned it was the first time in months that she would be off a week. I told her my last vacation (of about the same length) was just wonderful. The freedoms of waking up when you want and doing things that need to be done when you want is incredible.

The unit's getting more occupants this week. Some are regular suspects, such as the drug addict who's always got problems with his teeth. This time, he just added a couple more problems and most of them were courtesy of non-specialty physicians in his neck of the woods out-of-state. We could have saved him some time and trouble admitting him earlier, but when he's such a handful, no one really wants him back.

We also got a VIP...or at least this patient thinks he/she's one. I'm so happy I got to admit the other character. I was so upset I didn't hear tons of complaints about how "backward" the unit is, either, among the litany of shortcomings said person regaled the admitting nurse over two hours. My response: Hello, please tell someone who can do something about it! We're still waiting for Santa Claus to remodel and get us all the goodies and toys, like wireless internet access, that you're looking for in your accomodation. Besides, you'll only be here a couple of days, so why not just go a couple of miles that way and stay in a hotel with the person who brought you if it's so rotten here? Yes, I'm thinking all of this, as I put on my best, fake, customer service smile, and thanking my lucky stars that those mind-reading things are not on the market right now!

The Slug came back, with somewhat of a Jekyll and Hyde personality going on...one minute, nice, one minute her usual pain in the arse self. Not sure why...but still happy from vacation, so I don't care. One of our new nurses, who's been around the block, had fun teasing her, so we just enjoyed ourselves. This nurse is a breath of fresh air and has been a nurse for a long time. She came to us because of local downsizing, and we're happy we could get her. She doesn't wear a cape, but she does have the skills to do a super job.

Happily, the day rolled along and I actually got out on time. All paperwork complete, people fluffed and buffed and everything done as ordered. Now I get my requisite days to prepare for my long stretch ahead...the something big called working the entire weekend.

Stay tuned...more to come.

Sort, shift, shuffle

And that's how I'm ending a pleasant vacation at home. A few major things done, lots of minor things, and lots of assorted miscellany in between. Now I'm sorting school-related paperwork.

Except for a little sinus craziness going on, I feel pretty good. I wish I could do this little three day thing every month. (My boss would kill me, I'm sure!). I am also thankful. In talking with people I haven't talked to in a long time, I realize that I am happy and healthy and I'd just better start to be grateful for that. Many of my friends have their own health issues and lots and lots of caregiver strain issues.

Well, back to paper shuffling...then on to dinner with friends. I can't think of a better way to end vacation.

I'll be back to the old grind tomorrow. Stay tuned...I've got lots of goodies planned next week. Thanks for stopping by everyone! You make my day...now leave a comment if you please! ;->

Nursing practices and current trends

It surely sounds like I'm ready to go into an infomercial, doesn't it? No, I just got out of my state's "What's new in nursing" continuing education class recently.


The first part of it was, "Here's what YourStateNursingAssociation is doing in the Legislature", which is often very dry. When they started going over how a bill turns into law which turns into nursing practice, I had to imbibe in my highly caffeinated soda, since I got sleepy. Thankfully, we got a break right after this part.


After the break, we had the biggest, most rousing part of the seminar--the use of Propofol and nursing section. I almost felt like I was in the new Harry Potter movie, since the presenter and some others referenced "the recent case" (about Michael Jackson), but they never said any names. This issue is a big deal, not just for nurses, but also for physicians who use this drug. Just reading the package insert opens up a whole new world of liability if CRNA is not after your name in the right setting. Lots of ERs in our state are using this for small procedures, like dislocated shoulders, bone setting and stabilization, etc.

We also had fun stuff, too. A collegue of one of my mentors in nursing school gave a presentation on electronic records which was really cool, especially the one that compared drug prices for patients in our area. The disparity was glaring. Atenolol 20mg in one county was $3 for 30 days and in another section of the same county, $30. There were a couple of glitches in the presentation, as happens with just about anything technical. It would have been even more interesting if all of the government websites she referenced were actually working. I guess those pesky hackers are still loose!

Outside of that, I'm still taming the paperwork monster. I'm starting to view our paperwork queen for scholarships as Dr. Jeckyl and Mr. Hyde. One day, it's one thing, the next day another. I'm not sure why Paperwork queen wants all this stuff now, when I was told to wait for a cold day in the hereafter mere weeks ago, but I'm pushing the paper back and forth as fast as I can. They must have unearthed some money somewhere, somehow...and I'm not questioning it.

And school starts in a few weeks....and I already have homework. I'm so glad vacation is coming soon.

More later...