Sometimes you have to go with your gut

New nurses: this one's for you.

We take care of a lot of people at the Hotel Rehab, and it's normal for us to see a variety of society strolling through the front doors. Sometimes we are given plenty of information to do our jobs accordingly. Other times, we aren't.

Since I work with all of the folks who complete rehab, as a specialty nurse, I have to understand how to use my assessment skills. When something seems strange, it usually is. Police come and go in the Hotel for a variety of reasons, and it's always for something.

I took care of one of our folks in the SU. Said patient did well in his/her rehab stay, and would seem like a good fit for our aftercare program that I manage. While I do chart reviews of all of the patients to determine eligibility, and this one passed all of my normal reviews, something still wasn't right.

Said patient was getting ready to discharge. Since he/she was not exactly confident about this program when I discussed it, I didn't worry about it. I do not push patients to participate, because it's voluntary. In one of our discharge planning meetings, another consulting staff member, who I greatly admire, voiced concerns over this patient's "legal issues." In rehab, this, too is not uncommon, as many people may be in rehab due to accidents and may be managed by legal or worker's comp case managers from outside.

When I looked at my credit monitoring service e-mail recently, I found out why Officer Friendly was pacing through the unit. It wasn't because we have staff parking scofflaws, it was because my SU patient was a registered sex offender. His/her pending litigation might end up in a prison sentence. This, consequently, disqualifies SU patient from my program.

So for all you new folks: what does this mean? This means you tailor your care to the specific patient, and remember, no matter what to be professional. This article mentions a number of things you can do to make this happen, as a floor nurse, and discusses things your risk manager may ask you.

In my decade of practice, I've seen nurses act like fools and discuss these patients  loudly and use computers visible at the nurses' station. My advice: don't do it. You will look stupid, and you may be disciplined. You should discuss this with your nurse manager in your area in a private location to make sure you ensure the safety of staff, visitors, as well as the patients on the unit.

Finally, all of those things you learned about therapeutic communication and ethics come to the forefront in these situations. Yes, you can take care of these folks and be honest and direct. I often tell students this is why you don't overshare in ways that may make your patients uncomfortable or create other issues. Seek help from other team members, such as psychology and your chaplains, so you can make your care plan appropriate for your patient.

The joys of jury duty

Jury duty can be a blessing, or a curse.

Some of the perks/hazards/interesting things: 
 
1. It gets you out of the office. Plenty of interesting folks hang around courthouses. And even more pay traffic (or parking) tickets.

2. You could get sequestered.

2. You know it will get interesting if the folks can't follow directions at the metal detectors.

3. It's also sad seeing the little old people there (many because they need a conservator.)

4. At lunch time, you can eat, shop and roam around. (Lunches for court staff under an hour are rare in our neck of the woods).

5.  Finally, you realize that your job's not so bad after all, your family's not totally silly and the food at the Hotel cafeteria really is pretty good.

And soon enough, it will be time to go home again, back to reality.

That is all...stay tuned.

Dear idiot on the Starbucks parking lot

Hey!

Don't know if you and the girlfriend noticed today, but it's hot.

Since I got into the parking lot BEFORE you, I indicated my choice of spot by doing a very normal thing: turning on my blinker, stopping, then putting the car in reverse to back into the shady, available spot.

Yes, I did see you in my mirror, but only because you sped up behind me as soon as I put the car in reverse.

Guess what? I'm first so I win. I will get my parking spot. Please drive around. I'm not moving until you do. You have plenty of room.

Too bad you have to find another that's not in the shade. I have folks who don't tolerate the heat well with me today (I'm on a respite trip to Starbucks, anyway.) and I got here first.

Sorry Charlie. Maybe you'll just have to spend extra and buy her an iced, cold Frappuccino.

Sincerely not,

RehabRN

It's really Monday

It may be a holiday (banks are closed, Bubba's out of school) but it's still a Monday.

I told the nurse at my appointment this afternoon that there were several, telltale Monday signs. One, if it can go wrong, it will. Luckily, all my odd things that happened weren't life-threatening. Two, the doctor was late for my late afternoon appointment. No big deal...he's nice and doesn't short change you on your moments.Three, the parking lot was full. My favorite comment by one lady coming into the office, "There must be a lot of sick people here today."

Lady, if you only realized what you just said. I heard nary a cough (except for one cough out of a little boy on the far side of the room) while I was there.

Thank goodness they don't run late with the sick folks.

More to come...the week is still young.

Complaint department

I'm near a busy spot in the Hotel, not far from the lobby, so I hear a lot of the comings and goings among the staff, patients and visitors. Here are a few of the more memorable ones.

The employees complain about complaint procedures. Fill out this form in this many days and wait.

The patients complain about the food. While our food wasn't quite as scary looking as this, the dietitian tries. You just never know what that kitchen staff will do.

The visitors complain about the parking, the signs, the lack of wheelchairs in the lobby. One of our housekeepers remarked that he heard patients took our wheelchairs home. "Of course," I said, "Do you know that's why they don't have those folding wheelchairs at Saintarama and other big hospitals."

Tomorrow, I'm getting a sign like this. I'm sure someone will complain.

Misspent vacation day #23

1. Go rounding up your own medical records for a specialty appointment later this summer. Now do you understand why I like linked, interactive electronic health records? Time spent: 1 hour and 30 minutes. I had to fill out one hospital authorization, wait for one CD of images, and go to two physician offices which were, of course, each on the different sides of the campus.

Thankfully, one doc was near where I parked the car.

2. Dig through garage to find bike that husband has lovingly piled the dining room baseboard on top of in the pile. Get bike to gas station and only one tire inflates. Other tire zero.

Time to take old reliable bicycle to the shop.

Outside of the fun administrative details, I did get to see Giacomo again. Haven't been around his parts since Spring Break with Bubba. He's heading for the hills for two weeks soon but has to come back on weekends since he can't get anyone to work for him. Such is the life of those spiritual leaders, except this one.

I also got to have lunch with my old right side seat mate from nursing school. Yes, we sat way up in the front row and had a grand old time with all the instructors. I miss being around her. She is so darned funny. Reminds me of one of my very best friends. One of these days, the two of them will have to meet.

Now I'm off to my regularly scheduled rendezvous with Bubba. Joy! Any day away from work is fun!

Stay tuned...

Is the moon changing?

Maybe not according to these folks, but you would have thought otherwise recently at the Hotel.

The big cheese of Madison actually replied to an e-mail I sent to him. We're getting all progressive and the Manglement is trying to "do a system redesign and talk to the people who do the work." I nearly fell over, since he actually asked me for feedback on one of the SU's projects.

The patients, however were not patient. One character was just not happy. One minute, he was mad. Then he was sad. This repeated  over and over again for a while. Somehow I wonder if that lithium was really working.


Another character was about ready to turn vigilante on me on the parking lot. Mr. Explodo was really agitated when some of our fine (and incidentally, not visibly disabled) Madison employees parked right in front of the building in the handicapped spot. Mr. E. got in front of the car in his wheelchair to wait for security and the driver nearly ran him over. Just makes me wonder...ugh!

Thankfully, Mr. B. was a bright spot on my schedule. He came to his appointment in a cheerful mood and he was happy to work with us. It was bliss!

I wish I could order a few more like him. Stay tuned...