Is ICARE just letters?

For some people, it is. If you do a little research, ICARE shows up on Google about 535,000 times.

If you're a nurse educator, ICARE is a model for education design.

If you're a business person, it's a way of delivering excellent service based on the Ken Blanchard model.

If you're a cancer researcher, iCARE is a model for building risk models.

In some health care organizations, like VA, it defines a code of conduct.

I care about those who have served.

I care about my fellow employees.

I care about choosing “the harder right instead of the easier wrong.”

I care about performing my duties to the very best of my abilities


It's too bad that at the Hotel, some of our patients have told us:
"I'm not telling your manager anything. He/she is lazy and doesn't care."
"I asked that nurse to do something a different way, and he/she didn't."


However, my rehab nurse heart just skips a beat, when my patient recently said, "I've learned more today in the little time I spent with you today, than I've learned all month." Why? Because I took a few minutes to not just educate this patient about the specialty services of the SU (my job), but of the rehab unit as a whole.  I cared.


When do we realize, that as nurses, "I care" isn't just an acronym. It's a verb. It's actions: not just doing, but listening, being present, and doing right, even when it's hard. Even when you're busy, passing pills, doing dressings. Share the rehab wisdom you've developed (or for newbies, are developing)


ICARE is not I Come And Receive Everything. If you're a paycheck nurse, maybe you need another gig.


I care because I am a nurse and a human being with a conscience. It's my job and my philosophy (thank you grad school and Jean Watson).


Don't let the turkeys get you down today. Keep caring!


Enjoy your weekend wherever you are! 

That smell

You know it when you smell it. It's sickly, sweet almost, and nauseating. Once it permeates my nose, I'm done until I can get purge the remnants from my nostrils.

It's the smell of C-diff. I had a patient who had all the classic signs: loose stools, brown going to golden colored stool and the horrific smell. Rehab nurses are used to dealing with bowel, bladder and skin issues. This bowel problem made me want to run out in the arctic tundra that is our parking lot just to get away. And I was starving.

Thank goodness for bleach wipes and my handy, dandy air freshener. The air freshener permeated the room and made the smell go away.

Escaping and taking a nice, long walk helped, along with my lunch. It's amazing how therapeutic a lunch break and a walk at work can make you feel.

More to come...

All the wild and woolly things

It's getting much cooler here in RehabLand. The dreaded Arctic winds are making their way back, just as they normally do (or did). Last week, we had three of four seasons in a week, but it seems like winter is coming and no other season will be allowed.

The wild: all sorts of construction craziness. Since the SU sits near the front of the building at our pastoral campus, the woollies are the critters trying to get in. A few of them (namely mice) are showing up in our office rooms.

We're also getting a lot of patients. It seems like there's always a rush to get your rehab done before the holidays, but some people don't always make it. We do our best to be festive and motivating during the holiday season.

Lately, we're getting lots of unusual diagnoses including presbycusis and Colles' fracture. It's giving me plenty of homework looking up conditions. I also had a patient come to see me about MRSA. The CDC website was very helpful. Said patient felt relieved in knowing what to look for and they provide some nice patient education.

Well, I'm going to get wrapped up in my own woollies and get ready for tomorrow.

I wish you a great week wherever you go!

I'm praying...

For my patients, especially the sick ones. It really does suck being around here when you could be home for the holidays. Many come from far away, so they don't have family visits.

For my coworkers, you know who you are. Praying that saying that tough times never last really is true.

For my son, Bubba, who just decided to have a meltdown while Dahey had a friend in the house. Ugh! Being the disciplinarian, he got his attention, though.

For me, that I can get into the holiday season. I started reviewing my charitable contributions (which I do this time every year). I really do enjoy giving and receiving.

Peace, quiet, family happiness and a clean house aren't too much to ask for...are they?

We'll see...stay tuned!

Torn...

The dilemmas I've faced this week.

The first one was the dreaded certification renewal (one of them, anyway).

Getting a nursing certification is a little like qualifying for an equestrian event: lots of jumping over obstacles and looking perfectly put together.

After months of combing all my files for CE certificates to put in the application, making sure my membership was updated, then filling in the rest of the application and credit card info, I sent it off. A few hours later, I got the "we're reviewing it" e-mail.

Today, I got the all clear. I'm renewed for another five years. The hamster wheel starts again...

The last couple of days, not throttling some of my coworkers about the US presidential election has been another dilemma.

For those of you not in the know, we not only elected a new president this week, we will, on Bubba's birthday, January 20th, inaugurate the nation's first reality TV star, thrice divorced president married to only the second non-US citizen First Lady. Some of my coworkers want to talk about it all the time.

I'm not one of those people. We give out blood pressure meds for a reason at the Hotel. We're not supposed to be inducing conditions that will send people into rehab.

However, I'm looking forward to the weekend. I'm celebrating my favorite US veteran, Dahey.

Happy Veterans' Day to all of you who have served!

Tricks not treats

Lots of bugaboos on this Halloween Monday at work. Technical difficulties galore and a small fire right when I had patients scheduled for appointments. Thankfully, when I called our local help desk, I was #22 in line, but my call was answered by a real person in about 10 minutes. All the rest of the callers must have given up.

I went on to my afternoon assignment at Washington and stopped by Starbucks to celebrate with a Frappula Frappucino and extra espresso.

Sugar and caffeine might not solve the world's problems, but they helped make mine seem like it went by faster.

Hope you enjoy whatever is left of your day, wherever you are!

Signs of the end of summer

It was too good to last. Yes, summer is trying to escape here in RehabLand. It didn't even get to 90 degrees today, and for August, that's cool. The pools are still open (mostly on the weekends) but many are getting ready for the last weekend: Labor Day.

I escaped today as I usually do. I have to go on rounds at Washington, so if I'm not feeling adventurous, I just hop on a shuttle bus. The trip is short, so I don't see much. Standing outside is the part I like if the weather is nice: seeing the sun and soaking up some rays (even if I'm wearing heavy-duty sunscreen to avoid both cancer and wrinkles). Today was glorious. The potted plants aren't wilted and the flowers are blooming again as if it's spring.

The patients like this weather too. When you can convince your therapist to take you outside for a game, or to go wheeling around campus, you've won. We call it community integration and on days like today, it's a good thing.

Why? Because you learn how to get up and down curbs (and how to gauge where the water will be when it rains) and despite whatever illness or injury put you in a wheelchair, for the moment, you're free to hang out and be a lounge lizard. Don't worry, our patients get sunscreen too. Orders for sunscreen are harbingers of spring around the Hotel, just like the swallows coming back to Capistrano.

However, the shuttle trips never last. I'm always dropped off at the door to reality. And today, someone is waiting. Waiting for me, the resident expert, to help them solve one more problem, before they go off into the summery, yet cool sunshine.

I'll take it any day! Hope you enjoy every minute of gorgeous whenever it comes your way.

More later...

Perils of modern living in the office

If you have e-mail, it just might get hacked if you open attachments you shouldn't. I'm so glad one of my technical people actually confirmed my suspicions recently. Our mail has been terrible. The issues we have with technology are scary, but not surprising.

My latest issue: some of my coworkers want to be exempt from policies and procedures that can cause issues with billing some services they provide. This is another example of following the chain of command. They do it (or suggest it) so I have to make their boss aware of the situation. It sucks, frankly, when these same folks could have been doing this job (they've been dodging) for a few years now, had they let me put the resources in place.

More construction starts at the Hotel. We got some equipment (they forgot until I asked and money was found) for our exam room, so once we get our security devices (probably next month) we can officially say construction is over in our office.

Bye, bye convenient parking when the monsoon comes through later this week. Guess I may actually start wearing my backup scrubs. Our parking lot shuttle is a joke. I often see them at the local Wal-mart. Last time I checked, Wal-mart was not our parking lot.

Patients will be patients. They are now asking pointed questions and so it makes our lives very interesting everyday.

Off I go to another exciting day. Stay tuned.

Some you win...

I felt like I was winning today until I got to my patient as arranged today. When I saw him, he was a mess. Bedraggled and anxious. Terrified. Lonely. I worked with him the best I could, but it didn't seem to be enough.

I called one of our other staffers to help.  I did everything I could.

Finally, I wrote my note. I finished my work that needed to be done. Even though, I accomplished much, it didn't feel that way.

I tried. It was all I could do today. I will do the same the next time.

Full moon fever

Oh, the natives are getting restless, and for a moment, I didn't know why. Ah, the full moon!  It was one of those days recently. Everything and nothing goes right.

One patient I follow is still ditching me for his/her monthly follow-up. Since I have to report to his/her provider re: progress, this makes things sticky. Try, try, again.

I am finally (maybe) getting resources to start a program I proposed earlier this year. Got clearance from the local committee and everything. If all goes as planned, the key pieces will fall into place next week. I'll still be sending prayer requests to my favorite nuns, monks, and old ladies, though. Working in this arena is rewarding, but endlessly frustrating with the amount of backtracking I have to do.

Thank goodness some of my folks still love me!

And speaking of the love, my next door neighbor and I found out our abstracts have been accepted to one of our favorite conferences.

The show WILL hit the road again, just in time for hurricane season, Labor Day and a family wedding. Why not have everything big happen in one week's time?

Stay tuned and enjoy your weekend! Happy Easter to all who celebrate!

More later...

Why executives should proofread e-mails to staff

Dear Chief Executive:

Thanks again for taking time out of your busy day to send us a weekly update. I like that your updates aren't just boring old hospital numbers on admissions and outpatient visits, but include real stories.

I have to say, though, that your recent missive was one that will go down on the books as probably the most entertaining one we've had around here in years.

No, there were no inappropriate funny photos or jokes that could offend someone. There was just an inappropriate acronym (yes, I know we love them at the Hotel as much as anyone). Please remember: if we have an Iraq War veteran patient, most likely he has suffered as a result of an IED attack, not an AED attack.

We use those occasionally when our smokers fall out in the middle of the cafeteria (as you mentioned last week.)

Consider this your education session for this week. We just want you (and everyone else here at Madison) to feel safe when they see an AED in the hallway by the water fountain or near the ATM.

Sincerely (really!) yours,

RehabRN

Sometimes I wonder

Why do specialists forget the basics? Wouldn't you expect your doctor to know the basics about flu, even if he/she were not an internist or primary care provider?

I really did want to bang my head into the large conference table as I explained to a patient (who was being evaluated for a specialty rehab program) the basics of caring for someone (grandchild) with the flu.

Said MD walked in and acted as if he/she was clueless to any of the guidelines. It's very handy that the Nursing department makes us do an in-service on flu EVERY year here at the Hotel.

I thought it was a little overkill, but having enough knowledge to explain to patients seems like something an MD might be able to do, too.

I'm just adding this to the crazy day list at the Hotel.

More later...

The law of averages

TGIV! (Thank Goodness I'm on Vacation)

The law of averages still keeps cropping up at the Hotel.

What is the chance the maintenance guys will install your blinds in your office and treatment room and only one won't fit? Consequently, it will have to wait until next week. Hopefully, they'll find another.

What is the chance that a patient who's minding his/her own business as a patient would be fine one day, then slightly confused the next, then completely out of it the day after that? It was our patient and they have a slight clue what it may be (medication) but even tapering it, he/she's not getting better.

What is the chance that your boss will call a meeting, get caught up in the trappings of the holiday gifts he/she is given, and forget to do what he/she set out for the meeting?

Just another reason why each team meeting should have a written agenda and last no more than 30 minutes. If it were up to me, I'd take away the chairs to guarantee it's a short one, but the Slug would complain.

Again, TGIV! I can escape for a while and enjoy. Hope you and yours do this holiday season wherever you are!

We get attached

It's very easy to get attached to some of our patients. When I think about this topic, I hear all sorts of scenarios from my psychiatric nursing class, where we talked about why we like some patients more than others.

Some of them remind us of someone we liked, didn't like, was our neighbor, relative, or friend.

It's not confined to patients, either. Sometimes, we nurses, meet some incredible physicians and other staff in the hospital.

Our docs in the Hotel, while often quirky, are our doctors. So when one wins a major prize, we celebrate. She has been with the Hotel for almost her entire career. Other doctors just visit us, and while we're nice to them, we're not nearly as fond of them as we are of our own.

However, since I have been roaming around on behalf of the Hotel at our sister unit, I've met a lot of doctors I first learned about while reading notes. One of those docs was Dr. M.

Dr. M. was a surgeon at the Washington. We waited for him for a long time. The first specialist retired, they hired someone, then the other never showed up (got a better offer while awaiting information from our HR--the specialty is in demand). We had one doctor (on loan) but PrivateU called him back to work in their hospital (when he wasn't sitting outside the US awaiting his Green Card.)

After years of waiting (literally), Dr. M. came on board from oceans away. He was a jovial fellow for a surgeon. The patients really liked him. He was kind and down-to-earth. Many of our doctors liked him, because he had a phone number and answered the phone whenever possible when he was at his desk. He was also happy to answer any questions they had when they saw him (the infamous hallway consults). I got to help Dr. M. occasionally when he was on the sister unit, visiting folks after surgery. Dr. M. always seemed to be smiling. Eventually, Dr. M. had a real department with another surgeon and a nurse practitioner.

However, our happiness was short-lived. We got the news that Dr. M. died at home over the weekend. Arthur Schopenhauer said “Mostly it is loss which teaches us about the worth of things.”

The happy, smiling surgeon left us physically, but we'll never forget him or the good work he did for our rehab folks.

More later...

The answer: send someone a letter

I had a day yesterday that (again) questioned my faith in the leadership of the Hotel at the very tip top. The root cause: BS plain and simple.

How in Hades do we have people (with credit to do so) purchase equipment, tell everyone "go out and get some patients to use it" then suddenly drop it? This happens (of course) once you get the ninnies at your location to buy in. When asked late last week, when I went to order and couldn't find a gadget available, I got an e-mail that said "Well, we don't know if we'll have money next year to continue this" as some very valuable pieces of equipment sit unused on people's desks throughout the system as a totem of "Look what I have..this cool gadget!" As such, these "gadgets" which are really FDA approved health care tools, do nothing for patients.

I know they work. Some of my patients have them. I got them through a loophole, which I willingly followed policy and procedure TO THE LETTER to get. They are making a difference in the lives of these people. I see it on a regular basis. Some of our people were back and forth to the Hotel several times in a year. Guess what? One character hasn't been back in six months (and counting). Another is over four months and we haven't readmitted him/her.

When I asked our technical gurus (who have way more experience with this sort of shenanigans) what I should do, the answer was "write a letter to someone who can do something about it". The consequences of doing that, could very well cost me my job.

But after years of waiting, working, busting butt for things that turn to vapor, I'm just about there.

Will be writing, editing, and thinking very carefully this week about that very thing...

Stay tuned.

One minute slow...

Another one fast. My days are numbered in my current lair. The construction guys are coming to tear up my part of the SU.

I'll be a refugee for the next month, roaming around to see patients at bedside.

Which is not always a bad thing...stay tuned.

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

Dear Social Media Darling

Dear SMD:

It's nice of you to come back to the Hotel after your last momentous visit when you yelled, threw punches and screamed at a large contingent of staff.  It really is hard to expect a Hotel, because after all, we are really a hospital.

Posting your latest set of grievances on social media won't help.

We will be professional and do our jobs, but if you're looking for warm and fuzzy, there are plenty of pets available down the street at the local animal shelter.

Here's hoping this visit is more pleasant than everyone is expecting.

Yours professionally,

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.

The end of the week

This is almost the middle of July. I hear the siren song of summer, since here in RehabLand, Bubba and the other kids will be in school before Labor Day early in the morning (clutching pearls).

I have many warm memories of starting school in September (when it was still blasted hot) and one year, I dreaded going to school since my classroom was on the second floor. I was in fifth grade. I had horrendous headaches that year. I figured it was the ragweed (since all the windows were open way back when).

The Hotel was hopping this week, and so was I. I actually got to go out on a field trip. That part was fun. When I wasn't busy doing that, I was getting some groundbreaking work done. Since I volunteer for pilot projects (because our boss volunteers our department), I got to work with some new stuff. It was so cool to make care work anywhere! It also helps that the patients like it, too!

I'm going to stop here. It's time to relax and enjoy what I have of the weekend: housework and a little fun. Vacation is in sight. I can't wait.

Stay tuned!