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.

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.

It's almost over...

But we won't stop enjoying what we have left of the weekend and of my vacation, darn it!

Bubba and I had a great time out and about in our aunt's neighborhood. It was a food truck fest and a charity concert, headed up by my favorite police captain (and the power point/satire master) Cap'n Ned. Cap'n  Ned and I worked together nearly two decades ago (kind of scary) in MegaBurg, way before any of the niceties were added all around town, such as the cool amphitheatre.

Cap'n Ned's own band headed up the concert, and they had a U2 tribute band as the headliner. It was fun watching folks from many generations up there dancing in front of us. It was also homecoming in the neighboring towns, and since the MegaBurg park is scenic, we saw dozens of kids (and parents) walking by dressed up and taking pictures. A couple of times, they timed their parades to song lyrics that talked about young'uns being places they shouldn't...which made for some hysterical video clips.

Bubba even got ME up there and dancing to the U2 tribute band, but with all the smoke from the stage, cold air, and other assorted pollutants (this was outside), I thought I would have an asthma attack and require paramedic attention (because, of course, I never figured I'd need to bring my inhaler along). I sat out. Consequently, Bubba danced his heart out and had a blast, while I watched from the second row.

We spent money, Bubba got his pic taken with some famous football cheerleaders and bought a calendar they had, since proceeds went to their charity for fallen first responders. He had a grand old time, and so did I, spending some time in my old workplace of MegaBurg, marveling at all the good that's come there, and talking to old friends I don't see nearly enough.

So, we'll be off on our day soon, to make some more memories today. 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

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.

It's beautiful outside, but it's sad

This past week's been a doozy. I'm hoping I never repeat some of it again.

Work was work. We had our yearly inspection and I survived. The inspection team had some new and some old folks, so it was interesting to watch them.

Outside of that, one of my mother's in-laws died. I hadn't seen her (or any of her kids) in ages. I like this family, so it was pleasant. The crazy relative didn't show up for the wake. Still don't know if he/she is alive or dead. 

I was just getting ready to go to bed when another relative called me. Her son didn't answer calls as usual that day, so she went to the apartment complex where he lived near her. No one answered when she knocked and one of the neighbor's let her know she could see inside the apartment from outside, since Max left the curtains open when he worked from home. (He had a job that could be done remotely, and hadn't worked in an office in years.)

When they looked in, Max appeared hunched over his desk. My relative watched, but Max didn't move. She knew Max was probably dead. While it wasn't a surprise (Max had problems), it was sudden.

So, since Max's family (girlfriend and teen child) was out of town and she didn't have a key, she had to call the police to break down the door. She found Max dead. He was in his early 50s. It was sort of a circus arranging the apartment, having the police roaming around, lots of questions, and waiting. Happily, things calmed down before I could get dressed and leave.

Now, we're just waiting for Max's family to get back to complete the arrangements, and for the medical examiner to do his/her part.

Stay tuned...

Happy Thanksgiving!

Yes, it's been a crazy week. I am however so thankful for so many things.

I have so many things: I have a nice home, a car for each driver, and a good job to pay for it all.

I was able to take a couple of vacations with my family this summer. I also got to travel for work and for a group I belong to. I was able to afford it (or my employer paid my way).

I got a raise. It seemed like it took forever (almost three years), but when I read an article recently about a man who worked in a fast food restaurant (and two other jobs) who had not gotten ANY raise in three years, I count myself fortunate to have been given a substantial raise.

I have my health (even if I have a pesky cold right now). I have good health insurance (that came with my job) so I could afford preventative care.

I followed preventative care guidelines and hopefully (will know soon) will avoid losing one very important sense. I can't say I'm thankful enough for that. I hope to be a voice to advocate to others, to not skip on this important means of detecting life-changing conditions.

When I watch the news, we see so many terrible things. Riots, looting, destruction of small businesses, and death. I am thankful that as a caring member of my community in RehabLand (and as a citizen of the world), I can make a difference. I can donate to the food pantries, homeless shelters, and even to the small business owners of Ferguson, MO.

I am immensely thankful. Thank you for reading this and sharing my blog with others. I appreciate it.

Happy Thanksgiving to all wherever you are. Real nurses celebrate Thanksgiving every day, because they work every day. Thank you police, fire and EMS folks, who are also there with us. We couldn't do it without you.

More to come..

When you see

Several police cars in the parking lot and two hospital police officers in the lobby on your way into work, it usually means something is going on.

Boy, it's going to be an exciting day!

Stay tuned...

Turning the tables...

Usually, I have lots of stories, so I decided to turn the tables and tell you all about some of the stories I've heard on the unit from people passing through the Hotel.

I don't check for veracity, but I do enjoy a good story, true or not. And no, I'm not going to tell you about the stuff they tell us to get drugs. (The ER nurses like my classmate Q. get a new one of those every day.)

Police stories:

Dim bulb

In some professions, people developed a heightened sense of awareness of things. Police officers are trained to be highly alert, but some of the scenarios Good Cop (he called himself that when he roomed with another former cop--Bad Cop) told me about were just crazy.

GC was out on patrol one night and noticed a guy had his license plate light out (an infraction that would win a ticket in his town). Once GC got to the window and took the guy's license he said, "I didn't do it."

GC said something about the way he said that wasn't right. He asked again, and the guy says the same thing and "I didn't rob that liquor store."

GC asks Mr. Chatty to step out of the car. GC proceeds to cuff and stuff him. Before he knew it, the call came out on the radio about the robbery. GC calls his coworker back and asks him if he wants him to bring Mr. Chatty back by the liquor store (about 4 blocks away). Coworker says "come on over." Meanwhile, Mr. Chatty keeps talking...

Mr. Chatty is identified as the perpetrator by the store owner, and off he went to the police station and booking.

Get it straight

GC pulls over a man for speeding. Mr. Lam is apologetic and GC says, "I almost let him go. Just seemed like a really nice guy."

But Mr. Lam was not a nice guy. He was a fugitive wanted on federal warrants for murder. The warrants were 16 years old.

So how did GC figure out Mr. Lam wasn't who he said  he was? Well, if you give a bogus drivers' license to a police officer, make sure you sign the same name that's on the drivers' license you give to the officer. If you sign your real name (not your alias), someone, like GC, might figure you out.

Until you see it up close and personal

You never believe the statistics.

I do believe you, Bubba, and so do your teachers. And I hope and pray for all the other kids involved.

Pray for us, if you believe, 'cause I'm sure gonna need it to keep from killing certain "responsible adults". Will be so happy to see my PD friends real soon...

Stay tuned.

Don't stand so close to me...

What I wanted really wanted to tell a few people at work the other day...

Nuggets for February 29

Yes, it only rolls around every four years, so I figured I may as well go celebrate.
Here are a few nuggets from the blogosphere and internet for your viewing pleasure.


Fed up (from GuitarGirlRN) Things I've thought about techs on the floor for a while...and the irritations they cause.


Scot free (from 10 out of 10)A great post on police and drinking drivers.