Is this the sign of things to come?

I had an interesting conversation with my coworker's boss (who's really my boss's boss) recently.

I got to tell he/she about the latest tribulations trying to make things work. He/she listened, then mentioned how I have no appropriate training.

What I wanted to say:

"Yes, remember that quality training I took last year? That's how I got qualified to lead a quality improvement project? I've taken this training five years ago, too."

"Your quality person? He/she's not been trained."

"Would you like to tell the Hotel boss that I can't finish this project?"

Unfortunately, I didn't. I'm stewing...and plotting my escape. Being unappreciated is annoying.

Stay tuned...

It's the truth

Thank you KevinMD for this one. I need it.

I'm at a point in my life that I'm tired of putting up with bullshit. I entrenched myself at the Hotel to succeed at my goals: getting more education and getting a good job. But the view from here right now is annoying.



via GIPHY

In 2011, the Robert Wood Johnson Foundation called upon nurses to participate in their publication, Transforming Leadership: Leading Change, Advancing Health:

“Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors.”

I need a couple more doctors who listen to nurses in my life right now. There just aren't enough at the Hotel.

Stay tuned...

Nurses just do it

WiseOldRN stopped by my office today. Actually, he/she is on a schedule and comes by regularly. WORN has worked in an administrative job for over 15 years, but WORN is a proud diploma nurse licensed for many years, who could work "any service on any shift, leave and come back for more".

We have chats regularly and this week's was a doozy. WORN goes all over our hospital system so he/she has some tales. While I'm sure some are peppered with hyperbole, I know some of the characters involved so I'm aware that there is truth.

WORN started ranting when I brought up training. As a diploma nurse, WORN regularly went all over the hospital and worked everywhere. His/her last assignment (as a nurse) was in risk management and quality, but as WORN noted, the only place he/she didn't regularly work was case management. WORN figured being a registered nurse made him/her a case manager every day.

When nurses feel they don't have the skills, I remind them what the overall goal of the day is: managing their assignment. This can vary on the status of the patient, but in our world, bowel, bladder and skin are very important. When we forget about the little things: helping someone with a 4-5 day old beard shave (like I did on my lunch hour while visiting our satellite unit while his nurses charted) and comb his hair, it reminds us all that we are taking care of people, not just completing a task list.

Sure, we have plenty of tasks, but when we can't put care at the top of our task list, are we slowly but surely degrading the importance of having an RN care for each patient?

As WORN says, nurses just do it, if the patient needs it. We don't wait for a million other things, like policies, procedures, or unlicensed personnel.

We see what's in front of us, and do the work. We use that nursing process AND we care.

That's all for now. Gotta leave and take care of my patients. Hope you have a great day with yours, wherever you are.

Quality or not

We had the long (not awaited) meeting with our nurse manager. I like the manager, I just detest being stuck with some of my ne'er-do-well coworkers.

Our manager had the not enviable position of beginning the discussion about changes coming to our Hotel clinic and home care group. Some folks just rolled their eyes. One person was on vacation. My cohort had a migraine. I thought I would have one, too.

The Slug made a comment I'll never forget when the nurse manager talked about liking Madison since he/she "can make a difference here."

The Slug replied, "I don't want to make a difference, I just want to be."

Be lazy? He/she's got that down.

Be greedy? Absolutely, when all you're worried about when your job title is going to change in the computer to care manager (because that title usually--but not always--gets you a pay raise).

Be an idiot? Completely. But when you have YEARS of nursing experience, especially doing stupid things, it's not surprising.

Quality, caring employees might be just the Christmas gift for the Hotel this year.

Stay tuned...

The doctor IS right

I've been following Dr. Val for a while, and I have to say, part of the reason is that I get her. I get what's she's talking about because I work in rehab.

Physiatrists get rehab, since they train in a specialty known as Physical Medicine and Rehabilitation. I happen to work with wonderful physiatrists who have years of experience.

And I have thought the same thing when I have read and seen certain specialists, like Eric Topol  in the media. It would be nice to sum up everything we do into a little smartphone app, but it will never happen in this lifetime. Disclaimer: My work actually includes a whole lot of technological interventions.

If we ever get to smartphone-only health care, I fear for everyone who does get a diagnosis, like spinal cord injury, that can benefit from a rehab program by specially trained staff, just like ours at the Hotel.

Cheap is one thing, and quality is another. You can have both to a certain degree; however, we do have to be careful what we wish for. It may not be good enough after all, cheap or no.

Stay tuned....

I love the internet (or this week's Nuggets)

Which is where I ran into these articles, thanks to my favorite publications, as well as some fellow bloggers.

Hope you enjoy!

Mistakes
Frankly, since I've started working at the Hotel, I've been mistaken at odd times for a doctor, a nurse assistant, a sales person, a stripper and a random person in scrubs. I have never been offended by these descriptions because I take them at face value: the patient was delirious, delusional, demented or just plain oversexed (sorry couldn't think of a D adjective for that last one).

I ran into this KevinMD op-ed (which I highly enjoyed the angst because of the Nerdy Nurse) of this obviously almost 30 something year old woman who is mistaken for a nurse, when she has those coveted MD letters on her white coat.

All I have to say is, if you had the demented character who said you reminded him of a stripper, you'd have thanked your lucky stars he called you a nurse instead. Far worse has happened...

An innocent abroad

All I have to say is, I'm not going to say to much, or I'll have to plead the Fifth, but this is a very interesting article if you are a little technologically inclined. It's just the tip of the iceberg, and I thank my lucky stars that my only cultural barriers right now are between hospital departments.

If you only read the first two sentences...

You may very well see your own career trajectory right before your very eyes. The words that struck me:
"hospitals need to create a patient-centered culture founded in principles of compassion, service and high quality"

You got it, Sabrina. Indeed.

Let's be blunt...

Okay, sometimes as a rehab nurse, you have to do it.Using grandiose medical terms like micturition and defecation just don't cut it.

We have to ask "Did you pee lately? " (due to a variety of reasons) and "Did you have a bowel movement?"  Yes, nursing students, if you can't observe it, you have to get reports from your patients, and like those videos, you have to ask questions: color, consistency, etc.

We sometimes even resort to the old standby, especially for the really deaf hard-of-hearing folks, "SO-AND-SO (insert name here) DID YOU POOP LATELY?" This is always especially fun when the soundproofing is not so good in the exam room.

So, needless to say, since I have some of those old characters (many of whom don't hear well) as patients, I really enjoyed reading the headline below (which wouldn't surprise me if I heard it out of our folks..)

Michael Douglas: Oral sex caused my throat cancer (from the UK Guardian)

While Michael still needs some patient education, he may have already inferred something from the literature from the comments he made.

I just wonder how Catherine Zeta-Jones took it all when she picked up the paper.

More later...

Field trip!

I am one of those people who loves to get out of the Hotel and roam. Even if it's only to the cafeteria on a nice day.

Today was different. I had meetings at Washington (aka the Mothership).Since Bubba and Dahey were roaming around on RehabLand Elementary's February vacation (why they give kids a five day weekend in February...), I had them drop me off there and pick me up when I was done.

I was there and had 3 meetings with people in four hours. It wasn't too terrible, because I had time in between.

First, I had to meet with Dr. C. He's a surgeon our chief wanted me to talk to about the SU. Nice. He was a character, still in his OR cap, as if he'd just come from a case. Dr. C. is about 5 feet tall. In reality, I think he just wore it, so patients would think he was busy. For a surgeon, he was interesting. He sat next to me and looked me square in the eye when he talked, very unlike any of the other surgeons we work with.

Next, my old super, Reg, took care of me when I needed a computer to finish my work between one of those meetings. It was fun. He gave me his office on the unit in the middle of an allied health open house. Respiratory therapists and therapists of all stripes were being interviewed everywhere on that end of the building that's normally not occupied.

I visited Dr. V. next. He and I worked at Saintarama Rehab. We got assigned to the same committee for that reason. He's smart, but not a subject matter expert on this project, so that's why I'm with him. I started having flashbacks to undergrad when he started talking about SWOT analysis and Professor Brothers saying, "RehabRN, what are the opportunities for Company X?" Just as long as I don't have to take accounting again, I'm okay.

Finally, I visited the last person on our chief's list. The urologist. Everyone's favorite person among the male patients. A positive evaluation from him gets you the ED drug of your choice, based on your diagnosis. His waiting room was crowded. I was just shocked that he took time out to talk to me, along with his nurse.

Although I left later than I wanted, the diversion was worthwhile. Washington's coffee bar in the lobby has some really wonderful brownies. Yes, I was supposed to give up sweets for Lent, but I distinctly recall the priest saying, "Don't give up something you're just going to start again when Lent is over."

On my honor, I will never EVER give up chocolate. End of story.

Have a great weekend wherever you are!

If it was good today...

On a Monday, what, oh, what will it be like tomorrow?

At this point, I don't mind that Monday breezed by. It was lovely. Patients were happy and did as they pleased with relatively little irritations for the nurses or the medical staff.

We did have some weirdness go on. Check out the following and see what you'd do.


Supplies, supplies, supplies. 
Searching for them has been the story of our charge nurse's life. She spends way too much time being the unit purchasing and acquisitions agent.

Per usual on Monday morning, she gets her list and send it to the supply folks. Here are a couple of things on the list and what we got:

• tracheal suction kits: asked for 24 (for all our patients on trachs --about 4, so 6 per patient); got 4 kits.
• trach care kits: asked for 4 patient's worth, got one. One lousy trach care kit.  I say we make the patients (or their nurses) arm wrestle for it! 
• catheter bags (one for every current inhabitant with one--approximately 8 patients). What did we get? Three.

So glad I was not in charge as charge nurse vigorously banged head on desk while on hold with supply people.

If the Manglement calls this quality, I'd hate to see what they call disaster!

 Stay tuned...never a dull moment at the Hotel!