Hit the nail on the head

This could have easily been the theme of my week this week.

1. Yes, slacker coworker, when you sit in our weekly meeting and chart, instead of participating, you look like an idiot. When a patient with a LOS of 25 days and you really know NOTHING about him or her and they are your assigned patient, I only have one question. Why in Hades didn't you read THE CHART?! 

I know, rocket science...

2. The boss finally decides that the hallway consults are causing issues with continuity of care. Yes! That only took a year to convince him/her. We shall see what happens...

3. Thank you jo at Head Nurse for the link to this Suzanne Gordon article. Yes, communication is vital, and lack of it is deadly.

So far no Ebola in the Hotel Rehab and our specialty docs like it that way. We will keep praying it gets contained.

It's one souvenir from Dallas I'd prefer not to get on my next connecting flight.

Stay tuned...

Bringing home the Bacon

Yes, I'm very thrilled that Dahey has a new job, but the manglement at his employer, Overlord Contracting, leaves a little bit to be desired.

Dahey and I met at PrivateU, when his dreams consisted of being an industrial labor specialist. Throughout his career, he has successfully worked with lots of unions, crafts people, engineers, truck drivers, secretaries, and yes, even the occasional nurse.

Recently, the Overlord people were not amused when he asked about bringing home this Bacon, as in Davis-Bacon Act.

So, after the brouhaha in the break room died down, they made all of the employees hired recently come to a meeting. Telling people they will not get prevailing wage and appropriate overtime as dictated by law is really not a good thing, Dahey said.

Moments later, after much fidgeting, and several calls to the Overlord corporate office, they apologized. Bonehead Recruiter made a mistake.

And that is why I love him. 

Sunday night special

Oh, I can't wait until Monday. Dr. RPIA, one of the specialists I work with in the SU called Friday and left a message on my personal cell phone. Yes, I do actually have a phone in my office with voice mail, but I'm sure his/her ADD kicked in and he/she wanted a response immediately.
 
I'm sure s/he'll have a temper tantrum since someone in his clinic double booked him/her.

Hello not my problem, Doc. You can go to Helen Waite, our complaint specialist. Or sing the song below...




Heaven knows we can wait for another specialist like you to show up, since the last one lost his visa last month. Or we can make your chief start taking patients again.

Stay tuned...

Monday madness, part 107

Oh, I love Mondays, when they go quickly without incident. When does that happen, you ask? Maybe once or twice a month, if I'm lucky.

Today just was classic.

1. You're waiting for two patients to show up. One shows up for clinic. One doesn't show.  The four calls you made to his/her nursing home to get him/her to the appointment were a waste. I really love transportation companies when they screw up!

2. The crazy specialist you have to work with forgets how to code his encounters. The coding staff are off today. He/she decides to do something crazy and puts his notes in incorrectly. Nice...

3. You forget your lunch at home...in the fridge. All the while, as you wait for Dr. Crazy, you're dreaming about lunch.

Despite the weirdness that appeared, disappeared and reappeared, things did get better.

1. I escaped! Out of the building! For my ENTIRE lunch time. Hallelujah!

2. Since all the patients were done for the day, I drove down the road to my favorite coffee place and got a pound to take home and a drink. I was running late so a lady waiting for another store gave me her place in line. I thanked her profusely and gave her my coupon for a super cheap drink while she waited.

3. I finished the day, slowly, surely and very nicely. And away I went...

Stay tuned...

I needed a laugh

Dr. K, one of our specialists who works with us in the SU, was part of a profile article on our program for the local paper. All the PR Hotel staff approved, said all the appropriate PR incantations and they came out to take a photo of us seeing a patient. Patient signed release (and a couple of autographs for his neighbor on the unit who egged him on, out of earshot, of course.)

When I told Dr. K. a few minutes before he came into the room, he says, "Darn it. I should have worn a tie today."

"Why wear a tie?" I said, "You never wear that or your white coat anyway. No one would know who you are."

Monday again

Surprisingly, I did not have hundreds of e-mails when I returned to the office. I had about a dozen.  One of these days, the crazy admin who works for us will figure out that we ALL really don't need to receive a 9MB attachment on every e-mail she sends. (I bounced this request to the tech people today).

I worked with a patient (Mr. X) who always seems to show up in my office. Some therapists need to be working with him, but they're off doing other things, so I think of things for him to do. I allot about 30 minutes a day on this. I wish I could bill for my time in a clinic visit like the therapists do.

Meanwhile, Mr. X thought he was evading the medical staff on rounds by hiding out in an area near the remodeling being done in our part of the Hotel. Nope. They saw him. I managed to coax him out of the corner so he could talk to his doc. Once she arrived, I was out of there.

I also got a referral to one of our docs today. Patient found us on a website, made a phone call, and ended up in my voice mail. Before I could call, he called me. Mr. Persistent wants a second opinion with a specialist who works with us. He has a disease that requires a choice between two medications that will keep his disease at bay, but one, if he's got certain conditions, could actually kill him. Once specialist is back from his family jaunt across the country, he'll be on his consult list.

One patient made my Monday melancholy. Mr. E. has been coming to our place for a few years. His wife has never really coped with his issues very well. The caregiver stress they talk about in nursing school is starting to show. Mr. E. came in to a clinic visit with a week old beard. This is highly unusual for him, since he tends to shave every other day. Mrs. E. didn't come in with him, either, which is unusual.  She told us he had some issues and that she thought he was sick. She was correct. He got admitted.

Staff are getting bend out of shape about Mr. E. not being cared for. He's not the only one. I think Mrs. E. has finally broken. The strain of caring for her loving husband, who was once a tall, strong, highly educated man is killing her. Her back is strained from the weight. The role of loving wife and partner has been permanently replaced with caregiver. It's not what she signed up for. She doesn't say it, but the vacant look in her eyes tells you. The folks who promised to help just aren't doing it anymore.

The burden has fallen to us to carry at the Hotel,  as we wait to see how the rest of the questions in our minds will be answered.

Stay tuned...

Nurse as patient? Not!

Sometimes, I really don't like being the patient.

But now, (or earlier today) I was. I had to go see my favorite specialist. Dr. RG has known me since I was this (motion hand to waist) high. He's an international expert on all sorts of weird things in his spare time (usually the not so nice things you might find in a house figure into his work) He became my primary specialist once I aged out of the Children's Medical Center next door to PrivateU. All during college, work, PrivateU again, he'd seen me, at least once or twice a year.

I even sent my husband to him, once he was on my insurance and lo and behold, I find out that Dr. RG has known my husband's family for years because of a relative. We had much joking after that, but from that moment years ago, Dr. RG (who's always attentive) became even more attentive.

When Dr. RG's wife died a few years ago, he surprised me. One, he gave me a hug, because he said he realized that some of his patients (who had been seeing him forever like me) needed one and life was too short. Two, he was, and has always been the doctor to whom I could ask all those weird questions about research and other stuff. He is a font of knowledge. I knew when he gave me advice recently, it was the advice my relative would have given me if he were here. He wasn't, but Dr. RG was.

So now, after the usual checkup, I got a referral to two specialists. One was a second opinion (no bother to me) and another to a neurologist. Dr. RG thinks my problems could be something else, and I need to get them investigated.

Dr. RG told me something else. He's finally retiring. Not to worry, he said, there are plenty of good specialists at PrivateU to take his place. His replacement is nice, but I've decided to see Bubba's specialist. After all, I know he's been trained by the best, because I saw him when he interned with Dr. RG a few years ago.

Dr. RG is going to fulfill his life's ambition and work in a health clinic affiliated with PrivateU part time. He's thrilled and while I'm sad he won't be my doctor, I'm happy he'll still be around taking care of people who need him.

Stay tuned...

The tales of woe

The word of my day was woe.

"Woe is me." I heard from the specialist who's complaining that the other specialist at X Hospital is bad mouthing him to our patients. Who tells specialist this tale? The patient. Specialist has taken care of patient forever, before he/she ever even went to X Hospital in our system. Patient told Specialist the truth, and he decided to tell me.

Kids, haven't you ever heard that maxim, "If you can't say anything nice, don't say anything at all."? "No surprise" I told our Specialist. "He (and his hospital) have done weirder things lately." Frankly, I'm surprised upper management isn't reigning them in yet.

It was woe for our staff, too. I couldn't believe it when I saw our home health nurse doing assessment documentation on a newly arrived patient. She's usually out on the road somewhere, but for some reason, she got called into an admission that should have been completed by the floor nurse.  Not sure why the boss let that happen, but I'm so glad it wasn't me!

There was woe for one of our patients' families. Said patient died over the weekend. We really liked him (at least most of us did). Rudy was a very opinionated character who almost made it to his speed limit birthday, but he had a heart attack and never regained consciousness. He and I got along very well. I was the person who set up his Fritos whenever he was on our unit (he was a Frito maniac).

Rudy told me he wasn't afraid to die because, during one of his many spates of illness, he had had a near death experience. "Heaven is beautiful", he told me. "I saw it and I really wanted to stay, but they told me I had to go back. I saw the Devil, too."

"Really?" I asked. "How did you know it was the Devil?"

"He looked just like the pictures...and he had a bottle of Jack Daniels, trying to get me to go with him."

"No way!" I said. He just shook his head yes.

So from then on, it was our inside joke about Jack Daniels. I told him one night when he spiked a temp late in the shift, "Rudy, I know Heaven was nice, but could you just wait to go there until my shift is over? And whatever you do, don't take the Jack Daniels." Rudy eventually recovered and we laughed about it.

Happily, all of Rudy's last year wasn't a tale of woe. Rudy got to see his grandchildren born and he was so proud. I saw him from time to time and I always gave him trouble. On his last visit to the unit, I told him he had the most seniority (as in he'd been coming to our unit for so long) on the unit, so he'd better help us train our new staff.

"And Rudy," I told him, "if they say you're mean and quit, I'm gonna call you up."

He just smiled. I opened the last bag of Fritos I ever gave him during that stay while his family looked on bemused. Sure we spoiled him sometimes, but he was like our family. I figured out in the last couple of years, I'd spent more time on the unit with Rudy than I have with my own family.

Rudy was a Marine through and through. He loved the Corps and educated me that the Marines wear scarlet not red.

And like the old Marine saying goes, I send it out today to Rudy, not Chesty this time: "Goodnight Rudy, wherever you are." I'm praying you're in Heaven where it's beautiful and not with the Devil and Jack Daniels.

Godspeed, dear friend. I'll miss you and all your Fritos, too.

Some people

Dear Specialist:

Please do not call me when I purposely put my status (out of office) on my e-mail, phone, voice mail, Office Communicator and the call list. I will not answer because I have your number in my phone.

Just because you think of something while you're on vacation with your kids on spring break is not an emergency for me. And while you're at it, please stop cc'ing the world on e-mails because it makes you feel better. All it does is drive the people listed (including me) crazy...and fills up our mailboxes.

Go have fun and stay out of our hair. It's our vacation, too (if you'd ever stop checking your e-mail and voice messages.)

Sincerely not,

RehabRN

Changes

"Life is what happens to you while you're busy making other plans."--John Lennon

Yes, the changes are all over place already this year. And as luck would have it, there are helpful articles.
I saw the Specialist in one today in RehabLand's paper talking about his next adventure as a teacher. We will miss him, because his successor at Private U. is the dreaded Hated Specialist, who many patients at the Hotel have lots of stories about. HS, hopefully, will stay at the Private U. and not visit, but time will tell.

Then the NY Times magazine has this article about death in cyberspace. This made me think...maybe I do need one of those digital legacy services to keep all my online account information together so it is not a burden to my family to track down, if my eternal reward is issued anytime soon.

Sobering thoughts barely a week into this new year...more to come.

The end of the specialist

Our specialist and his crew left recently. I hadn't seen them much since I went to the SU, but the specialist, being the old surgeon he is, was as surly as ever. Maybe just a chance to posture before I got out the door. So to be silly, I went and whispered to his senior assistant NP, and got a chuckle or two. I was nice, though, I thanked him for the things I learned while he was around via e-mail. His assistant may come back, so who knows when we'll meet again.

The SU has been hopping recently with the hustle and bustle. As usual, we have our cancellations, but on a recent day, we needed them. The doc can get overwhelmed. I'm just trying to keep him afloat. If  we don't have him, we don't have an SU. He has been a joy to work with.

On another note, the Big Cheese told me first (can you believe it?) that he may have a new job for me, that is right in line with my grad school work. I'm so excited. I'm hoping I get it, and the sooner, the better. Even if it  is a new position, with new responsibilities, I'm ready. Going to the SU has been a good thing for me, and getting out of the floor environment is refreshing. Yes, every department has something going on, but hope abounds up here. Maybe it's the atmosphere or maybe it's the fact that I feel like I'm wanted.

Nevertheless, even when it's hard, it's making my holidays happy. They'll be even happier when my grad school project is done.

Not long now...back to work! Stay tuned!

Wild and wonderful

That's been my story at work lately. The transition from one shift to another sometimes can be wild.

One day, I walk in, get going and the gates of Hades open all at once. Nurse Assistant has a patient who's got shortness of breath and "looks funny". Well, he's not acting funny, but probably is a little shaky from the albuterol he just took. Get him situated, tell docs, do vitals, get more albuterol. In a few minutes, patient looks happy as a clam and is chatting away as the nurse assistant gets him ready.

Another day, the specialists round. They like me. Not only do I get to deal with my patients, I have to help them with paperwork on a couple of others, because I know how to work the computers for that feature, even though, all I do is act as a witness. Gee, I feel so special! Thankfully, boss and company only follow these people around once a week. Other nurses thank their lucky stars that they don't get "picked". I've known the specialist for a while before I came to Madison. He can be loud and obnoxious, but underneath, he's a softie. He just doesn't want any of the nurses to know that.

Doc Specialist is also a running doc. It seems like the specialists drift to one of two categories--they either golf or they run. Our leader is the exception. He's too brainy to do either; although, if I had to guess, he'd probably fall in a lot easier with the runners rather than the golfers.

So after all the wild and crazy antics, I get a phone call. Miraculously, I got a scholarship for grad school. They confirmed I was there to send the fax to me. I looked it over and saw it was for the entire amount of the program. You could have knocked me over with a feather. I'll have some other restrictions and requirements as a result, but my financial burden will be lessened. I was so relieved. I don't have to keep doing number-crunching to figure out how many extra shifts I need to pick up to pay for each semester. Now, I just have to concentrate on getting my work done and my schoolwork done...just like Bubba, who starts school soon. Should be fun getting into school routine after some time away from it.

More to come...stay tuned.

Slide on over, folks!

You'd think Tuesdays wouldn't be so bad...nurse brings in lots of pens from the conference, people are happy and we are slated for no admissions. I could dream about it, but it wasn't easy at all today. I told our specialist that I am one of the most highly paid janitors/support staff as I filled every single cart on the main hall with isolation gowns. Why? We have support staff, who don't really feel it's their job to do it. No, sitting in front of the boob tube (reserved for patients) and playing pool (also reserved for patients) is really a more productive effort. If my male boss only had some balls. Removing the pool table ones to his office might help the situation.

I had three patients today, and our clinic nurse actually got one ready, since she needed him for a procedure early. I was very grateful. The other two were their usual eccentric selves, and yes, for them it's all about bowels. One goes too much, one goes too little. One gets out of bed without issue and the other leaves a trail on the sliding board as he's transferring. What does the nurse win, Pat? Another heave ho back to the bed for the patient, with the nurse leading the charge.

Just remember all you nursing students out there, if a patient is stuck in transfer halfway on the bed, you can get them all the way there by employing a maneuver I like to call "the dump". Basically, you get their legs and heave them onto the bed. They may be on their side and a little off kilter, but once you get them to the safety of the bed, put up whatever rails you can on any side they could slide out on, and maneuver them around from the other. I love low air loss mattresses, especially if they're made up right, because, by nature, the sheets are slick and you can slide most people wherever you need them to go in bed with little effort.

Said sliding mess patient eventually did get cleaned up, got lunch and got to the wheelchair for afternoon therapy. It was a workout though, for him and for me. I read this article tonight very carefully, so I can keep my back out of trouble!

After all that excitement, I got to move another patient because his roommate was isolated for a new bug. Yes, I'm an expensive mover, too.

More later...stay tuned.

Ice and snow are back again

In these parts, the folks have to be reoriented to driving in winter weather. Ahh, there's nothing like the first snow fender benders to slow up your morning.

Today was a typical Monday, where somebody, everybody and nobody worked. Somebody was supposed to gather supplies for the patient going on pass out-of-town tomorrow, everybody knew about it, but nobody did it. An astute nurse who always helps out got the ball rolling and two other nurses (including me) got the job done...by quitting time. What a miracle!

I got assigned the only admission for today. Our doc comes down to assess the patient, and then decides to take said patient up to the clinic where it's more private for her assessment. A little later, we get a call that said patient will be discharged. Huh? Patient just arrived...about an hour ago and ate lunch. This patient had some issues that didn't really require being an in-patient so said doc discharged patient. Said patient will be back tomorrow to work with specialist, which was really the only reason why patient visited us. I'm so glad I didn't start the really long, eye-crossing paperwork!

The icy winds were blowing when I left, but I escaped intact, and only a few minutes late. Another day done...hooray! More to come...