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.

If only I could say this...

I have had many therapeutic conversations with my friend, the Pharmacist out Yonder. We have always had some interesting stories from work.

As usual, she tops me again, even when I told her about her old neighbor's not-really-a-surprise-party-anymore surprise party my traveling partner's been planning. (Drat!)

She had to call a doctor recently to get a prior authorization for a certain antipsychotic med dose. She clarified the prescription, found out it needed the prior authorization, and called the insurance company.

The (not so) nice people at the insurance company gave her some information, but told her the MD had to call them back.

She calls the MD to explain the situation, and he says, "I'm not really in the mood to call the insurance company for that."

Really? I said. How can he NOT be in the mood?

I think I'd promptly be in the mood to find another doctor.

That is all...hope you enjoy your day wherever you are.

Old school

It's always interesting to see people you don't normally see on a daily basis. I did that recently by going to one of the local watering holes and meeting up with some folks from high school.

We were mainly there since one of the group was in town for various graduations, weddings and other assorted upcoming trips. Another classmate drove across the country to RehabLand to pick up some relatives and head on out to a destination wedding.

The weather was glorious so we sat outside and just enjoyed the weather.

As usual, there are some curious dynamics. Many of the folks who were there are school teachers and assorted professionals. One is a housewife who raises animals for sale (chickens and pure breed dogs). Another person worked in health care on the administrative side. We had a nice long conversation.

But simmering beneath the surface, is always  something. While I had that long conversation, I realized that some people are nursing grudges that are nearly 30 years old. I kept my therapeutic communication hat on, but later, the nurse appeared.

"You have options. You can let it sit there and drive you crazy, or you can do something about it and let it go. You are not where you grew up. It's only a part of you. What you choose to do with it, is your choice."

I don't think she really ever understood it that way, before.

And so we took off into the night, and left our erstwhile waiter a big tip. Because after all, we did take up his table forever.

More to come...