So many posts...

...so little time. I can't believe 400 have flown by this fast! Whew.

Work is crazy lately, even though it's not the full moon this weekend. I am so tired. Not sure if it's the hours I'm keeping lately or the virus-of-the-month the doc tells me is going around. We have two people scheduled to go home tomorrow and three arrivals on Tuesday. (I'm so glad I'm off!)

More later...back to decorating before work.

Other random weirdness

Today passed reasonably quickly. I had only one patient and the med wagon again today. Things were pretty good. A few people didn't feel well, so things were quieter than normal. The Slug was still her lazy old self, taking an almost two hour lunch so we got to deal with the doc admitting her patient, but nothing new about that.

My patient was a riot. Instead of complaining to my boss the first thing this morning, as he's been doing for the last few days that I've worked, he sits up and tells me, after I get him a pan of water to wash up with, "Maybe I can get in the shower." "Sure you can," I say, "that's why the bathroom's attached to your room." This works out well, especially with rehab patients, since we can get them to do things on their own when everything is nearby in your own bathroom. (We're an old unit, so each room does not have a private bath attached.)

I go down to pick up a shower chair, which is basically a wheelchair with a padded seat with a hole in the middle. Said patient, who did a wonderful sit-pivot transfer for me yesterday, refused to do it today. I had to go roll out the old, reliable hoyer lift and deposit him on the shower chair. I ran the water, got it the right temp, and rolled him into the bathroom. Once he was in there, he was oohing and aahing to no end. He washed himself from top to bottom pretty well and all I had to do was wash his back. It's amazing how much work it is to get clean from top to bottom, but he did it. I even got the unit blow dryer and he dried his hair to finish up. It wore him out, so he skipped his AM therapies.

He ate lunch in bed and then just before he's supposed to get up and go back down to therapy he says, "I have to take a dump." Yes, the docs call him a simpleton, and yes, he's got those earthy quips to prove it. After about half and hour waiting for the farts to become feces, I convinced him to give up until his bowel program in the evening.

Again, I hoisted him out of bed and into the wheelchair, got him all situated and escorted him down to therapy (the docs want to make sure he actually goes). He goes and hangs out with the rest of the guys and all was well.

I would have put him back in bed, but one of the nurse assistants told him the store was going to be open until 5PM tonight. He got his money and was off to do some Christmas shopping. I made sure he was ready and wished him well.

Finally, I finished up my med wagon paperwork. It is always so much fun. I save some of the work until the end so I can get things squared away when things aren't so crazy. I finished everything and walked out of work to a stiff breeze and light snow. Things should be interesting tomorrow. I just hope I don't freeze my toes in the snow!

More later...

My life and nuggets for December 15

Hello all! I survived the weekend and all the assorted festivities for my birthday. Turning over a speed limit birthday recently on the odometer wasn't as bad as I thought it would be.

Bubba is alive and well and still coughing here and there, but not as much. School was closed today due to weather. With the forecast for the coming week, we'll see how it goes. Dahey is working outside right now and I don't think he was too upset about stopping due to the cold and ice. Thank goodness the heat works on our unit (some places better than others, anyway).

Today, I was passing pills and doing my best to get my patient up to therapy today. I took care of this guy last week, but he stayed in bed. Today, he was motivated. It's amazing how they get that way when the docs tell them they'll be with us until February if they don't get up. We even practiced transfers to and from the commode in the middle of the day (just one of the joys of unscheduled bowel routines...when you gotta go, you gotta go.)

Some of my coworkers just look aghast when a patient tells them they have to go. I guess they're just a little too used to a lot of quads and others who can't tell when they have to go and going on their bowel routine (usually in the AM or after dinner). I figure the unexpected is the often the most important part of rehab--teaching people how to live. And yes, Virginia, living involves a lot more than seeing Santa Claus. It involves boring old stuff like moving your derriere to the commode and toileting.

Surprisingly, my patient was duly proud of himself and his transfer efforts. (I needed backup on the way back to the chair, but we did it.) I made sure I told the therapists so they have something to work with in therapy with him, or at least, they'll have a chuckle or two at their next team meeting.

When I wasn't busy today, I spent some time reading my Nursing Practice in Multiple Sclerosis: A Core Curriculum book. I also cleaned up my locker. Now I can actually find things!

Here are a few nuggets I encountered on the internet when I was working.

I read that one of our patient's had a T6 corpectomy with decompression surgery and cages. This page at Augusta Orthopedics in Staunton, VA shows different cages and how they're used in spinal surgery. If you want to know more about cages and spinal surgery, check out this Google book, Complications of Spine Surgery or this Google book, Motion Preservation Surgery.

One physician even has his own blog about spinal surgeries: http://drlloydhey.blogspot.com/. Another group of medical professionals has a site devoted to spinal issues here: http://www.spine-health.com/.

Finally, if that's not enough spinal issues, check out http://www.spine.org/Pages/Default.aspx for more information on NASS, the North American Spine Society.

And when I wasn't finding stuff on the spine, here's the latest NY Times article about the effectiveness of colonoscopies. We have a lot of patients visiting us for these procedures lately.

Did you know...living with your in-laws can stress you out? It was a very big deal in this Japanese study.

More goodies to come...stay tuned.

Customer service?

I really enjoyed Kim's recent post on the patient/client dilemma. Yes, the business world creeps into every little area, including your friendly, neighborhood hospital, and hospitals run by Uncle Sam, like Madison.

So, since I'm nosy (and a former employee in this business sector), I looked around to see what everyone's been talking about for medical and/or hospital-oriented customer service and here's what I found.

First, I went to Google and did a few arbitrary searches and the results are listed below:

• 17,900,000 for hospitals+customer service
• 12,000,000 for hospitals+bad experience
• 18,200,000 for healthcare+customer service
• 453,000 for healthcare+bad experience
• 463,000 for doctor's office+customer service
• 422,000 for doctor's office+bad experience
• As you can see, this is a pretty popular topic.

Next, I went sifting through some of the results. Not surprisingly, some of the searches revealed more articles linked to bad experience than those linked to customer service.

So what was really interesting about these searches? Many are advertisements for training clerical staff. From one newspaper site, Boston area hospitals employed secret shoppers to check on staff on phones and in doctors' offices. Most likely, they are using secret shoppers based on this article from Houston that shows the bottom line for many hospitals is coming down to customer service. If you aren't nice to people in certain areas of the hospital, they won't come back and spend money on their outpatient services.

Finally, the most interesting thing I came across was this article called "What can we learn from Mickey Mouse" which talks about the book "If Disney Ran Your Hospital" by Fred Lee. This article was interesting because even though it is three years old, people are finding it and still commenting on it.

Here are some of the best comments, including one from the author. I think the last one reiterates what I think and what Kim mentions in a nice, little package.

Comment from: Jane RN, MS [Visitor]
Disney does customer service like nobody else, having experienced it myself in '04. Our comfort was their priority. Nothing seemed beyond consideration, and each employee made us feel welcome. "Disney Hospital" patients would feel safe, appreciated, respected, and more at ease. They would rest better, eat better, heal faster, perhaps even leave sooner. How much better things would be if we truly treated them as our guests rather than as interruptions, or a room number needing meds. I've seen it too often. Are we too proud to provide this level of service?

Comment from: Lisa [Visitor] · http://www.hospitalimpact.org
People do not need a book or a Disney staff to teach customer care, what they need is to look at how they'd like to be treated, "do onto others as you would yourself."

Comment from: Fred Lee [Visitor]
Maybe the best way of saying it is – a hospital without compassion is like Disney without fun.

Comment from: 20 yr. RN - (Familiar with butts and stressed family) [Visitor] (NOTE: this is a comment in regard to a person, most likely a nurse (but not identified as such) talking about dealing with butts and obnoxious patients)
It's not about you and what you have to deal with. It is about compassion for others and what they are having to deal with, having a heartfelt desire to provide the best, "CARE," possible to meet their, and yes, their family members needs. It's about having patients/clients and their families leave the hospital knowing their needs where met in an exceptionally professional and caring manner whether the client leaves the hospital by car or by hearse. The intent is not to create an amusement park in a hospital. It is about being patient/client centered in ones thinking rather than being task centered.

New Change of Shift today

Check it out here! Also, if you like the cool Change of Shift gizmo on the right sidebar of this blog, go to www.blogcarnival.com and get this very same widget for your blog.

Out sick

Not me, but Bubba. The childcare searches were futile early this morning, so I got the pleasure of calling in today.

Meanwhile, Bubba is lying on the couch watching cartoons on PBS and snoozing in between. At least, he's a cooperative patient so far!

More later...

Pick and choose

That pretty much describes my day, or at least the attitude of most of my patients. Two out of three could get up and go in their wheelchairs and both of them opted out. One didn't get ready until just before lunch appeared on the unit.

The tasks of the day weren't terrible--Foley replacement, WoundVAC dressing and managing ileostomies and colostomies. The Slug did get on my nerves a couple of times, but I managed to hide my irritation, since that would just be something she'd enjoy.

Education showed up and we had an impromptu in-service on flushing and drawing blood from central lines. I learned that our facility actually marks the lumens proximal and distal on our central lines. We don't have too many in rehab, since we mostly have folks with PICC lines.

I helped a couple of other nurses on the unit get their people up and out of bed. I try to do this with at least one person a day because I never know when I'll need help doing the same thing. Since none of my people got up, I just rounded and turned people. One of the other nurses, A., set up two of my patients for lunch, so that worked well for me. I fed Mr. I'm going home next week. He's happy to know he's getting out before Christmas.

Two patients left today and none were admitted, so it was relatively peaceful. One patient got to be bed bingoed to another room since he tested positive for MRSA in the nares. It worked out okay since Mr. W. was being discharged and his room, right across the hall, was a MRSA isolation room. Mr. Hogg (not his real name) in the Clinitron didn't mind at all, since he'll have a new roomie who likes to stay up late at night just like he does. I like Mr. Hogg. He's funny and is another artist on our unit. He draws cartoons that are downright hysterical, particularly of staff and the occasional nursing student. One of the characters he drew recently had a cleft chin that reminded me of Hank from the Family Guy.

I finished my paperwork and got to check out some of our VIP patient's photos from his ceremony last week. They were really good and the organizers even had a book made to commemorate the occasion. I'm sure he'll never forget it!

After that, it was time to get my coat and go home. More tomorrow.

The weather outside is frightful...

No fire here, but at least I got a few things done today on my day off. More to come...stay tuned. It's back to the old grind tomorrow.

Everybody's got one...

My dad, who was prone to colorful language for some reason or another, used to have a saying, "Opinions are like a*&holes, everybody's got one." I'm realizing as a rehab nurse that it's not just opinions that everyone has...it's the nosy patient.

You know him/her if you're in a situation where you care for patients for a longer term than your regular acute hospital stay. He/she's the patient who's always wanting to know the "dirt" on the unit and will ask everybody stuff about everyone else.

This patient, if mobile, likes to hang out where the nurses congregate, especially at the nurses' station. Said patient will listen to your every word and then repeat it all over the place. This same patient will also look at your computer screen and printouts whenever he/she gets the chance. Last night, our guy--let's call him Nosy-- was watching everything. He was watching me write notes (I spent a lot of time minimizing my screen) and on my break, he kept trying to read my e-mail. What joy!

So how do you deal with this kind of patient? Our guy Nosy isn't really mean, but he is extremely bored. First, get him something to do. If he's busy, he's not going to have time to talk to you. Our Nosy likes to visit other patients in their rooms and talk, so we let him do it, if the patients agree and it doesn't interfere with any other regularly scheduled business. Nosy always wants to know why people are with us, so we tell Nosy, "Ask him/her. If they want to tell you, they'll tell you." This is one instance where I like HIPAA...it can be used to keep the nosy patients out of your hair sometimes.

Second, if keeping him busy isn't enough, tell Nosy the truth. Here's what we do a lot: "Nosy, I think you're great, but I have work to do here with Nurse X. We have to talk about our work and we can't share that with you. If you go and come back in about xx minutes, we'll be happy to chat with you later."

Finally, if that doesn't work, take your chat with Nurse X elsewhere. We have a staff lounge that is off-limits to patients, so when all else fails, we have to go there. Excuse yourself and disappear.

New sheriff

We're getting a new boss...if he passes the screening.

Nuggets for December 6

Happy St. Nicholas Day to all! It's been a busy week at Hotel Madison, but it's been fun.

Evenings is always a blast of a shift to come back to if only for the havoc we sometimes have with staff. (One was a no-call no-show last night.) Patients are generally good, unless of course, they're busy sundowning. Last night was decent enough, so I am happy for little things. Our shift missed the annual holiday party that our manager has, so said manager sent pizza.

In addition to all of the early in the shift hubbub, we had a TV crew show up to talk to one of our patients. Nothing like having hospital PR staff, the nursing staff and TV people on your floor roaming around just before the craziness of dinner time.

Here are a few of the interesting topics I've encountered recently.

One of my patients I noticed was taking Demeclocycline. I thought it was an odd antibiotic to use until I read this article about SIADH.

Last night, our charge nurse and I were talking about one of our patients who has a tenodesis splint and one who needs one. Another option for this problem: one of our docs talked to a patient this week about getting tenodesis surgery to improve his pincer grip.

Finally, I saw a drug I haven't seen in a long time at our place...good old hydralyzine show up for one of our new patients on the floor. This patient was a character. He looked exactly like a famous criminal and when I checked him to give him the hydralyzine and told him what it was, he denied hypertension. (Surprise, surprise.) He's with us only for a short visit, so he'll easily be home by Christmas.

More later...

Out of order

Everything functioned pretty well today, but the order of our day was a little off with all the excitement.

One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)

I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.

At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.

My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.

He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.

One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!

Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.

One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.

I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...

Nuggets for December 2

Here are a few things that have been topics of conversation on our unit and the things I've discovered about them on the internet. Enjoy!

Can you smell cancer?
This was one of the questions recently that folks were talking about since one of our nurses (actually a couple) has worked in oncology.

"So and so (fill in patient name here) is a real pain"
This patient-focused article from the University of Washington talks about the different types of pain in spinal cord injury (SCI) patients.

Stress and the holidays (an oldie but goodie)
It's not just the patients, but the nurses, too, get a little stressed out this time of year.

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...

The long and winding road

Do you ever wonder how in the world you ended up where you are now? I do all the time.

I know there are a lot of folks out there in this worsening economy who say, "I need a job that lasts like a healthcare one." For them, I'd like to pass along a few things about my experience.

First of all, yes, healthcare is indeed a necessity. Unlike sales or marketing or computers, everyone needs to have access to a doctor and/or hospital. With that access comes access to a variety of other assorted healthcare professionals, namely nurses.

Nurses are in a lot of places from schools to hospitals to local, state and federal health agencies. Nurses do lots and lots of paperwork in addition to doing patient assessment, administering drugs, general patient care and patient education.

Second, before you go jumping into the nursing school pool, be prepared to wait. Some nursing schools have waiting lists of two or more years. Do your homework!

One of the best books I've encountered that discusses many of the nursing specialties out there is Opportunities to Care: The Pfizer Guide to Careers in Nursing. It has a general overview of issues in nursing and a general overview of the role of nurse in the healthcare setting, as well as career planning and words of wisdom. The most valuable part is that it has lots of little vignettes that describe different specialties. (Shameless plug: you can find the rehabilitation nursing story on page 132 in Chapter 27.)

Third, I'd be remiss if I didn't mention something that LaTonia Denise Wright is always talking about in her blog, My 2 cents. Please, please, please consult a lawyer if you have any legal issues in your past. You might go out and get a degree in nursing, but no school on earth will guarantee that your state will license you if you have certain convictions, which is why you need to get an attorney who knows what will and will not work in your state before you start. Your state Board of Nursing is out to protect the public, not your investment in nursing school.

Finally, if visiting hospitals, talking to people and checking out the nursing program of your choice and its statistics and everything else I've mentioned above hasn't scared you away, and you've got all your prereqs in order, dive in. It's an experience you'll never forget.

The welcome mat's always out...

Many thanks to all of the Change of Shift folks stopping by lately. I really appreciate your visits.

Come over anytime and visit some of the other folks noted on the sidebar to the right. DisappearingJohn and Dr. Wes have sent me a whole bunch of folks in the last couple of days, so if you haven't visited them already, go click on their links and visit.

More goodies later...gotta run!

Rest after Thanksgiving...or TGIF

After a day and a half where I got to play the roles of wife, mother, cook and galley slave, I was happy, happy, happy to go back to work where the only dishes I saw belonged to patients and I did not have to wash them. Hooray!

I got one of the same patients (a/k/a Mr. Easy--he gave himself that name) and one I haven't taken care of in a while, Mr. I'm Going Home in a Week (if my family actually comes for training). He's a sweet old man and as usual, he's getting anxious about leaving the hotel. Who wants to leave after a year plus of 24/7 staffing to scratch your nose when you'll have to go with your family who won't like it when you ring for them 20 times in two hours? No one really does.

Overall, Mr. IGHIW was in a reasonably good mood with only a couple of bouts of anxiety. I got him in his chair and out of his room for about two hours, so that worked for him. He was tired when he got back.

Mr. Easy ate too much yesterday so he vegged all day in bed, even when his wife came. He ate a little lunch and just slept all day. No fuss, no muss.

I got to do some paperwork and talk to our big boss about getting my certifications next year. I'm still working out the details, but I know for sure I will get at least one, depending on what the official regulations are. Both are attractive, since we get a bonus and pay grade advancements for getting them, but if there are technicalities, I want to know about those ahead of time.

Now, the weekend is here, so now I get to pay the bills and go on about my other fun weekend duties.

More later. Enjoy your weekend, wherever you are!

Change of Shift: November 27, 2008 Volume Three - Number Eleven

Welcome to the November 27, 2008 edition of Change of Shift. Many, many thanks to Kim from Emergiblog for letting me host this edition. Look around and if you like what you see, feel free to come on back!

Happy Thanksgiving to all of our US readers. As you're working on your unit or basting the turkey like me, have a look at all the submissions for this edition. You won't be disappointed by our cornucopia of submissions.

General

Nancy Miller presents Here’s to a Long and Healthy Life! posted at Photography Colleges.

Alvaro Fernandez presents Brain Fitness 2: Sight & Sound, at PBS posted at SharpBrains, saying, "PBS just announced the second installment of their popular Brain Fitness Program show: "Join host Peter Coyote in "Brain Fitness 2: Sight & Sound," the follow-up to "The Brain Fitness Program," as he explores the brain's ability to change and grow, even as we age, helping us maintain and improve our vision and hearing.""

Erika Collin presents 50 Awesome Video Games for Physical Therapy and Rehab posted at U.S. PharmD. Since I'm a rehab Wii-kind of gal, check it out! There's nothing like getting that problem patient boxing away to warm up those muscles!

While muscle strains and pulled ligaments are not very serious injuries, they can be extremely painful. With this in mind, Dean Moyer of The Back Pain Blog shares some thoughts on Neck Pain Relief That's Quick and Easy. Dean, we need you on my unit!

Nurses

Hueina Su presents Best of Both Worlds posted at Intensive Care for the Nurturer's Soul.
and Rx for Balance: Keynote at Northeast Regional Oncology Nursing (NERON) Conference posted at Intensive Care for the Nurturer's Soul.

Kathy Quan presents The Nursing Site Blog: Share Your Ideas with Nurses in Congress posted at The Nursing Site Blog, saying, "Health care and the nursing shortage are on the top hot topics for the next administration and Congress to discuss. Nurses can begin to get comfortable "talking" to legislators who speak the same language. There are 3 nurses in Congress this term. Let's start sharing ideas."

DisappearingJohn presents Dealing with a decision made... posted at DisappearingJohn RN, saying, "A new and exciting job awaits me" Good luck John!

Jeff Long presents Travel nursing pay day. How important is it for you? posted at Travel Nursing Blog.

Nurse Laura, Oncology RN from NurseConnect.com blogs about Rapid Response Team to the Rescue! Nurse Kathy, Clinical Manager, RN from NurseConnect.com blogs about "Self Talk."

MojitoGirl at Sunburned Paradise gives us a close up view of Key West roosters in a post you have to read to believe. Ay carumba, mi amiga! Oy!

NurseExec has some great insight for all of the nursing students out there who want an RN to tell them how it is. Check out her On Nursing post for her first-person account.

Strong One presents Act the Part and You Will Become the Part posted at My Strong Medicine.

Nursing students

Sarah Scrafford presents Forget Facebook: 50 Social Sites for the Serious Student and Job Seeker posted at Career Overview.

MachoNurse describes his first week in clinical in Week One post.

That concludes this edition. Thanks for stopping by RehabRN. Come back anytime!

Submit your blog article to the next edition of change of shift using our carnival submission form or check out Nurses Notes, the next host site.

Past posts and future hosts can be found on our blog carnival index page.

Thankful

Although my co-workers and I kvetch, whine and moan about the least little things, today, I have put aside the slights of some of them and I am thankful. We stopped b(^t$%ing about the people we can't change.



I am most thankful that I work at the Hotel Madison. Many of my classmates this holiday season have to take low census (from their vacation if they want to get paid) or get docked because their hospitals need to save a buck. Thank you Uncle Sam for that no low census thing! I can use my vacation for what it was intended...actual vacation...when I want it!



I am thankful I woke up today. It sure beats pushing up daisies as I told K., one of my coworkers. It's been a little depressing seeing some of my old patients in the obituary section of the newspaper lately, but I'm getting used to it, not numb necessarily, but more aware.


Today was a pleasant day. One patient went home to see his family for the weekend and the other was very laid-back and relaxed. No admissions and no time stress today.

I'm off tomorrow, so check out Change of Shift. Back to prepping for Thanksgiving dinner! Stay tuned...

What happened?

I wonder this often when I work and when I see things such as....

...the urine bags that are always full.
On our unit, everyone is assigned patients, including the nursing assistants. In many places in our grand state, those assistants could be delegated to by folks such as the LPNs and RNs. Our assistants regularly refuse delegation, and often neglect their own tasks, such as this, that seem too "demeaning" or "boring". Or my personal favorite...they'll only do the task for you if they "like" the patient.

One of my patients was assigned to the escapist assistant I mentioned before in this blog. Again, his Foley bag was getting ready to explode. If only the boss paid attention...maybe I can ask Santa for that for Christmas.

...a new patient assessment that is not done at 2345.
This patient arrived around 1130AM and said nurse supposedly did all his documentation. It's not unusual for some of the paperwork to be floating around on people who arrive at 1500 or later, because our daytime people leave not long after that, so we on evenings, finish up whatever they don't do. This nurse didn't do much. We had two lowly notes for the patient: one the H & P from the admitting doc and the generic "patient arrived at xx time" one for the admitting nurse. Not a nice surprise!

...that someone who refused a shot got one.
This is what one of our elderly patients told C. tonight that the med nurse (same as the admitting one mentioned above) gave him a vaccination that he did not want. I guess she missed that class on assault and battery in nursing school.

My trainwreck came back from dialysis in a happy mood. He barely rung his call light all night.

Off I go for off-day errands...back later!

Happy Monday!

Reasons I'm happy:

1. It's my last evening shift this week...today! Hopefully, when I get back later in the week, I'll get some new people. I've had a doozy this week, but it's not his fault. When you're a trainwreck, you're gonna have issues.

Thank goodness for therapeutic communication (and some very understanding coworkers) or I'd have jumped out the lunch room window by now.

2. My turkey is thawing. I'll be cooking for my family Thursday, which means Wednesday night will be a late one prepping, chopping and baking some stuff.

3. I am feeling good. So many people I work with are getting colds, etc., and feeling crappy. I went back to sleep this morning and I feel much better. It's amazing how sleeping works!

4. I'll be hosting CoS (Change of Shift) also on Thanksgiving. Another reason to stay up late on Wednesday.

5. Finally, if you're feeling ambushed, check out Jo's latest post at Head Nurse. It made me laugh so hard. My, how people infer things from these blogs!

More later, stay tuned and stay well!

Nuggets for November 22

I should be thankful that things are not worse, but it's been busy at work lately. Fall is turning to winter and that means we're heading into pneumonia season. We've got a couple of cases all ready. Lots and lots of coughing going on! Chest PT for everyone!

Now for something completely different....here are a few tidbits of interest I've run across in the blogs this week.

This penis reconstruction story makes me think of Fournier's gangrene again. (from Highly Trained Monkey)

What's wrong with nursing (from My 2 Cents)
One of these days...

Sometimes the best therapy is a long-drawn out rant (from Spook RN)

An ingenious Christmas gift you gotta see (I found this thanks to ER RN)

Thinking of going back to school? Some of those professors will be talking about YOU if you aren't very nice...I really loved the "who's the geekiest" post recently.

Field trip!

Bubba is on one today at school, and if I had time to hang out, I'd take this to my nearest Wal-Mart just for fun. Many thanks to mylife1060 at Hell on White Clogs for this little gem. Enjoy!

The holidays are coming...

And, as usual, I never feel like I'm ready! I've been busy shopping for Thanksgiving dinner and cleaning out cabinets and freezers. After that, I'll get to clean some more in between working.

On top of it this year, I'll be fluffing and buffing around here as I get ready to host the Thanksgiving edition of Change of Shift. The submissions are trickling in, so if you're so inclined, get going on yours and send it in!

You know it's the holidays on our unit because food is appearing everywhere. It's tough to be a nurse or hospital employee when wherever you look (in only JCAHO-approved places, of course) there's food--candy, cookies, you name it. A few people have dropped hints to families that no nurse can deny a good piece of chocolate. I'll second that, thank you. Bring it on! I'll just have to do a few more laps around the Hotel to burn off that candy!

More later! Send those posts in...I'll be waiting!

It's that time again...

for Change of Shift, and crzegrl and Zippy are hosting there, so head on over.

As I mentioned before, RehabRN (that's me...pinching self) will be hosting the Thanksgiving version of CoS, so submit away!

Happy Friday all! More goodies to come...

New favorite on the floor?

I've been shopping and I found these new comfy shoes...heaven! Guess I need more socks!

Nuggets for November 12

Here are a few of the latest posts of interest I've encountered from the blogosphere.

Nurse William enlightens the masses on the duties of the triage nurse in the ER. Don't miss it!
http://nursewilliam.blogspot.com/2008/11/er-stuff-you-need-to-know-part-1-triage.html

The MERCI project helps recycle medical supplies that might be thrown away to help developing countries.
http://nurseattorney.blogspot.com/2008/10/merci-project.html

Dust in the wind tells us what it's like to go from nurse to triage patient
http://dustitwind.blogspot.com/2008/10/waiting-room-watching.html

Being on call from donorcycle
http://donorcycle.blogspot.com/2008/10/its-still-exciting-to-be-on-call.html

In case you missed it like I did, Nurse Ratched was featured last week in Colin Son's Medscape article in the Pre-Rounds section. Even though, the election is over, go read it.

Move it continued...

Since I'm cleaning the house for the move, I've also decided to get some work done on this blog. There are some amazing people out there who help bloggers out there and I've sought them out (you know who you are!). I've got a lot of ideas and I'm pretty excited.

Please pardon the mess while you're here, but everything will look pretty when it's all done!

I like to move it, move it...

And we'll be doing a bunch more of that at our house soon, both literally and figuratively.

There's always plusses and minuses to moving, but I'll be glad to do it, since Dahey's heading to a new assignment. I love the current Hotel Madison, but they all understand. My shopping buddy, A., will miss me, but now she says, she'll have another place out of town to hang out. My boss and other folks were sad, too, but understanding.

As a result, I'm going to have to figure out which way RehabRN the blog will go. I'm working on some stuff for that, too. I met a lot of neat people at the conference. It was such fun.

More later...

For the soldier...

...the sailor, the airman,
the officer,
the XO,
the COB,
the submariner,
the SEAL,
the parachutist,
the Green Beret,
the lowly KP potato peeler,
today we honor you all.

For the young men and women in the prime of life,
for the husbands, fathers, brothers,
wives, sisters and friends.
And the aunts, the uncles, the cousins.

For the combat nurses, the docs and the corpsmen in the field.

For the young and the old,
Injured and healthy,
Strong and frail.

For the wounded,
I am proud to be your nurse,
To just listen,
Or tell your story.

For the fallen,
Who left everything to fight--
Families, fortunes and friends,
And never returned.
You, truly, gave all.

May we remember, not just today, but every day.
That freedom has a price;
Paid in blood, sweat and tears,
In toil and tribulation,
On battlefields of the past, present and future.

Thank you veterans, one and all.

Wild and fun

The wild part:

In the middle of the day, I let our dog out on the front porch. He likes to bark at everything, but I noticed he had an unusual bark at something today. I looked out and a very large red fox was running around in the yard across the street. In our neck of the woods, it's not an uncommon site in the early morning hours, but at mid-morning, it was strange. WildDog decided to come inside, since I would not let him run over and chase the red fox across our street.

The fun part:

Work has actually been pretty pleasant. We are experiencing low census right now and most of the folks are in good moods. Things are getting along swimmingly. I somehow (holding breath) am not working Thanksgiving Day.

I can't wait to get up and bake away. I really love the cooking part of Thanksgiving. This year, I'm also very, very honored to be hosting Change of Shift right here at RehabRN on November 27.

For more information, check out Kim's page on CoS at http://www.emergiblog.com/.

Finally, a major Happy Birthday shout-out to my bro-in-law the major and professor. I hope you enjoy your blast from the past we sent!

The roles of the rehab nurse

This is a series of occasional articles geared toward new nurses entering rehab. If you've been around the nursing world for ages and you have some comments, feel free to throw them out there.

Recently, I attended a conference about multiple sclerosis and one of the presenters talked about how important the roles of a rehab nurse is to patients and the vaunted interdisciplinary team. Here are a few roles you play that may not have been so obvious.

1. Scheduler
Rehab nurses get schedules thrown at them by PT, OT and whomever else can think of something for them to do. We get to coordinate how people get from A to B and sometimes, we even get to say, "No way. You're not taking my people." Knowing how to work the schedule is a very important thing, for your sanity and the sanity of your patients and the rest of the rehab team.

2. Cheerleader
Rehab nurses cheer on patients, to be adherent to medication regimes ("That sounds nicer that 'compliant' "--actual quote by a presenter), to get out of bed and do therapy, and also to look at the sunnier side of life. Yes, some days suck, but you just have to deal with whatever gets in your way and motivate your people. I do not use pompoms, although, I have been known to use Diet Pepsi (or patient's drink of choice) as a motivator. Sometimes, as they say, you gotta fake it 'til you make it.

3. Marketer
Yes, this plays into the previous role of cheerleader. I have to "sell the program" as I always tell people. The program is, you will get out of bed, you will get your life going and you will have a routine. You can be sick and tired, but you have to at least try. Sometimes the best sales pitch is the one where the patient derives it from himself.

4. Therapist
Sometimes, all you may do is to listen therapeutically. You don't get the alphabet soup after your name like those therapists, but you get an earful. Think about how you can use that rant, rave or entreaty to help that patient. If you need help, ask for it, from your charge nurse, manager or your psychology staff. I couldn't live without ours.

Whirlwind trip is over

After way too much fun and excitement on United Airlines last night, I finally made it home. Since there was no coffee on the plane, I drank some Coke and was awake enough to get home in one piece without falling asleep. It was tempting but I just don't sleep well on planes.

I enjoyed the seminar with my partner-in-crime, A. We got a lot of shopping and walking done in between sessions and it was fun. I met a lot of interesting people and the organizers plan on keeping in touch with us, to see how we're doing. Since we all work for the same place, I'm not surprised that they're doing this....it'll probably end up as a research project or something!

Today so far has been busy, and tomorrow I'll be back to work after a week away. I'm as ready as I'm going to get right now. Back to housework...stay tuned.

Conference all day

Well, it's looking pretty official out here in the Emerald City...my package is on its way home, filled with smoked salmon, salted caramels and souvenirs for family and pens and all sorts of freebies to take to work.

I got lots and lots of pens and stuff. They had all sorts of medication branded stuff--even blue liquid soap. (I passed on that, since that doesn't ship well, nor would it pass the TSA 3-1-1 rule.) A, my cohort, packed her own box, then E, one of the other RNs from Texas who we met, came along with us shopping and then to the Post Office, so we could ship the goodies.

Tomorrow, we go to another class and to a tour of the local unit. Stay tuned!

Sleepless in Seattle

I'm busy messing with the wifi in the room on my Palm with keyboard.

So far, so good.

I voted already, have you? If you haven't, go vote!

More later from the Emerald City...

Test post from Palm

This is a test. This is only a test

Whew! Another week over!

It was busy going from evenings to days. Thankfully, when it got really hairy, I was not working evenings.

One nurse was off this week, since a family member recently passed away and she headed out of town for the memorial services. One night in particular was crazy without her. I heard about it on Friday. I'm glad I was not working evenings. I would have just gone crazy!

My time back on the day shift was not bad, just busy. I got to pass meds a couple of days, then just take care of people on Friday. That was lovely, even though I felt like all I did was draw labs and run back and forth. For some reason, labs pulled from PICC lines on our unit always get screwed up. I don't mean sometimes, but most of the time. We get screwy results from the PICC, so then the doc orders a redraw from a vein, which usually drives the patients crazy. I had to do this with one of my patients. He was getting persnickety, so I tried an easy vein, but it didn't work, so I had to use one in the hand for his blood draw. While I'm not the best IV sticker, I can get blood out of hands and arms pretty good. I also like to think that I keep people from getting all bruised up, too, which I normally do. This draw, happily, went as usual.

The same patient needed a Vancomycin trough, so I drew that from the PICC. He was not going to let me get it any other way. I looked up the protocol and followed it to the letter, so I knew
I would not mess it up! I did a lot of fluffing and buffing, so I was happy to be finished.

Today, while I was perusing the paper, I found out one of my favorite patients died. Mr. B., the crazy plumber I took care of at Saintarama died this past week. The obit showed a photo of him that I recognized. It was from a photo with his family that he had in his room. He tried but never succeeded in getting rid of the trach after his illness. I will miss him. He was so funny.

I'm getting up early, early, early Monday morning to drive to the airport. We're taking off to our Pacific Northwest conference. The weather says rain, rain, rain, but at least, we'll be away from Madison. It should be fun. I'm going to have to tinker with mobile Blogger and see how that goes.

Have a great weekend all....more next time!

CoS

Is up at crazymiracle...head on over if you haven't already!

Bed bingo on a crazy Monday

You know you're in for some excitement when you get to work and everyone's all shuffled around. This is known as "bed bingo". Bed bingo happens for a number of reasons, and it's mostly related to isolation status. We had one patient come up positive for a new organism, so as a result, five people got moved around to get rooms ready and everyone in their correct group.

Note: our facility cohorts patients in the same room with the same organism and we only have one (yes, one) private room among our rooms.

I got the same assignment and the med wagon far away again. This can be frazzling, but I dealt with it. The thing that is most frazzling is when one shift forgets to do the things to which they're assigned. Since our boss has been in and out with things, the tasks that normally get done on the floor have gone to the wayside a bit.

The housekeepers are the biggest problem right now. They have had some turnover in the last few months and they can't seem to keep the paper towels in stock in the staff bathrooms, nor can they keep the trash emptied. I've mentioned this to one of the housekeepers who usually sets us up well, but I'm not sure why it's not getting done. A lot of people on the evening shift are getting frazzled, and I'm one of them. I'm not on evenings all the time, but I see things on days and then I go to evenings and it gets annoying. With cold and flu season here, I wish one of the docs would notice and throw a fit, since maybe that might get something done. Running out of paper towels in the bathrooms and patient rooms is not an option!

Besides that, some of our day staff are not even attempting to pull their weight. Unfortunately that saying, "When the cat's away, the mice will play" is very true. I dread working behind some people. You should not immediately have to empty urine bags when you get on your shift, but I have done it every single night on evenings this round. One day, I had to make the patient's bed and get all the linens. This is the job of nursing at the ranch, and the nurse who had this patient couldn't get it done before she left at noon, and the nurse who followed her for four hours had made no attempt, either. Thankfully, I had the bed made...just as the patient was returning with his family from a day pass. I also got lucky and had to empty the bed bag for this guy, too, since this was just one more thing they forgot. I have to say most people are consistent--when they don't do something, they really follow through and miss everything. End of soapbox.

Ahh...that venting felt better....on to more fun stuff. My younger patient is doing more every day. It's really good to work with him. He puts the active in active rehab. He's even paying attention to his diet, which is really important for SCI patients. We talked about his bowel routine protocol and despite the assessment of the docs and the charge nurse, he's probably going to stick to a daily routine.

One of my other patients was really depressed because his blood pressure would not stay up even with his TEDs, binder and Midodrine. We talked about it and hopefully, it can be resolved soon enough.

I'm going to stop here...more later! I'm going to enjoy my off day! (Happy Birthday, Mom!)

Topics of note

Here are a few items I've encountered in my day-to-day practice and some related articles.

Oral care
How many of you out there really know if your patients brush their teeth? For a lot of SCI patients, if the nurses don't do it, patients don't get their teeth brushed. Reuters Health ran an interesting article in the past week about the relationship between oral hygiene and pneumonia. It's not just associated with ventilators anymore, folks.

Devices and other goodies
On our unit, we have lots of people with Baclofen pumps. Baclofen pumps are wonderful things that can get a patient who's in what looks like a permanent fetal position back to the straight and narrow, so he or she can ride in their wheelchair and do lots of other normal things we take for granted.

One of our patients who came in this week has an interesting variant: he has a baclofen/morphine pump that delivers both drugs intrathecally.

Bugs!
A recent patient came in and screened positive for a UTI. The culprit: E coli, which according to Todar's Online Textbook of Bacteriology is responsible for 90% of UTIs. This same patient has a history of odd bugs, including Kocuria Kristinae.

Way out in left field

Since I've been mindlessly meandering on the 'net today, I found this quirky item listed as a Rehab Nursing costume for Halloween. Oh, I really wonder who thought this one up...Hugh Hefner perhaps?

The only thing good about it is that pleather wipes down easily, especially if you get those spraying bowel program kind of folks.

Sleepy Sunday

Try as I might, I just couldn't go back to sleep this morning. It probably has to do with waking up once and the old sleep button just does not re-engage for me....arrgh!

Last night was busy. I had three patients, two of whom were the same as the night before and two of the three were out on pass at dinnertime, which was nice. I also inherited the med wagon up in the front from J. when she left her 12 hour shift at 2000.

It's only one med run (around 2200) so what should be so hard? The answer: a whole lot of needy patients. If it wasn't one thing, it was another. People would not ask for stuff in advance, they all waited until I got to the room. I doubled back and got everything filled reasonably quickly, but I was still pushing pills at 2355, which really sucks. I just figured I get stuff done before the night shift came on to do their turns.

M. the charge was off last night and P. took over. That team has the neediest patient on the floor--Mr. B. He rang the light over and over and over. Poor P. was never out of the room for more than 5 minutes and the light would go on. Mr. B. is typical of many post-ICU patients: he thinks we only have 1-2 patients and are waiting outside his room for him to call. No dice. Most of the time, we have people assigned to us all over the place on the unit and we are trying to get them turned, bowel routines done, fluffed and buffed and ready for bed all at the same time. Hopefully, he'll get a little more relaxed, but so far, it's not happening. We shall see...

My people were pretty good for the most part and I got everything done by midnight. It was pushing it, though. I'm going to work with a few other things tonight, so hopefully, things will go more smoothly.

More later...

Heard on the unit...

Yes, I haven't had an installment of this in a while, so here goes...

"I'm so happy to see your smiling face." Mr. J.

Some people love to see you come back to work. Others...well, they aren't exactly thrilled. Mr. J. is a riot and he's always got a funny perspective on things. I think some of that has to do with his previous job--police detective.

"It really smells down here." Nursing supervisor last night when he was on the unit.
"That's the smell of success." Yours truly (RehabRN)

Yes, it's not really a secret, but to all of you nursing students going to rehab, especially with SCI patients, evening shifts tend to be...shall we say, aromatic. Many patients who do active rehab have bowel programs in the evenings, usually immediately (30-60 minutes) following dinner. The reason? This allows the patients to get the most out of therapy, particularly, in terms of time, since while nurses work 24/7, therapists do not. Most of them work the day shift Monday through Friday and usually they rotate the weekends, where they work a max of four to eight hours, depending on the rules of the unit, etc.

If you smell something, that means we have people with good, working bowels. If they're consistent, this also means that they won't have accidents in between, either and will get the most out of therapy. We start everyone on bowel routines daily, and then after two weeks, they will move to qod (or every other day). Some people do well like that, and if that doesn't work, they stay on a daily schedule.

"I don't know what her (MD's) rationale is, but I'm getting out of here on Monday." Mr. R.

I admitted this guy on Tuesday. Sure he's in for a short trip, but for some reason, we get a lot of patients who get sick once they arrive and then they have to stay with us. Mr. R. is very impatient to leave, which is pretty unusual for most of our patients. We tend to keep people a long time.

Life's a party...

If you're Bubba at our house. It's Halloween party season.

I'm so tired from evenings, but we're departing for the latest seasonal party at my sister's place.

More goodies later...

A rainy Thursday

I'm looking out the window and it's gray and rainy. The wind is also cool, too. Fall is definitely here in our neck of the woods. There is some fall color, but most of the leaves have been blowing away and not really turning too well.

I need to clean my house before my in-laws come over this weekend, and I don't want to do it. The dog looks outside and sees the damp concrete and looks at me as if to say, "You want me to wait out HERE while you vacuum? No way!" This will make things very interesting (since he tends to chase the vacuum cleaner.)

To start today, I got Bubba to school and then I went to get Bubba some stuff and some Halloween makeup. I'm actually planning on wearing a costume this year. I have enough makeup for me, Dahey and Bubba to get made up a couple of times. Rest assured, all of the makeup I bought is water soluble, made in the good ol' US of A, and supposedly hypoallergenic. (We'll test it out and see...) No idea what the boys will be this year. Bubba keeps vacillating back and forth on what he wants to be. We have costumes galore Dahey has collected since the summer and of course, Bubba doesn't want to wear any of them.

After the trip to the store, I got out my carry-on and started packing some of my stuff for the conference coming up in early November. It's in the Pacific Northwest, so I'm expecting more of the cold, rainy stuff. I won't pack everything yet, but it's easier to inventory and get stuff when you have to look at the bag every day. I just throw something in once I think of it, then I reassess when doing the final packing and checking off the list (yes, I have a list for everything I pack). I do this in an effort not to forget the important stuff, like underwear and socks (I have done this several times on trips).

I'm still working on my CRRN review. I really like the Datachem software, since it has a lot of questions and answers (about 750 in the database). If you buy it at www.rehabnurse.org (in the Bookstore section) and you're a ARN member, you get $10 off the list price. I got the Certification Review software, too, and it's a little more flashy, with a lot of sounds and feedback when you answer questions.

Well, since I'm back to work this evening, I'll stop for now and start cleaning. Hopefully, the dog will stay out of trouble! More later...

Nuggets for October 22

Yes, it's my day off and I'm again scouring the blogosphere for some good stuff. I've had a few people send me links to their blogs, so I'm adding those as I can, to share the link love. Check out the sidebar for some from the good ol' USA to Canada and even one from the Czech Republic about a nurse who snaps photos for fun while checking out nature.

In the MIA section
I'm also lamenting the loss of Podunk Memorial. Mielikki, where ever you are, I really enjoyed your blog. I wish you the best!

Terry at Counting Sheep sold www.everydaynurses.com, so I haven't seen anything from her in eons. Good luck Terry!

Here are a few things I found meandering today. Enjoy!

From the ER (ED, or whatever you choose to call it for the moment...)

Braden from 20 out of 10 has a great post on never events. Bayer may be right and the government may indeed be idiots if they buy this renaming thing. Why call it a never event if it can get renamed? Perhaps some funding in the way of adequate equipment and staffing from CMS might help. Naw...that would be too logical.

You can get more than you bargain for if you tagalong on a ER visit. CrassPollination has this great tagalong story you'll enjoy, even if you don't work in the ER.

From transplant city...

Donorcycle is one of my favorite transplant blogs to read. While there haven't been a ton of posts lately, I'd suspect she's busy. Some days are better than others according to this post. I really like the bird imagery, TC!

And finally, in the 'tis the season category...

Awake in Rochester has this great post about ghosts. My answer is yes....maybe not seen but have heard and felt some around me, and it wasn't even scary.

And then there was one...

I started the day with two patients and I ended up with just one, and I'm not even in ICU! Woo hoo!

First, I had to send Mr. R. to a nursing home in a nearby state. It's probably the last time any of us will ever see him. I got his big dressing done and was very careful with it. It was really messy because it was leaking all over the pad he was on when I got to him. Just before that, I had to do a dig stim on him, too, since he didn't get his bowel routine (daily suppository) today. I did this in an attempt to get him cleaned out a little before he left. I cleaned him up, put his theraboots on and a clean gown so he'd be ready to go.

He's not doing well. He was stable, but we don't know how long that will last. He didn't tell us today, but I know he knows he's going home to die. I think it was bittersweet for him and A. was upset that she forgot to say goodbye since she was busy with another patient. I packed all his stuff carefully, put his AM snack in with his lunch and made sure the paramedics knew where everything was. He should see his family today, or so he told me. I hope it all works out for them. We know we did a decent job because he told us he'll miss us. I pray for my patients and he'll be one of the ones on my list. I'll never forget him.

Once I got all Mr. R's paperwork done, Mr. HIJ #1 was my patient for the rest of the day. He was needy as usual, but I got his bath done, his dressing and then I hooked up his IV. He wanted a soda, since none of the volunteers came around today with any, so I went downstairs and bought him one. I even caved in and bought myself one while I was at the machine.

Our boss was gone today, so most of the staff scattered from the nurses' station for most of the day. The slackers, including the Slug, never came near the nurses' station, because you might end up doing some work if you hang out there. I don't care. I'd rather do work than spend my whole day hiding just so I can do nothing. Our charge, P., was busy ordering blood and going with the docs on wound rounds this morning. Thankfully, we don't have tons of people to be inspected, so this went quickly.

I ate my lunch in peace around 1130 before the trays came and I set Mr. HIJ up when his lunch arrived. A the NP and I planned our itinerary for our conference in November. It should be fun. We're on the same flight and we plan on getting some sightseeing done near our hotel before the conference starts. We'll have to start out from here really, really, early, but I think it will work out well.

By the afternoon, I even remembered the other stuff I had forgotten earlier, so Mr. HIJ was happy. He was feeling hot (but afebrile) by the end of the day, so I got him all situated with his fan and everything in his room and he got very comfortable and fell asleep. After that, I finished off as many orders in the computer as possible and then I went on my way home.

Back tomorrow...we'll see how many admissions we really get (supposed to be five!).

Nuggets for October 20

Here are a few of the interesting items I've found lately. Enjoy!

Think pushing someone in a wheelchair is hard? Imagine running a half marathon with your favorite patient? This nurse in Michigan will be running with hers and he wants to win! (from the Detroit Free Press)

There's a new type of bariatric surgery out there--TOGA--which eliminates all of those incisions. (from www.nytimes.com)

Is this opening a Pandora's box? The DNA Age-Taking a Peek at the Experts' Genetic Secrets (from www.nytimes.com) may not be for these folks who have lots of resources, but it could be for you.

And now for something completely different....

If you missed it, check out the Palin rap sketch from SNL this weekend. It's not Tina Fey, but it's funny.

Loss, greaving and removal

There's been a lot of all these things going on lately in my life. Last week seemed like funeral central between the funerals, wakes, and news of people we know (or know their families) dying.

On the removal topic, my one patient of the day Friday got his halo removed. It was not a painless procedure, either. I had to go with him to Washington to see the neurologist. It involved unscrewing some pretty deeply seated screws and my (and his family's) attempts at diversion weren't always the best. I premedicated him for the trip, but by the time we got to the removal, he could have used another PRN dose of morphine.

We found out from the neurologist that the halo and its rods were actually made from carbon fiber. The patient's family took one of the rods (and one screw--the clean one) home as a souvenir. He didn't want anything else--just to get rid of it. As a replacement, he got a Miami J collar and he has to get used to that. I washed his hair once we got back, cleaned the pin sites and he ate some lunch. He can shower on Monday, which he's really looking forward to doing. On a related note, I found this great post from a woman who described her own halo removal happiness in an ABC format. I'm thinking about passing it along to him.

The actual procedure and x-rays didn't take very long, but the whole trip to Washington and back surely did. I was happy to get back at about 1300, so I could finally sit down. I charted and straightened up his room, and before I knew it, it was time to go home.

I'm off this weekend, so more goodies next week. Stay tuned.

A pretty good day

I was lucky enough to have my three same patients back and my day was reasonably easy. The Slug was coordinating our Boss's Day festivities, so it was pretty haphazard as I expected, and she disappeared for not just one plus hour, but two and a half hours. Heaven forbid you actually do this stuff on your OWN time!

I got Mr. B. ready and he kept having orthostatic hypertension. He'd get set up in his chair and in an upright driving position and his BP would just plummet. I had no choice but to contact the NP. He kept dropping in spite of his TED hose, abdominal binder and his 5 mgs of Midodrine. I got an order for another 5 mgs of Midodrine at lunch time and he did well, but he got woozy again on me late in the afternoon as I was leaving. I passed this on to the evening shift. Tomorrow, I get to go with Mr. B. up to Washington to see the neurosurgeon. They will do some flexion-extension x-rays to determine if he can get his halo removed.

The other Mr. B. got back from his trip to Washington without a hitch. The GI docs found a cancerous polyp on his last colonoscopy and were looking for the area where it was removed today. They searched his entire colon and could not find it, even though he had a tattoed polypectomy last time.

Mr. W., my other patient, a para who did all of his own care left today. He was very nice and was very happy that his colonoscopy didn't show anything bad at all. I put in his discharge notes and wished him well.

The afternoon went reasonably well. I got my hotel confirmed for the conference I'm attending in November. I'm still getting the flight situated. I missed two Accuchecks at lunch time because two of the diabetic patients escaped to the free lunch one of the veteran's organizations has each month. I managed to get all the Accuchecks done before anyone ate anything else and I escaped at 1600. Fall is definitely here in our neck of the woods. It was blue skies and sunny, but the wind was cool and crisp.

More later...

Back to days

I got the pleasure of no med cart today with my patients. Hooray! I always feel trapped every time I have to drive that thing.

I had two colonoscopy patients (one got his today, other gets his tomorrow) and Mr. B., who I took care of over the weekend. It was relatively placid. I got Mr. B. up in his chair by 1030. He had one big request, "Don't scrub me today. I feel like my skin is falling off." Ah, yes, we do offer spa services at Madison--the VA has a laundry contractor who doesn't use fabric softener, so we have really hard washcloths and towels. I try to pat carefully, so people don't feel like they're getting their skin rubbed off. I also use lotion, which for some strange reason, many of our employees will not use.

Mr. B #2 was getting his second gallon of GoLytely today at noon. He's scheduled for a colonoscopy tomorrow, so you can guess what I was doing all afternoon--cleaning. He'd turn and he'd be dirty. Turn him again to get it out from under him, and more came out in spurts. He is a very nice man, so I made sure to keep him clean. He just couldn't keep his external catheter on, and he used about four this morning. He ran out of his own, so I had to get him a couple of ours. Hopefully, they lasted until C. got back there this afternoon. I left her with a hamper, bags and a large supply of towels, pads and washcloths, just so she could deal with the outflow.

I was really, really happy to hit the road today. More tomorrow...

Dumb, de dumb, dum...

That was a lot of my night last night. Dumb, crazy stuff happening. Can I just blame it on the upcoming full moon? Nope, probably has something to do with the fact that I was just tired with a capital T last night and required several caffeine infusions to get rolling.

Here's a list of some of the dumb things that happened on my last spate of evenings.

1. While I was driving the med cart one night, I noticed that one of my patients had an order for Mupirocin to his nose. The order wasn't really specific in the med software, so I had to open the charting software to see what was happening.

From the MD's note, the Mupirocin is being used for MRSA prophylaxis. When I went to administer this to the patient, I explained the procedure I was going to use (put it on a swab and swab inside his nose). The patient then proceeds to tell me that the other nurses put the Mupirocin ON the outside of his nose.

This is just more evidence of why we need more in-services on how to do the cultures and the treatment for MRSA. It also helped that the pharmacist added the important details (put in nose) and it now shows up in red on the screen when it's due.

2. Another classic case of don't look it up and learn. I just heard about this one last night.

We have another patient on Lidoderm patches. One of our very experienced nurses only looked up lidocaine and saw an odd side effect. She called the doc and he screamed at her, telling her that there should be none of those side effects because the lidocaine was not going directly into a vein.

Thankfully, I used Lidoderm patches a lot at Saintarama, but I wasn't working that day to pass that helpful information along.

3. Don't adjust the roller clamp, don't get any IV going.

I hate it when pumps go off all the time. One of my patients, Mr. AB #1 who's going back to the western state he came from today kept having problems with his IV pump last night. I kept missing releasing the roller clamp before I got the pump started. His tube feeding pump was also acting crazy, but I managed to fix that.

4. Just put one pad beneath the guy you just gave a gallon of GoLytely to five minutes ago.

That's just horrible. One of our new nurses (literally--one year in December) had this guy in the AM and K. the LPN got lucky and got this guy padded up before the first explosion. He still was messy, though. Colonoscopy preps are just a nightmare, not just for the nurses, but for the roommates, too. You'd think they'd put all the colo prep people in the same room. Our patients come in two to three days ahead for prep so they can keep their skin intact. It is very hard for SCI patients to do this at home without 24/7 support.

Now that I've created some interesting pictures, I'm heading out to go run more errands and clean more stuff. Back to work tomorrow, so more excitement ahead. Stay tuned!

Working the weekend

It's been very busy outside of work this weekend, so I'll be back later for more posting fun.

Meanwhile, the evening shift continues along swimmingly....stay tuned!

Nuggets for October 9

Yes, I was off yesterday. I found quite a variety of goodies out there I hope you all enjoy! Here's the fall harvest this week...

In the "you'll never look the same way at this again" category

Remember all that debate over embryonic stem cells? Well, scientists may be able to use cells found elsewhere on the body to do the same job. Head on over to the WSJ Health blog and this article to find out the latest stem cell generation location.

Last week, I pointed you in the direction of impactED's helminth therapy article. Yes, indeed, according to my allergist (a top researcher at PrivateU), people with worms tend to have less allergies. If you really want to get your own set of worms, you can't get it from him, you'll have to head to http://www.wormtherapy.com/ and figure that out on your own! I think I'll pass on that, thank you!

Health promotion articles

Like dark chocolate? Your heart may like it, too, if you eat small amounts every day according to this Reuters article.

More infection control guidelines courtesy of our friends at the AHA and JCAHO. (from http://www.nytimes.com/)

Another reason for a healthy economy and plenty of jobs: Family income impacts children's health (from Yahoo! News Health)

Quote

"I'm beginning to understand myself. But it would have been great to be able to understand myself when I was 20 rather than when I was 82." Dave Brubeck, jazz pianist

Crazy, crazy day

I ran and ran again today, but at least, things were a little calmer than yesterday. Some people remembered that I helped them out a lot, so they helped me on a couple of things. It was nice. We had two call-ins, so the boss called one of our night people who was off and she came in pronto. I was happy because she took one of my assigned people, so I only had two patients and the med cart.

The Slug was in and she was slacking away as usual. She had to do one admission, but after that, when the boss left for his meeting, she took her 2 hour lunch while the rest of us scrambled to set up and/or feed our people who needed it. She does not get it that the time you take to run to X sandwich shop on your lunch hour is part of your lunch hour (which isn't really an hour--it's just 30 minutes).

Nope, she takes that time (anywhere from 15-30 minutes) and doesn't count it when she comes back and sits on her derriere. She started eating at 1215, and I ate my sandwich, and she didn't leave the lunch room until 1345. This did not include the time it took her to go get her lunch. This was just the time I observed. Management looks the other way.

Besides that, I just pray I work a shift that she doesn't because I get tired of these antics and all the "emergency" calls she gets. One of her callers actually sounded indignant today because I told him she was at lunch. "Well can't you just go get her?" "Well, no. I'm busy taking care of patients." I told him. (I was getting ready to give some meds and the secretary was at lunch. No one else was in sight.) I put the idiot on hold and I overhead paged her, even though I knew exactly where she was. I figured she needed the exercise to walk over to the phone, and I could go do something else.

I had my same two patients as yesterday. Mr. S. needed a new Foley (a special one at that--16 FR with 30cc balloon Coude) and I put it in as soon as it arrived on the unit. We change indwelling catheters once a month and then, per policy, we send a UA and C&S to the lab when we're done.

Mr. S. was supposed to get a loaner wheelchair so he could get up, but the PT couldn't get his configured right away because she was too busy. Mr. S. was very understanding, though. His neighbor, Mr. HIJ #1, who recently moved to this room since he got a special bed, was as demanding as ever, but I kept him relatively quiet. He wanted me to get him a soda, but he got distracted doing some crafts, so he didn't even worry about it.

I ran back and forth giving the meds on the last run, which at 1600 really isn't too bad. People were streaming in and out of the latest group meeting in our main gathering area, so I had to chase some of them. I got everything straightened up and passed on to C., who was taking my med cart. I got out of there as fast as my legs could carry me without running. P and I walked out the door as a camera crew was coming in to film a story. P. told me, "Stay here long enough and you'll be on TV, too! I've been on one show already. With those powder puffs, I felt like Oprah!"

Even though, it was gray and cloudy, it was good to escape. Off tomorrow and back to evenings on Thursday...stay tuned.

Back to work

Oh, I had to wake up this morning to the alarm clock, which I have not done in days!

I got up early so I could make my breakfast and lunch and get ready to take Bubba to school. Dahey leaves before we do, so he was out and off to work in the dark.

I got Bubba to his latchkey program and away to work I went. I checked my e-mails and boy, there were a lot! The most exciting one was the invite to a special out-of-town conference in November. I have to get all my paperwork done tomorrow so I can go. The admin upstairs, L., has been assigned to help me. (You know it's going to be interesting when she tells you that you have to fill out a 12 page form...in order to book your flight.)

I had two patients I haven't had in a long time and I was the med nurse on one hall. It kept me busy. Today, the docs make group rounds to inspect wounds, so this is also interesting. I try to hang out in the room, undo the dressing, then get everyone cleaned up. They got into my room early, but I was really busy with these two guys...and their roommate had me helping him, too. Mr. R. is very needy, which is not unusual for a COPDer. He's always worried about something--his mask, his bowel program, his turns. He looked a bit ashen today, which is very scary in light of the fact that even with his fragile health, he's a full code. I pray we don't have to do CPR on him while I'm working!

I met some new LPNs visiting us with the recruiter. We're looking for them, so we'll see if they come to work for us!

More tomorrow...getting tired and I need to go to bed!

Why nursing school is a lot like hazing

Yes, I've been thinking about the halycion days of nursing school for me and only one word fits: hazing.

Here's the top 10 reasons why nursing school is a lot of hazing.

10. Everyone gets herded into a big room and then you have to stand in line and get your mug shot taken. This is so all the humiliators, I mean, instructors, know you and you can't hide behind anonymity. Everyone is anxious--what is a care plan, what is a clinical, where do I get comfortable white shoes, anyone got cheap books?

9. You have to learn to wash your hands...again. (Yes, this was one of the first "labs" I participated in during nursing school...no joke!)

8. You have to wear a uniform that rarely looks good on anyone, with or without accessories.

7. You have to sit in large lecture halls for weeks on end with people who are sick and too worried about flunking to stay home. This means any and all germs circulate around the HVAC system, so eventually, everyone gets sick.

6. Instructors wear you down at every turn. You are very, very tired. They make you read hundreds of pages a night for one exam a week. They want you to answer questions in class so they can make you look stupid, even if you have the right answer.

5. Care plans. Enough said. Thank goodness some places have easy to use automated ones!

4. APA paper format. I came from a business background and have long used MLA and Chicago style. APA still sends shivers down my spine just thinking about it.

3. You don't get the true stats on how many nurses survive one year out post school until you're in your last semester. That was when they sprung it on my class in nursing management. (If they told you that in advance, you wouldn't give them the money for nursing school, now would you?)

2. You develop bowel and bladder problems from your clinicals. "This is just like floor nursing," your assigned nurse says. "No one goes to the bathroom on our shift."

and finally...you realize nursing school is like hazing because....

1. You survived nursing school with just a few scars (or sprained ankles, like me, because you tripped in the hall or on the steps) only to get to be the newbie again when you orient to your new job...and surprise! The hazing starts all over again.

Clinical narratives, nursing and image

I read my latest AJN and there is an article that discusses Benner's concept of clinical narratives and how they work in nursing.

If you read this above-linked PDF in detail, you may already realize that many bloggers, including myself, already describe many of these situations. We may obfuscate, consolidate and agglomerate our people and situations, but the comings and goings of our lives as nurses are on the screen. Take note, that this nursing narrative concept was developed in 1993.

I wonder, if Professor Benner looks out in the blogosphere and sees the narrative she defines in this document. I ask you, the lurkers and the bloggers, to start your story if you haven't written at all and if you have, I ask you, please continue to tell your story.

Besides the narratives, there are things we can do daily. We can project a positive image in how we carry ourselves and how we do our jobs. I got the e-mail below in a mailing list digest which discusses the image of nursing. Note the items in bold below, that I've chosen to highlight.

RE: [ni-wg] Are you proud to be a nurse? (from a faculty member at http://nursing.umaryland.edu/)

"Yes, I am proud to be a nurse, but am I proud of how nursing promotes itself and how others perceive us? Not really. Each semester, I ask my first semester undergraduate NI students to close their eyes, picture a physician and a nurse, and then describe what they see. These students, who have no nursing background, usually describe the physician as middle-aged, well-dressed (frequently wearing a lab coat), and very professional looking man. This description has not changed much over the years – varying little with student age and background, but changing somewhat with race and national origin. The nurse students pictured has changed a great deal over the past several years. At first, many students reported picturing a middle-aged, somewhat matronly looking woman in white, occasionally wearing a cap. However, as the incoming students are getting younger (actually younger, not just in context of my age), the nurses they picture look different. Many students report younger women wearing ill-fitting, multi-colored scrubs with animal prints. They reported them as looking harried and dour. Overall, the reports are of nurses that look overworked, unprofessional, and unhappy. This is not something I am particularly proud of. I asked several students who made such negative reports why they chose nursing if they see it in such a negative light. A common response was that they want to be part of changing nursing from a devalued occupation to a respected profession.

Yes, I am proud to be a nurse. I am even prouder of my students who want to be better nurses than those they pictured in their minds eyes."

Yes, Professor. I am proud, too, and this fuels me to do better.

Nuggets for October 1

Here are a few goodies I've encountered on my meanderings on the internet recently. Enjoy!

From the blogosphere...
Hell on White Clogs had this crazy scenario involving Google and residents on fhe floor of one unit. All I have to say is...I'd have to say no to that cath if I didn't see the "real doc" with experience, thank you very much!

ImpactEDnurse had this post about helminth therapy...ugh! I think I'll have to show my allergist this one. I'd be scratching my eyes out, too.

Code blog has this story of the Bigger Picture. Oh, yes, I go there so many times. What do they not understand?

Out in news land...
The Chicago Tribune had this recent article about ways to combat compassion fatigue (aka burnout) among nurses.

The NY Times is running a special section called Decoding Your Health. In today's installment the author discusses using the internet to get medical information. I particularly like this line, "The goal is to find an M.D., not become one."

TV station KTTC of Rochester, MN ran this article about nurse practitioners recently on their web site. It also points out that Nurse Practioner Week is November 9th through the 15th.

NursingLink has this article about avoiding back injuries, which is a good thing, no matter what type of setting.

A subject near and dear to a rehab nurse's heart...bowel routines. Since it was recently National Rehabilitation Awareness Week, this article discusses how one Delaware hospital works with patients to relieve constipation.