You know it's Monday when...

"It's a cruel, crazy, beautiful world./Every day you wake up/I hope it's a blue, blue sky." --Johnny Clegg

1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.

And in between all that, I had 1) other patients and 2) lots of documentation to do.

So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!

Stay tuned...

The weekend draws to a close...

Lots and lots of fun was had by all at the RehabRN household.

I got lots done in the house and started getting ready for the next road trip coming in a few weeks. Travelling partner and I don't have to share a room this time, but we plan on learning AND having fun, even if Manglement makes us give three presentations on our spiel when we get back to the Hotel. We may even let Big Boss buy us lunch this year (he/she ditched us last year in Vegas).

Bubba went to his last baseball games and had a grand old time, hitting and fielding. He even talked Dahey into a bounce-back thingamajig so he can practice all the way up until soccer season. Dahey managed to find it on the local sales board at the grocery store.

WildDog actually got to go outside once or twice, and get spoiled with freshly broiled chicken and the occasional leaf of salad (he loves veggies as much as meat).

So now, I return to chores, until I get another moment of freedom. Stay tuned...

Coincidence?

I often wonder about some people. When Mr. X, our demented howler, came back from Saint Suburban's acute wing after a bout with urosepsis for rehab, I wondered how did I get so lucky to admit him.

Well, turns out, later in the week, I also got lucky enough to take care of him on my regular shift. Thanks Charge Nurse! Just up my alley...I get (just about) all the people no one wants. I fluffed and buffed him (including shampoo, shave and nail filing), got him up to therapy, got him lots of nice equipment, then bam! He comes back to the unit and says, "My butt itches."

If he wasn't so old, and RehabLand was not so far away, I'd think it was this patient who visited Nurse K in Montana.

I am just so happy I don't get to work this weekend, even if I have to stay home and clean my house. There are worse things to do...

Stay tuned.

Patient comments and assorted shenanigans

Ah, being in charge ain't all it's cracked up to be. Here's a few things I had to deal with recently during my time in charge.

Playground politics

Patient needs help, doesn't get it, so he makes a mess. Other patients give him trouble about it. Muttering and rolling around follow up and down the hall.

One nurse solves problem: give patient his own little trash can. No more stuff on floor, and no more complaints from other kiddies.

Common sense...it's amazing! Now if the rest of the staff will pay attention...

Signs of a patient who needs to go home
Patient decides to keep wheelchair, walker (which he can't use anymore) and other wheelchair in his room. Problem: he has two other roommates and we don't allow wheelchairs in rooms overnight due to safety hazards (mainly for staff). Patient throws fit when I try to take the last wheelchair out of room, and he barricades it in a corner so far that I would have to rearrange furniture to get it out, turning on all the lights and possibly calling security.

Decision: bounce ball back to nurse manager...make her decide. The night crew did not need anymore excitement,  thankyouverymuch!


Yes, I miss you too
Patient X (who was recently admitted), "I thought you didn't work here anymore?"
Me: "No still work here, you just saw me on the SU, when you went to the clinic."
Patient X: "Oh, that's why you were there."
Me: "Yep. Any questions?"

Stay tuned...

Happiness abounds...

When you get lucky and some people actually want to work overtime. I was aghast when Madame Butterfly, one of our night shift nurses, called in sick. She left me in a lurch until another nurse (who wanted our rare OT) came in so I could go home.

Yes, I am a happy camper!

Catastrophe and chicanery

It never fails...the Hotel doesn't change.

Who else would put up with one person who constantly talks about being on the "team" and working together and then when the team needs him/her the most, because two of the folks working have very close relatives who have had 1) a stroke and 2) mental status changes after hitting their head, calls in sick leaving the crew horribly short?

Another one of our nurses has sciatica (and a few other medical conditions) so bad that he/she cannot stand to work.

At least, it was pleasant while I worked. Everyone who could, including "Mr/Ms. Team" showed up. I'm just hoping none of our other employees get any ideas about calling in sick while I'm in charge!

Stay tuned...it's one drama after another at the Hotel Rehab.

Savoring the last moments...

Of vacation until I go back to work. So I'm taking my self on in...and this is really what you're gettin', kiddos!



More to come...stay tuned.

The joys of teamwork

I don't know how my coworker J. kept all the balls in the air when managing projects for our little tech team at BehemothConsumerProducts, where I worked at many moons ago, but I certainly appreciate it now.

Lately, I've been taking on that role in my graduate school classes, which, incidentally, require at least one team project per semester. Add to the excitement: all the members of the team are not necessarily in the same state, or even country. Ah, the joys of online learning.

Nevertheless, I orchestrated a beautiful team plan, divvied out all the tasks and organized meetings online and via phone when needed. I even posted our completed project ahead of the required time.
And while I was enjoying myself at a long awaited celebration with one of my nurse friends, one of the teammates got wigged out over one little thing.

Happily, I was able to smooth it over with the instructor, and get everything settled.

Only one thing remains: said nurse needs a psych consult. I can't diagnose it, but someone definitely may need a prescribed chill pill.

So glad the semester is over. CJ, one of my other classmates, an escaped rehab nurse from down south (now a tech trainer), and I celebrated by phone, by lifting our well-deserved glasses of pinot grigio in our respective places.We survived another semester of grad school. Happy, happy, happy.

And now I return to the last full day of vacation. Reality hits again next week...hope I'm ready.

When in Rome

I would have gone if they would have let me have a longer vacation, but alas, they would not. So to slake my thirst for something Italian, I hopped in the auto and drove a ways to the Italian neighborhood of BigTown nearby.

I love this Italian neighborhood because everything is close. You park on one street and you can literally walk along the business district from one end to another in a pleasant walk, passing schools, the local church and lots of neighborhood homes, most small but neat and tidy, with little Madonnas and tri-colors in the front yards and the occasional "Beware of dog" signs in Italian.

First, I stopped for lunch at one of the sandwich places. It wasn't crowded, but the gaggle of screaming kids with two harried ladies nearly gave me indigestion. I like the guys who own the place, so I was happy with my lunch.

Next, I strolled down to the stores. I passed a couple of bakeries and grocery stores getting their deliveries. Good thing I wasn't here yesterday, or I'd have been run over by the mass of humanity that seems to show up on Wednesdays.

After that I headed over to the salumeria, which is world-famous because several Brat Packers had standing orders from this place because Frank Sinatra discovered it on a concert trip. It's a real hole in the wall, but an actual meat factory that sells all over the world. I had an interesting conversation with the lady at the counter over Abruzzese and Calabrese sausage. Yes, everything south of Milano is southern to the Lombards, and one day, I'll get to a restaurant that appreciates the difference.

I headed out with my sausages and took a break at the corner coffee store, which also happens to roast and sell coffee commercially. One of the employees was roasting a batch, so I sat in the front window seat and watched, as the drone of the roaster provided some nice, soothing white noise. The smell was delightful. I got a cup and a spicy chocolate biscotti and soaked up some sunshine in the front window (which wasn't as horribly hot as outside).

It was a relaxing way to end my trip to the Italian neighborhood. One of these days, hopefully, I'll be on my way to the old country...

Heat and furry friends

Yes, in summertime in these parts, you always hear stories about people leaving their dogs (and  sometimes their kids) in the car "for just a minute."

Since WildDog is getting older and belongs to the Loyal Order of Double-Coated Dogs he needed a good bath and grooming.

He now looks a lot lighter, and he's happy he's escaped those groomers, even though they were very nice.

I bribed him with cookies before and after. I'm just hoping he doesn't leave as many hair clumps all around the house.

Misspent youth

I spent a good chunk of my free time at university, sitting under a sycamore tree, propped up on the luxurious green grass, letting the wind blow through my hair.

When I wasn't in the breeze outside,  I jammed my Walkman in my room to all sorts of stuff, including these guys, way back when...

It's not too far off

It's not exactly the same but Old MD Girl must have been at the Hotel recently. I really hate cases like these.

My favorite quote recently about one of our patients sent to our hospice unit at Madison: "Well hospice thought that patient we sent them would die faster."

Last time I checked purposely ending someone's life was a crime. Hmm, guess hospice doesn't want to do end-of-life care anymore unless you're DOA. Makes things easier on staff. Yeah, right....

Memories for me, too

Grumpy had a post recently called Memories that made me think about this disease. We had a family friend die of this horrible disease.

Hopefully, one day, there will be a cure.

My least favorite thing

As a nurse, revolves around a body product. Yes, I deal with pee, poop, blood and sputum all the time, but my Achilles heel (in the right context) is emesis.

That regular ol' vomit will send yours truly to sick bay in the right circumstances. Alas, sometimes those rascally patients will do it once in a while.

So at work the other day, at the nurses' station, I was talking to the charge nurse and a few others about these Achilles heel issues we have.

Charge nurse:  "Oh, I just can't do sputum. Coughing, spitting...yuck!" To Mr. J., one of our characters with a trach who hangs out at the nurses' station to catch up on gossip between therapies, "J., I know I've known you for years, but you'd better not cough anything over here or else." J. just rolled his eyes and went somewhere else, since we started grossing him out. Obviously, no gossip was going to be discussed.

Newbie nurse: "I worry about someone having an arterial bleed. That much blood is scary. What if I pass out and can't hold pressure anymore?"


Our most experienced rehab NP: "RehabRN, did I ever tell you about when I worked at the kids camp one summer before cell phones? (this automatically piques the interest of the junior nurses, who can't imagine life without one.)"

"I had a kid with a high temp that wouldn't go down whatever I did. I was really worried about him, so I called the parents at camp and told them what ER I was taking Johnny to. On my way out of camp, my husband Bob was driving in, per usual. I rolled down the window, told him what was going on and that he could stay or follow me."


"I thought Bob elected to stay back at camp, so I kept going to the ER. All of a sudden, Johnny says, 'My stomach really hurts, I think I'm going to be sick.' So I pull over to the side of the road, and he opens door."


"What I didn't know, was that Bob decided to follow me, stop once he saw me pull over, then approach the passenger's side of the car. Kid then proceeded to vomit all over Bob once he opened the door."

"Needless to say, Bob doesn't approach the car from the passenger's side of the car anymore."

Lessons learned: Listen to your experienced NP wife, get a cell phone, and never assume anything with kids.


(BTW this post was inspired by NurseXY's comment about his sick kid. Hope you have a great vacation, dude, with little to no more vomit in store!)

Shoulda gone to Rehab

Not mine, but down the way. In some ways, drug rehabilitation is way harder than physical rehab.

RIP Amy Winehouse.  Death is a horrible way to get rid of the demons.

Developing a good reputation...

Takes more time and effort than a bad one. Working hard daily with your patients to develop a system that works really is work, even though Manglement may not reward you for it.

So, you have to go out and motivate yourself, even if no one else will.

Per Hotel policy and procedure, I had to fill out extra paperwork for a free CE thing I'm doing, but I figured while I was at it, I may as well let the boss's boss know what I'm up to. Yes, I am getting my master's degree. Yes, I am a certified specialty nurse, and yes, I need to do these CE things (including out-of-town ones that I get scholarships to attend).

Stepping outside of my little box on my little unit at the Hotel helps me to do that...and see the country.

And I take pride in developing a good reputation, even if it's a little inconvenient on occasion. My patients deserve it.

Thanks so much Mr. I. for saying I was your "number one nurse" while you stayed with us when I packed you up ready to go. I work hard to earn that reputation from you, and all my patients.

Time to celebrate

And relish in doing nothing....for a whole week if I want.

This joy is vacation and I'll take every second I can get!

More to come!

Some things just contradict others...

And it is getting very hard to stay. Thank goodness I'm going on vacation.

How to tell if your boss is an idiot, part 2

Or how to tell if your boss and his/her boss are not getting along.

Since Madison requires that nurses transferring to the clinic I'm going to be oriented and trained by our crack corporate training staff (Employee Edu-mucation), I told my boss once I found out what the training schedule was, as this needs to be completed soon.

1.Send e-mail to boss. Boss says "Sure, go right ahead." (which is totally unusual, since Boss doesn't usually act like he/she cares about anything right away.

2. Read this e-mail. All is good. Will talk to admin person (who coordinates all the details) in morning.


3. No, boss comes out and says "Read your e-mail." His/her boss says, "No way are you just going to that training. You have to submit Form X to Committee Y and get approval from Director Z before you can even think about going to that."

And the final line (after Boss's boss CC's  the corporate training director, chief nurse and other minions -- 4 in all).

4. Boss's boss says, "Please fill out form X and send in ASAP so we can get this done."

5. Needless to say, once I looked down from the computer, I noticed it was time to go home. And so I left this paper for another day...

Stay tuned ...

Dear Mr. Poikilothermic

Dear Mr. P.:

I love you to death because, despite the loss of voice you occasionally have, you are so darned snarky and funny that you make me laugh.

But since it is over One Hundred degrees here in RehabLand, I must have the air conditioning on in your room. As Dad used to say, "You can always put on a sweater, but can't take one off if you don't have it." I wish we had rules on what the temps could be.

So here's your blanket, so I don't melt into a puddle in your room with my gown, gloves and other assorteds on, because I will if you keep that thermostat above 85 degrees again.

Sincerely (unless I melt into a puddle, then deal's off),

RehabRN

It's still hot, hot, hot here even late at night!

Which reminded me of this song...

I'll never forget

Today was your birthday, Dad. Wish you were here.

Just when you think you've seen everything...

Something completely different happens. We got a person who came onto the unit at the Hotel who asked to be "checked in" right at dinner time. Rehab is not a unit people just typically appear on, so this was the first red flag.

Patient then says, "Oh, I was over in the unit down the way over 10 years ago. Can I just go back?" Patient then describes an experience between psych and drug rehab (they mistake us all the time--no surprise when the word "rehab" is on the sign). I call the supervisor who asks me, "Do you think he's a mental health patient?" Yes, I reply without belying that the super has asked if he has suicidal ideation, which he did not.

Thankfully, I managed to get walk-on to the ER, where I later found out that he told them a different story. He was indeed suicidal, so he won a free trip to the psych unit. Not sure if he'll rehab or not at our lovely Hotel, but if he does, I'm sure he'll see the drug rehab folks, and not the physical rehab folks that I'm used to working with here on our unit.

Sometimes people just want to go home again at your hospital.

Stay tuned...

How to tell if your boss is an idiot, part 1

Yes, more and more, either he/she's got amnesia or needs a vacation, I'm rapidly coming to the conclusion that my boss is a first-class idiot.

Case in point: recall the post about uncompensated training recently? Guess what? I can be compensated per rule #xx in the handbook.

Our person who normally handles this is out of the office (on vacation) but the chirpy HR lady  they switched me to at Central HR said, "Yep. If he/she can't let you use that comp time for a day off, you get your OT."

I e-mail this and proposed clinic training plan to boss.

His/her response: "Really?"

So glad I'm not working or I'd bang my head firmly into the wall...over and over. Just makes me wonder what else he/she's been messing up in the mean time.

More to come...it's one thing after another here at the Hotel!

Some things I wish I didn't know about...

1. An older nurse at work and her sexual escapades with other staff and patients. Surprisingly, she's still working with us, which is a whole other ball of wax as my Grandpappy used to say.

2. What happens when a prostate cancer patient has a bowel impaction and you have to digitally remove it.

3. That my favorite classmate from nursing school has cancer. I wish I could just make it go away.

More later...

Transitions, part 1

How hard is it? Plenty, when you're dealing with Manglement at the Hotel.

Here's my transition plan as of this week:

1. Get e-mail from Second-in-command Assistant Chief Nurse Mangler:
Go right ahead and see X, since she's been running the clinic while we've been waiting for you to get hired. We'll let you know when your start date is later, because we're waiting for people to come back from sick leave and the new hires to start.

2. I discuss specifics with my department Nurse Mangler.
NM: "Sure. Set up time with X and let me know what's going on."

3. I call X, set up appointment, come in on day off. I have to do this since NM can't possibly let me leave for a minute to go up two floors to see X for one hour, even though some of his/her favorites park in the cafeteria three blocks away while on duty for longer time periods than that.

NM is okay with this plan and it's confirmed via e-mail and verbally by conversation in hall with several witnesses present.

4. Meet X on my day off and get items I need to set up for a learning plan in the Hotels' Learning System. Total time for this, including printout of manual: two hours. As a result of this meeting, also advise NM that I have to attend another quarterly department meeting this week before I work an evening shift.

NM: Fine, just get to work on time.

5. Now after investing this much time in meetings, learning plan setup, etc., NM tells me I will not be compensated for my time to attend meetings, etc., until I start in the new position (which is the same department, but a different "cost center" per accounting.) Otherwise, "if I let you off for comp time, you're stealing time from this unit." (yes, this was a direct quote)

6. WTF?! Express "concern about lack of compensation" with a straight face and proceed to assemble everything for HR.

7. Notify X that I will have to start training later, which sets off its own cascade of idiocy all the way up to the boss of the center.

8. Get call from center boss. Center boss says "hold tight and we'll straighten this out. You won't lose anything"

And they wonder why people are so frustrated! If this was not my dream job, I'd run straight out the door.

Stay tuned for the continuing saga, because drama at the Hotel is new everyday. 

I see friends shaking hands
Saying "How do you do?"
They're really saying,
"I love you"
-Louis Armstrong "What a wonderful world"

Yes, friends, it really is a beautiful world, Manglement or not. This is one of Bubba's favorite songs. Who would believe I'm the mother of a boy who loves the "really old stuff" as he calls it. I heard, "Mama, play Louie" more than once this weekend while riding around town.

Enjoy the day! I will, rain or shine.

Things that make me smile

Yes, even though some of our nurses say we should not nominate people for department awards for doing the little things as part of their job, it is the little things that people remember. It brings back all those lectures on servant leadership. Keeping things stocked and thinking of the nurse who follows you are two things that were impressed upon me in my first nursing job, and  yes, it is everybody's business.

And as a result, the things that have made me smile recently during all this Manglement madness have been the little things.

1. Patient X goes home and calls me recently from a restaurant we talked about all during his stay. I even got the lowdown on the daily special.

2. Patients who say "please" and "thank you". There are just too many barbarians who have forgotten their manners. Mr. X., thank you for thinking of me and being polite, even when many of your other fellow patients do not do the same.

3. Dr. F. brought us all goodies this week. It made us feel important, too.

4. And finally, one of my patients came back to the unit, We had a really nice chat and I told him about his old roommate sending us a card, which was posted on our bulletin board. Before he left, he told me, "You know, I miss seeing you. You are the best."

Thanks Mr. D., and so are you. We loved the candy, even if it means another mile on the treadmill for me.

Stay tuned.

If it was good today...

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

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

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


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

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

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

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

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

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

Adios, arrivederci, sayonara

Middle age is when work is a lot less fun and fun is a lot more work.  ~Author Unknown

We've got just about the average number of baby boomer nurses who are eligible to retire soon, and since Manglement is being so kind, a couple have taken them up on their offers. Two so far have announced they're retiring, and those two alone have 75 years of combined experience in a variety of bedside settings, including the last 10 in rehab.

It also helps that Manglement is threatening to upend the Hotel and send all the specialty nurses floating here, there and everywhere since they're saving money by not hiring anyone. This is sending morale into the crapper, even in the units that traditionally have been extremely happy. Many are just sick and tired of all the idiocy of nurses in Manglement who haven't seen a live patient in a floor setting in years coming out of the woodwork and saying, "Just do more with less."

Less is certainly what they're getting out of some of the folks who work at our satellite hospitals. It is just sad.

Maybe one day, the nurse execs will lose their bonuses over it for all the turnover, but I'm not holding my breath.

It's getting pretty unsafe in these here parts...can't wait to move to the new office, if and when they can get all the construction done. Stay tuned.

A truly new economy

I saw this article while I was online today and thought about another article I read recently, which said, "Welcome to the new economy."

It certainly seems like a different kind of idea to me. If you can have a nurse case manager or life care planner, why not a paid cemetery visitor?

Just sayin'...more to come. You never know what will show up in the news.

Found one too many strings on my scrubs today....

Thanks for this one MG. Silly, silly, and not my kind of strings today!

Grandstanding

Dear Wannabe Lazy Grandstander:

Some people just don't get it. Working as a team does not mean showing off to the management, unions and the like to look like "you're so into everything."

No, it just shows how much you only think about yourself, when you attend multiple meetings instead of taking another shift's place so they may attend the meeting you already sat through once. How coincidental, since someone else gets to do all your work!

There is an I in our team, (you) and here's hoping someone erases it from the list one of these days. Then it will really BE all about you.

Sincerely not,

RehabRN

A judgment for today...

Punishment is now unfashionable... because it creates moral distinctions among men, which, to the democratic mind, are odious.  We prefer a meaningless collective guilt to a meaningful individual responsibility.  ~Thomas Szasz

One of me favorites...

Oh, the days of the Kerry dancing
Oh, the ring of the piper's tune
Oh, for one of those hours of gladness
Gone, alas, like our youth, too soon.
When the boys began to gather
In the glen of a summer's night
And the Kerry piper's tuning
Made us long with wild delight!
Oh, to think of it
Oh, to dream of it
Fills my heart with tears!

Happy Fourth of July

Happy Independence Day, America!

And I never realized until today that there are so many verses to this song. Read and enjoy!
America the Beautiful
Words by Katharine Lee Bates,
Melody by Samuel Ward

O beautiful for spacious skies,
For amber waves of grain,
For purple mountain majesties
Above the fruited plain!
America! America!
God shed his grace on thee
And crown thy good with brotherhood
From sea to shining sea!

O beautiful for pilgrim feet
Whose stern impassioned stress
A thoroughfare of freedom beat
Across the wilderness!
America! America!
God mend thine every flaw,
Confirm thy soul in self-control,
Thy liberty in law!

O beautiful for heroes proved
In liberating strife.
Who more than self their country loved
And mercy more than life!
America! America!
May God thy gold refine
Till all success be nobleness
And every gain divine!

O beautiful for patriot dream
That sees beyond the years
Thine alabaster cities gleam
Undimmed by human tears!
America! America!
God shed his grace on thee
And crown thy good with brotherhood
From sea to shining sea!

O beautiful for halcyon skies,
For amber waves of grain,
For purple mountain majesties
Above the enameled plain!
America! America!
God shed his grace on thee
Till souls wax fair as earth and air
And music-hearted sea!

O beautiful for pilgrims feet,
Whose stem impassioned stress
A thoroughfare for freedom beat
Across the wilderness!
America! America!
God shed his grace on thee
Till paths be wrought through
wilds of thought
By pilgrim foot and knee!

O beautiful for glory-tale
Of liberating strife
When once and twice,
for man's avail
Men lavished precious life!
America! America!
God shed his grace on thee
Till selfish gain no longer stain
The banner of the free!

O beautiful for patriot dream
That sees beyond the years
Thine alabaster cities gleam
Undimmed by human tears!
America! America!
God shed his grace on thee
Till nobler men keep once again
Thy whiter jubilee!

Holiday fun

We could hear and even see some of the fireworks from the park down the street if you went outside. That was the closest I'll get to 4th of July festivities, since I'm working at the Hotel.



For the most part, the headaches are subsiding. I'll just chalk it all up to allergies to something. I've been taking all my meds religiously and adding a couple of OTC ones as needed. I hate doing it, but I also hate having a stopped up head and ears.

So far, besides Manglement issues, there's been no trouble at the Hotel. We can only wait  for what  happens next.  I hope I'm spared some of the drama, but suspect I will have to deal with it soon enough. The great  halcyon days of the Hotel are most likely over. It's just going to be interesting to see the kicking, screaming and jockeying that comes next.

Stay tuned...gotta enjoy the moments before it  all starts again.

Corporate mayhem

Sure, you can work for a non-profit hospital, but yes, you can have corporate mayhem. That's been happening at the Hotel.

Upper Manglement has decided that we'll have some "town hall meetings" to make us aware of some changes coming down the pike, and none of the rumored changes are good. Census is down and costs are up. Our chief hospital honcho is coming down for not one, but multiple meetings and the rumored agenda involves funding, staffing, unit management and even a few transfers. No one knows the real agenda, but we've been told to be ready for anything, and be specific.

As a former corporate worker bee, I'm teaching my coworkers how to create opportunities--use talking points. No, I'm not Norma Rae, but after patients, nurses working in the front lines of healthcare keep the rest of the house open. Without 24/7 nursing staff, hospitals cannot run. So I'm prepping people who one of our senior nurses has asked to speak with talking points. It's like Toastmasters all over again. I finally have a use for all those note cards I couldn't use in nursing school.                            

It should be an interesting week! Stay tuned.

Something everyone needs

This would be a cool thing to have, but I'd never get Bubba away from the computer.

Wish me luck as I drag my migraine-muddled mind back to work today.

Stay tuned!

Headaches...literal and figurative

Woke up again to a stuffed up nose and clogged ears, which by the time I get upright equals a headache.

'Tis summertime again in RehabLand and all the pollen's come out to play.

Will resume normal postings  as  soon as my head cooperates...

Change up

Here I thought, at the beginning of the week that I would have to work day shift for a while and lo and behold the boss switches my schedule around.

So working half in one shift, and half in another, I got to see some crazy stuff I don't normally see.

We occasionally have discharging patients who don't want to go home. We had one this week. This patient tried to think up every excuse in the book. It doesn't help it if the patient also has psychiatric issues and is not only anxious, but getting manic.

Psychiatrist, psychologist, and MD get patient a nice dose of something especially calming for the road. Nevertheless, the patient gets halfway home and calls to say, "I need to come back." MD tells transportation to take patient to nearest emergency room if things get crazy.

Another patient gets  in his wheelchair with snacks and a soda and proceeds to roll his chair off a wheelchair ramp in front of the Hotel, into the curb and somehow flip the chair. Thankfully, he couldn't go too far away. We have no idea why or how he did it. Called our docs, called the on-call doc, called the super. Patient gets the all clear. Lots and lots of fun paperwork to do for the charge nurse.

Another anxiety attack was averted when Mr. Z's nurse finally found his soda and snacks in his room. I don't think he could handle losing those items, which would have been worse than breaking his leg!

Stay tuned...we'll see what shift I work next!

My Monday

1. Rain.
2. Drop kid off at camp.
3. Take car to mechanic for funny noise. Get rental.
4. Go to work late.
5. Take care of usual suspects.
6. Hear one of suspects "compliment" me on what a "fun" person I am. (Said suspect is up to something).
7. Suspect leaves for doctor's appointment with specialist.
8. Idiot pulls fire alarm.
9. Get ready to evacuate, but figure out there's no fire.
10. Notify boss and security. Secretary gets to tell fire department, who have arrived looking for a big fire.
11. Go back to charting.
12. CNA logs me out of system because I rolled 3 feet away from PC and wasn't using it.
13. Suppress urge to kill CNA. Get computer back and start charting.
14. Five minutes before I leave, get new patient weighed (forgot about it earlier).
15. Five more minutes, get weight charted and finally leave.
16. Come home and find out Dahey's car needs help.
17. Call tow truck.
18. Thank lucky stars I have a rental. Dahey picks up Bubba.
19. Lather, rinse, repeat (hope not!) tomorrow.

Fun Sunday

This is for M., one of my dearest friends in the world who manages a pharmacy out west. She would have been a helluva math teacher if she hadn't decided to be a legal drug dealer for the Evil Empire.

You can check out other cartoons here: http://www.xkcd.com/

Ethical dilemmas

In rehab, we keep people for a long time, as long as they're progressing. In the Hotel, we keep people a long time, because we can for a variety of reasons.

Sometimes, we even have staff get entangled in the issues. Here are some that have come up since I arrived at the Hotel.

1. The infamous, "He said, she said". Someone overhears part of a conversation, and reports it. Patient and nurse have two different stories. Reporter decides to write it up and nurse, of course, gets in trouble, because, as in most service industries, "the customer is always right." Patient is mad at nurse for rest of stay, and nurse is in hot water.

2. Patient stays with us for protracted periods of time when they actually need to be somewhere else. Examples: 86 year old patient with metastatic cancer says, "I can be rehabbed." Oncologist says patient has six months max due to the nature of the mets. We lose a rehab spot, because our boss says, "Go ahead and try." Hospice case worker fortunately has his head on straight: "We'll keep a bed for whenever he's ready to cross that bridge."

3. Nurses get involved (financially, sexually, etc.) with patients. It's no help when said nurse is a favorite of your nursing administration. Nurses also abuse the kindness of patients by eating their snacks, etc. I counsel them to report to no avail, because they fear retribution while they're still here.

4. Boss trains two people for a specialty position over the  past year. Both people will be gone from Hotel by September, and boss knew this. WTH is the matter with the boss? Does he/she like training people for other companies? Obviously...training wheel starts over again in a few months.

5. Succession planning. What's that you ask? Well, it means that you train in advance for people moving, retiring or just quitting your organization. As usual, this is just another thing lacking at the Hotel.
Happily, this is not a bad thing. At least, it gives me a topic for my latest grad school paper to write about due this coming week.

Not your average day

What a day. All was going well, I was on time getting our patient ready to roll when, as I was carefully prepping a dressing, I inadvertently snipped an access line. Nothing like lopping the end off a central line that was scheduled to come out Tuesday.

Off goes patient for an early appointment to get this removed. No harm, no foul, but no one can bring back the "saved" time that was lost.

All I had to say once it was done...TGIF!

Stay tuned...

A wonderful present

“My interest is in the future because I am going to spend the rest of my life there”
Charles F. Kettering quotes (American engineer, inventor of the electric starter, 1876-1958)

Today is my best friend's birthday. We went out to celebrate recently on my day off. We escaped children, dogs and husbands to sit and enjoy ourselves discussing everything and nothing at all. Thank goodness we had a wonderful waitress who didn't mind that we took a two hour lunch chitchatting!

And today, I got a present. Besides having a wonderful friend, I found out I was chosen to work in a different part of the Hotel. It will be a change from my normal routine, but it will be interesting nevertheless. I have never interacted with patients daily in this type of clinic, so it will be exciting.

I'm still on hold as to when I'll move to that area of the Hotel. I can now wait without wondering what was going on in HR.

Stay tuned...

Word to the wise

Dear Royal Pain Lazy Slug RN:

If you particularly go out of your way to leave me out of a conversation about an important event when I know the answer to your question, I can and will not answer it.

When you ask me why, I also will explain to you (with appropriate people who saw and heard scenario #1) exactly why I did what I did.

And, of course, being a wonderful person (since I happen to like the patient this issue involves more than you) I will give the answer as professionally as possible when no one else finds it.

It's the least I can do.

Hope you enjoyed the results. At least, Mr. X did.

Sincerely (for now anyway),

RehabRN

He didn't tell me how to live; he lived, and let me watch him do it.  ~Clarence Budington Kelland

Happy Fathers Day, Dahey. Bubba and I love your quirky voices and baseball coaching.

Dad, I miss you much.

Just for fun

My travelling partner and I went to a local patient symposium the other day to talk about stuff we do in rehab, complete with show and tell.

Had a lot of fun. I just hope the tape recorded version is not so bad. My makeup artist, hair stylist and wardrobe person were not working that day.

I'm glad I wore my *dress* scrubs.

More later...

Dislike

I tell you if Facebook had a DISLIKE button, I'd be putting it on a few things here at the Hotel.

Some of the random chaos I came back to after a weekend off during inspection season:

1. Candy wrappers on the floor in a clean storage closet. Come on people, put them in your pocket until you can get to a trash can. There's a reason why there is no trash can in a clean utility room!

2. Paranoia, part 3. Boss thoroughly combed the unit for any little piece of paper in the wrong place, had us label, mark, time, date and initial everything. Then Ms. Inspector woman comes to a clean utility room and finds something unmarked. Automatic ding.

3. Paranoia, part 4. Somebody let a patient keep his/her paperwork from Dr. X out of their storage closets, they then left it on a wheelchair, and in their haste to put the wheelchair into storage, it stayed on the seat. Ding #2.

4. And finally, the last dislike: coworkers acting like arses just because they can. What goes around comes around...

Stay tuned. The inspection madness isn't over yet.

Nuggets for June 15

Happy June 15! Since I haven't done a Nuggets section in ages, I thought, why not? I've been reading some really interesting medical stuff for my grad class, and lo and behold, some of my favorite MD bloggers have interesting posts that should be seen.

So here goes, folks. Please enjoy the scenery. There is some very vivid mental imagery here if you really think about these items...just sayin'

Enjoy!



So you have been living in this century for how long now?
ER Doc from Serenity Now Hospital has a great post about a really out there patient who is still figuring out how to use the telephone. 

The epitome of tact or Why you should turn off the cellphone in the ICU
Grumpy, one great neurologist (and no, I don't work for him...he's nicer than our boss) has a public service announcement you'd think was obvious.

Never assume...

Last but not least

KevinMD has a couple of posts you shouldn't miss.

Medicine or family first discusses a series of articles running in the NY Times debating if part-time physicians should exist.

And now, since it's bikini season, he discusses a hairy (literally) topic which can have some significant complications.


Stay tuned....more to come.

Heard on the unit

Call it the Chronic absurdity version of Heard on the unit. Guess which one(s) is(are) true?

1. So and So just lets his/her blood pressure get high to get attention.
2. I think X is paranoid and has a list of people to investigate if anything happens to him.
3. Did I get "any"? How could I get "any" in here?
4. Where is Mr. Z? I haven't seen him in a long time, so is he sick?

Answers: all true.

So is the Hotel Rehab really a crazy place? Well, some folks (like me) say rehab is a little psych and a little med-surg, so who'd be surprised with what patients (and some staff) say.

The first one shocked me because this is what one staff member said about another. I think she needs a vacation very badly and/or we have a whole lot of Munchausen Syndrome going on at the Hotel. There are some people who even suspect one of our insulin dependent diabetic staffers is overdosing on insulin for attention.

Hello, neuropsych! Can you help US? We need a real EAP folks. I'm going to go to HR and find out if they have one yet. Or I'm getting a poster of a beach in the tropics so people can chill out while eating lunch.

Surprisingly, the same person who noted this diabetic fact also noticed that since "X has become paranoid, there have been no hypoglycemic incidents." Hmm...

Number three was my fault. Never assume that patients understand pronouns or articles refer back to something you've already discussed when their minds are obviously somewhere completely different. The reply noted was when I had asked Mr. X, who keeps refusing to let the lab draw his blood (or let us draw his labs). I had asked if he had had any blood draws recently, and repeated, since he's quite deaf, "So have you had any...blood draws?" Of course, Mr. X missed the last part. Oops!

Mr. X was also startled to discover that RNs have magical "selective hearing" when necessary. Mr. X. had been dropping double entendres left and right and wondered why I was not playing along. I had to put on the RehabRN Old School Nursing Cap (which I had to borrow from F, my mentor) and lay it out, chapter and verse, according to Hotel policy, which meant, no, I cannot and will not discuss certain things at work with you. End of story. If you want Viagra, you have to talk to the psychologists, who then refer you to the appropriate medical team member for evaluation.

And finally, yes, Mr. Z. hasn't been around recently. He had a psychotic episode while apparently high/drunk/stoned on something on our unit. Security has been advised by the hospital legal staff that he cannot come back until he proves he has completed his substance abuse treatment program and meets other conditions.

Yet another thing I gloss over with a blank, "You know, I don't really know."

Stay tuned. You never know what I'll hear next.

Happy Flag Day

Out comes the Old Glory scrub top for work. Happy Flag Day, all!

Irony in the news

This story from South Texas just made me bristle...and want to cheer.

A fitting end to an unfit perpetrator.

Who knows what...

Tomorrow will bring. We escaped the surveillance of the inspectors for a day. I admitted one very nice patient who drove on over and stated, "You said you'll be done Thursday. I have things to do this weekend, so I'll be out of here then."

We don't get that many who actually show up, then leave as promised.

It's very refreshing. Now if I could go on vacation and do the same. Only 42 days until then. It seems like forever.

Stay tuned for more inspection excitement...

OMG inspection season

Yes, we all have to be fluffed, buffed and on our best behavior all week this week . The charge nurse cried, "OMG the OIG are back again."

It seems like they've come every year since I started here at the Hotel. And tomorrow is Monday, and said charge nurse is out-of-town with daughter who's getting surgery tomorrow.

I'm just praying I don't get stuck with the inspector like the last time.

Stay tuned.

When it rains...

It pours, the lights flicker, the wind shakes the windows and WildDog starts opening doors to tell us he's not staying in a room by himself.

No, siree, I'm a guard dog and I'm "guarding" you whether you like it or not.

At least he does not destroy things or jump in bed. He just sits on my side of the bed and whines...and I wake up to pat him on the head to quiet him.

I love summer thunderstorms. At least, it wasn't a tornado!

A fond sendoff for the week

Dear CNA:

What part of delegation do you not understand?

You have report and I am going home. While I am down the hall walking out the door is not the appropriate time to complain that I did not clean someone up when I found out about the person's status thirty seconds before I started walking out the door.

I choose delegation of an appropriate task to you today, as I have reported off to your shift and to the charge nurse and I really wanted to get to my car to get to Bubba's baseball game. I know you can't believe that I actually wanted to leave on time, since it so rarely happens, but it was true.

And no, I will not hold this against you, unless you decide to ruminate all week over this "injustice" of making you work immediately out of report, which is great for me, but not for you.

Sincerely not,

RehabRN

I'm sorry

Due to the nature of rehab nursing I occasionally have to do things I really don't like. For those things, I am sorry.

I really didn't want you to be in pain when I put in that catheter, but the fact that we had orders to catheterize you every four hours made me lobby with the physician that perhaps a Foley is not inhumane when you have a horrific case of prostatitis and an equally neurogenic bladder. No one needs that trauma every four frickin' hours when you're pushing 80 years old and are otherwise in good shape.

And yes, Dr. So and So, if you get your derriere chewed because you gave me an order for a lidocaine urojet so I could at least alleviate a little of the pain when putting in the catheter, please call me, and I'll offer to cath the non-impaired culprit WITHOUT it.

I'm not the greatest IV stick in the world. Thanks for understanding when I had to poke you twice to get you that IV for your infection, since we had no oral meds that would work equally well. I'm a "three strikes you're out" kind of girl, so if I don't get you in three, you're getting a nurse who's better at it than me.

Finally, folks, don't make fun of me giving patients suppositories and relieving impactions that come from having to take lots of narcotics to at least knock the edge of your pain for you to function in rehab. I'll order lidocaine for this too, if you need it, because I'm sure it hurts.

And I'd want someone to do the same for me.

A song here

Another there. When the singing and dancing groups aren't visiting the Hotel Rehab, the cicadas are. They are all over the trees, and occasionally on a patient who decides to sit in the shade on the bench in the back.

I even had one land on me as I was coming out of the local library with Bubba. Thankfully, Dahey was with us to remove it. The cicada he said looked like an artsy pin on my lapel.

I'm just so glad it didn't fall off in the crowded library. That would have been interesting.

More later...back to reading for my grad class.

No less momentous

On this very day in 1944, the largest assault of the Second World War occurred just off the coast of France.

It's summertime

As the song and an old friend used to say, and the livin' is easy. We'll see how many people call in sick on such a beautiful Monday.

Back to our regularly scheduled Monday...stay tuned!

Thud!

Dear Bubba,

When you get a new baseball bat, swing a little too hard and klunk Dad (Dahey) in the head, you know it's time for a little education.

Please dear, do not inflict a TBI on your dad. Mom has enough TBI patients at work to take care of and I'd like to not have one at home.

Love and Kisses,

Mama (aka your personal RehabRN)

The power of suggestion

It's been interesting lately at the Hotel. As usual, as the temperatures go up outside, the tempers flare on the inside. Lately, things have been wilder than ever.

We have a full house again, with lots of work and lots of scheduled vacations, we are back to some folks working overtime. People are crabby, whiny, and generally out of sorts. A few people are even angry, patients and staff included.

Several patients are angry at the doctors for keeping them at the Hotel when they could be home enjoying summer. This, in turn, makes them lash out at the nursing staff. A few of the people I have taken care of have gotten so incensed that they have mounted a campaign to get one staff member in trouble.

How? They composed a suggestion and put it in the suggestion box on the unit which is monitored by the Manglement for the sake of maintaining the ever-onerous "high satisfaction" ratings. Since the named staff member was already in hot water, said person got called to a meeting with the head honchos to determine his fate.

And when that drama is over, someone also "suggested" that staff is sleeping on the night shift. No one knows who did it, but it's caused lots of anger amongst the ranks of the night shift and among the supervisors, too.

So I'm thinking of making a few suggestions myself out of the box:

1. Get a framed copy of the patient agreement put up on our unit. You'd be surprised how many times we try to enforce the rules and patients say, "I knew nothing about that." even though they get a copy and are advised in advance.

2. Maybe we all need to start spouting chapter and verse, so patients really get it  when they have a complaint with staff. My line, "You need to notify the charge nurse, then the nurse manager. If that is not resolved appropriately, patient relations number is extension XXXX, because it is your right  (as noted in #1) to get your needs addressed."

3. Do not whisper: speak and communicate. Tell other nurses if their patients have problems before reporting it to the boss as appropriate.

51 days...

Repeating it to myself...in 51 days, I will not be in the hot Hotel, in 51 days, in 51 days, in 51 days.

Counting down to vacation...yes!

A very interesting perspective

In light of recent issues at the Hotel, (see previous post) I really enjoyed this Facebook discussion topic on the Oncology Nursing Society's page, especially this comment about patients and friendships:

there are certain patients that you just connect with. And, they are "gifts". There are those who remain your heart long after they are gone. These friendships are not by choice, sometimes I think that they are destiny. However, when these rare occasions happen, I think that you need to have boundaries, you need to set ground rules. 

If a patient would send a friend request to me, I would have to think long and hard about my reply. For the most part, it would be "no". You also need to be strong enough to face these patients when they confront you about your response. 

 

Some people just don't get it

Case in point:

Dear HippieRN:

Being friends (or thinking you are friends) with patients is really not a good idea. Working here is really work, and since the Establishment says friendships are not a good idea, it means that it really isn't a good idea. You can think whatever you want to yourself, but verbalizing those thoughts with patients (and their significant others) is not a good thing. Yes, that's the reason why the boss changed your assignment recently and had a little chat with you.

What you did was not really therapeutic communication, so please don't do it again. Your count, as they say in baseball, is 3-2 right now, and you're not a home run hitter type.

Doing your work and not texting or chatting in person (or online) with patients really IS a good thing.

Here's hoping you get a clue, otherwise, your dope slap (and a pink slip) is waiting.

Sincerely,
RehabRN

When they say evacuate...

They mean evacuate. I wish I could hang a few of these photos from St. John's in Joplin, MO up on the unit so my patients could see them. Maybe then, the next time we ask them to move for a storm warning, they'll do it.

I just don't think people get it.

That is all.

No typos here

Yes, Kim's got the latest version of Change of Shift up over at emergiblog.

Go on over and look.

Finally!

Someone read my name on my board and sent a letter telling the boss what a wonderful experience he/she had while I took care of him/her.

I had taken care of this character before, and he'd always "forgotten" to mention me.

It's nice to be remembered once in a while.

Stay tuned!

Shake it up

I shook up the assignments when I worked last. I'm sure I'll hear about it again for ages. Why, you ask? I needed to get things done quickly once I arrived, so I did the assignment at home. I did not account for the people who worked the weekend, just as the boss regularly does.

Everyone did get  a reasonable assignment, though. I balanced every one's patients so no one had anything impossible. As the leader, I had the lightest assignment, because  I got the assignment to be the troubleshooter for everyone. Thankfully, the day was steady and not crazy. Our on-call doc kept me busy, when patients weren't thinking of some things for me to do.

Here's a list of some of the oddball items for the day:

1. One patient was doubled over in his chair and discovered by our chief when he was going to the elevator. Said patient was helped up, then got an order that he needed a strap to get up. He begged me to find something. I looked and looked all over the unit and I finally found one...in my car (I use it with a couple of elderly relatives I occasionally transport.)

He thanked me with a large piece of chocolate cake his wife brought him from one of the local premium bakeries. Yum!

2. Since our doc saw him doubled over, he figured he might need some labs. I drew those, then put in an IV after our super nurse, Mike, the old ICU nurse couldn't get him. Turns out this patient has a secret. His hand veins are the best...and hurt the least. I got one in his hand on the first stick (because couldn't get one in the one of the several monsters on his upper arms).

3. And finally, one patient had an urgent request: he wanted a backgammon board. I scoured the games section of the rec room and didn't find one. I did find him some dominoes, and left a message for the  rec therapy people so they can fulfill his "urgent" request  when they come back.

Only time will tell how the rest of the week goes, so stay tuned!

This Memorial Day

For my great uncle, who was killed in action in France, January 23, 1944, and left behind a wife and three children for the freedom I enjoy today. Thank you. 

I think of you today as I take care of my veterans who returned.

All gave some and some gave all
And some stood through for the red, white and blue
And some had to fall
And if you ever think of me
Think of all your liberties and recall
Some gave all.
--Billy Ray Cyrus, Some Gave All

That's more like it!

Weather: Sunny, with hot and muggy temperatures.

Air quality: the fine smell of charcoal is wafting around the neighborhood as people grill. Not as much as usual, though, since everyone's getting those gas grills.

Mood: Bubba has taken a break from playing outside. All is good.

All the ingredients of a great holiday weekend, which ends for me tomorrow. Back to work for the holiday. I can't complain.


Stay tuned.

What holiday?

I'll spend mine working in one way or another.

Got up early today and attempted to pay bills. Found out my sibling (who is disabled) had a 4 figure phone bill. Checked it out online, then discussed with said sibling and found out someone he/she knows has been scoring very expensive Eastern European phone calls from him/her, in addition to "borrowing" money. Got everything documented and hotlined him/her. Happy holidays? I don't think so. Not when you have no money in your account.

Installment #1 of 2 sets of books for the next grad class arrived today. Hope the other one (which has the required text) shows up by the time class starts in about 10 days.

Bubba and friends are having fun at the baseball tournament next door. Dahey is out making sure he's not eating everything in sight.

Should be a fun day....stay tuned.

LRR part 2

If you read the last installment, you'll understand why I abbreviated the title above.

Yes, it did certainly seem a bit like Groundhog Day at the Hotel, with a twist. Mr. J. ended up sick, then sent to our lovely sister hospital for a workup before the holiday starts. Yes, keeping an acutely ill rehab patient on a unit staffed with skeleton crew for the first major holiday of the season is NOT a good thing. Thank you Dr. F. for finally figuring out this important fact.

Mr. J. wasn't thrilled, but since he'd like to possibly make it back in time for his son-in-law to bring his favorite barbeque this weekend, he thought it was a good idea. Amen!

Thankfully, Mr. J. was still being evaluated by the time I left, so I was not required to fill out all of his discharge paperwork. Hooray!

In the grand scheme of things, repetition can be a good thing.

Stay tuned!

Lather, rinse, repeat

It's not just on a shampoo bottle. It's the story of my life in taking care of Mr. J., one of our usual suspects. My shift went as follows.

1. Suction him (very frothy trach) on first rounds.
2. Do AM bowel routine.
3. Return in 30 minutes to clean up, then suction again.
4. Finish bowel routine.
5. Suction. Leave.
6. Move bed from across unit storage so admission has a bed in his room (and all other assorted furniture). Do dressings on other patient. Thank goodness she can survive without me!
7. Come back, do AM care, dressings, PICC dressing (since he has one that's falling off), turn.
8. Suction 'cause you rolled him a little too much changing the linens.
9. Reposition and all is good for about 30 minutes.
10 Admit new person down the hall.
11. Feed Mr. J. lunch.
12. Suction after lunch. Fluff, buff, make all comfy.
13. Turn, clean up, drop full suction canister on table and floor.
14. Clean up mess, call for Housekeeping. (Thanks Bob! I couldn't live without you.)
15. Get Mr. J. ready to get up. Mr. J. decides to stay in bed today.
16. Suction.
17. Reposition. Fluff, buff.
18. Take care of other patients.
19. Finally, eat lunch during department meeting: elapsed time 10 minutes (I ate slow with a salad).
20. Send labs on new patients. Let new patient take a nap.
21. Finish admission and assorted paperwork.
22. Get ready to leave and hear a tornado warning called on intercom: Code Gray. Everyone out of the pool!
23. Wake up napping patient (already awake) and help him transfer to wheelchair to get into hallway.
24. Quitting time comes.
25. Run out the door, do not pass go, do not collect $200.

Getting Bubba home safely after making it through a hailstorm and watching the tornadic clouds on the horizon just two miles away: priceless.

I celebrated the end of the tornado warning with a drink , a soak in the tub and a good scrubbing, and lather, rinse, repeat.

More to come...

Cops and nurses

Yes, cops and nurses have a lot in common.

Sometimes we're dealing with sundowning patients who are perfectly content at the beginning of the shift is fun, but don't forget, they add a extra level of excitement just before shift change.

One of our security guys was on rounds and asking if one of our people had "called anyone" today. Nope, I tell Officer T., Mr. X. is good. He just calls his wife, she understands he's demented and plays some music he likes over the phone. Officer T. leaves.

Mr. C., who was being good all night, got perturbed when his son left without getting his ice cream. He called him and he told him he'd be back tomorrow. Hence the agitated cascade begins....and ends with a call to 911 on his cell phone. Unlike the hospital phones where our 911 routes everyone to security, his cell phone sent him to the nearest 911 call center for CouldaWouldaShoulda County.

CWS county does not appreciate 911 calls from demented rehab patients. Officer T. and partner come over to visit Mr. C. and talk to him. Mr. C., agitated, refused to talk to me, but told the officers the same story. He refused to surrender his phone however. I eventually left and passed on the task of getting the phone to Z., the following charge nurse, called  the on-call doc, then notified our house super.

Now if only I'd stopped to get a donut (or a drink) after everything. Maybe next time.
Stay tuned.

Terrible tornadoes

Are currently terrorizing the middle of the country, and a really scary story..a tornado hits a hospital in Joplin, MO.

So happy our tribe made it back in one piece, since there were storms aplenty on our way back home. Bubba was content assembling his new toy dinosaur (which has a million pieces) and a trip to Dahey's favorite sandwich place. He wolfed down his Italian sandwich like we hadn't fed him in days. This couch potato child swam and played for hours and he ate everything in sight.

He also slept soundly every single night, which was lovely. Can't wait until the tribe can hit the road again one of these days.

It was nice to be away, though. I, am back to reality: housework, computer work and work at the Hotel. I'll be praying for no tornadoes.

Why is it...

That when you're a kid on vacation that things just seem more interesting than they do at home?

This explains Bubba's fascination with a particular dinosaur exhibit...that he had to see...that he ALREADY saw in RehabLand. It's just more fun seeing it on a gorgeous day with thousands of other people and just as much fun when you don't have to worry about posing for photos because Dad forgot the camera.

At least, so far, we've gotten a souvenir plastic cup to remember the trip from the bowling alley up the road.

Now after all that dinosaur visiting, Bubba's sound asleep snoring away. We'll see how it all goes.

More to come...

I am a nurse...

I am a leader.

This was the slogan for the ANA video contest. And this is the winning entry. Today, I thank not just Mandy, but all you school nurses out there. You rock!

On the eve of the voyage

 To get away from one's working environment is, in a sense, to get away from one's self; and this is often the chief advantage of travel and change.  ~Charles Horton Cooley

Yours truly, Dahey and Bubba will be heading down the long road travelling for a piece. Will update as we can.

Stay tuned for exciting updates from the road. Kids (and husbands) are so much fun.

Yes, we're a little crazy

To the average Joe/Jill patient, what we do at the Hotel seems kind of nuts. Rehab units are places where you can get up and get out, and you even have your own entourage, besides me, your unit tour guide.

Dear Mr. ABC:

Some people think I'm nuts when I tell them this, but it's absolutely true. I'm the tour guide and I usually get the job of helping you initially, getting settled in and used to the rhythm of the Hotel.

No, we're not like SuperLuxeRehab unit sown the street which gets remodeled, redecorated, repainted every time someone sneezes, no, welcome to the gritty world of the Hotel, which saw it's last wallpaper change in 1994. Now, the signs and some equipment you see are brand-spanking new, but  that's just because. We didn't want the signs (management says we have to be "just like everyone else"), but we did want the equipment, since it makes our jobs easier.

No you won't get a private room just because you have MRSA. This is not SuperLuxe. Join the MRSA club in a double room (almost 75% of our people have it, and some other bugs for which we isolate, too).

We are rehab nurses, so the three things we care about are bowel, bladder and skin. People will come in asking all kinds of questions on those three things, so don't be surprised. This is why I explained the reason you need a post-void bladder scan for a while.

We'll also bug you daily about your bowel habits, to make sure you're going. Yes, we really do care if you're going and want details, if you bother to look.(If you don't, we will.) Bowels that work tend not to cause problems, unless, of course, they work a little too much. Moderation is the key.

Skin, to me, is a no-brainer. As I tell patients, it's supposed to be clean, dry and intact. This is why we look at it regularly. If you need help cleaning it, that's what we're here to do. If you can do it, we are thrilled. One less bath I have to do, so I can do other stuff you need.

So, yes, Mr. ABC, we may seem crazy, but we care about you, and your bowels, bladder and skin.

Hope you enjoy and make good use of your stay at the Hotel.

Sincerely,

RehabRN

The story of the numbers

I read in the paper today that if the debt ceiling is not raised by August 2, there will be lots of trouble, according to economists. As a Govermint employee, I'm thinking I may need to beef up the emergency fund and plan a staycation for this summer, instead of that cross-country trek for Bubba to see Uncle Ray and his kids out East.

Ahem...back to the interesting numbers. As an escaped business person, I'm always looking at numbers, and as a rehab nurse, too. We got labs, input, output, pressure ulcer sizes, TED hose sizes, you name it.

For fun, I always read the stats of this blog. Some of them are not entirely numeric.
Since this lil' blog has kept stats (about 6 months after I started) here are the numbers:

Total    33,273     
Average Per Day    35     
Average Visit Length    1:19     
Last Hour    1     
Today    13     
This Week    245    

I am also fascinated by the places my visitors come from. Here's a recent sample:

State of Ohio (state.oh.us)

Federal Aviation Administration in beautiful downtown Atlantic City, NJ (www.faa.gov)
No wiseguys...looks like they just came over from my friend Maha's place (pakazoid.blogspot.com)

Kuwait National Petroleum Company (www.knpc.net)
Did my bro-in-law tell them about me? He's a FOBbit now, so maybe he did that while waiting for his food at TGI Fridays.

Last but not least...
Some nice person in Adelaide, South Australia using on.net found this blog on google by typing in label bubbling.

No matter the numbers, no matter where you are, thank you for stopping by. Come on back whenever...you never know what I'll serve up next!

Stay tuned...

One of these days...

Spring will return to RehabLand. I guess it's just another example of global warming (or in our case, cooling).

Stay tuned...

Ah, those were the days...

I felt a lot of relief when I finished nursing school. To date, it has been one of the hardest things I've ever done, childbirth included.

So tonight, I raise a glass to all the graduates of PrivateU, my alma mater, who are getting ready for all the festivities coming up. If I were in charge of the nursing school commencement, here's what I'd tell you all, nurse to graduate nurse.

1. Enjoy waiting for your ATT (Authorization To Test). It'll get there when it's darned good and ready.

2. Take an NCLEX prep class with a guarantee if you can afford it. If not, plan on studying full-time for at least three weeks (Monday through Friday like an 8 hour job). Enjoy the weekends to digest everything.

3. Follow the instructions exactly when taking the test. Know where to go and get there a little early.

4. Breathe and count to 10 if you get the question from hell.

5. Do the same even if you get the TV commercial Viagra (Cialis, fill in your drug of choice) slam dunk easy question.

6. Do not throw up when you're done taking NCLEX. Relax and enjoy. You'll have to wait however long no matter what for results.

7. If you have a job, work hard and realize, yes, you really do need to keep studying those things you don't know on your own time. You need to do them at work.

8. If you don't have a job, make your search your full-time job, Monday through Friday, eight hours a day. Three words: network, network, network. Join a nursing organization if you have to (many have new nurse discounts) and volunteer if you can. Don't despair. Been there, done that, many moons ago (and waited over a year for a full-time degree-appropriate job).

9. Use every resource available to alumni of your institution for your job search. Register with them (if needed) even if you have a job. You never know when you'll look for another one.

10. Nursing is hard and there is a reason why (you'll soon find out) many new grads (somewhere around 50%) quit nursing after one year. Think of it like Survivor. Learn to outwit, outlast and outplay whatever madness comes your way. Always wear good shoes and use the rest room whenever you can.

And finally, make time to have a life. Have friends you can count on, in nursing, and outside nursing. Have family relationships of value. And most of all, take care of your physical and mental well-being, even if it means you get your toes pedicured once a month, get that monthly massage, or have that lunch with a friend monthly. Live so that you may have something to give to your patients and your coworkers at work and to the people you love when you get home.

This is just the beginning. Enjoy the trip. Congratulations!

Relief

So glad this semester of grad school is over. It wasn't horrible, but I need the break.

And yes, I rocked it with a grade of A to add to the arsenal. She allowed us to be unconventional (no APA format needed in our final project.) and I made it work. An artsy theory professor wasn't a bad thing after all.

This was just what I needed after another week of back pain. Hopefully, it'll go away soon. Stay tuned!

All's well...

That ends well is how the saying goes, and happily, my day went well. I got a recalcitrant patient out of bed after he cut up yesterday, only to have him be sent back for low blood pressure. Turns out when we gave Mr. W his meds exactly as ordered, he got a little too much, which required a quick Narcan push.

Mr. W later confessed to not taking his meds as prescribed at home and doing dangerous things, like taking extra extended release morphine at one time. MD and I tried to reinforce how this is really a bad thing, but somehow, he thought we were joking. As a result, MD will drop some meds and be titrating other meds from a much lower dose.

I knew Mr. W. was feeling much better after his Narcan and being flushed with some fluids, because he started acting like his old perverted self.

Mr. W: "I'm cold can you warm me up?"
Me: "Want a blanket?"
Mr. W.: "No, (motions to side) I want you to get over here and warm me up."
Me: "Did I tell you my husband is a former sharpshooter who's jealous and occasionally visits me at work?"
Mr. W.:"So are you rejecting my proposal?"
Me: "Yes. My counter proposal is a blanket...or two if you really want an extra."
Mr. W. "Oh, all right. Just don't tell the sharpshooter. Some guys get all the luck."

Some things I do well...

Like proving to the nurse who tested me, that yes, indeed, I am still allergic to dust mites.
Thankfully, I do not need to start shots. So glad it'll be time for some antihistamine soon!

More to come...stay tuned for all the excitement.

How come...

Some people go right away and check on their people on first rounds?
Some people go off in a group and go straight to the internet and shop instead?

What are the consequences?
Some people have everything done when they want and know where their people are located in the room.
Others, go to their rooms, after shopping, or when summoned, when their people are located on the floor, with the wheelchair to the left, the  slipper to the right and staring up at the ceiling.

Just another thing I wish our boss would enforce..rules. We are so lucky Mr. X. did not get hurt badly.

Stay tuned...

Whenever

I think I'm too big for my britches, or feeling low because I didn't get something I really wanted, I feel grateful that I didn't get everything out there that I could have gotten.

If you want to read a compelling story, check out AJN's Off the Charts blog for Dispatches from the tornado zone in Alabama by Susan Hassmiller. She is blogging about her experiences as a Red Cross volunteer.

Finally, if you can, please give.

I do take chances, too

I take my chances, yeah I don't cling to remorse or regret
I take my chances, I take my chances, every chance I get
--Mary Chapin Carpenter, I take my chances, 1992

And since the instructor told us to go for it, no APA format needed, I took that chance.
Looks like it paid off  in a good review...yes!

Happy Mother's Day

God could not be everywhere and therefore he made mothers. ~Jewish Proverb

Hope all the mothers out there, especially those working today, have a great holiday. I'll be joining you shortly, once Bubba tells me what the big surprise is.

All dressed up

And no place to go...so the saying says.

So why on earth wouldn't our illustrious education and resource nurse make sure all of us had our in-service on a very specialized piece of equipment once it's finally installed on our unit to make life easier?

Could it be any of the following, so pick the most logical one below:

1) He/she was too busy following the safety and construction people around while work was getting done.
2) The boss didn't make him/her set a deadline for which to train staff.
3) He/she is terribly lazy.
4) He/she  lost the user's guide so we have to wait for a new one.

Two to three of the above items are true. Go on, take a guess which one isn't.

Stay tuned...

My Monday midweek

Yes, when I start rotating my shift, I always feel like it's Monday. I work several days in a row, and then, eventually it's over, but it never fails that the first day is momentous.

First fun item: one patient gets taken off the floor after much nurse cajoling of MD because his oxygen sats wouldn't go up. Diagnosis in the ER: PE. So glad he didn't get to code on us!

Second fun item: the dualling trach patients. Who would have to be suctioned the most...patient #1 at one end of the hall who swore he didn't need to be suctioned, then asked as you left the room or patient #2 who would get turned, then need suction or would need suction at the most inopportune times?

Third fun item: Mr. C. got rejected  for his colonoscopy that day, so let's just prep one more day and have him drink a gallon of GoLytely again to clean him all out. Yes, he got cleaned out, but it was fun changing linens all freaking shift. Clean, clean, clean to keep him from breaking down. Heavens!

Fourth fun item: Mr. Needy. Move this, move that, lift me up, 'cause I can't see my computer, etc., etc. I  would have killed him if it wouldn't have made a mess. (I really like our housekeeper Bob, and  he'd probably run away if I made a big mess like that.) Mr. Needy just made my shoulder pain turn into back pain very quickly.

Thankfully, one of my menagerie of patients, Mr. S. was so sweet. He's been training to do some of his care I'd normally do, so he was ready to fly solo. I was so happy. (One less thing I had to do.) I made sure he got his snacks and whatever else he  needed on rounds. He was the highlight of the night.

Down for the count?

Mr. S. got discharged recently. He told people that "two ladies jumped on my chair" and now it won't do anything. He claims the ladies "broke it". Mr. S. also tells a patient or two (via phone call and one, Mr. Chatty relays info to us) that he's sitting in his shower chair on his porch waiting for his neighbor to fix his chair. Our wheelchair specialist is not amused.

Oh, the heave ho going on at the Hotel is getting better. They've fixed us up with top-of-the-line ceiling lifts. The renovation's coming, but, in the interests of safety, and the fact that they've already spent the money, the Powers That Be deigned we get them. It's about freaking time. Who else moves more patients than us? Only one other rehab is in our system, and they had lifts way before us. To top it off, 95% of their people walk, even the amputees.

So I'm not sure if all the excitement of the new power equipment or if it's just the weather, but my back is acting up. So much that it warrants a trip to Dr.B to figure out what's up. I don't really want to be out of commission, but I really don't want to end up really injured either.

Stay tuned...

A little coincidence here...

A little bit there could be construed as a little more than coincidence.

What a wild weekend! I escaped from the Hotel, so it's been fun working on the final paper of the semester. The coincidence: when your instructor is also a film maker who made a movie about an area where more than a few of your patients are from. I only got to see the trailer, but it was eye-opening to see the remoteness of the area.

Bubba had a party and the kids had a good time playing soccer until the rain came. At least, no tornadoes came with it.

Who knows what the week will bring. Just hoping it's not a ton of admissions.

Stay tuned.