Saturday, March 6, 2010

Heard on the unit

A few of the more interesting things in our neck of the woods.

"He's too heavy." (multiple people)
We're getting more and more bariatric patients at the Hotel. Some people are getting so irate at staff meetings that they are refusing to move some people. We have equipment, but no one wants to help each other when people have to get up for whatever reason.

I think we need some team building...fast!

"Get out of here you b&(*h" Mr. Demented to nurse manager and male staff
At least, we girls, don't have to be the only ones to put up with inappropriate behavior from this one.

"I'm going to go home and grill a steak." Mr. H.
Mr. H. has been with us for nearly a year. Spring is coming. He's having food fantasies and swapping so many grilling stories with people that he's making me hungry. He should be good to go in the next couple of days.

"I can't believe we didn't think of that sooner." Charge M.
M. our charge nurse has been around for a very long time. We used a rare, side entry maneuver to get a patient into his/her wheelchair without issue after one of our new nurses brought it up. We haven't used it in a long time, so that's probably why we forgot it, but so did the therapists.

Friday, March 5, 2010

Change of Shift

The latest edition of Change of Shift is now up at mamatrauma.

Go check it out...one of my posts actually made it in. Thankyou...thankyou verrah much!

Thursday, March 4, 2010

Crusin' into the weekend

Even though, I will be busy doing homework this weekend, I am looking forward to it. My day was a lot of heavy lifting today. Thankfully, I used a technique one of our newer nurses pointed out to us the other day, and I still can't recall why we hadn't thought of it in the first place. (We have used it before!) Life is so much easier, when you can get people in and out of their wheelchairs simply.

Mr. X., our patient from a recent post has gotten more not so good news. His surgery has become more complicated. He's got a lot more thinking to do, because it will be life-altering.

I have a moderate to large manual I have to read by the weekend.

Stay tuned for more updates....

Tuesday, March 2, 2010

What's next? Beer?

Had a good chuckle over the latest, beverage-inspired political group:
Coffee Party, With a Taste for Civic Participation from www.nytimes.com

Monday, March 1, 2010

So glad it's Monday...

And the crazy full moon weekend is over. Being in charge ain't all it's cracked up to be!

My shift in the hot seat included:

1. Assigning all the patients. The Slug was in charge before me on the previous shifts, and lo and behold, one patient went unassigned. Granted, said patient is easy to care for (little to do on our shift) but it really looks bad if you forget to give him/her a nurse.

2. Avoiding mutiny in the ranks. Another installment of "he said, she said, I wanted OT and didn't get it." My advice: communicate. Said nurses could have and would have avoided the whole drama thing if they just would have talked to the people they needed to.

No, it's just too easy to be passive aggressive and yell at your co-workers...

3. Dealing with a patient who thought chest pain is no big deal. The joy of all the tests, time spent on the phone, with the on-call doc, with the patient's regular doc, the supervisor, the pharmacy. I really miss my phone headset on those days.

4. Blood pressure issues and a patient who doesn't want to go home. He/she is mad at the world and I was the lucky target. Finally, we got everything under control...at least for the oncoming shift.

And blissfully, every single person showed up before I was ready to leave the building, so I was not forced to stay and work a double. I am always so, so happy to go home.

More to come...

Sunday, February 28, 2010

Charge it, baby!

I just love being in charge...the authority, the paperwork, the personal interaction with families and staff.

Now if it really were as great as this, I'd have more time to post, wouldn't I?

Stay tuned for more excitement....

Thursday, February 25, 2010

Nuggets for February 25

Yes, I'm a little behind, but I've been saving up so many goodies I've found, I thought this would be a better use of my time at this very moment, instead of getting ready for work.

Here are a few of the items I've found out on the 'net and in the blogosphere while meandering. Hope you enjoy!

Tips and tricks
Ian from impactEDnurse has a great little video about keeping air bubbles out of your IV
lines.

Not Nurse Ratched
has an informal tip for you (or your patients) experiencing nausea. Not sure where it came from, but would be happy to do the research. The Hotel is full of smells, particularly on evenings.

While it's not a specific trick, this PBS segment on Dr. Atul Gawande's book, The Checklist Manifesto, talks about using checklists in hospitals and health care.

Jo has a survival guide to the night shift at her blog, Head Nurse.

Check 'em out
If you work odd hours, such as evenings, nights and weekends, you need to check out Life in the Trenches: Nursing at Night and on the Weekend. This blog is a part of Dr. Patti Hamilton of Midwestern State University's RWJF funded research project about nursing at these times of day and what happens.

We've heard a lot about the Haiti earthquake's wake lately, and one thing, you don't always hear about is how to meet the psychosocial needs of patients after disaster. Somehow, I stumbled upon this interesting CEU article called Psychiatric Emergency: Caring for Patients in Crisis.

The OMG section
Rehab is predominantly a low-tech area of nursing, because patients need to get up and running with a minimal number of devices. As an escaped techie, though, I never cease to be amazed by all the technological prodecures and devices that are on the market or will be there soon.

Liver transplants that do their job, then fade away is about a transplantation procedure, used primarily in kids, featured recently in the NY Times.

Coping
Bravo Roger! I found the Well blog article over at the NY Times which discusses life for Roger Ebert since his cancer surgery. Appearance is not everything. You might just blurt stuff out, as your wife says, but sometimes they are things we just need to hear.

Scuba diving accessible to people with disabilities? Check it out here in this article. (from www.pva.org)

Tuesday, February 23, 2010

Prognosis

Some things change, and some things stay the same. And while some appear similar, life will never be the same for one of our patients.

Mr. X came to us for a sore that wouldn't heal. This is not exactly a big deal with many of our patients because, due to the nature of their various injuries, slow-healing wounds are not uncommon. Some people have them on and off for years, as did our patient.

One day, the doc comes in and tells patient, "I don't like that wound. We need to do a biopsy." I accompany one of the providers from the service that day and he does the biopsy and sends it off.

A few days later, on the next rounds, Doc tells him, "You have a malignancy. We will have to evaluate you to see what we need to do." A few specialists later, they evaluate the plan and Doc tells Mr. X that he has options. "One, they can operate. It is not without peril, since about one third of patients don't survive the surgery. Two, they can let it go and do nothing."

While my account may seem terse, Doc explained the patient's options very slowly, carefully, and most of all, very compassionately.

Mr. X says, "I want to do something." Doc tells him he'll have more information for him by next week.

So he waits...

Monday, February 22, 2010

You want what?

The story of my days recently.

1. You want to admit how many people today? Our usual is one per MD during normal business hours, but we went way over the limit on a recent day. No wonder they were snapping so much!

2. You want what kind of lunch? We're all out.
Don't you just love it when the dietician says, "I wish they'd put Ms. X on her colonscopy prep early. We're out of xx food item she needs."

3. You want to get up everyone 250+ lbs. plus today on a stretcher? It just seemed that way for a while...my back's still hurting.

4. You want my evaluation? I've already sent it.
Now please put me on the list for a pay raise, and I'll forget all about how many times you asked for and I e-mailed my information that you requested over and over!

Stay tuned...it can only get better!

Friday, February 19, 2010

Splat! Gold!

I love watching the Olympics on TV. Swoosh! Bam! Slide!

One of my patients who's a big WWF wrestling kind of guy is just enamored of curling. I can barely pry him from the TVs when it's on.

A whole lot of hoisting, lifting and swinging people around. One of these days rehab nursing will be equated to Olympic sports, because somedays, you need that Herculean strength to manipulate the poses, lifts and cushions to get people going.

More to come...

Thursday, February 18, 2010

Technobabbly

Can I just say that I need to read a little more on nursing terminologies and start making a flash card game or a map to keep it all straight?

Thanks, I knew you all would understand. (whew!)

Life at the Hotel Rehab is still the same. The sights of patients going here and there to therapy. The smells...thankfully not of vomit, although a few flowers would be nice. (Hint: no one bought us any flowers this year. Where's Mr. Romantic when you need him...Indiana?) The sounds were of all those rolling people laughing and smiling and hanging out with people coming in for our regularly scheduled lunches by one of the organizations.

And I escaped...just so I could spend time at school with Bubba, when he got his citizenship award. Aww...I'm so proud. You only get so many of these moments in life, so I am going to savor them.

Stay tuned...I'll be back!

Tuesday, February 16, 2010

Not quite...

Nursing school ready, and certainly not Hotel Rehab on evening shift ready....

Bubba tells me about his day at school.

"Mom I puked at school today."
"Okay," I ask, "what happened?"
"Something smelled really bad in the boys' bathroom and it really made me sick."
"How are you now?" I ask.
"Much better, thanks. " says Bubba.

The joys of school...makes me wonder if the custodian threw sawdust down on the floor.

Monday, February 15, 2010

Snow!

And if I didn't need another holiday gift...the powdery white stuff is all about.

Just may be sledding before I go to work, just after I clean off the car.

More to come...enjoy your day wherever you are!

Saturday, February 13, 2010

Holiday weekend...

If there's not enough to do....

Birthday parties x 2.
Ice skating.
Mardi Gras
President's Day...and a little fella gets to spend the entire day with Mommy on Monday 'til Daddy gets home.
Chinese New Year

And yes, again, it's Valentine's Day tomorrow. The Hotel is happily decorated with hearts and lots of cards and drawings by the neighborhood kids.

This year, they've even covered some of the hallways. It's just too cute. The patients who get up are regaling us with some of their favorite ones and the rest are looking at their own-- "Look at that drawing.", "Aw, he can't spell, but it's so cute." "She put glitter on MY heart, Bob." To top it off, they've even scheduled a concert. Lots and lots of staff taking patients to a fun party.

And I suspect many of our people will be thinking of this quote, since they're away from home this year.

Can miles truly separate you from friends... If you want to be with someone you love, aren't you already there?
Richard Bach

Enjoy your day! Stay tuned...

Thursday, February 11, 2010

Great expectations

That's what I get for opening my mouth in class.

The instructor assigned me to quiz, query and otherwise get one of our guests to tell us everything we'd possibly want to know about a certain nursing terminology.

Oy! Off to my reading...stay tuned for more goodies!

Tuesday, February 9, 2010

Not so sharp...

And I'm not talking about razors, either.

A recent admission: patient comes in for an evaluation by a specialist that he/she cannot get in his nearby hospital. Patient unpacks stuff and I notice three packs of smokes. Patient had a screaming fit when I advise him/her of our tobacco policy. Nevertheless, I had to do remove the smokes according to appropriate policies. Patient was counseled re: quitting. We offer appropriate support for those nicotine needs-- patches, gum, etc. Patient calms down and apologizes.

To assure his happiness, said patient also brings some snacks, and a few cans of soda. In addition to the soda, I notice the non-alcoholic beer. Another argument ensues (nicely of course), but I had to get one of our bosses to confiscate that. Patient just refused to part with the near beer without an authority present.

The ironic part: Admitting MD notes that patient would have come to us sooner had he/she not been busy cleaning up legal issues related to alcohol.

Friday, February 5, 2010

By hook or by crook...

I'm probably going to end up in Vegas this year...maybe for my anniversary! Dahey said we could renew our wedding vows there for fun at one of those chapels. I told him only if he wears an Elvis costume. I was told I have to be Priscilla...not sure if the blonde or brunette one!

Anywho...enough of me. The work week ended with much excitement. The docs obviously didn't think we had enough to do, so they gave us a few extras at the last minute, like getting a PICC line and blood cultures for my patient who slept most of the day, because he stayed up watching movies all night and ringing the light for candy.

Our boss decided to redo a presentation my conference companion and I had done for one conference and submit it for another conference. Of course, all of the information had to be done stat, because, the boss never wants to wait (and he/she has ADHD) and the deadline is 1201 EST. This conference is in Las Vegas, too.

Happily, right now I'm working on a group project in my class and it's going very nicely. We have a larger group and being the project manager, I'm having fun doing and doling out the work where needed. We will deliver on time, by golly!

So now, a couple of shots...of espresso later, I'm ready to go to bed. To sleep, perchance, to dream...of a free weekend.

Stay tuned....more to come.

I love this job some days

Those are the days that click. I got to have fun recently. At Madison, nurses from Washington, our main hospital, come to the beautiful Hotel Rehab to hang out with us and see how we care for our patients in rehab. Our people sometimes strike the old school nurses as "needy", and some of them are, but some of their needs are not optional--they are necessary. Many of them see them when they're sicker than sick, or just before they come to us.

I got the pleasure of being shadowed by a nurse with way more experience than me. She has been a nurse almost as long as I've been alive. M. retired from World Renown Hospital, one of our nearby local university-affiliated trauma one centers. She saw the opportunities at Washington and said, "I want to try it."

M. and I discussed issues that come up with our people and all the rationale why these issues can be a big deal. I even gave her some of our patient ed cards so she had something to take back. On top of that, she actually thanked me for my explanations of our policies, procedures and how we operate.

It's lots of fun telling a willing audience about what you do and have them be interested.

Thursday, February 4, 2010

Change of Shift, February 4, 2010

Howdy all! I'm just back from a major cross-country road trip in the land of Dead Man's Wash and Bloody Basin. Only slightly saddle, or seat-sore from all the switchbacks, so I'm recuperating from beautiful but dusty environs, cactus pollen and the quirks of roadside hotel beds.

Sit on down at the bar, have a beverage of your choice, and enjoy the official, genuine authentic February 4, 2010 edition of change of shift.

Aaliyah Williams
presents 10 Tips to Help You Take Control of Your Medical Records posted at MPH Degree, saying, "Your medical records, whether paper or electronic, are important documents that are generated or updated every time you visit a doctor."

Faithe Jamse presents 17 Healthcare Trends that Are Actually Bad for Us posted at Masters in Health Care, saying, "Computerization, recession issues, the digital divide and even the price of gas all affect people and their health care. This list of seventeen healthcare trends and why they might be bad for us shows that some issues might be debatable."

Canika Jackson
presents 11 Ways You Can Get Medical Care for Free posted at Radiologic Technician Schools, saying, "Medical care is an expensive proposition and any price discounts or freebies are hard to come by. However, if you donate the time and energy, you can find some surprising savings."

And since I've been travelling lately, Dean at the Millionaire Nurse blog has this timely post called Journey to Money Success--It Has to Start Somewhere. Be sure to read and think about this when you have to pay the tax guy coming up soon, or if you're one of the lucky folks who'll be getting a refund.

Nurses and students

Janine posts about life and death and all the Shades of Grey on her similarly named blog. You'll never think about feet the same again after you read her post, My Big Toe.

Laney from over at Nursing Student Chronicles hits the nail on the head in regard to assessment and a new nursing student in her post, And then my head exploded.

Stefanie Kelly presents 57% Nurse Case Managers and Non-Clinical Nurses Look for New Jobs in 2010! Should You Be Looking Too? posted at Pathway Medical Blog, saying, "Survey shows 57% of nurse case managers and non-clinical nurses looking for new jobs in 2010."

Lisa presents Hey world, I just wiped your grandpa's ass, are we cool now? posted at experiences of an ICU nurse, saying, "let me know if the title is too offending and I could change it." Naw, I do rehab, so wiping butts (and teaching technique) is a large part of my job. Bodily functions are not a bad thing, but some of the products do stink!

Heartstrong presents Celebrate National Wear Red Day® this February with The Heart Truth®! posted at Healthy Hearts with Heartstrong.

the muse presents Nursing Orientation ? Good One or Bad? posted at the Muse, RN, saying, "Sorry! I may be too late, but I hope not. " Nope, you made it!

Mamatrauma tells us about a day gone awry in I hit my stride...then stumbled.

Nursing Policy

Mike King presents 100 Ways to Serve Others posted at Learn This, saying, "Nursing requires a strong attitude of providing care to others. This list outlines 100 ways to serve others in all areas of life, but certainly applicable to nursing as well."

Dot from Fibro World, a patient's blog about dealing with fibromyalgia, has a great post called, I wanted to hit my doctor when he said... which details the frustrations patients may have dealing with healthcare professionals. It will certainly make you think!

Trish Torrey discusses How are nurses portrayed on tv? And why does it matter to us. in this about.com post.

Katie Freeman presents 25 Free iPhone Applications to Help You Stay Healthy posted at Masters in Health Care, saying, "In today’s busy society, having access to applications that can help you stay healthy while on-the-go is extremely helpful."

That concludes this edition of Change of Shift back in the land of RehabRN. Thanks for visiting!

Submit your blog article to the next edition of change of shift at emergiblog February 18 using the carnival submission form. Past posts and future hosts can be found on our blog carnival index page.

Wednesday, February 3, 2010

Sick, tired and broken

Me, me and the major necessities of life. Thank goodness friends will come around when you need them!

Another good thing...Change of Shift...here...tomorrow.

Don't miss it!