How to tell

If your nurse manager reads the Wall Street Journal. I decided to pay attention to my manager's communications and noticed:

1. He/she follows his/her name with his/her MBA or MPH credential. Master's degrees in other areas besides nursing have a cachet today.

2. Your boss's e-mail signature includes the subtitle of this article.

3.  Finally, your boss is becoming a walking buzzword machine, and once you read a few articles, you'll see all of them.

That is all...TGIF!

Biennial joy

Yes, I've been looking for this for a while: the infamous renewal mail from the RehabLand State Board of Nursing.

The last renewal period, the Manglement at the Hotel thought it would be nice to terrorize anyone who did not renew in advance (meaning the second it was mailed out). One of my coworkers got a nastygram from the CNO stating, "Your employment can be terminated if this is not renewed one month early per the Hotel police."

Oh, really? You want to terminate hardworking nurses because they did not renew their license FAR ahead of time? Thankfully, said CNO has retired and hopefully, is enjoying the sunsets somewhere else, far, far away (and gets sand kicked in his/her face from time to time).

Even with online renewal (which is LOVELY), please folks, take your time filling these out. They  have some serious questions (including some new ones below). If the answer to any is YES, you cannot fill them out online. (So glad I'm a no!)

Since you last renewed, have you ever been convicted, adjudged guilty by a court, pled guilty, pled nolo contendere or entered an alford plea to any traffic offense resulting from or related to the use of drugs or alcohol, whether or not sentence was imposed? (this includes a disposition of a suspended imposition of sentence (SIS), suspended execution of sentence (SES), or placement in a post plea alternative or diversion court and includes municipal charges of driving while intoxicated, driving under the influence and/or driving with excessive blood alcohol content.)
Yes No
Moral of the story: Drinking then driving can cause issues with your license for years.

Since you last renewed, have you had a judgment rendered against you based upon fraud, misrepresentation, deception, or malpractice related to your practice as a nurse?
Yes No
Moral of the story: Don't steal, lie, cheat or commit any other fraud. Leave the pyramid schemes to someone else. You don't have time for that.

NEW! Are you listed on any state or federal sexual offender list? (they thought this up after a few issues)
Yes No
Moral of the story: Yes, we have to ask, and yes, it can be a problem. Just another thing not to do as a nurse

By checking the following box, I declare that all statements or representations submitted with this application are made under oath or affirmation and are true and correct to my best knowledge under penalty of section XXX which specifies that anyone who makes a false statement in writing with intent to mislead a public official in the performance of his official duties is guilty of a class B misdemeanor.
   
Select this box if you agree to ALL the above statements and have answered all questions that were presented.

Moral of the story: If you don't, you have some explaining to do...on paper via mail.

I'm so glad I'm done. Happy renewing!

Cold again

Yes, the temperature is dropping and I have a virus form holding my sinuses hostage.

After consulting some of my favorite people (the neighborhood pharmacists, since BFF Rx is out of town) I've found a cocktail that is making life manageable.(Dayquil + Zyrtec)

I just hope I can talk today. Yesterday, despite tea and cough drops, was not so good.

Since Bubba  and Dahey will be indulging in a long weekend starting Friday, so will I. I just hope to spend it getting well, not being sick.

Stay tuned...

More on interviewing

Yes, I know I talked about this last year, but since I'm now on my 10th interview panel (I did a bunch last year), I've found a few more things to add:

Things that may cause us not to hire you:

1. If you are a travel nurse and tell me you just want this job until a gig comes up in Florida, you may not get hired.

Yes, spring will be in RehabLand soon. Why should we bother our HR folks to do a whole bunch of work if you won't stay anyway?

2. If you have issues, we may not hire you. As part of a credentialing process, we have to do a background check.

The state of RehabLand will not renew your RN license if you have tax issues.

3. If you may be part of an investigation due to criminal wrongdoing and/or a sentinel event, thanks for letting us know, but we may not select you for hire.

A really unusual job

Yes, in the life of a rehab nurse, it's all about bowel, bladder and skin.

So I was intrigued when I read an article recently about how one company needs stool donors to fight C. difficile.

Sure, some shifts it seems like you have people who want to compete in a "how many times can I stool" competition.

Just be warned, as the article I read mentioned, "It's harder to get into this program than it is to get into M.I.T." You must be local, and you will be paid for your efforts: about $13,000 per year.

Feel free to share with those friends who are in their neighborhood. I'm sure they won't mind at all.

Happy weekend to all!

Bright, shiny, and WARM here in RehabLand. Hope you enjoy your weekend wherever you may be.

Let it go

I'm singing that song in my head a lot lately. Since we've had a full moon this week, I think some of our more melodramatic, er, crazy folks have been living up to the hype.

One of my favorite moments: the idiot who said, "We really shouldn't help you. You're not in our department and you're too much work."

"Really?" I said? "We work for the same company and have the same patients." It's a good thing this was a virtual meeting (i.e. he was nowhere near me). It made things really interesting for the new MD who just joined our group. I will remember this when said idiot needs paperwork help soon. 

I love it when 1) someone neglects to tell you when they have a problem, 2) when you find out, you go to all the proper people to resolve it and get a root cause, then finally 3) said melodramatist decides, in her best Scarlett O'Hara routine to tell everyone, "I just can't do it because nothing works right."

I have one potential job on the horizon, I turned down one, and another in the wings.

So very ready to let all of this BS go.

Stay tuned...

For Phil tomorrow...

Yes, folks, it's one of the ONLY days of the year that we watch rodents with pomp and circumstance. It's Groundhog Day eve.

It is Super Bowl Sunday, but you have to admit, Groundhog Day is pretty fun, too, even without multimillion dollar commercials. So lots of sites, like Cake Wrecks, are celebrating Phil and all the other furry characters around the country who will be busy prognosticating early tomorrow morning.

And if it's not on in your area, check out the classic movie Groundhog Day.

I will be thinking of all of you, because I'll be hoping my day (and yours) doesn't keep replaying and that someone predicts an early spring.

Happy Groundhog Day to all...

Blowin' in the wind

Yes, it does seem like answers lately ARE doing that. It's been extremely windy here in RehabLand lately. From the "dirty fronts" to the Alberta Clipper, the winds are blowing.

The winds of change are also coming soon to RehabLand. We know it because it's leaking out of the management suite slowly, but surely. Our manglement finally GETS what I do in the SU, and they know realize how woefully executed my programs are (due to lack of cooperation from manglement, staff, etc.)

Some folks are even seeing cryptic messages in the media. They are slow on some things, but may be smart on others.

I'm having flashbacks to my other life before nursing. And some of them ain't pretty.

How to tell when change is in the wind (my $0.02)

1. Headquarters hires a new boss from outside who has a reputation for "cleaning house" in a Fortune 500 company. 

Some of our armchair pundits at the Hotel may have missed the hint when he/she said, "Some folks won't be with us on the journey." in that welcome e-mail.

Translation: If we can fire you, we will. If we can downsize/rightsize or RIF (reduction in force) you, we will.

2. Said head honcho gets permission to bring in a bunch of high-powered consultants with whom you can sit in a meeting (where you're supposed to be asked about your job) and they will grill you like your at Nuremberg. 

The grilling will have very little relevance in relation to you or your job or the reason why they (Manglement) asked you to come in the first place.

My favorite part: watching one of the old doctors (not a consultant, but an "expert") nod off during your session. The runner up was the grilling they gave the education chief. Best description: deer in the headlights. This was scary.

Translation: We're already paid for our time, so this is just a foregone conclusion, but we're trying to figure out how we can get more work "analyzing" your organization.

3. Head honcho publishes a "manifesto for change".

Believe it or not, the Hotel is in it. People like that at work because it makes them feel "safe".

Translation: You'd better believe the Hotel is going to change. Don't feel too comfortable just yet.

Should be interesting to see what happens...

Interesting rehab conference in June

If you rehab cancer patients on your rehab unit,  you may want to check it out. This is going to be free and located at the NIH in Bethesda, MD.

I may have to see if I can escape to go!

That is all...super busy week. Lots more stories on tap, but will have to sit down long enough to process, then tell them.

The doctor IS right

I've been following Dr. Val for a while, and I have to say, part of the reason is that I get her. I get what's she's talking about because I work in rehab.

Physiatrists get rehab, since they train in a specialty known as Physical Medicine and Rehabilitation. I happen to work with wonderful physiatrists who have years of experience.

And I have thought the same thing when I have read and seen certain specialists, like Eric Topol  in the media. It would be nice to sum up everything we do into a little smartphone app, but it will never happen in this lifetime. Disclaimer: My work actually includes a whole lot of technological interventions.

If we ever get to smartphone-only health care, I fear for everyone who does get a diagnosis, like spinal cord injury, that can benefit from a rehab program by specially trained staff, just like ours at the Hotel.

Cheap is one thing, and quality is another. You can have both to a certain degree; however, we do have to be careful what we wish for. It may not be good enough after all, cheap or no.

Stay tuned....

State of the union

I missed the actual address because I've been busy with Bubba, the birthday boy, the last couple of days. No wonder I fell asleep early!

Stay tuned...

It's beautiful outside, but it's sad

This past week's been a doozy. I'm hoping I never repeat some of it again.

Work was work. We had our yearly inspection and I survived. The inspection team had some new and some old folks, so it was interesting to watch them.

Outside of that, one of my mother's in-laws died. I hadn't seen her (or any of her kids) in ages. I like this family, so it was pleasant. The crazy relative didn't show up for the wake. Still don't know if he/she is alive or dead. 

I was just getting ready to go to bed when another relative called me. Her son didn't answer calls as usual that day, so she went to the apartment complex where he lived near her. No one answered when she knocked and one of the neighbor's let her know she could see inside the apartment from outside, since Max left the curtains open when he worked from home. (He had a job that could be done remotely, and hadn't worked in an office in years.)

When they looked in, Max appeared hunched over his desk. My relative watched, but Max didn't move. She knew Max was probably dead. While it wasn't a surprise (Max had problems), it was sudden.

So, since Max's family (girlfriend and teen child) was out of town and she didn't have a key, she had to call the police to break down the door. She found Max dead. He was in his early 50s. It was sort of a circus arranging the apartment, having the police roaming around, lots of questions, and waiting. Happily, things calmed down before I could get dressed and leave.

Now, we're just waiting for Max's family to get back to complete the arrangements, and for the medical examiner to do his/her part.

Stay tuned...

Read this

Several years ago, I was sleeping when I was suddenly awakened around 3AM. I went to work and found out one of my patients coded around the same time I woke up.

I thought of him when I read this post on the American Journal of Nursing's blog, Off the Charts today.

And I, too, thought of those family members who aren't around anymore. The pain subsides, but some of it never goes away.

Love, however, goes on.

Winter in RehabLand

If deep cold wasn't enough, we got a reprieve. The last two days have been above freezing (32F). Now the weather people are predicting freezing rain.I don't care. I have everything stocked up and gassed up the car. From the looks of the stores, it was mild panic.

Just let the light and heat stay on and I'm good.

Do your thing, Mother Nature. I hope I'm ready. If not, I'll just keep reading all this interesting stuff while I wait.

Stay tuned...

My patient gig is up...for now

Recently, I got to go on the other side of the fence. I had a sleep study in a sleep lab, after my two home studies looked funny.

I got basic prep over the phone, but I still had to call to make sure it was okay to take my meds in advance, etc. Preparing Dahey and Bubba was fun, too. They are always wanting instant communication when I am gone, so I had to let them know I was going to spend most of my time there sleeping. Translation: Don't call and send me a bunch of text messages. 

To keep the environment quiet, I had to turn off my cell phone and all my electronic devices since I was going to be wired up in bed. They budget 45 minutes to do this. My tech was great. I got wires on my head, which seemed to involve sandpaper, to make sure the electrodes and the goop got a good seal. I also got belts around my chest and waist. For good measure, I even had some leg electrodes with weights (kind of like those used when fishing). All the leg ones were attached with a good amount of goop and sealed with Medipore tape.

My room looked just like a hotel: heavenly bed type setup with a million pillows, flat screen TV and there was even a very nice leather recliner. Since I hadn't had any caffeine all day, I was ready to go to sleep when I got there.

Lights out were at 9PM for me. It took me about another hour to fall asleep. Then the fun started. My cannulas came off, not once, but twice. My room got hot, so the tech had to come in and cool it down. She warned me of this earlier, because if you sweat, the electrodes can come loose. (No way I was going to do this one twice!) Finally, the room got cooler (I think the duvet and the pillow top on the bed made me hot, but not sure.) I slept, but it was not quality sleep. I could hear trucks going down the road outside.

Miraculously, I woke up and it was nearly the wake up time we discussed when I started. I had to take all the wires in the bathroom with me, but when I got back, she took them all off. Relief!

The PhD who interprets the labs was in before I left, so I got a report. Yes, I have periods of apnea, but since none was severe enough for CPAP during the night, I probably won't get one. (My best sleep is on my side, so he recommended that). I just missed the score for a CPAP (barely). What does this mean? I will have to discuss with my doctor and see what he can wrangle with the insurance company.

As Dr. X, the pulmonologist told me, the PhD said he'd just put me on one, too. A borderline score shouldn't be an eliminator, but since insurance companies look at the almighty dollar, it is. CMS even has guidelines on this for Medicare. There are alternatives which I will have to check.

Now, I just have to wait until my next appointment to see what the verdict is.

And if cold weren't enough...

Now we have snow too.  Thankfully, it's light, fluffy, and can be swept away easily with a broom.

I can't wait to go to work on a day like today. This is when I really wish I could telework. Somehow, I don't think we'll have too many people go AMA today.

Off to warm up the car and remove my own personal icicles.

More to come.

Brrr!

Curses! The Arctic Blast is back. In a crazy week with a full moon, quirky coworkers and several threatened AMAs, you just need something else to keep you busy.

I think I'll just close my door all day tomorrow and hibernate in place.

That is all...

Bad luck? Perhaps

As we sent one rehab patient to hospice recently, I read this article from the BBC with much chagrin.

Could our patient Mr. Z really have just had bad luck? Could that mutation have been stopped before it metastasized all over and sent him to rehab?

One commenter said, "Mutations get all the bad press."

Fine time they should!  Lifestyle changes are important, but as the saying goes, sometimes you do everything right, and something goes wrong. I have a litany of relatives who've been burdened with these cancers by fluke, food and lifestyle. Horrible disfigurement and shortened lives make for a story, but try telling that to kids growing up without parents, families suffering from impenetrable sadness and loss.

Knowing we got him on his way, no matter how long our little bit lasted, with a little more dignity, is a very good thing.

Stay tuned...

The merriest of all

Dahey brought home some caramels his coworker's wife made for us. They melt in your mouth and are simply smooth and scrumptious.

Since I didn't get my sparkling wine last night (due to a spill), I'm having it now with these caramels.

It is a wonderful dessert. I hope the rest of 2015 is this smooth and sweet.

More later...