So glad

Monday finally flew by at the Hotel. I went in early to check mail and messages, and my phone rang. One of our patients passed away over the weekend. It wasn't entirely unexpected, but that call really changed the tone of my day.

Mr. C. had a wonderful Christmas according to this relative. He even got to celebrate a major wedding anniversary. He saw family and friends and experienced the fun of the holidays with his immediate family around him. His grand kids all opened gifts at his house.

Ms. Relative thought he was getting a cold and was possibly getting sick. Mr. C. said, "No, I just need some sleep." Mr. C. went to sleep smiling, she said, because he had so much fun seeing his family. When she went to check on him later, he was gone.

Considering the wild, crazy last few years Mr. C. had, this was the best way for him to go: at home in his sleep.

I worked a lot with Mr. C. and his family in the last year, I'll miss him, too.

More later.

RehabRN book club: Holiday edition

Just to follow up on our last edition: Shrinks is so worth your time if you'd like to know how psychiatric treatment has evolved over time. While I'll never work psych (although we ALL have psych patients, no matter what area we are), it was a very meaningful book for me.

In my humble opinion, it should be required reading for all nurses before or during your psychiatric nursing class.

Here are a few other books I enjoyed recently:

1. The Laws of Medicine by Siddartha Mukerjee
This is a very short little book that's worth your time. I'm going to check out the Emperor of All Maladies soon.

And on the nightstand right now:

2. American Smoke by Iain Sinclair
Just started this one about the author who follows the trail of American literary stars such as Jack Kerouac and William S. Burroughs.

3. Lights & Sirens by Kevin Grange
I've called for lights and sirens a few times at the Hotel, so I was intrigued by this description of the life of a paramedic.

More to come on these books. Have a great week!

Back to reality

It was fun, but too short. Yes, vacation is nearly over. It was fun though, spending time with Bubba and Dahey and some of the other assorted relatives who were roaming around Rehab Land.

I saw some movies. Between Redbox, our local library, the movie theatre and cable TV, I saw lots of stuff: things I haven't seen in years (Elf, Scrooged), things I see every year (It's a Wonderful Life, A Christmas Story) and movies I wanted to see this summer (Trainwreck, Inside Out).

My trip to the movie theatre was not for Star Wars (I was busy being an elf while that was going on) but with Bubba to see Daddy's Home. While it's not for everyone, it is a good one for kids, and per usual Will Ferrell movies, there is a big dance scene.

I wanted to see more holiday lights, but the weather of late has not cooperated. Tornado watches and rain ruined any chances of that.

Being away, however, when you are with people you want to be with, is priceless. While it was a lot of work, it was worth it.

I hope you enjoy your holiday season and the new year to come.

Stay tuned.

The law of averages

TGIV! (Thank Goodness I'm on Vacation)

The law of averages still keeps cropping up at the Hotel.

What is the chance the maintenance guys will install your blinds in your office and treatment room and only one won't fit? Consequently, it will have to wait until next week. Hopefully, they'll find another.

What is the chance that a patient who's minding his/her own business as a patient would be fine one day, then slightly confused the next, then completely out of it the day after that? It was our patient and they have a slight clue what it may be (medication) but even tapering it, he/she's not getting better.

What is the chance that your boss will call a meeting, get caught up in the trappings of the holiday gifts he/she is given, and forget to do what he/she set out for the meeting?

Just another reason why each team meeting should have a written agenda and last no more than 30 minutes. If it were up to me, I'd take away the chairs to guarantee it's a short one, but the Slug would complain.

Again, TGIV! I can escape for a while and enjoy. Hope you and yours do this holiday season wherever you are!

All I want for Christmas

Yes, it's a song, but it's chorus resounds in the Hotel.

On the floor, all most of our folks want is to go home for Christmas. As nice as it is in the Hotel with all the volunteers and goodies and Santa (we even offer some shopping), most people want to go home for Christmas.

The folks who have no one, or no real home that looks like Currier and Ives, however, want to stay with us. Someone to take care of you is a happy holiday for them.

Some folks want a diagnosis for an illness that just cropped up. One minute, you're healing up. The next, you're sick, sick, sick and no one seems to know why even after multiple consults.

My office mate and I are still awaiting things to do our job, namely window blinds. That HIPAA assuring privacy thing really is a big deal, Mr./Ms. Hospital Interior Design person. We cannot do all of our jobs without it. So we rearrange, we encroach, and we crash in other areas. This makes for some other unhappy coworkers, but we manage. 'Tis the price of improvement and remodeling the Hotel, we say.

However, my relative is asking for something big: an accessible neighborhood. One in which you can ambulate by walking, your walker or your electric wheelchair, without fear of being hit by cars on a busy street. And since it's not far from the Hotel, it matters to us, too.

The social media campaign began yesterday. The news story airs tonight.

It's a big Christmas wish, but one that really should come true. Somebody's life may depend on it.

Stay tuned...

Dear Medicaid

You suck.

Why? Let me count the myriad ways...

One, you are the payor of last resort,  but alas, when you have a loved one who goes to the emergency room because someone else caused their injury as they were going down the street, you are checked first.

It's especially nice when the injury occurs on the same day as the spend down deduction and you freak out said relative by saying, "Your Medicaid rejected you".

Two, you assume so much.

Three, when in doubt, you cut people off. It's way simpler than finding out what the actual problem is (i.e. a little timely communications re: the changing of spend down payments by $4 also helps) I guess.

That's okay. In the spirit of Christmas, besides assisting said relative in hiring an attorney, I'm just going to hang on the phone lines at your place and remind you of what the state laws really are when you've collected your $150 spend down.

And I'll make sure the nice people in Saint Elsewhere ER and the attorney do, too.

Sincerely not,

RehabRN

RehabRN reading continues...

It's so nice that Bubba's been feeling like reading, so Dahey and I take him regularly to RehabLand's public library (which is pretty darned good).

Here's a couple of things on the burner right now.

1. Child, please by Ylanda Gault Caveness. This author works the parenting sites and has lots of interesting perspectives as the mother of three kids.

While my childhood deviated on many planes from hers, due to ethnicity, etc., there were more than a few common sayings mentioned in the book that I heard in our house among my parents.

I chuckled to myself more than a few times reading this book, and frankly, there are some hilarious moments that will make you laugh out loud. (and even disturb your neighbors sitting nearby).

Little book with a whole lot of parenting wisdom. I highly recommend it.

2. Shrinks: The untold story of psychiatry by Jeffery Lieberman I just started this one, and the intro is just right. It sets you up in a patient story, and draws you in. The stress, anxiety and the ambivalence of the general public to consider the benefits of a medical psychiatric workup.

I can't wait to continue down the road of this story penned by the former president of the American Psychiatric Association.

Stay tuned!

'Tis the season

Oh, the holiday parties, lunches, etc. begin. We recently got our decorating requirements from the safety staff at the Hotel: no lights near patient beds, no blocking egress with trees or decorations, or covering up fire alarms (yes, they have to tell people that).

The weird requirement, though, was the "No decoration can cover more than 10% of a door". Guess I have to tell the elves that the fancy bow on our door is actually over the limit.

If that's not exciting enough, it's always fun when I'm off work and see some of our fine floor unlicensed nursing staff out shopping at 9AM. The local mall is located two miles from the Hotel. It's not lunch time, either.

Oh, I so want to call the house supervisor, to ask if he/she knows where all his/her employees are, but I know nothing will be done.

Stay tuned...

Almost home

The office mate is at a conference. His/her previous office mates dropped off the rest of his/her stuff yesterday. Why people don't move EVERYTHING when they move is beyond me. I'm just surprised they haven't asked to change the locks yet.

We are still in a fishbowl with no window coverings (blinds, etc.) which means no patients in our treatment area. One of these days our interior design staff will get a clue.

I'm hoping that clue comes special delivery today.

The patients that pass do like coming in to look around. Most folks in wheelchairs can do a 360 in the space in front of our desks, which is nice.

It's nice to be almost home.

I just hope...

I don't kill my new office mate. Since I forgot to take some stuff into my office before the holidays, I dropped what I needed off. I noticed my helpful coworker moved stuff on my desk. Not because he/she needed to do something near my desk. I think it was "just because".

I admit I have OCD, but when someone moves around stuff on your desk, when essential equipment (i.e. your computer) hasn't even been moved by the IT staff (since most of them took off Friday, too), I get frustrated.

Needless to say, I moved it all back. I'll call my IT guy myself, since I saw my trouble ticket, i.e. the ticket to officially move, was not touched. My neighbor had no PC, either, and we have no connected phones.

This may take some getting used to at first. Thankfully, this person roams to our other clinics.

I'll be counting the days...

Stay tuned.

Happy Thanksgiving

What I'm thankful for this year:

1. Furniture at the Hotel. I have been shuttling around taking care of patients, and now I'm back home...at a desk.

2. Health. It's something so many people don't have. Health really IS wealth.

3. Family and friends. Some of them passed away this year. I am so glad to celebrate with the ones here today.

4. A family photo. We finally got one outside this year. It's going on the Christmas cards.

Wishing you much health, happiness, and good food today wherever you are.

More to come...

Quality or not

We had the long (not awaited) meeting with our nurse manager. I like the manager, I just detest being stuck with some of my ne'er-do-well coworkers.

Our manager had the not enviable position of beginning the discussion about changes coming to our Hotel clinic and home care group. Some folks just rolled their eyes. One person was on vacation. My cohort had a migraine. I thought I would have one, too.

The Slug made a comment I'll never forget when the nurse manager talked about liking Madison since he/she "can make a difference here."

The Slug replied, "I don't want to make a difference, I just want to be."

Be lazy? He/she's got that down.

Be greedy? Absolutely, when all you're worried about when your job title is going to change in the computer to care manager (because that title usually--but not always--gets you a pay raise).

Be an idiot? Completely. But when you have YEARS of nursing experience, especially doing stupid things, it's not surprising.

Quality, caring employees might be just the Christmas gift for the Hotel this year.

Stay tuned...

We get attached

It's very easy to get attached to some of our patients. When I think about this topic, I hear all sorts of scenarios from my psychiatric nursing class, where we talked about why we like some patients more than others.

Some of them remind us of someone we liked, didn't like, was our neighbor, relative, or friend.

It's not confined to patients, either. Sometimes, we nurses, meet some incredible physicians and other staff in the hospital.

Our docs in the Hotel, while often quirky, are our doctors. So when one wins a major prize, we celebrate. She has been with the Hotel for almost her entire career. Other doctors just visit us, and while we're nice to them, we're not nearly as fond of them as we are of our own.

However, since I have been roaming around on behalf of the Hotel at our sister unit, I've met a lot of doctors I first learned about while reading notes. One of those docs was Dr. M.

Dr. M. was a surgeon at the Washington. We waited for him for a long time. The first specialist retired, they hired someone, then the other never showed up (got a better offer while awaiting information from our HR--the specialty is in demand). We had one doctor (on loan) but PrivateU called him back to work in their hospital (when he wasn't sitting outside the US awaiting his Green Card.)

After years of waiting (literally), Dr. M. came on board from oceans away. He was a jovial fellow for a surgeon. The patients really liked him. He was kind and down-to-earth. Many of our doctors liked him, because he had a phone number and answered the phone whenever possible when he was at his desk. He was also happy to answer any questions they had when they saw him (the infamous hallway consults). I got to help Dr. M. occasionally when he was on the sister unit, visiting folks after surgery. Dr. M. always seemed to be smiling. Eventually, Dr. M. had a real department with another surgeon and a nurse practitioner.

However, our happiness was short-lived. We got the news that Dr. M. died at home over the weekend. Arthur Schopenhauer said “Mostly it is loss which teaches us about the worth of things.”

The happy, smiling surgeon left us physically, but we'll never forget him or the good work he did for our rehab folks.

More later...

Critical thinking

Is critical thinking in nursing really dead?

Sometimes, I wonder if it died recently, because many of the nurses who work at the Hotel tell strange stories.

What would you think of a rehab unit where...

1. Nursing staff don't want to get patients up to therapy after lunch? They went all morning, they say.

2. Nurses want scheduled pain medications because (I'm quoting because they actually said this) "He has to ask for prn meds and he never does, so we can't give it to him."

Pain is a part of rehab, but not taking care of it, especially in folks with addiction history, is criminal. Nursing is about alleviating suffering and promoting wellness.

Hmmm...wonder what part of the pain assessment they missed? How about the first part where the nurse actually talks to the patient. If Mr. Z. tells me is pain in his legs is a 10 after his first rehab session, even though he's got his long-acting on board, guess what I'm doing?

That's right...looking for PRNs. If those aren't appropriate, how about ordered adjuvants like cremes, gels or patches? Or my personal favorite: doing the interdisciplinary thing and calling your PTs (or whoever has them) and getting some warm packs if this might help (since we don't have a towel warmer like Saintarama).

If his pain isn't resolved, then we should consult the pain specialist group that is right down the way. They do take consults.

My $0.02 on this rainy night.

Consumer reports

That was my day today. Providing patient information for Dahey to share with folks at work who recently found out their boss has cancer. Despite everything, he feels good, but is not cleared to return to full duty. He's bored and they found some paperwork for him to do. He'll have to car pool, so it should be interesting.

I also got some information I made in a complaint against a business from the state office that handles those. Nothing significant, but it was nice to know that the process highlighted that the vendor was, at the very least, very "liberal" with the truth. If I could only rent a billboard and not be sued, or borrow this guy, because his sentiment is mine, too.

So glad Monday is over. I'm waiting for all this precipitation to end!

Stay tuned...
 

I look on

This Friday the 13th is definitely memorable. I got home, plopped down on the couch for a few moments and then I saw it. Another group of terrorists attacked a large city and mercilessly murdered people just enjoying the beginning of their weekend. People having a drink, enjoying a soccer game, eating some food.

Later, I found out a nurse who worked with one of my classmates overseas, a father, an all around good guy, was also killed by terrorists recently, in another large city.

It just makes me wonder why people say, "They were killed because..." I think of my own "becauses": woman, white, wrong neighborhood, wrong car, wrong hair color, too much money (or sometimes not enough). I feel vulnerable.

The rationale doesn't make sense anymore. Evil and defense are uncomfortably overlapping with lives of people not bothering anyone, just trying to live, make a living and exist.

I pray for peace, because that's the most basic thing we are sorely lacking. A little extra insight for everyone wouldn't hurt, either.

Peace to you all, and may you live (safely) wherever you dare go.

God bless us everyone.

A mes amis en France: je t'aime tous.

Happy Veterans' Day

Our day started pretty much like any other. Dahey went to work and Bubba went to school. I had the day off.

I got a lot of things done around the house, made phone calls I've put off, and even went to the doctor for my well woman exam.

And as I was making a coffee this afternoon, I realized that I am so very lucky. I have a house with running water (that's potable, too) and plumbing. Many women and girls can't do laundry, take care of themselves, their families or even chores because they lack those very things.

I also realized that many women today are not allowed out of the house alone, or they're too afraid to go out, because of rules, or worse, living in a bad neighborhood where crime is commonplace or war is at your doorstep, or you're just a woman.

I thank my lucky stars every day that I live in a country so advanced to have basic necessities, because I know it's not the same everywhere. I can get into my car and complete all these errands on my own in relative safety, because there is no war going on in my neck of the woods.

So today I thank our military veterans, men and women, like Dahey, who answered the call to serve Uncle Sam here and abroad, on submarines, PT boats, tanks, destroyers, or Strykers.

I raise my glass to you. May you have much health and happiness, and safe passage in times of trouble. You pay the ultimate sacrifice and I reap benefits I can never repay.

Peace and godspeed.

What not to do as a nurse: Fall edition 2015

Yes, the quarterly Board of Nursing newsletter just showed up in my mailbox, and as usual, it contains some pretty interesting stuff.

For all you newbies (or even not so newbies), make sure you don't do any of these at work.

1. Practice without a license. 

I was quite surprised at the number of folks listed in this section this time. Remember: you have to pay up at whatever interval your state requires to be legal.

2. Create documentation discrepancies

Time and time again, there were multiple examples in this issue. My personal favorite was the nurse who charted a skin assessment (multiple times) even when she didn't work.

In particular, if you are in home health, and this happens, they may call into question that you ever visited your client. In fact, if they pay you and you lied about your charting, they may ask for the money back (this happened.)

Moral of the story: as the old nursing saying goes: If it wasn't charted, it wasn't done, really does apply. Other folks really do read your notes: risk managers, quality managers, and even some patients.

3. Inappropriately use your medical record access

No, it didn't involve any celebrities, but please follow your organization's policy on medical record access. This nurse, who had been counseled before re: this issue, decided to look up about 20+ other folks just for the heck of it, and got dinged.

Rule of thumb: if you're not taking care of this person (or you are not evaluating them for a program, etc., as part of your job), do not read their medical record.

4. Forget to be careful in the OR

This was one I haven't seen in a long time, but if you are sending patients to the OR, make sure you send the right patient to the right OR suite. Screwing that up can cause lots of time to be wasted and trouble (in the form of lapsed safety). Identifying your patients really is a big deal.

Also, if your job includes sending specimens to pathology, please do it.

5. Forget to double check those safety devices

One nurse was dinged because he/she did not verify that a fall risk patient really had his bed alarm turned on. Said patient then escaped to the floor.

Yes, some people may fall no matter what you do, but you, as a professional, need to document and be responsible for these folks.

6. Take off without giving report

The stories I could tell about the Slug and this issue...said nurse did not inform appropriate staff that he/she was leaving for the day after lunch, and consequently, left  people in a lurch. Thankfully, no one was hurt.

And finally...

7. Don't self-medicate and go to work impaired

Unfortunately, there were several incidents of this in this newsletter. One person actually used his/her own prescribed medication inappropriately and was sent home due to impairment.

Also, treating yourself with propofol for pain relief is also contraindicated. If you are in a lot of pain, it may be time to see a pain specialist.

Stay tuned for our next edition.

Drought

I feel like I should be posting more here, but I'm having a bit of a drought. Here in RehabLand, we actually had too much rain earlier in the year, and now, despite the little we've had recently, the weather powers that be tell us, it's back to drought.

I'd like to say "WT..." but of course, propriety gets the better of me.

Work sometimes seems like a drought with the occasional downpour, too. One minute: it's all hands on deck, and by the way, we may not be able to support that new process we told you to start in June. "Really?" I say. "And are you schizophrenic?" is what I really, in my heart of hearts want to ask these myopic individuals, but I don't.

However, I have learned to open my mouth when someone cares to hear. Fortunately, in the last version of the Seinfeld meeting (aka about nothing, but should be) it shined a light on what's really happening: they don't want to support this, because they are spending money somewhere else. Call it a cost center, call it whatever you like, but it's a shell game I've seen before in my other life.

It's total BS. Pure and simple.

Nevertheless, I'm still pondering where RehabRN 2.1 might show up. I met one of my mentors for drinks to do a little networking (and just a tad of soul searching) with someone safe. I'm investigating an area that touches on rehab, occupational health and legal nursing. I just have to prep myself to get into those shoes.

Where I go, is up to me. I keep moving forward, even if I'm in the same place. Time marches on.

Hope you enjoy your weekend of working, or even, soul searching. Life's too short not to savor every moment.

Until next time...

Halloween post-script

Q. What's scarier than ghosts, goblins, and candy hangover?
A. A major inspection on a Monday.

I wish it were a Halloween joke, but alas...

Cross your fingers!