Eclipse eve...

It will be dark, then light will return, just like every day. Except Monday, August 21, when it will happen twice during a solar eclipse.

This past week, has been both dark and light. I have had feedback from people that I never expected. When you think you're doing your job right, remember that some people may find fault.

I found out that the bully in our department has targeted me. So guess what, Bully? It's gonna stop.

How? I am going to go to your boss (and mine.)

I'm going to access the resources available at work.

And I am going to file a formal complaint in HR.

Yes, Bully, you have attached your name to subversive and threatening behavior. S/he who shall not be named is no more. You do have a name. And it's getting formal.

Stay tuned...

Is this the sign of things to come?

I had an interesting conversation with my coworker's boss (who's really my boss's boss) recently.

I got to tell he/she about the latest tribulations trying to make things work. He/she listened, then mentioned how I have no appropriate training.

What I wanted to say:

"Yes, remember that quality training I took last year? That's how I got qualified to lead a quality improvement project? I've taken this training five years ago, too."

"Your quality person? He/she's not been trained."

"Would you like to tell the Hotel boss that I can't finish this project?"

Unfortunately, I didn't. I'm stewing...and plotting my escape. Being unappreciated is annoying.

Stay tuned...

Observations

1. When you follow policy and procedure to ask for a schedule change, expect it to take exactly as long as the policy says, because, "Well, you know, people do go on vacation in the summer."

As if it really matters when you ask...

2.  Gomerblog (one of my favorite spots on Twitter) is so dead on for this one. I used to keep track of how many people actually darkened our door just to get Viagra for free...

3. I'm on a quality committee related to issues the Hotel has regarding discharges of folks from rehab.
Just wondering if I should take this diagram to work. It might help us get people out quicker.

4. Finally, since I've decluttered a lot recently, I'm finding more time to do other stuff, like exercise. I have to admit, it's way better for my sleep than vegetating on the couch immediately after dinner every night.

They may just be right about that Healthy Nurse thing this year!  While I was not at the gym today, I managed to get some great walks in all over the mall and the nearest Target doing my back to school shopping. Thank goodness for activity trackers that show how many calories you burn for an exercise it tracks.

Hope you enjoy what's left of the weekend, wherever you are. Monday will be here before you know it.

On the other side

Did I blink during Nurses' Week and suddenly it's August? Yes, I did. And Bubba reminded me today that in two weeks, he starts high school.

What's happened? My boss was removed, then two months later resigned. When I found out why, I wasn't surprised. Basically, being a bully comes back to get you.

Bubba went to MiddleState U's Science Camp again. He had fun. We picked him up and enjoyed a weekend hotel jaunt in a suite free (that's what happens when you save years of credit card points). We ate, drank and were merry. We wouldn't miss our designated IHOP stop for anything, because it's become a tradition.

The summer of the first year of Trump has been heartening. I last switched jobs fortuitously right before the big 2008 crash.

I'm ready again, but I'm older and more leery. There are some things to be said for basic security, short commutes and decent benefits. All the folks at the Hotel eligible are getting out as soon as they can.

Nevertheless, I'm preparing for whatever fall might bring.

Stay tuned.

Happy Nurses' Week!

In case you missed it, the yearly celebration of nurses has begun. We got the whole week covered at the Hotel with "fun" stuff in between work.

Since the theme for this year's celebration is "healthy nurse, healthy nation", maybe it is time for some nurse-centric play-by-play from yours truly.

Yes, the Hotel has some great facilities, so we are fortunate that a lot of the celebrations occur right by our unit, but the problem: many people don't attend. Why? Because they don't have time.

So consequently, if we could get ANYTHING we asked for this Nurses' Week, here's what would be on the list.

1. Unlicensed staff that actually listen, work, and communicate with the RNs. Too many of them on our unit have a bad habit of dissing the RNs. It needs to stop. Period.

We work together as a team. If you diss the RN you're assigned to on your shift, it's a rubber-glue scenario. You make yourself look bad, too.

2. How about the Captain Obvious question: if you want everyone to document everywhere, why not make it easier at the bedside?

Just saying! If you think logging in after walking 300 feet to the nurses' station, then opening the software, then logging in again, finding the patient, then starting your note is good, you haven't taken care of a bedside patient lately.

No, rehab supposedly has stable patients, but you really need things, like computers that accept the data from the beds, the scales, etc. without double charting.

3. Since I went big on #2, why not on this one. How about a fully stocked cabinet outside each room with the basics, a la TCAB projects of the not so distant past? It would have helped if they had planned this on the last remodel, but here's some food for thought.

Having supply staff actually supply it, would also be nice. If you can't do it outside every room, how about on every wing. Steps do make a difference in a workday (you could be charting, checking labs, etc.)

Finally, no matter where you practice, I wish you a very Happy Nurses' Week. Your work matters and you make a difference.

More to come...

Rain, rain, go away

My day since Friday. Will the sun come out? Stay tuned...

via GIPHY

Just when you think you have it all figured out

In the early 2000s, when I was working a progressive yet conservative financial company, we talked about the business book, Who Moved My Cheese. In a way, in the years before 9/11 it made sense.

Then 9/11 happened, and that brighter, shinier future dulled and disappeared in a cloud of smoke and fire.

As I'm finishing up my work as a volunteer for a nursing organization this week (Happy Volunteers' Week!), I thought, "Wow. I've made it. There's really been nothing extraordinary that's happened while I've been the chairperson, so I can at least say, I did it. Add this prestigious title to the list. Check."

Until recently, when that "all set scenario" changed. It might have seemed like one meeting with some organization folks and some of us nurses, but as I look back, it could be the start of something big. We are changing things in the group that could change how people join the organization and get certified.

We are looking forward to how we can change to make things better, to help a younger generation grow and prosper in rehab. To me, it's as exciting as anything.

I can't wait to say one day, "Yes, I was there when..."

Hope you have your own moments of clarity this week, too. Stay tuned...

It's the truth

Thank you KevinMD for this one. I need it.

I'm at a point in my life that I'm tired of putting up with bullshit. I entrenched myself at the Hotel to succeed at my goals: getting more education and getting a good job. But the view from here right now is annoying.



via GIPHY

In 2011, the Robert Wood Johnson Foundation called upon nurses to participate in their publication, Transforming Leadership: Leading Change, Advancing Health:

“Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors.”

I need a couple more doctors who listen to nurses in my life right now. There just aren't enough at the Hotel.

Stay tuned...

Is ICARE just letters?

For some people, it is. If you do a little research, ICARE shows up on Google about 535,000 times.

If you're a nurse educator, ICARE is a model for education design.

If you're a business person, it's a way of delivering excellent service based on the Ken Blanchard model.

If you're a cancer researcher, iCARE is a model for building risk models.

In some health care organizations, like VA, it defines a code of conduct.

I care about those who have served.

I care about my fellow employees.

I care about choosing “the harder right instead of the easier wrong.”

I care about performing my duties to the very best of my abilities


It's too bad that at the Hotel, some of our patients have told us:
"I'm not telling your manager anything. He/she is lazy and doesn't care."
"I asked that nurse to do something a different way, and he/she didn't."


However, my rehab nurse heart just skips a beat, when my patient recently said, "I've learned more today in the little time I spent with you today, than I've learned all month." Why? Because I took a few minutes to not just educate this patient about the specialty services of the SU (my job), but of the rehab unit as a whole.  I cared.


When do we realize, that as nurses, "I care" isn't just an acronym. It's a verb. It's actions: not just doing, but listening, being present, and doing right, even when it's hard. Even when you're busy, passing pills, doing dressings. Share the rehab wisdom you've developed (or for newbies, are developing)


ICARE is not I Come And Receive Everything. If you're a paycheck nurse, maybe you need another gig.


I care because I am a nurse and a human being with a conscience. It's my job and my philosophy (thank you grad school and Jean Watson).


Don't let the turkeys get you down today. Keep caring!


Enjoy your weekend wherever you are! 

Frights aren't just for Halloween

It's been scary in the Hotel Rehab lately, and it's not because of ghosts or Halloween. We've seen a lot of our folks get sick and go out on leave. Our latest one is the building greeter. Believe it or not, having a greeter is part of the overall improving patient and employee satisfaction.

M. our greeter, shows people where to go, gets wheelchairs, makes phone calls and does all sorts of stuff that I often don't have time to do for patients and visitors.

M's boss told us that he's getting surgery and may not be back for at least two months. I will certainly miss him and so will our patients. Some have even gotten grumbly when I can't do stuff for them because they were so used to having him around. Maybe this news will improve their behavior.

Our nurse practitioners had a major job analysis done throughout the hospital system. For some, the changes that will happen mean they'll have to go back to school. Ours are lucky, they shouldn't have to do that, but the work they can do will change. Not sure if our medical staff are really aware of what all they do. They will be aware soon.

Finally, I'm constantly reminded that not everyone who's in rehab is totally well. They do get sick, again, and they do die. It's sad and yes, sometimes frightening. Some cases are sudden and some are not. I'm really glad we have many options for hospice for our patients. One of my SU patients recently decided it was what he/she wanted.

A whole lot of interventions doesn't always equal quality of life.

I've got to stop here. The frog singing outside is making me crazy...and I'm tired.

More later...

Sick day

When you absolutely, positively need a break before the end of the week? You call in sick (or in my case, exhausted).

The last straw? The doctor who almost no showed my last patient appointment of the day, then shows up in the last 10 minutes. What does this mean? My patient is taken care of but, I miss my important diagnostic that my PCP had ordered, but I couldn't do at lunch time. More unpaid OT...not fun.

Never fear, however. This nurse case manager found out that Saintarama urgent care can indeed do the tests that Dr. H. put in electronically. The outpatient area was closed when I left work.

"Come on over" the lady in the urgent care said. "We'll take care of you. We're here until 8."

Happily, no pneumonia, but a nasty, nasty case of viral bronchitis. The only thing I didn't have was some codeine cough syrup.

Problem now solved...and I stopped barking and coughing a while ago.

Back to work tomorrow, then excitement with Bubba who starts spring break.

Never a dull moment at the Hotel or at home. Stay tuned!

Everything AND...

I almost sound like one of those bad infomercials. They seem to promise the world, but when you get down to it, it's really plastic.

Such has been my week. I thought the cold I got would go away if I took my cold medicine diligently. It didn't. I went to a big (over 1,000 folks) conference in sunny Florida and I suffered as a result.

I feel for all the consultants, etc. who have to fly regularly with a cold. I felt like I brought (and swallowed) a small medicine cabinet before I even got on the plane. I also bought some Earplanes ear plugs, since I knew my sinuses were stuffed. Even with all the drugs, etc., my ears still hurt (although I'd suspect less than if I didn't have the ear plugs).

Florida in winter is lovely. You actually don't feel so horrible when it's 80 degrees every day. Wearing sandals was also therapeutic. While I didn't go to the beach, my feet felt like it in those walking sandals. I sat outside and enjoyed lunch one day (since it was warm and sunny). There were threats of rain, but they never materialized. I even got in 10,000 steps almost every day. It helped that the hotel was a short walk from the conference location AND that the conference was in a convention center that was pretty big.

Coming home was another adventure. Thankfully, the plane was not full. I got to enjoy an aisle seat and no one next to me, which is rare these days. I made it two whole days before I caved and decided to seek medical attention for the infection I got.

Now I'm playing the doxycycline shuffle. It's really not fun rearranging meals and vitamins for the antibiotic, but since I'm feeling a little better, why not?

Hope you enjoy your day wherever you are. I'll be soldiering on...stay tuned!

Nurses just do it

WiseOldRN stopped by my office today. Actually, he/she is on a schedule and comes by regularly. WORN has worked in an administrative job for over 15 years, but WORN is a proud diploma nurse licensed for many years, who could work "any service on any shift, leave and come back for more".

We have chats regularly and this week's was a doozy. WORN goes all over our hospital system so he/she has some tales. While I'm sure some are peppered with hyperbole, I know some of the characters involved so I'm aware that there is truth.

WORN started ranting when I brought up training. As a diploma nurse, WORN regularly went all over the hospital and worked everywhere. His/her last assignment (as a nurse) was in risk management and quality, but as WORN noted, the only place he/she didn't regularly work was case management. WORN figured being a registered nurse made him/her a case manager every day.

When nurses feel they don't have the skills, I remind them what the overall goal of the day is: managing their assignment. This can vary on the status of the patient, but in our world, bowel, bladder and skin are very important. When we forget about the little things: helping someone with a 4-5 day old beard shave (like I did on my lunch hour while visiting our satellite unit while his nurses charted) and comb his hair, it reminds us all that we are taking care of people, not just completing a task list.

Sure, we have plenty of tasks, but when we can't put care at the top of our task list, are we slowly but surely degrading the importance of having an RN care for each patient?

As WORN says, nurses just do it, if the patient needs it. We don't wait for a million other things, like policies, procedures, or unlicensed personnel.

We see what's in front of us, and do the work. We use that nursing process AND we care.

That's all for now. Gotta leave and take care of my patients. Hope you have a great day with yours, wherever you are.

Visits with bigwigs

Today was one of those two day visits. In theory, everything is clean and shiny, but it wasn't. The big shots got in before the housekeepers started mopping up the big dried coffee stain in the lobby.

I was fortunate to stumble upon the visitors as I was leaving my office to go to the restroom down the hall. Since I am well acquainted with one of them, I escorted them to the meeting room. They were thrilled with the coffee and pastries.

As luck would have it, I was scheduled in not one but three meetings. Since they ran over, I excused myself from the second one, so I could escape and do some work. Since the Slug needed someone to impress and was being a total toad, it was really for his/her own safety (and the safety of my license) that I left.

When I went back to my desk, I kept making phone calls. I called several patients and checked on orders for equipment. It was fun to get away.

Finally, the visitors had had enough in the last meeting and we finished by 5PM, over an hour past my usual. I was so glad to go home.

More excitement is coming...stay tuned.

Sometimes you have to go with your gut

New nurses: this one's for you.

We take care of a lot of people at the Hotel Rehab, and it's normal for us to see a variety of society strolling through the front doors. Sometimes we are given plenty of information to do our jobs accordingly. Other times, we aren't.

Since I work with all of the folks who complete rehab, as a specialty nurse, I have to understand how to use my assessment skills. When something seems strange, it usually is. Police come and go in the Hotel for a variety of reasons, and it's always for something.

I took care of one of our folks in the SU. Said patient did well in his/her rehab stay, and would seem like a good fit for our aftercare program that I manage. While I do chart reviews of all of the patients to determine eligibility, and this one passed all of my normal reviews, something still wasn't right.

Said patient was getting ready to discharge. Since he/she was not exactly confident about this program when I discussed it, I didn't worry about it. I do not push patients to participate, because it's voluntary. In one of our discharge planning meetings, another consulting staff member, who I greatly admire, voiced concerns over this patient's "legal issues." In rehab, this, too is not uncommon, as many people may be in rehab due to accidents and may be managed by legal or worker's comp case managers from outside.

When I looked at my credit monitoring service e-mail recently, I found out why Officer Friendly was pacing through the unit. It wasn't because we have staff parking scofflaws, it was because my SU patient was a registered sex offender. His/her pending litigation might end up in a prison sentence. This, consequently, disqualifies SU patient from my program.

So for all you new folks: what does this mean? This means you tailor your care to the specific patient, and remember, no matter what to be professional. This article mentions a number of things you can do to make this happen, as a floor nurse, and discusses things your risk manager may ask you.

In my decade of practice, I've seen nurses act like fools and discuss these patients  loudly and use computers visible at the nurses' station. My advice: don't do it. You will look stupid, and you may be disciplined. You should discuss this with your nurse manager in your area in a private location to make sure you ensure the safety of staff, visitors, as well as the patients on the unit.

Finally, all of those things you learned about therapeutic communication and ethics come to the forefront in these situations. Yes, you can take care of these folks and be honest and direct. I often tell students this is why you don't overshare in ways that may make your patients uncomfortable or create other issues. Seek help from other team members, such as psychology and your chaplains, so you can make your care plan appropriate for your patient.

Back to business

Working always makes things interesting. From my space near the front door of the Hotel, I see a lot.

This week, I've had a lot of visitors. Folks looking to learn stuff I can teach them, families learning about when and where they'll go when they go home. I've even gotten to plan some projects and pitch new ones that need resources. I feel like I'm going somewhere, even though I'm running.

My regular characters come see me. One rolls in and it's obvious he needs help. His leg is dangling. He's slumped a little more than usual. He tells me the new wheelchair is having issues. His headrest is messed up and his foot pad won't stay on the chair, so we have to carry it upstairs.

Thankfully, he didn't have one of those spasms, that to the uninitiated, look as if he could just fly right out of the wheelchair. If I had a dollar for every time he's frightened new staff, I'd be rich.

Nevertheless, I fix what I can, empty his leg bag, and get him to the motor pool, otherwise known as therapy, so the wheelchair specialists can fix him up, literally, and figuratively. One smiles and tells him she knows where the "real tools" are.

He follows along, and I leave, knowing I've done my warm handoff to the next discipline.

Now for more fun...FIM certification!

Stay tuned.

Monday sick day

Yes,  I had a lovely weekend, until Sunday morning. I woke up with horrible abdominal cramps and gas. Nothing happened, so I made a breakfast of oatmeal and coffee.

All Hades broke loose, literally and figuratively. I heard a horrible growl in my stomach. That's when the diarrhea started. Whatever I ate at the fast food joint (lovingly known as Jack in the Crack --chicken) or the swanky seafood house near the fancy hotel district (scallops), did me in. After that, it was body aches, fever and diarrhea after every drink. I stayed hydrated by drinking, then running into the bathroom once an hour. Gotta love foodborne illness, or at least that's what I suspect. Needless to say, I won't be volunteering to make anything for anyone for dinner or dessert for a while, just in case.

Since I felt lousy, I actually did something I am loathe to do: take a nap. It helped, but I eventually had to take Tylenol so my fever did not get above 102. Thankfully, it broke overnight and I've been afebrile all day. The nursing supervisor actually answered my call and my boss my text when I called.

I rested today. I felt bad in the morning, but got progressively better. My stomach is still undecided, but I'm sure when I get hungry enough, my appetite will be normal again.

Heck of a way to spend a Monday. More fun to come...stay tuned.

PSA: Healthy peepers

I didn't think I was at risk for glaucoma, until I ended up at the eye doctor, and he was looking at me funny. Needless to say, I'll never forget that Veterans' Day, when my doc gave me the news.

Why am I talking about this? Well, it's National Glaucoma Awareness month in January.  Almost three million Americans have it, and many, like me, don't even know it. You are at higher risk if you are African-American, male, diabetic or have a family history (even if it's distant like mine).

Glaucoma is known for robbing people of their sight. I had LPI to allow my eyes to drain properly, which also helped the pressure. Some people may also need medication or other surgical procedures.

Some folks put off or delay eye exams because they fear they're too expensive. I have had vision insurance for years, and I did not know that it (along with your medical insurance) can make regular check-ups reasonable. If you don't have vision insurance, check with your PCP for more options in your area.

Your vision is priceless. I know I couldn't be a good parent, wife and nurse without it.

What are you waiting for? Go visit your favorite ophthalmologist today.

More to come...

Happy New Year...sort of

Yes, it's 2017, the New Year's festivities are over.

It's cold, we have a new president and I have a surly teenager.

Still getting used to it all and letting it all sink in. I haven't forgotten you, dear folks. I've been swamped at work and when I come home (when I don't have some viral mess that's going around the Hotel) I rest.

My biggest goal this week, is to put the Christmas decorations away. No, I am not an Orthodox Christian. I am a late packer.

Even though it may seem apocalyptic at the moment, I won't have YUGE news, a la our Cheeto-in- Chief, but at least it will be real.



More to come. Stay tuned.

Because it's December 30

We will celebrate with relatives we haven't seen in a LONG time! Lots of kids, food and drink.

Today, we will get ready. It will be fun.

Stay tuned...