Nuggets for June 29: Near miss

I'm happy to say that I'm writing this post from the happy land of looking at the big picture. My reasons for writing were not because I actually had this happen to me, or in my workplace. Rather, I'm presenting this as a something to think about while you're working.

First, no one is infallible. Second, computers are great, but they can't critically think. Three, this could happen to anyone.

Here are a couple of articles from the blogosphere about near misses.

Paul Levy from Running a Hospital in Boston blogged about near misses in this blog post.

Florence dot com blogged about her own Coumadin experience in this Nurses' Week article.

An oldie but goodie related article: Health Care Renewal talks about workarounds in bar coded medication administration systems.

Mental health

With an interdisciplinary team in rehab settings, patients get the full spectrum of assistance to accomplish their goals and achieve a better quality of life following illness or injury.

Nurses, however, don't always use similar, available resources. How many times has your hospital's Employee Assistance Program sent out cards with phone numbers on them and have folks discussed the benefits? Probably a few times.

I found this interesting article on www.nurse.com called "Nurses With Depression Need Peer Support." It addresses a lot of issues, particularly this fact:

"Some 9.6% of full-time healthcare practitioners between the ages of 18 and 64 suffered a major depressive episode in the year before an October 2007 report published by the U.S. Substance Abuse and Mental Health Services Administration compared with 7% among all full-time workers."

Heat

It's sizzling in our neck of the woods, even though, last week, it was flooding. Go figure.

Work was just as hot. Nothing terrible, but some rooms, especially the ones I was working in, were so warm, that I quickly started dripping once I put my isolation gown on and headed in the room. I had to wipe my brow several times while working with one of my patients who was on bedrest. He was antsy, so I told him, I'd rather not drip all over him.

Abductor pillows are the hot commodity on our unit. Can you say total hip anyone? I don't mind abductor pillows...until you have to turn people. They are just not the best thing to maneuver, but with one of our patients, I use the pillow to hold stuff in front. The pillow is stiff enough to handle it.

I threw another application out there for a specialty scholarship. Hopefully, I'll get it.

The weekend is coming...I can't wait!

Change of Shift, Volume 3 Number 26

Welcome to the June 25, 2009 edition of Change of Shift. Many thanks to Kim at emergiblog for allowing me to host this edition.

'Tis the holiday season, so I thought I'd go for a holiday theme for this edition. So since I'm thinking holiday more in the sense of how our British friends and other folks around the world view holidays as Americans view vacation. Ah, relaxing and not being at work tops the list for me.

So while you may not have a Mai-Tai with which you can enjoy this version of Change of Shift, let me be your virtual tour guide, sit back, take a load off and enjoy the stories we have here with your favorite beverage or company in your favorite place and have your own holiday/vacation wherever in the world you are.

The fit holiday

In case your idea of relaxing involves exercise...of any kind, Alvaro Fernandez presents Debunking 10 Brain Training/ Cognitive Health Myths posted at SharpBrains: Your Window into the Brain Fitness Revolution, saying, "Think about this: How can anyone take care of his or her brain when every week brings a new barrage of articles and studies which seem to contradict each other?" I'm with you, Alvaro. I take vacations from reading scholarly articles because my brain will explode if I don't!

On another "fitness" note, Courtney presents Laughter Exercises posted at Depression to Happiness, saying, "Sometimes, laughter can be the best medicine."

While it's not exercise, sagarika presents Dimensions of Health posted at Social Work for Mankind. I have to say she's made me think of social work in a much different light.

And if you're not too comfortable from the trip, Dean from Rebuild your Back discusses Neck Pain, Massage and Ice.

The boys on the beach

You've been there on the beach holiday with sand, surf and of course, surfer dudes. Some are blond and hunky, and once in a while, you run smart fellows who know where all the good waves hit the beach. While most of our guys are not surfers, they know how to tell a good nursing story.

Raise your glass for the men in nursing! Here are a few of the best stories from the guys.

Coturnix presents On Being a Nurse - a guest post posted at A Blog Around The Clock. I have to admit I was floored by this post. It's not all fluff, but a great substantive read.

Chris presents I Did NOT Go To Medical School To Play Nurse In The Bedroom! posted at The Man-Nurse Diaries, saying, "If this is too racy for CoS, let me know so I can submit another! Thanks!" I'll let you all decide what you think. Chris, I loved it! You made me laugh (especially with that photo!) At least, you didn't send tips on how to be a call girl (yes, I did get one of those.)

Sean Dent presents Nurse Jackie vs. HawthoRNe : Hollywarped Television Nurses posted at My Strong Medicine, saying, "The warped sense of Hollywood in regards to nurses." Sean, I'm with you. If only everything was like it was on TV...resolved in an hour or less!

And last but not least, Keith of Digital Doorway has a fish story you have to read to believe: Of Tetanus and Fishing Line. It was about this big (*hands spread out in air*) and it got away! His alter ego, Bob the Nurse relaxes and gets ready for his vacation!

On the family vacation

What family hasn't piled everyone in the car, luggage and all and traipsed hither and yon down the highway on vacation. While they're not exactly family, some patients grow on you, especially if they've been around your place for a while. One patient, Steve Catoe discusses how he makes an impression on nursing students in Miss ATEC « Adventures of a Funky Heart! posted at Adventures of a Funky Heart! Steve, thanks for the memories. I still remember my first irregular character!

When you're out on the road, you have to eat. Christina from Both Sides of the Mask discusses Workflow and workarounds of nursing in of all places a restaurant chain you just may know.

Mona from the Tangled Neuron discusses Axona as used with Alzheimer's patients. As Mona mentions in her subtitle, she's a "layperson reports on memory loss, Alzheimer's disease and dementia." Also Mona states, "This personal site chronicles my search for answers on my father's dementia. Although it's too late to help Dad, I hope any information I can find helps others. " It never hurts to have a guide out there on the trail to help you along the way.

And if mom's not around to help you get it together for the trip, Ashley Cook presents Spring Cleaning and Women's Health posted at Healthy Living Tips, saying, "Some natural alternatives for cleaning around the house." You may not do it on vacation, but you will someday.

The return trip

Being on holiday is bliss, but unless you just got the winning lottery ticket, you eventually have to go back to work. Here are a few good ones to ponder about when you have to go back to work.

As Kim tells us, healthcare can be a headache and it's not just going back to the work environment.

Barbara Olson from florence dot com talks about automation and if it "dumbs down" healthcare providers. (Note: this article requires registration to view).

Nurse Laura from NurseConnect.com discusses the Unwritten Rules within the Nursing Profession.

Victoria Powell has two great articles on her blog you need to see: The Business of Advocacy, and Nurse Life Care Planning.

And if you think your return to the working world was tough following your vacation, maybe you'd better read Caroline's story from brainscramble called Assault. In two minutes or less, you'll be counting your blessings!

That concludes this edition. Thanks for coming along on a virtual holiday with me. I'll be eagerly awaiting my next real world holiday in a few weeks.

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

Have a great weekend wherever your travels take you!

Rollin', rollin', rollin'!

Keep them posts a-rollin'...they're coming in, folks. Change of Shift is here tomorrow (pinching self again).

Don't be left behind...send yours in via the BlogCarnival link on the right side or e-mail me (see the About me section).

Gotta run...more later.

Back and forth

That's been my day today. It seems that all I do whenever I have free time is paperwork and go to meetings.


Here's the story of my "leisurely" day off.

1. Take Bubba to swimming class. Pool is inside and horribly, horribly humid. Thank goodness a few people talked to me or I would have fallen asleep on those bleachers.

2. When I go home, plan on going back to sleep. No dice. I get the e-mail I was dreading. My funding for my grad program from my employer is pretty much DOA. "Don't call us, we'll call you." was the e-mail I got in reply to what the status was on my application.

3. Go do administrative stuff with sibling who needs help doing admin tasks. More fun.

4. Fax a bunch of information to an agency for "speedy" results on another issue. Speedy results means I may get it by the end of the week.

5. Sort, sift and collate. It just never ends.

Meanwhile, more posts are coming in for Change of Shift. Thanks! Keep 'em rolling!

Disturbances

It's crazy, hot and stormy around here. The humidity hits you like a wet blanket when you go outside and though, it seems like it will rain again, not even the weather people know when.

Just like the weather, we have crazy people on the unit...and it's mostly employees. Why some of them are like this immediately following vacation is beyond my comprehension. They just cannot come to work and do a job. No, they want sympathy, or any kind of attention really. It's really nerve-wracking. Hello, neurospsych...can you do an in-house consult?

Besides the crazy people, a lot of crazy things are happening with the non-neurotic people who we work with--car break-ins, house break-ins, deaths, and assaults. All this in the last two weeks could be another thing making the unit hot, besides the ever-questionable functioning of the air conditioner. If we only had water therapy!

The patients I've had were reasonably good lately. No muss, no fuss, not even from the one I expected the most trouble. With all my extra time, I'm finally finishing some of my "required learning" for the computerized in-services. I can only hope it will be as sedate the rest of the week.

And if it ain't crazy enough at work, I'm just amazed at the news lately.

Steve Jobs gets a liver transplant (from http://www.cbsnews.com/)
It's somewhat shocking in many regards, not just because of wealth or status. Should keep those medical ethicists busy for a while.

VA has a rogue cancer unit (from http://www.nytimes.com/)
If Sister Mary Martha, my kindergarten teacher would have seen this, she'd have gotten out that big pointer she used to use and would have a) whacked said doctor, then b) poked him really hard. If only someone at that VA would have!

Finally...keep those cards and letters rolling for Change of Shift here on 6/25. I have to tell you, I may just have a section called the "men's edition" because so many guys are sending in great stories. C'mon ladies, let's give the gentlemen a run for the money, shall we?

Stay tuned...more to come!

Come one, come all....

Yes, I'm hosting the next Change of Shift on 6/25. We still need submissions. Send in your favorite nursing stories, hospital or work situations with nurses, reviews of the new nursing shows and whatever nursing/nursing related topic strikes your fancy at this moment in time.

Send your submissions in via the Blog Carnival submission bar on the sidebar at the right of this page or e-mail them to hotelrehab at nyms dot net.

Please note: spammers not allowed. It's getting old, folks. Go bug the other spammers, please.

Nuggets for June 19

There were just too many good things I found out there this week, that I had to add this special edition of Nuggets (special because they only usually appear once a week...).

Enjoy!

Rehab-o-rama

As a rehab nurse, I know the FIM, but truthfully, it sometimes drives me crazy when I have to look at someone and when we talk about them in a meeting spit out their FIM numbers. Some are easy, since we take care of bowel and bladder all the time. Those other ones, however, tend to mess me up.

I found this article about how one hospital educated staff on their FIM scoring. It's very clever and involves a cartoon character. Hey, if it works, go for it!

Play nice

Since my OR pal reminded me...It really sucks that they have to write articles like this, but a recent one from AdvanceWEB talks about how nurses in the OR sometimes need to be reminded to be civil.

Relax

Need a quick, contemplative moment? This article by a certified hospice nurse may help you achieve your goal (also from AdvanceWEB).

And from the blogosphere....

Not Nurse Ratched is a new nurse who talks about making her first big med error. Listen up, all you new nurses!

Crass-Pollination had this great post about the inpatient shell game. Just call it bed bingo on steroids or you know it's bad when someone needs to die for you to get a free bed.

And Keith wins the most interesting day post for this one: Bat in a Basket. We have critters all around Madison, but thankfully, no bats.

Escaping the paper monster...

Sure, I was off, but most of my days were doing paperwork. It was nice to go outside periodically when I wanted and drink coffee whenever I wanted, which is relaxing.

I've learned a few things lately:

1. Gonna have to get creative on financing for grad school...don't you just love regulations (and I'm sure someone's going to say "It's the economy, stupid.")?

2. Learned a few more things about research nursing. I joined a journal club in the area and got together with some local nurses, one of whom I met recently before the meeting. We had a great dinner and talked about Kaplan-Meier curves and hazard ratios. Just remember: it never hurts to network!

3. You can powershop in a hurry and sometimes get lucky. Even with the heady material we had to read, I had a great time and since I didn't want to get lost, I got to the restaurant early to check out everything, then I went and scoped out the local, swanky shopping mall. There were sales galore, so in the last few minutes before the meeting, I found something. I'd show you all the link, but I'm saving it for my anniversary, and I know for a fact someone who reads this blog would click on it just to see it. (Yes, Dahey reads this blog...)

Anyway, should be a fun day at work...more to come.

Nuggets for June 16

From the blogosphere:

Head Nurse has a great post about organ donation, and yes, I have that cool, new logo on my license that alerts you that I'm open to being a donor, if the need arises. I have met lots of nice people, at my job and in the community, who are alive today because someone told someone they love that they wanted to be a donor.

Thank you donors, recipients and families. What a gift! For more information, check out UNOS (United Network for Organ Sharing).

In the news:

The economy is keeping some people from retiring, including nurses, but in California, there could be a shortage if the economy rebounds. (from the Sacramento Bee via the ANA SmartBrief).

Nurse.com had this interesting article about the presence of nursing on hospital trustee boards. Isn't it about time? This article touches on how the skills nurses use every day are similar to what people see as necessary skills for good leaders. Amen, Heather!

And on a related note:

While you may have a secure job and not need one to have one right away, please, please, please get a resume and have it in your own files. Sometimes you need one just to keep track of the things you do and the skills you acquire. One of my HR trained relatives likes to keep a log of what goes well each year and what he/she learned for his/her annual review. It also helps, especially if your state, or specialty certification requires it for renewal purposes.

I was one of a few nurses on my unit who was asked for a resume recently. As the only one with a resume, I had to help the others get one together to submit. I found this great article at CampusRN by Donna Cardillo about how to write a nursing resume. It's short and sweet and has some great tips. Put yours together today if you don't already have one. Never assume...

Itchy and scratchy

I love it when I wake up with eyes like this! I just tried out a sample of this new product, so I'm not sure if it's that or just the pollen outside. I really like the results so far, I must say!

Work was fun once the week ended. Thankfully, I'll have some extra off time this week to do paperwork for school. Ah, I really missed filling out forms. Thankfully, the SuperDuper U staff sent everyone a welcome letter with links to everything you need to do before the semester starts. It should be fun checking off everything I can this week.

I read this post at head-nurse and immediately thought of my unit. Ah, summer is always interesting when you have spinal cord patients around. It never fails...the quads are too cold, the paras are too hot. Occasionally, we get a quad, like one we have now, who's a combo (gets both hot and cold), but with all the isolation rooms we have and the nylon gowns we use, I never feel like my deodorant lasts the entire shift.

Needless to say, more than a few staff wanted to strangle the maintenance guys when they said they'd turn off the AC in the early afternoon for a repair, leave it off all night and maybe turn it back on in the morning. Maybe never came. Their boss came over and told our boss that the AC would come back on in two hours, tops. Happily, no one got hot under the collar!

Gotta run...more stuff to do...stay tuned.

Channeling Change of Shift

Yes, it's that time again, and the latest and greatest Change of Shift is up at Florence dot com.

Yours truly will be the next host on June 25, so if you're feeling so inclined, send us your nursing or nursing-related stories. Thanks Kim!

I'm looking for real people, people, so put those fingers to the keyboard and tell us about life in your world. Nursing is 24/7 and that includes holidays. While mine's not a holiday edition per se, feel free to drop in your favorite working the holidays stories, if you're so inclined.

Wanna submit? Check out the submission info via this handy, dandy BlogCarnival link or e-mail me at hotelrehab at nyms dot net.

Yes, they really do...

...like me. I got accepted to SuperDuper State University grad school. A plus...most classes are online. Hooray!

Guess I can't take up any new hobbies (drat!).

Deep Thoughts

With all due respect to Jack Handey, I've been pondering the following lately.

1. Why, oh, why would someone's family think it's appropriate to bring granddad alcohol to the hospital? Especially when he's on meds that will make him really, really stupid (and potentially sick)?

2. What doctor would purposely forget a patient's Baclofen order, when s/he's been on a high oral dose for ages?

3. Why on earth, in this, the 21st century, do we still have to have books that read like this? And why on earth would your coworkers tell you, in a diverse organization, "That's just the way it is."
That, like rehab bowel programs, smells really bad and for one, I'm tired of it. It's one of the things that drives me nuts about Madison.

And on that note, I leave you, back with Jack...check out the notecards. They are a riot!

More to come....from happier climes.

Another full moon

Yes, today, folks, we'll finally see it...if the storms blowing through don't cloud the sky this evening.

On our unit, we've known it was coming for days, since all of the patients start acting up in a variety of ways. The full moon will do that to some folks, I guess...

I've been encountering a lot of interesting stuff lately. I took care of a patient who had this listed on his diagnosis chart: Hypermetropia. Since I must have been snoozing during that part of the opthamology section in pathophysiology, I decided to look it up, and alas, it's simply farsightedness. I did find a really cool page on WebMD called How to read your eyeglass prescription which tells you why it's written the way it is. Very interesting...even if I don't need anything for my eyes just yet! I'll be ready for a family prescription to come my way.

One thing I was getting confused on was an SGPT result. Turns out it's just the same as an ALT, which I was looking at somewhere else.

Next, I ran into a diagnosis for mitral valve insufficiency and aortic valve stenosis. While it's not heavily clinical, I found a great set of heart articles on this very subject from the Texas Heart Institute in Houston. If you have to explain this diagnosis to a patient, go check them out. Note: they also have a special section for professionals, as well.

We had an interesting situation recently. One patient with generalized swelling was a difficult stick for a blood draw. When you missed the vein, you got fluid. Anasarca is a very challenging condition to deal with, especially when doing blood pressures or any other procedure that may put pressure on the skin. Just putting a stethescope on to do a blood pressure left a mark on this patient.

Finally, be careful how you use OTC medications. This information about ibuprofen is very good from www.rxlist.com. Remember, there's a reason why they say, "All things in moderation."

War stories

Yes, there was a lot of storytelling going on during my latest turn on the evening shift. It's kind of funny that way, when you're gone a day or two, and things are really different when you come back.

War stories are common on our unit, since we're a government-run hospital, but how you get the guys and gals to talk, or let them talk can be a whole 'nother story in itself.

One of our more cantankerous folks was rolling by on his way to getting something, so I stopped him and asked if he wanted his pills right now. Sure, he says, I'll take them. We chitchat for a minute and I keep doing my thing. Mr. C. starts talking about his time in the military during the Korean war. "See that scar" he says. Sure, I see it, because I'd just given him his heparin shot. "I got that on my way to Korea. I never made it to the front." I shake my head, therapeutically listen, and he keeps going.

Mr. C. never made it because he had a bad appendix and developed complications. An astute medic pulled him out of the crowd and when they landed in Europe, Mr. C. got a trip to the hospital. The docs didn't want him going too far once he was released, so they found a job there on a base to keep him busy moving supplies along to Korea.

We have also had some World War II vets hanging out with us. One of them was a Marine injured in the Pacific. He's a character and I'm sure his stature alone may have scared more than a few folks in that theatre. I think about some of my relatives when I talk to them, because they'd tell the stories of the war, when I was a child, and my brother and I listened very intently. Most of our relatives who went to World War II came back. One did not. I think of him a lot and the family he left behind.

Maybe it's just because of demographics, but we have lots of Vietnam-era guys at our place, including some of the employees. Lots of folks talk about the jungle and dreams they had while they were there. Some were more premonitions than dreams, but they colored their lives just the same. One guy told me about the lost opportunities from Vietnam--delayed families, deferred education, the bad attitude of some folks that often caused other problems in the jobs they came back to or started after their service. The angst among some who were injured, while other folks their age were in school and never drafted. The volunteers. Some people say, "Who'd volunteer for Vietnam?" and on our unit, you'd actually see some hands, proudly raised, almost defiant. "That was me," one guy told me. "Better to volunteer than be drafted," he thought.

Today, we see some of the Iraq and Afghanistan vets coming in with stories of their own. Swimming at Saddam's place. Guarding air fields in Kuwait. Driving through Afghanistan in the Hindu Kush mountains with snipers everywhere.

And while they're not my words, I leave you with a story I received recently from my husband's old dear friend who is at a southern US air base. His story is a short, but a compelling look at the life of an airman who lost her life recently.

I previously wrote many of you about the presentation of an Air Force Cross, the second highest medal an Airman can receive, next only to the Medal of Honor.

At 1000 yesterday morning, we met in the same hangar, not to pay tribute to a warrior amongst our midst but homage to one who would no longer be physically present with us. SrA Ashton Goodman was a 21 year old (22 next week), from Indianapolis, IN who served as a vehicle operator in the 43d Logistics Readiness Squadron. She had three short years in the AF but had already served as a truck driver, ferrying supplies and personnel from Kuwait into Iraq, been promoted to SrA six months below the zone, and called upon to brief the Chairman of the Joint Chiefs of Staff.

This time she volunteered for a one year tour working with a Provisional Reconstruction Team (PRT) in Afghanistan. SrA Goodman was killed last week when her vehicle was struck by an improvised explosive device (IED). Her funeral was Tuesday in Indianapolis. The Wing took up a collection and flew the family here for yesterday’s memorial.

It started with a slide show presentation, a speech by her squadron commander (it was obvious she had made a positive impact on him and the unit), presentation of the Combat Service Medal and Purple Heart to her parents and several comments from squadron members. One squadron member sang a gospel tune that started eyes watering.

Then came the final roll call. Names of squadron members were called and answered until they came to her, silence. Her name was called again with more silence. Once more, still silence and then her full name followed by a 21 gun salute and taps. I challenge any of you to sit through that with a dry eye or after attending such a ceremony to ever hear taps again without a deeper sense of pride and commitment to those who have paid the ultimate sacrifice.

Nuggets for June 3

After a temporary hiatus, the Nuggets are back!

Multiple Sclerosis links:
Here are a few links I thought I'd share as a result of my conference last week.

National Multiple Sclerosis Society
http://www.nationalmssociety.org/index.aspx

MultipleSclerosisPro.org
http://www.multiplesclerosisprofessional.org/

PVA's page on spinal cord diseases
http://www.pva.org/site/PageServer?pagename=disease_main


From the blogs...
I'll never think of making someone NPO the same again...
http://serenitynowhospital.blogspot.com/2009/05/npo.html

Sadness for a traveling OB nurse
http://rvtravelerrn.blogspot.com/2009/06/can-you-help.html

And a related item: What is anencephaly?
http://www.ninds.nih.gov/disorders/anencephaly/anencephaly.htm

Things not to do on Twitter: announce your vacation.
http://casesblog.blogspot.com/2009/06/dangers-of-social-media-twitter-your.html

And for something completely different....
Therapists wired to write
http://www.nytimes.com/2009/06/04/fashion/04shrinks.html

Slide on over, folks!

You'd think Tuesdays wouldn't be so bad...nurse brings in lots of pens from the conference, people are happy and we are slated for no admissions. I could dream about it, but it wasn't easy at all today. I told our specialist that I am one of the most highly paid janitors/support staff as I filled every single cart on the main hall with isolation gowns. Why? We have support staff, who don't really feel it's their job to do it. No, sitting in front of the boob tube (reserved for patients) and playing pool (also reserved for patients) is really a more productive effort. If my male boss only had some balls. Removing the pool table ones to his office might help the situation.

I had three patients today, and our clinic nurse actually got one ready, since she needed him for a procedure early. I was very grateful. The other two were their usual eccentric selves, and yes, for them it's all about bowels. One goes too much, one goes too little. One gets out of bed without issue and the other leaves a trail on the sliding board as he's transferring. What does the nurse win, Pat? Another heave ho back to the bed for the patient, with the nurse leading the charge.

Just remember all you nursing students out there, if a patient is stuck in transfer halfway on the bed, you can get them all the way there by employing a maneuver I like to call "the dump". Basically, you get their legs and heave them onto the bed. They may be on their side and a little off kilter, but once you get them to the safety of the bed, put up whatever rails you can on any side they could slide out on, and maneuver them around from the other. I love low air loss mattresses, especially if they're made up right, because, by nature, the sheets are slick and you can slide most people wherever you need them to go in bed with little effort.

Said sliding mess patient eventually did get cleaned up, got lunch and got to the wheelchair for afternoon therapy. It was a workout though, for him and for me. I read this article tonight very carefully, so I can keep my back out of trouble!

After all that excitement, I got to move another patient because his roommate was isolated for a new bug. Yes, I'm an expensive mover, too.

More later...stay tuned.

All the world's a stage...

And men and women merely players, according to William Shakespeare.

I'm back playing the Palace as I tell my regular customers at the Hotel Rehab, and still getting my bearings, or should I say, catching up on sleep, from the past week of conference excitement.

More to come...I promise! Stay tuned.