No typos here

Yes, Kim's got the latest version of Change of Shift up over at emergiblog.

Go on over and look.

Finally!

Someone read my name on my board and sent a letter telling the boss what a wonderful experience he/she had while I took care of him/her.

I had taken care of this character before, and he'd always "forgotten" to mention me.

It's nice to be remembered once in a while.

Stay tuned!

Shake it up

I shook up the assignments when I worked last. I'm sure I'll hear about it again for ages. Why, you ask? I needed to get things done quickly once I arrived, so I did the assignment at home. I did not account for the people who worked the weekend, just as the boss regularly does.

Everyone did get  a reasonable assignment, though. I balanced every one's patients so no one had anything impossible. As the leader, I had the lightest assignment, because  I got the assignment to be the troubleshooter for everyone. Thankfully, the day was steady and not crazy. Our on-call doc kept me busy, when patients weren't thinking of some things for me to do.

Here's a list of some of the oddball items for the day:

1. One patient was doubled over in his chair and discovered by our chief when he was going to the elevator. Said patient was helped up, then got an order that he needed a strap to get up. He begged me to find something. I looked and looked all over the unit and I finally found one...in my car (I use it with a couple of elderly relatives I occasionally transport.)

He thanked me with a large piece of chocolate cake his wife brought him from one of the local premium bakeries. Yum!

2. Since our doc saw him doubled over, he figured he might need some labs. I drew those, then put in an IV after our super nurse, Mike, the old ICU nurse couldn't get him. Turns out this patient has a secret. His hand veins are the best...and hurt the least. I got one in his hand on the first stick (because couldn't get one in the one of the several monsters on his upper arms).

3. And finally, one patient had an urgent request: he wanted a backgammon board. I scoured the games section of the rec room and didn't find one. I did find him some dominoes, and left a message for the  rec therapy people so they can fulfill his "urgent" request  when they come back.

Only time will tell how the rest of the week goes, so stay tuned!

This Memorial Day

For my great uncle, who was killed in action in France, January 23, 1944, and left behind a wife and three children for the freedom I enjoy today. Thank you. 

I think of you today as I take care of my veterans who returned.

All gave some and some gave all
And some stood through for the red, white and blue
And some had to fall
And if you ever think of me
Think of all your liberties and recall
Some gave all.
--Billy Ray Cyrus, Some Gave All

That's more like it!

Weather: Sunny, with hot and muggy temperatures.

Air quality: the fine smell of charcoal is wafting around the neighborhood as people grill. Not as much as usual, though, since everyone's getting those gas grills.

Mood: Bubba has taken a break from playing outside. All is good.

All the ingredients of a great holiday weekend, which ends for me tomorrow. Back to work for the holiday. I can't complain.


Stay tuned.

What holiday?

I'll spend mine working in one way or another.

Got up early today and attempted to pay bills. Found out my sibling (who is disabled) had a 4 figure phone bill. Checked it out online, then discussed with said sibling and found out someone he/she knows has been scoring very expensive Eastern European phone calls from him/her, in addition to "borrowing" money. Got everything documented and hotlined him/her. Happy holidays? I don't think so. Not when you have no money in your account.

Installment #1 of 2 sets of books for the next grad class arrived today. Hope the other one (which has the required text) shows up by the time class starts in about 10 days.

Bubba and friends are having fun at the baseball tournament next door. Dahey is out making sure he's not eating everything in sight.

Should be a fun day....stay tuned.

LRR part 2

If you read the last installment, you'll understand why I abbreviated the title above.

Yes, it did certainly seem a bit like Groundhog Day at the Hotel, with a twist. Mr. J. ended up sick, then sent to our lovely sister hospital for a workup before the holiday starts. Yes, keeping an acutely ill rehab patient on a unit staffed with skeleton crew for the first major holiday of the season is NOT a good thing. Thank you Dr. F. for finally figuring out this important fact.

Mr. J. wasn't thrilled, but since he'd like to possibly make it back in time for his son-in-law to bring his favorite barbeque this weekend, he thought it was a good idea. Amen!

Thankfully, Mr. J. was still being evaluated by the time I left, so I was not required to fill out all of his discharge paperwork. Hooray!

In the grand scheme of things, repetition can be a good thing.

Stay tuned!

Lather, rinse, repeat

It's not just on a shampoo bottle. It's the story of my life in taking care of Mr. J., one of our usual suspects. My shift went as follows.

1. Suction him (very frothy trach) on first rounds.
2. Do AM bowel routine.
3. Return in 30 minutes to clean up, then suction again.
4. Finish bowel routine.
5. Suction. Leave.
6. Move bed from across unit storage so admission has a bed in his room (and all other assorted furniture). Do dressings on other patient. Thank goodness she can survive without me!
7. Come back, do AM care, dressings, PICC dressing (since he has one that's falling off), turn.
8. Suction 'cause you rolled him a little too much changing the linens.
9. Reposition and all is good for about 30 minutes.
10 Admit new person down the hall.
11. Feed Mr. J. lunch.
12. Suction after lunch. Fluff, buff, make all comfy.
13. Turn, clean up, drop full suction canister on table and floor.
14. Clean up mess, call for Housekeeping. (Thanks Bob! I couldn't live without you.)
15. Get Mr. J. ready to get up. Mr. J. decides to stay in bed today.
16. Suction.
17. Reposition. Fluff, buff.
18. Take care of other patients.
19. Finally, eat lunch during department meeting: elapsed time 10 minutes (I ate slow with a salad).
20. Send labs on new patients. Let new patient take a nap.
21. Finish admission and assorted paperwork.
22. Get ready to leave and hear a tornado warning called on intercom: Code Gray. Everyone out of the pool!
23. Wake up napping patient (already awake) and help him transfer to wheelchair to get into hallway.
24. Quitting time comes.
25. Run out the door, do not pass go, do not collect $200.

Getting Bubba home safely after making it through a hailstorm and watching the tornadic clouds on the horizon just two miles away: priceless.

I celebrated the end of the tornado warning with a drink , a soak in the tub and a good scrubbing, and lather, rinse, repeat.

More to come...

Cops and nurses

Yes, cops and nurses have a lot in common.

Sometimes we're dealing with sundowning patients who are perfectly content at the beginning of the shift is fun, but don't forget, they add a extra level of excitement just before shift change.

One of our security guys was on rounds and asking if one of our people had "called anyone" today. Nope, I tell Officer T., Mr. X. is good. He just calls his wife, she understands he's demented and plays some music he likes over the phone. Officer T. leaves.

Mr. C., who was being good all night, got perturbed when his son left without getting his ice cream. He called him and he told him he'd be back tomorrow. Hence the agitated cascade begins....and ends with a call to 911 on his cell phone. Unlike the hospital phones where our 911 routes everyone to security, his cell phone sent him to the nearest 911 call center for CouldaWouldaShoulda County.

CWS county does not appreciate 911 calls from demented rehab patients. Officer T. and partner come over to visit Mr. C. and talk to him. Mr. C., agitated, refused to talk to me, but told the officers the same story. He refused to surrender his phone however. I eventually left and passed on the task of getting the phone to Z., the following charge nurse, called  the on-call doc, then notified our house super.

Now if only I'd stopped to get a donut (or a drink) after everything. Maybe next time.
Stay tuned.

Terrible tornadoes

Are currently terrorizing the middle of the country, and a really scary story..a tornado hits a hospital in Joplin, MO.

So happy our tribe made it back in one piece, since there were storms aplenty on our way back home. Bubba was content assembling his new toy dinosaur (which has a million pieces) and a trip to Dahey's favorite sandwich place. He wolfed down his Italian sandwich like we hadn't fed him in days. This couch potato child swam and played for hours and he ate everything in sight.

He also slept soundly every single night, which was lovely. Can't wait until the tribe can hit the road again one of these days.

It was nice to be away, though. I, am back to reality: housework, computer work and work at the Hotel. I'll be praying for no tornadoes.

Why is it...

That when you're a kid on vacation that things just seem more interesting than they do at home?

This explains Bubba's fascination with a particular dinosaur exhibit...that he had to see...that he ALREADY saw in RehabLand. It's just more fun seeing it on a gorgeous day with thousands of other people and just as much fun when you don't have to worry about posing for photos because Dad forgot the camera.

At least, so far, we've gotten a souvenir plastic cup to remember the trip from the bowling alley up the road.

Now after all that dinosaur visiting, Bubba's sound asleep snoring away. We'll see how it all goes.

More to come...

I am a nurse...

I am a leader.

This was the slogan for the ANA video contest. And this is the winning entry. Today, I thank not just Mandy, but all you school nurses out there. You rock!

On the eve of the voyage

 To get away from one's working environment is, in a sense, to get away from one's self; and this is often the chief advantage of travel and change.  ~Charles Horton Cooley

Yours truly, Dahey and Bubba will be heading down the long road travelling for a piece. Will update as we can.

Stay tuned for exciting updates from the road. Kids (and husbands) are so much fun.

Yes, we're a little crazy

To the average Joe/Jill patient, what we do at the Hotel seems kind of nuts. Rehab units are places where you can get up and get out, and you even have your own entourage, besides me, your unit tour guide.

Dear Mr. ABC:

Some people think I'm nuts when I tell them this, but it's absolutely true. I'm the tour guide and I usually get the job of helping you initially, getting settled in and used to the rhythm of the Hotel.

No, we're not like SuperLuxeRehab unit sown the street which gets remodeled, redecorated, repainted every time someone sneezes, no, welcome to the gritty world of the Hotel, which saw it's last wallpaper change in 1994. Now, the signs and some equipment you see are brand-spanking new, but  that's just because. We didn't want the signs (management says we have to be "just like everyone else"), but we did want the equipment, since it makes our jobs easier.

No you won't get a private room just because you have MRSA. This is not SuperLuxe. Join the MRSA club in a double room (almost 75% of our people have it, and some other bugs for which we isolate, too).

We are rehab nurses, so the three things we care about are bowel, bladder and skin. People will come in asking all kinds of questions on those three things, so don't be surprised. This is why I explained the reason you need a post-void bladder scan for a while.

We'll also bug you daily about your bowel habits, to make sure you're going. Yes, we really do care if you're going and want details, if you bother to look.(If you don't, we will.) Bowels that work tend not to cause problems, unless, of course, they work a little too much. Moderation is the key.

Skin, to me, is a no-brainer. As I tell patients, it's supposed to be clean, dry and intact. This is why we look at it regularly. If you need help cleaning it, that's what we're here to do. If you can do it, we are thrilled. One less bath I have to do, so I can do other stuff you need.

So, yes, Mr. ABC, we may seem crazy, but we care about you, and your bowels, bladder and skin.

Hope you enjoy and make good use of your stay at the Hotel.

Sincerely,

RehabRN

The story of the numbers

I read in the paper today that if the debt ceiling is not raised by August 2, there will be lots of trouble, according to economists. As a Govermint employee, I'm thinking I may need to beef up the emergency fund and plan a staycation for this summer, instead of that cross-country trek for Bubba to see Uncle Ray and his kids out East.

Ahem...back to the interesting numbers. As an escaped business person, I'm always looking at numbers, and as a rehab nurse, too. We got labs, input, output, pressure ulcer sizes, TED hose sizes, you name it.

For fun, I always read the stats of this blog. Some of them are not entirely numeric.
Since this lil' blog has kept stats (about 6 months after I started) here are the numbers:

Total    33,273     
Average Per Day    35     
Average Visit Length    1:19     
Last Hour    1     
Today    13     
This Week    245    

I am also fascinated by the places my visitors come from. Here's a recent sample:

State of Ohio (state.oh.us)

Federal Aviation Administration in beautiful downtown Atlantic City, NJ (www.faa.gov)
No wiseguys...looks like they just came over from my friend Maha's place (pakazoid.blogspot.com)

Kuwait National Petroleum Company (www.knpc.net)
Did my bro-in-law tell them about me? He's a FOBbit now, so maybe he did that while waiting for his food at TGI Fridays.

Last but not least...
Some nice person in Adelaide, South Australia using on.net found this blog on google by typing in label bubbling.

No matter the numbers, no matter where you are, thank you for stopping by. Come on back whenever...you never know what I'll serve up next!

Stay tuned...

One of these days...

Spring will return to RehabLand. I guess it's just another example of global warming (or in our case, cooling).

Stay tuned...

Ah, those were the days...

I felt a lot of relief when I finished nursing school. To date, it has been one of the hardest things I've ever done, childbirth included.

So tonight, I raise a glass to all the graduates of PrivateU, my alma mater, who are getting ready for all the festivities coming up. If I were in charge of the nursing school commencement, here's what I'd tell you all, nurse to graduate nurse.

1. Enjoy waiting for your ATT (Authorization To Test). It'll get there when it's darned good and ready.

2. Take an NCLEX prep class with a guarantee if you can afford it. If not, plan on studying full-time for at least three weeks (Monday through Friday like an 8 hour job). Enjoy the weekends to digest everything.

3. Follow the instructions exactly when taking the test. Know where to go and get there a little early.

4. Breathe and count to 10 if you get the question from hell.

5. Do the same even if you get the TV commercial Viagra (Cialis, fill in your drug of choice) slam dunk easy question.

6. Do not throw up when you're done taking NCLEX. Relax and enjoy. You'll have to wait however long no matter what for results.

7. If you have a job, work hard and realize, yes, you really do need to keep studying those things you don't know on your own time. You need to do them at work.

8. If you don't have a job, make your search your full-time job, Monday through Friday, eight hours a day. Three words: network, network, network. Join a nursing organization if you have to (many have new nurse discounts) and volunteer if you can. Don't despair. Been there, done that, many moons ago (and waited over a year for a full-time degree-appropriate job).

9. Use every resource available to alumni of your institution for your job search. Register with them (if needed) even if you have a job. You never know when you'll look for another one.

10. Nursing is hard and there is a reason why (you'll soon find out) many new grads (somewhere around 50%) quit nursing after one year. Think of it like Survivor. Learn to outwit, outlast and outplay whatever madness comes your way. Always wear good shoes and use the rest room whenever you can.

And finally, make time to have a life. Have friends you can count on, in nursing, and outside nursing. Have family relationships of value. And most of all, take care of your physical and mental well-being, even if it means you get your toes pedicured once a month, get that monthly massage, or have that lunch with a friend monthly. Live so that you may have something to give to your patients and your coworkers at work and to the people you love when you get home.

This is just the beginning. Enjoy the trip. Congratulations!

Relief

So glad this semester of grad school is over. It wasn't horrible, but I need the break.

And yes, I rocked it with a grade of A to add to the arsenal. She allowed us to be unconventional (no APA format needed in our final project.) and I made it work. An artsy theory professor wasn't a bad thing after all.

This was just what I needed after another week of back pain. Hopefully, it'll go away soon. Stay tuned!

All's well...

That ends well is how the saying goes, and happily, my day went well. I got a recalcitrant patient out of bed after he cut up yesterday, only to have him be sent back for low blood pressure. Turns out when we gave Mr. W his meds exactly as ordered, he got a little too much, which required a quick Narcan push.

Mr. W later confessed to not taking his meds as prescribed at home and doing dangerous things, like taking extra extended release morphine at one time. MD and I tried to reinforce how this is really a bad thing, but somehow, he thought we were joking. As a result, MD will drop some meds and be titrating other meds from a much lower dose.

I knew Mr. W. was feeling much better after his Narcan and being flushed with some fluids, because he started acting like his old perverted self.

Mr. W: "I'm cold can you warm me up?"
Me: "Want a blanket?"
Mr. W.: "No, (motions to side) I want you to get over here and warm me up."
Me: "Did I tell you my husband is a former sharpshooter who's jealous and occasionally visits me at work?"
Mr. W.:"So are you rejecting my proposal?"
Me: "Yes. My counter proposal is a blanket...or two if you really want an extra."
Mr. W. "Oh, all right. Just don't tell the sharpshooter. Some guys get all the luck."

Some things I do well...

Like proving to the nurse who tested me, that yes, indeed, I am still allergic to dust mites.
Thankfully, I do not need to start shots. So glad it'll be time for some antihistamine soon!

More to come...stay tuned for all the excitement.

How come...

Some people go right away and check on their people on first rounds?
Some people go off in a group and go straight to the internet and shop instead?

What are the consequences?
Some people have everything done when they want and know where their people are located in the room.
Others, go to their rooms, after shopping, or when summoned, when their people are located on the floor, with the wheelchair to the left, the  slipper to the right and staring up at the ceiling.

Just another thing I wish our boss would enforce..rules. We are so lucky Mr. X. did not get hurt badly.

Stay tuned...

Whenever

I think I'm too big for my britches, or feeling low because I didn't get something I really wanted, I feel grateful that I didn't get everything out there that I could have gotten.

If you want to read a compelling story, check out AJN's Off the Charts blog for Dispatches from the tornado zone in Alabama by Susan Hassmiller. She is blogging about her experiences as a Red Cross volunteer.

Finally, if you can, please give.

I do take chances, too

I take my chances, yeah I don't cling to remorse or regret
I take my chances, I take my chances, every chance I get
--Mary Chapin Carpenter, I take my chances, 1992

And since the instructor told us to go for it, no APA format needed, I took that chance.
Looks like it paid off  in a good review...yes!

Happy Mother's Day

God could not be everywhere and therefore he made mothers. ~Jewish Proverb

Hope all the mothers out there, especially those working today, have a great holiday. I'll be joining you shortly, once Bubba tells me what the big surprise is.

All dressed up

And no place to go...so the saying says.

So why on earth wouldn't our illustrious education and resource nurse make sure all of us had our in-service on a very specialized piece of equipment once it's finally installed on our unit to make life easier?

Could it be any of the following, so pick the most logical one below:

1) He/she was too busy following the safety and construction people around while work was getting done.
2) The boss didn't make him/her set a deadline for which to train staff.
3) He/she is terribly lazy.
4) He/she  lost the user's guide so we have to wait for a new one.

Two to three of the above items are true. Go on, take a guess which one isn't.

Stay tuned...

My Monday midweek

Yes, when I start rotating my shift, I always feel like it's Monday. I work several days in a row, and then, eventually it's over, but it never fails that the first day is momentous.

First fun item: one patient gets taken off the floor after much nurse cajoling of MD because his oxygen sats wouldn't go up. Diagnosis in the ER: PE. So glad he didn't get to code on us!

Second fun item: the dualling trach patients. Who would have to be suctioned the most...patient #1 at one end of the hall who swore he didn't need to be suctioned, then asked as you left the room or patient #2 who would get turned, then need suction or would need suction at the most inopportune times?

Third fun item: Mr. C. got rejected  for his colonoscopy that day, so let's just prep one more day and have him drink a gallon of GoLytely again to clean him all out. Yes, he got cleaned out, but it was fun changing linens all freaking shift. Clean, clean, clean to keep him from breaking down. Heavens!

Fourth fun item: Mr. Needy. Move this, move that, lift me up, 'cause I can't see my computer, etc., etc. I  would have killed him if it wouldn't have made a mess. (I really like our housekeeper Bob, and  he'd probably run away if I made a big mess like that.) Mr. Needy just made my shoulder pain turn into back pain very quickly.

Thankfully, one of my menagerie of patients, Mr. S. was so sweet. He's been training to do some of his care I'd normally do, so he was ready to fly solo. I was so happy. (One less thing I had to do.) I made sure he got his snacks and whatever else he  needed on rounds. He was the highlight of the night.

Down for the count?

Mr. S. got discharged recently. He told people that "two ladies jumped on my chair" and now it won't do anything. He claims the ladies "broke it". Mr. S. also tells a patient or two (via phone call and one, Mr. Chatty relays info to us) that he's sitting in his shower chair on his porch waiting for his neighbor to fix his chair. Our wheelchair specialist is not amused.

Oh, the heave ho going on at the Hotel is getting better. They've fixed us up with top-of-the-line ceiling lifts. The renovation's coming, but, in the interests of safety, and the fact that they've already spent the money, the Powers That Be deigned we get them. It's about freaking time. Who else moves more patients than us? Only one other rehab is in our system, and they had lifts way before us. To top it off, 95% of their people walk, even the amputees.

So I'm not sure if all the excitement of the new power equipment or if it's just the weather, but my back is acting up. So much that it warrants a trip to Dr.B to figure out what's up. I don't really want to be out of commission, but I really don't want to end up really injured either.

Stay tuned...

A little coincidence here...

A little bit there could be construed as a little more than coincidence.

What a wild weekend! I escaped from the Hotel, so it's been fun working on the final paper of the semester. The coincidence: when your instructor is also a film maker who made a movie about an area where more than a few of your patients are from. I only got to see the trailer, but it was eye-opening to see the remoteness of the area.

Bubba had a party and the kids had a good time playing soccer until the rain came. At least, no tornadoes came with it.

Who knows what the week will bring. Just hoping it's not a ton of admissions.

Stay tuned.