On ICD-10

It's so nice to know, if I ever have a patient playing a trumpet during his/her appointment, I can use this ICD-10 code:

Y93J4 Activity, winds and brass instrument playing

Or my other favorite, if you go to Hawaii and get attacked by a macaw, there are plenty of ways to describe it:


W6111XA Bitten by macaw, initial encounter
W6111XD Bitten by macaw, subsequent encounter
W6111XS Bitten by macaw, sequela
W6112XA Struck by macaw, initial encounter
W6112XD Struck by macaw, subsequent encounter
W6112XS Struck by macaw, sequela
W6119XA Other contact with macaw, initial encounter
W6119XD Other contact with macaw, subsequent encounter
W6119XS Other contact with macaw, sequela

Hope your ICD-10 transition goes smoothly.

Everything IS great

It's vacation. And it IS approved.  All I ever wanted, especially after the crazy week I've had.





Here's hoping for nothing crazy or any weird snacks. See you next month!

An obituary for Yogi

There is much sadness these days for all the baseball fans here in RehabLand. While we are far away from New York City, many mourn one the passing of the last great characters in baseball, Lawrence Peter "Yogi" Berra, the pride of the Yankees.

Here in the wilds of the middle of America, it ain't proper to like anything coastal. "Them people are strange" is a comment that is not uncommon. In the villages, towns and small cities, baseball is the life of summer. People come out, see neighbors, and have a good time.

Yogi, however, was someone people could identify with in RehabLand. He was a son of immigrants who grew up in St. Louis, MO and never forgot where he came from. He was tough and never let people's impression of him become his destiny. Beneath that smiling, crinkly face was a sharp guy with an eye for baseball, and how to navigate it successfully.

In later years, Ron Guidry wrote a book about going to spring training with him. I highly recommend it. It's a fun book to read.

It really wasn't over, 'til it was over, and what a life it was. Thank you Yogi for giving us a lot of smiles and excitement watching our national past time. You will be missed.

The answer: send someone a letter

I had a day yesterday that (again) questioned my faith in the leadership of the Hotel at the very tip top. The root cause: BS plain and simple.

How in Hades do we have people (with credit to do so) purchase equipment, tell everyone "go out and get some patients to use it" then suddenly drop it? This happens (of course) once you get the ninnies at your location to buy in. When asked late last week, when I went to order and couldn't find a gadget available, I got an e-mail that said "Well, we don't know if we'll have money next year to continue this" as some very valuable pieces of equipment sit unused on people's desks throughout the system as a totem of "Look what I have..this cool gadget!" As such, these "gadgets" which are really FDA approved health care tools, do nothing for patients.

I know they work. Some of my patients have them. I got them through a loophole, which I willingly followed policy and procedure TO THE LETTER to get. They are making a difference in the lives of these people. I see it on a regular basis. Some of our people were back and forth to the Hotel several times in a year. Guess what? One character hasn't been back in six months (and counting). Another is over four months and we haven't readmitted him/her.

When I asked our technical gurus (who have way more experience with this sort of shenanigans) what I should do, the answer was "write a letter to someone who can do something about it". The consequences of doing that, could very well cost me my job.

But after years of waiting, working, busting butt for things that turn to vapor, I'm just about there.

Will be writing, editing, and thinking very carefully this week about that very thing...

Stay tuned.

Wheels of change

The construction still continues. Our administrative leader is optimistic it will be done early. It helps when our folks get early finish bonuses.

I run back and forth, round and round in the interim. I found out last week, when I went to get something ordered for a patient, that the item I was looking for wasn't available to order. It makes me wonder if I'll even be able to do the things my management wants, if I don't have equipment.

Dahey hopes his TDY duty will be done before Halloween. The fun aspect has worn off. He wants to come home. Bubba and I had a pretty good weekend. We roamed around town and even saw a hot air balloon land in one of the local parks. It was unscheduled, so all the kids in the neighborhood came out. (We were driving by, and went to look). We even fixed a fancy meal he planned and that went well, even though he could have done more work.

More motivation and fun this week. Stay tuned!

Nurses unite

It's kind of funny when you think about it. About three million of the nation's most trusted profession labor in relative obscurity day in and day out.

All of a sudden a bunch of ladies on morning talk show get catty about the Miss America pageant. They diss a nurse AND boom! Social media mayhem!

It probably wasn't a good idea. You know, pissing off the people who wipe your backside when you're ill and can't, who make sure you don't lie in that excrement and get contact dermatitis, or worse, a pressure ulcer (since if you can't clean yourself up, you may not move either) is not a good thing.

So in light of some of the nurses who proclaimed nursing as their talents, here's mine (minus the video).

You know, I've been you. I've been on the outside. I've wondered, "How in the heck can someone say nursing is a talent?" Nursing requires a lot of skill. You have to know what you are doing to keep people alive, perform procedures and to document a lot of stuff, so your hospital gets paid.

But alas, after more than a decade living in the "real world" a couple of nurses said, "You know, you ought to think about being a nurse." And after having a kid, going to business school and working in the business world, I thought, "Why not?" So I went to nursing school and learned skills and went out, got a license and started on my way. And by the way, nursing school was a LOT harder than business school!

However, on the floors and in the rehab centers, you find out skills will only take you so far. Anyone can get skills. You have to put it all together and hustle and some days, when all the planets align, the supplies are there, everyone is on time to therapy, you high five and patients are happy. And other days, no one wants to get up, important stuff is missing, patients crash, you are exhausted and you cry.

Handling it all with grace, compassion and all those skills really is a talent. Because we're not taking care of a balance sheet, we're taking care of people.

So yes, after almost a decade as a nurse, I'm ready to say, nursing really is my talent, too.

Kelley Johnson: I'm with you--stethoscope, scrubs and all. No matter what our costume may be, providing excellent, clinically competent care as a caring nurse is a part of the ensemble that's never out of style.

The missing piece

Dear Social Studies Teacher:

I'm so glad I spent a lot of time dealing with this country in my other life. I've been there several times and visited just about every provincial capital. I can tell you all sorts of things and can answer 90% of the questions on this assignment with my eyes closed and one hand behind my back.

However there is no way I can help Bubba identify weather patterns on Map B and C if said maps are not included with the rest of the worksheets.

I may have a pretty good memory for trivia, but no idea on weather maps.

Please send them home and Bubba will complete them tomorrow.

Sincerely yours,

RehabRN
Bubba's personal secretary (aka Mom)

Homework

Bubba's been getting homework after I decided to go online and find some reading materials appropriate for his situation.

Here are a couple of the ones I picked:

• Dude, That's Rude (Get some manners) by Pamela Espeland & Elizabeth Verdick
• Speak and Get Along! Learn the Mighty Might, Thought Chop and More tools to make friends, stop teasing and feel good about yourself by Scott Cooper

They are entertaining, and only time will tell if they really stick. Gotta start somewhere.

TGIF (aka counting the days)

This has been a busy, crazy post-holiday week. I'm so happy it's over. I'm adjusting to my new home at work by floating. I have equipment that allows me to work all over the Hotel, so I'm taking advantage of it.

The volunteers are nice, but the real dust-stirrers this week are the construction guys, but thankfully, the dust is contained. They are drilling stuff in our building (which is also being repaired for settling). If you didn't have a headache when you got to work, you might have one when you leave.

Bubba decided to give me a headache. He got in trouble. I got a call from the principal and now he'll be on in-school suspension for two days. He opens his mouth and inserts foot a lot. He is very filterless sometimes, and the think it-close the mouth-let it go mode doesn't always work with him. He is also not yet the master of the double entendre. I am baffled why my child has to be punny at school when the education system has zero tolerance for anything.

It's not as easy as when I was a kid. If you said the wrong thing, the nun (or other teacher) gave you the dope slap.

You never did it again.

So happy it's the weekend! Hope you enjoy wherever you may be!

Best laid plans

Oh, it wasn't Monday, it was the day after a holiday and I could tell. People who were gone all week this week are buried on their return to the Hotel. (Yes, vacation is nice, and so is having that extra day until you return).

I hoped to get one of our patients set up for a clinic visit. I was greeted by the gentleman who waters the plants in my temporary home. "Don't get him upset" was what one of my coworkers said.

It's nice to know the volunteers rate higher than the actual employees here. Did I want to be in "his space"? No. Do I work here? Yes. Do I rate higher as an employee trying to do my job in a temporary location? I should! I take care of ALL my assigned patients, not just the plant guy.

Unfortunately, I'm not the only refugee in the building. Our boss has decided to move one of my cohorts, too. He/she is not happy.

To top off my day, I was working with a patient and found out he got his new stuff from the Hotel to work with us. He just needed to download one little thing. We also found out (in doing our test) that the one little thing was discontinued...on Labor Day. Ugh! Glad he can use his adaptive equipment in other ways, just not for what we intended.

Time to go to Plan B....stay tuned.

Forever grateful

I am happy to be off work today, especially since I thought I was going to be wearing a cast on my dominant arm. Let's just say walking up hills and wearing certain footwear is hazardous. (I wasn't going far, so I thought I was immune). Nevertheless, after a quick trip for an x-ray and eval, I found out, I was scraped, sore and suffering from a really bad bone bruise between the bones of my arm.

I raise my glass today in honor of those who have come before us, who died and were disabled on the job to give honor to a hard day's work.

The honorable today includes all of you: nurses in the EDs, in the ORs, in the rehab units, in the clinics, in the every inpatient, outpatient, consultant and administrative role.

Your work is honorable and I salute you! Happy Labor Day wherever you are.

One minute slow...

Another one fast. My days are numbered in my current lair. The construction guys are coming to tear up my part of the SU.

I'll be a refugee for the next month, roaming around to see patients at bedside.

Which is not always a bad thing...stay tuned.

Clueless

Dear Therapist:

I understand your job is to do therapeutic crafts with patients in your clinic.

I don't appreciate it when you leave said patients unsupervised in the area I'm supposed to work and they make such a mess that it will take another two days of housekeeping to clear the air enough so I can breathe again.

Yes, it is a pain that I'm in this space you claim as your own but it's temporary. You only have 4000 square feet elsewhere plus another 3000 of storage. There's only about 400 square feet here free that I can use due to the junk, er, craft supplies.

Remember nurses take care of the health part of health and wellness in rehab, and if the air's contaminated where I'm supposed to work, I won't be healthy enough to take care of patients.

I'm going to take the high road on this one, but if it gets ugly, I assure you, I'll make sure you don't forget it.

Wishing you many clues,

Sincerely,

RehabRN