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.

The year of ethics

The American Nurses Association declared 2015 the Year of Ethics. They also updated their Code of Ethics for Nurses with Interpretive Statements this year, too.

Lately, there are lots of ethics issues in the news. This recent article series talks about risks for manicurists calls into question the ethics of nail salons. There are sections of major newspapers discussing everything from genomic issues to the latest celebrity ethical dilemma.

In the Hotel, we deal with issues, too. Is it ethical to share your cell phone number so patients can call you back promptly when the phones in the facility don't always work? Is it ethical to be Facebook friends with patients? Is it ethical to deny certain patients items during care that aren't denied of similar patients, when there is no risk to health and safety? Are prejudices appropriate as health care providers?

So many things to consider this year, and every day.

We are the most trusted profession after all. Shouldn't we be ethical?

More to come...

Random thoughts

It's a stormy day already here in RehabLand, and Bubba's up early wanting donuts. My head is splitting. AND I double booked myself at work today. I can't wait for this day to be over.

Here are a few points to ponder:

There's always some new technology to learn in nursing. It just amazes me, though, that some people figure out how to "game" it as soon as they can. It really gets scary when this gaming potentially interferes with care.
There's an updated version of this code, but somehow, I don't think people like the Slug actually read (or practice) it.

If you get tired of the bullies, check out this advice on bullying or parallel violence from Katie Duke.

And finally, if you want to feel good about what you do, no matter what, check out this post from KevinMD.

Thank you patients. You are the reason why we are all here.

More later...

Ethical considerations

My boss's boss wasn't sure I encountered any of these in my job in the SU, so she left them off the requirement for my performance review. Consequently, they sent it back and did not review me.

Luckily, she was able to unearth the review this past week and send it back. Of course, it was late. Even more BS to put up with....

Nevertheless, I was not at all surprised when I saw this article about a little boy awaiting a heart transplant.

I have encountered this attitude much more than I'd like at the Hotel and our sister hospitals.

It really makes me sad.

Real life ethical dilemmas

I've been following this story intermittently, and I thought it was quite telling that it took so much effort to get to the bottom of it.

Sometimes it's very frustrating to see things happen for ego stroking and for money.

Scary...

Ethical dilemmas

In rehab, we keep people for a long time, as long as they're progressing. In the Hotel, we keep people a long time, because we can for a variety of reasons.

Sometimes, we even have staff get entangled in the issues. Here are some that have come up since I arrived at the Hotel.

1. The infamous, "He said, she said". Someone overhears part of a conversation, and reports it. Patient and nurse have two different stories. Reporter decides to write it up and nurse, of course, gets in trouble, because, as in most service industries, "the customer is always right." Patient is mad at nurse for rest of stay, and nurse is in hot water.

2. Patient stays with us for protracted periods of time when they actually need to be somewhere else. Examples: 86 year old patient with metastatic cancer says, "I can be rehabbed." Oncologist says patient has six months max due to the nature of the mets. We lose a rehab spot, because our boss says, "Go ahead and try." Hospice case worker fortunately has his head on straight: "We'll keep a bed for whenever he's ready to cross that bridge."

3. Nurses get involved (financially, sexually, etc.) with patients. It's no help when said nurse is a favorite of your nursing administration. Nurses also abuse the kindness of patients by eating their snacks, etc. I counsel them to report to no avail, because they fear retribution while they're still here.

4. Boss trains two people for a specialty position over the  past year. Both people will be gone from Hotel by September, and boss knew this. WTH is the matter with the boss? Does he/she like training people for other companies? Obviously...training wheel starts over again in a few months.

5. Succession planning. What's that you ask? Well, it means that you train in advance for people moving, retiring or just quitting your organization. As usual, this is just another thing lacking at the Hotel.
Happily, this is not a bad thing. At least, it gives me a topic for my latest grad school paper to write about due this coming week.

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!