Oh, it's Monday

Since I had an earworm the other day, I very well could have had this as one today. It really was a Manic Monday.

When competent (but lazy) RNs refuse assignment, you just have to wonder.

OMG.

Where are the Magliozzi Brothers when we need them?


 
Blame it on the train/But the bus is already there...

Happy Hump Day

An artist is not paid for his labor but for his vision.~ James Whistler

It's hard to have vision when the labor is all you have time for some days, when people absolutely, positively refuse to do what they say they will and leave you with the rest.

And do you think it could get worse? Yes, it could. Your big boss tells you to help him/her with the big chief of medicine meeting today. The one positive: you can just send your report, because, in finest tradition, the people in the field (i.e. troops) are not allowed to attend. (Hallelujah!)

Gotta love that interdisciplinary teamwork (head smacks firmly into table)!

Stay tuned...you never know what will happen at the Hotel.

Dear Charge Nurse

Thanks for sitting on your lazy arse and pontificating about how "short" you really are today.

I will not create safety hazards because you just don't think I need the help in the SU. I will be happy to put your name on the accident report should the need arise.

Thankfully, one of the unlicensed staff shows more nursing judgment than you can. She rocks. Don't worry. I made sure to tell your manager how good SHE really is in a nice, glowing letter.

You. Not exactly the same...just saying, when they say the charge nurse is ultimately responsible for safety on a shift, they mean it.

Sincerely not,

RehabRN

Ever have a Monday? I did.

My Monday:

1. Get up, drive Bubba to camp, have gas light come on.
2. Drop Bubba off at camp, go to gas station.
3. Get blocked in by monster truck (luckily monster left before I was ready to go.)
4. Get behind every slow idiot who does not understand the difference between a yield sign and a merge sign. For some reason this is a HUGE problem here in RehabLand.
Remember kids, yield is red (may need to stop), merge is yellow (go slow, don't stop dead)...
5. Go to work and find out you need to sign more useless papers. (Don't sign them because they are as useless as the last ones.)
6. Find out that the scheduled opening of the patient unit really isn't  as scheduled. This means your programs have to find a new home until it is open.
7. Spend a good chunk of the morning doing admin work on room arrangements, etc. Secretaries don't do that...that would be WORK (a 4 letter word)!
8. Finally get all the details done, e-mails sent, arranged, rearranged and technical details scheduled. How much of this really required an RN?
If you guessed absolute zero, you are correct.
9.  Meanwhile, secretary is still attached to desk phone whispering each time I pass the printer. Would love to audit her phone log! (Which would require an Act of Congress). If I had a dollar for every minute she wastes, every copier she leaves run out of paper, ink, toner, etc. (and every single one is no more than 20 feet from her desk)...
10. Eat lunch, attend a conference call.
11. Get a call that Bubba is sick. Dahey to do pickup duty.
12. Get on conference call that starts, stops and sputters. Give up when I can't hear a thing.
13. Finally get everything done and go home.
14. Start to wind down and relax...and another telemarketer calls.
15. Thank goodness for online complaint submissions!

Charging on

Yes, I'm out of the charge nurse racket for another bit. Thank heavens!

It was reasonably pleasant on the last round of Charge-o-Rama, even though RPIA LPN  tried starting a riot by mentioning all the lazy people I had on my shift. Really? I replied. I'm keeping everyone busy, myself included, and we still had time to sit down.  I was just thrilled to death I didn't have her to schedule around now that she's on light duty for twisting her ankle. (Thank you boss!)

I'm still in holding pattern re: my future in a new position at the Hotel. It looks good, but  I'm not holding my breath. HR around here is slower than dirt, and to top it off, they're even advertising on TV more lately. I'm sure my lowly, newfangled Hotel position is way down the list, since they're recruiting ICU and OR nurses, as well as ICU docs on the slick commercials in our area. "Come work at Washington, where we know patients."

We'll see...back to grad student studying while I have some free time today. Stay tuned!

Adios SU

I left the SU in good hands. The nurse I replaced temporarily came back and she looked quite happy. All that had been in shambles in her world at was right with the world and she was ready to celebrate at work.

We celebrated by eating donuts. She and I ate most of them, since many people chickened out, since they all started New Year's diet programs. Life is made to be lived and a good donut is still a good donut, she said.

The floor is still the floor. It was the crazy busy place it always is, only there was much quiet today. I don't know why, but things were very, very slow when the lunch trays came (we pass out any to isolation patients). A couple of senior nurses and I just looked at each other wondering where everyone went.

I had a decent assignment, but as many of you already know, when you go from one job to another, it can be challenging. I use a completely different set of skills when I work the floor vs. SU.

The majority of people were happy to see me--one so much that even though he usually squanders time lolling around in bed driving nurses nuts, he actually got up when I went on rounds and stopped in his room. This particular patient has been around regularly since I started at Madison and we have a very good rapport.
"What are you doing here?" he asked me and his nurse. I replied, "I came back and I'm here to tell you to get your a&$ out of bed." We chuckled and he complied and got up when his nurse came back.

The doctors acted as if they hadn't seen me in years, even though, I saw some of them every day while I was reassigned. Surprisingly, they were happier to see me than some of my coworkers. The Slug, happily, was at a conference and not available.

Overall, the day flew by. I was lucky enough to squeeze my lunch into it all. We'll see how it continues...stay tuned.

How I live

In spite of some of the crap I had to deal with today, it wasn't as crazy as usual this Wednesday. Our RPIA (Royal Pain In the Arse) secretary actually scheduled the right amount of people. This is the first time this year. She, as usual, copped an attitude when I asked her to do something that was clearly her job. I'm just trying to make documentation of her errors easier to do. I would like to spend more time being an RN rather than a secretary babysitter.

On another crap note, the big boss attended our monthly meeting and determined that crap was the word of the day in reference to said secretary. Boss has his/her own plans on replacements, but not sure if/when that will ever happen.

So despite not having to deal with actual live crap in the SU like on the  floor, it's mainly a mental exercise in living well. Do little things with great love I've read (according to Mother Teresa), so I realized that's how I survive.

This week Bubba and I visited Giacomo and got him a diet-friendly present that doesn't elevate his blood sugar. He was pleasantly surprised. Parts of it will even last until the Super Bowl rolls around.

When we weren't shopping for our friends, Bubba got his store-bought cupcakes to take to his evening class and some for school tomorrow. I packed his presents and if there's no snow, he'll trudge off  again with his cupcakes and goodies.

Finally, I really despise when our clerks let our older patients roam around and be in the wrong place. One patient was in our office waiting for an appointment that was clear across campus. (No one knew why he was still sitting there). I found out and called the other office. Even though Mr. X. was late (and some clinics cancel you if you're over 15 minutes late), they said they'd take him, since he was on the way. Score one for the little old character and the good people in the other campus clinic.

It made me think of this quote from Von Ryan's Express, an old war movie I liked as a kid, with Frank Sinatra, Trevor Howard and Edward Mulhare.

Maj. Eric Fincham: I once told you Ryan, if only one gets out, it's a victory.

Stay tuned....

Some things change...

And some stay the same.

The unit was pretty much same old, same old last night. Nothing particularly new and exciting.

1. The Slug is still the Slug and wouldn't know his/her backside from a hole in the ground (Dad's favorite saying...only a little spiced up!). He/she obviously didn't look out the window before swearing, "Oh, all these patients are crazy because it's a full moon." Not really, but perhaps on whatever planet he/she's on, it is!

2. Ringing the call light at the change of shift is becoming commonplace whenever I work evenings. One patient decided he needed help in less than the five minutes it would take the ongoing shift to get him situated. So what does he do? He says, "I think I'm having a heart attack. My left arm feels funny." Roommate was oblivious to all the commotion and snoring away.

Here goes the fire drill. Get vitals, get him repositioned, get out the EKG machine and call the doc on call. Nice. Thankfully, the evening charge nurse and I went down with some of the night shifters and got him all situated until the doc arrived. No other classic signs and a "I thought I'd say that so someone would come down here right away." almost merited the famous Dope Slap from the night charge nurse.

3. And finally, some people are still on evening bowel routines on our unit. Some are scarier than others. One of my patients had one which reminded me of a horror movie about tapeworms.

That is all...stay tuned for more excitement.

Sweet end to the week

I didn't have to get angry at anyone today. I keep reminding myself that frowning will cause wrinkles, and just being happy for the heck of it will irritate the people who drive you nuts.

My people were pretty good. One was up and one in bed, but the census has been low, so I can round on them, and do lots of other stuff without issue. I even helped out another nurse who was busy with his/her heavy (literally and figuratively) patient. Family education is a big part of what we do, so I had to verify that this family could do what they say they can do. Besides, I like the patient. He's a very nice guy. It's not hard to help him.

I actually had time to get into lots of interesting discussions today: about lazy coworkers (one of whom was chewed out by the boss for his/her lack of diligence), family education and dynamics between spouses when one has a debilitating disease or condition, previous lives and packing boxes.

One of my coworkers may trade me her schedule for part of next week, so we'll see if the boss lets me do it. I hardly think it will be an issue, but you never know. With our pre-JCAHO inspection, who knows what will happen.

I'll ponder it all this weekend...while I rest and relax. Stay tuned!

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.

There is a light...

At the end of every tunnel, if you really look hard. Sometimes, you have to dig through a lot of dirt and excrement to get to it, but you get there.

I had a really crazy last few days. I realize that some of the people I work with really don't work as a team if certain people aren't there to influence them to do so. It really pisses me off, but I can't do anything about it.

So what do you do? You find the people who'll work with you, and you work with them. You help them and they help you. And if you need the other ones, you have to put on the RN hat and delegate. I don't like pushing people, but I'm getting sick of this crap. If they only knew that I don't ask them for help because I get really perturbed about their followup comments, "Oh, she's not very efficient," "Oh, she does it different than I do, " or my favorite, "Why does she talk to the patient before we turn them?"

One of my patients, who is a lot sharper than he looks told me last night, "I noticed a lot of people make you do stuff on their schedule, and if you don't they get mad." Surprise, surprise. I have found that if I give people options and tell them I have to do other things, too, 95% of them will make a choice when given two options. That other 5% is another story, but even they can often be convinced to cooperate.

A lot of people think therapeutic communication is hooey, but I look at it more as negotiation. Some people we work with need control, because so much of their lives are out of control. This establishes some for them, and saves me some time in the process. It may not be old school "my way or the highway", but they can't say I didn't give them a chance.

My day, although I missed a little sleep, has been delightful. Dahey and Bubba took me to brunch and gave me lovely little presents...just what I wanted! We went out to eat and let someone else cook and do dishes. I came home, did a little shopping and now I'm getting ready for day 4 of 5. I'll deal with it as I go.

My light is the fact that after this week, I won't be at work much for the rest of the month, due to vacation days and conferences. When I looked at the new schedule with this on it, my heart leapt for joy.

Plenty of days to recharge ahead...and lots of light at the end of the tunnel.

Happy Mother's Day to all of you out there, wherever you are, wherever your momma is, here or gone. Mom's responsible for this missive today! :-)

Bed bingo on a crazy Monday

You know you're in for some excitement when you get to work and everyone's all shuffled around. This is known as "bed bingo". Bed bingo happens for a number of reasons, and it's mostly related to isolation status. We had one patient come up positive for a new organism, so as a result, five people got moved around to get rooms ready and everyone in their correct group.

Note: our facility cohorts patients in the same room with the same organism and we only have one (yes, one) private room among our rooms.

I got the same assignment and the med wagon far away again. This can be frazzling, but I dealt with it. The thing that is most frazzling is when one shift forgets to do the things to which they're assigned. Since our boss has been in and out with things, the tasks that normally get done on the floor have gone to the wayside a bit.

The housekeepers are the biggest problem right now. They have had some turnover in the last few months and they can't seem to keep the paper towels in stock in the staff bathrooms, nor can they keep the trash emptied. I've mentioned this to one of the housekeepers who usually sets us up well, but I'm not sure why it's not getting done. A lot of people on the evening shift are getting frazzled, and I'm one of them. I'm not on evenings all the time, but I see things on days and then I go to evenings and it gets annoying. With cold and flu season here, I wish one of the docs would notice and throw a fit, since maybe that might get something done. Running out of paper towels in the bathrooms and patient rooms is not an option!

Besides that, some of our day staff are not even attempting to pull their weight. Unfortunately that saying, "When the cat's away, the mice will play" is very true. I dread working behind some people. You should not immediately have to empty urine bags when you get on your shift, but I have done it every single night on evenings this round. One day, I had to make the patient's bed and get all the linens. This is the job of nursing at the ranch, and the nurse who had this patient couldn't get it done before she left at noon, and the nurse who followed her for four hours had made no attempt, either. Thankfully, I had the bed made...just as the patient was returning with his family from a day pass. I also got lucky and had to empty the bed bag for this guy, too, since this was just one more thing they forgot. I have to say most people are consistent--when they don't do something, they really follow through and miss everything. End of soapbox.

Ahh...that venting felt better....on to more fun stuff. My younger patient is doing more every day. It's really good to work with him. He puts the active in active rehab. He's even paying attention to his diet, which is really important for SCI patients. We talked about his bowel routine protocol and despite the assessment of the docs and the charge nurse, he's probably going to stick to a daily routine.

One of my other patients was really depressed because his blood pressure would not stay up even with his TEDs, binder and Midodrine. We talked about it and hopefully, it can be resolved soon enough.

I'm going to stop here...more later! I'm going to enjoy my off day! (Happy Birthday, Mom!)

Vacation...all I ever wanted!

Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!

Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.

I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.

One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.

I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.

We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.

I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.

As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?

Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!

Stay tuned...back to work next week!

Not so late

Thankfully, everyone showed up for the night crew. I was warned in advance because as a rule, the charge nurse must stay over if anyone is missing from this shift. Since our charge had already volunteered to work as the fourth person, if someone called in, I'd have to stay. (We have other people who could, but usually they decline or have already left by the end of shift...which is a whole other story). Alas, this did not come to pass.

I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.

I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.

My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.

Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!

More later.