Never a dull moment

It may be a holiday week, but it's been busy! The Hotel is always hopping around the holidays because people want to go home. If they can't get home, we have to take care of what we can before lots of other people take off for the long weekend.

While some of our folks would like to go home, they get sick. One character mentioned that he/she had a transient loss of vision. He/she was worked up, then he had another incidence. Between the opthomologist who said the patient had a fugax and the neurologist who wanted a stat carotid exam, he/she ended up with a quick trip to Washington for an overnight to get all the diagnostics done and issues resolved.

In rehab, it's very rare to have a patient on TPN. In fact, I've yet to see one in any of our units (acute or otherwise) because if you're on TPN, you're usually sick and not a rehab candidate NOTE: this may vary in other settings.

However, if you end up with a chyle, a not uncommon sequela of the infamous triple A, you could need TPN for a while, as one of our recent patients did. Thankfully, no more TPN and patient is working up on the diet list, slowly but surely.

One of my favorite things to do is to read imaging reports. We have lots of rehab patients with CTs, Xrays and many, many MRIs. I follow along in the reports and learned this week about Thornwald cysts which popped up in a patient's report.

Finally, since it's turning to winter here in the northern hemisphere, I also learned about thunderstorm asthma, which was sending people to emergency rooms all over the southern hemisphere recently. Just makes me wonder how many of these sent me to the emergency room as a new asthmatic. My poor mother!

Thanks for following and reading along! May you all have a wonderful Thanksgiving  (or rest of the week) wherever you are!

RehabRN book club: Summer 16 edition

The reading clubs (yes, even for adults) are back at RehabLand's library system and Bubba and I are reading away. Dahey always does (he could spend every waking minute reading if left to his own devices...) but never competes in the contest.

While my boys have methods to selecting the books they get, I don't really have one, outside of the fact that I like new books. Ones with catchy titles and authors I recognize also helps. Lately, I've taken to just picking up a book while I wait for Bubba, randomly opening the book, and reading a few pages while I wait.

If I like the book, I check it out.

The two books on my reading list right now are those kinds of books.

The first one I'm reading is Beyond the tiger mom: East-West parenting for the global age by Maya Thiagarajan. I liked it because Ms. Thiagarajan is a teacher. She's got street cred. She's not just avowing a philosophy to make us working mothers look like slackers. To top it off, she has some great ideas for interventions you can try at home with your kids.

My favorite quote in the book is not just applicable to education, it's also applicable to my job as a nurse:

"Don't worry so much about making everything "fun"...I personally believe "fun" is the wrong word to use. Learning should be challenging, meaningful, rigorous, engrossing, interesting, and satisfying." (p.132)

You could easily switch learning to work and it would still make sense.

The next book on my list right now is We have the technology: How biohackers, foodies, physicians, and scientists are transforming human perception, one sense at a time by Kara Platoni. I'm only a couple of pages into this book but it's looking promising.

More updates to come. Hope you enjoy whatever's on your reading list. Feel free to discuss.

Dear Boss

I know you are stressed. I'm sure you're kind of on autopilot, but I notice things.

I notice that you said, "You learn this in therapy" in way too many places recently. Yes, people learn things in therapy, but when you have a RN in the room and a therapy student with patients in a education class, you have to make sure the patients understand one thing.

They should learn EVERYWHERE at any time. Yes, everywhere. If they don't, they may not survive.

Nurses work 24/7, and frankly, we should be teaching patients that amount of time, too. It's not just during therapy, or by nurses on breaks from therapy, it's whenever they can. I view saying "hi" to someone in the hall as an education opportunity. Like the fellow who wandered into the clinic at Washington while I was talking to my nurse friend T. He learned something, because I took five minutes to teach him (thank goodness for those brochures in my bag!).

Our therapists might be good, but they are not here 24/7. Our nurses are. Please don't discount them. Empower them. Encourage them to do their best, to learn more, to get certified, to be the best they can be.

Sincerely (because I really do care),

RehabRN

Still...

Silent waters run deep, and since the flood waters are still about in RehabLand, we're paying attention.

No unnecessary water use and water conservation is the status almost a week into all this neighboring excitement. We are doing our part, which Bubba loves, since he thinks he'll melt if he takes too many baths. I've cut down laundry to one load as needed (when someone panicked because he thought he was out of underwear and socks) and I only do dishes when I fill up the dishwasher, then on eco or one hour mode.

We'll live reusing most of the towels and sheets. We are lucky. We are dry. Many of our neighbors a few miles away are not.

It is so much to be grateful for today.

More later.

So glad

TGIF! A long weekend awaits with Dahey and Bubba. I can't wait. It's been far too long.

It was an exciting week. Dahey returned from TDY. Hallelujah! I have a backup for the soon-to-be teenager who needs a parent pal sometimes. I love Bubba, but Momma needs a break! The boys are already planning their next adventure to the movies for The Martian.

We survived the inspection, but maybe, after a few of these, I'm becoming jaded. Some of the things they asked us has very little bearing on nursing. I like to consider myself informed, but I had no idea about some of the stuff they asked. Happily, most of my other colleagues in the department felt the same.

Happily, we saw a few patients and got some work done. Since we've had a few exciting things happen lately, I've gotten to put on my research hat. One of our patients seemed sick but really had a anteroapical MI on our acute unit. Diagnosing an MI in a spinal cord injury patient, or one with diminshed sensation due to stroke, brain injury, etc., can be challenging.

I learn something new every day. Another one of our patients had issues being intubated so the doctors elected to do awake airway intubation for his/her surgery. It was very interesting to me to watch the staff who participated in this video below.

Hope you enjoy your weekend, long or short, wherever you may be!

Anniversary, it is...

But a happy one? Not exactly.

This weekend is the anniversary of Hurricane Katrina wreaking havoc in New Orleans and along the Gulf Coast. It has gone on record as one of the deadliest natural disasters in US history.

We should learn a few things though.

1. No matter where you are, you should have an emergency plan. Yes, my plan's not the best, but I am fortunate, that most of the time, I work close enough to walk home if anything happened here in RehabLand. Bubba is close to home at school and we have some basic supplies on hand.

Don't forget your desk/locker/car trunk. You can store some basics in there too, just in case.

2. Figure it will take three days to get help. We are fortunate that a lot of important public services are less than a mile from us, but we still stay ready. When it's time to evacuate, you need to evacuate.

However, there are happy things. Very soon, in September, many rehab professionals will descend on the Crescent City (or the Big Easy) for their annual conferences. If you are there, and are free, I'd highly recommend one or both (ASCIP for all you SCI nurses or professionals and/or the Annual ARN conference, for any rehab nurse). New Orleans is a pretty city with lots of history and delicious treats. Don't miss it.

Who knows...maybe I'll even see you there. Stay tuned!

Little things

Lately, little things mean a lot, or little things can get on my nerves. I'm working hard to let the latter ones go.

Bubba waits for making decisions and it drives me crazy. I almost had a heart attack over him changing his mind about a field trip. I forgot important stuff and had to come back home before I could go to work. A little stop and check would have solved everything.

Some people get on my nerves at work. It might be their attitudes or habits or anything. I just think sometimes, it gets magnified. I am singing that song "Let it go" in my head a lot lately. I can't fix them, so I have to let it go. I'll let them fall on their faces first, because no matter what, they are right. Once they get scraped up, they'll get it.

It's time to live for the good little things, not the bad. Savor the good and let the bad ones go.

Learning every day

I tell my patients and other nurses that I learn something new every day. Lately, it's been very true. So many things in my life, at home and at work are precipitating the changes. I'm hoping they are all for the better.

While I'll never become a maternal/child nurse, I learned about STABLE the other day from one of my e-mail groups I belong to related to technology. This course is provided virtually for those nurses who are in rural areas who cannot attend in person, due to time or expense.

I'm learning more than I ever wanted to know about some new technologies. Just because it's expensive, doesn't always mean it will work. A long, arduous task was made harder. However, I shouldn't complain. I have a technical guy with a lot of history, who can figure out just about anything. I am extremely lucky.

I have to remind myself of that very fact, too. I am lucky to be able to learn so much.

More later...

The things you find

Since I've been on vacation this week, I've been trying to get my end of the year stuff done. Dahey has some financial stuff to take care of that he finally got around to today. 

It was a lovely day in RehabLand, so we took Bubba outside and taught him about how you can quickly clean up piles of leaves from the old oak, which, of course, never sheds them all until you have a lot of wind (or snow) in winter. We put leaves in cans, we put leaves in bags, so we will be ready the next time they come by to pick them all up. Bubba was tired by the time we were done.

I filed some paperwork. I thought I was only filing this year's stuff. Well, 2013 must have been really crazy, because most of the paperwork was still unfiled for that year. Luckily, this was easily fixed (by sorting it out and filing it). 

Besides filing, and giving away old stuff, I found some new stuff. I put a DVD player a relative didn't want in the closet.

I figured I might as well get it out and start using it to get my exercise program back on track. Each year, I write down my top 10 goals for the year. I only accomplished 3 of the ten this past year.

The appointments that needed to be made were made with all the folks who were still in their offices this week. The rest will wait until next year. A couple of resolutions written down, and hopefully the start of many more successful ones.

More to come...

Rehab nursing in a nutshell: the series

Oh, since I'm still thinking about  what I learned at a recent rehab nurses conference, I figure I'll share what I've learned along the way.

If you haven't already read some of the old stuff in this blog, feel free to go back in time. I've tried to keep most of the stuff that captures how I felt as a new nurse.

Frankly, being a new nurse wherever you are is scary. There are nice people out there, and there are the trolls and Nurse Ratcheds who will make your life hell (or at least attempt).

First rule: DO NOT LET THEM.  Sometimes the best thing you can do is to find a mentor (if you are in a residency program, thank your lucky stars...) and learn how to be a good nurse.

You can learn on your own some of the additional stuff you need to know in rehab.

Just remember Rule number 2: you will never stop learning. Don't even try, don't get sedentary, don't get sedate.

I can't tell you how many over 60+ year old nurses I saw at the recent rehab conference. Three of the original 12 nurses who started one group showed up. One had a cane, but let me tell you, she used that cane with confidence, and she went from session to session, several which I attended.

Our closing speaker (a nurse) helped his/her mom complete her CEUs for her license. She's 84.

Not sure if she's a rehab nurse, but she would have fit in fine with all of us (and would have ended up with lots of CEUs).

That's enough of an assignment for today. Enjoy the rest of your weekend, wherever you are.

More to come...stay tuned.

They don't have a T-shirt for this

Being a certified nurse can be nice, but documenting all of those continuing education things can be a pain.

Hooray! You're a certified nurse! Fast forward (it really didn't seem that long) and before you know it, it's time to renew that certification.

However, it's not impossible. Here are my tips (from personal experience since I've done this a couple of times this year) on how to get your stuff together and submit without ripping all your hair out.


1. Be organized. Keep good records of what educational seminars, conferences, webinars, etc. you attend. I bought a small scanner for receipts, but I scan every single document I get and put it in a folder on my computer.

You can really collect a lot of stuff over most certification periods (three to five years is standard).

2. If you go the electronic route, always remember to back up your info and put it in a safe place. You don't want all that time and work to go up in smoke. You can backup stuff online or on DVD or in a fireproof file box.

3. Start early. Many organizations charge late fees (and many are not cheap). Some (like one East Coast organization I will not mention) like to audit the folks who file late. For the most part, organizations audit a certain percentage of recertification candidates (this percentage varies).

How do I know? I was one of the lucky folks who got audited when I forgot to mail in my stuff while I was on vacation this spring. 

4. Read the instructions carefully and make sure you send in the appropriate amount of contact hours. Some organizations distinguish between online learning, webinars, conference calls, etc.

5. File electronically if your organization allows it. See #3. No late fees if you can send it in online by the due date and most send you a confirmation e-mail once you're done.

6. If you can't file electronically, always, always, always keep a copy of your completed application.

One friend applied for a certification and the certifying body lost his/her application. Thankfully, he/she had a copy and after a couple of phone calls, resent it, and all was good on the road to certification.

Without that copy, it would have been pretty ugly.

Enjoy your recertification adventure!

Still alive and kicking

Yes, folks, adjunct teaching is not for sissies (or anyone who values their free time). I feel as if I've been buried beneath a ton of paperwork, which not only includes coursework, but pre and post class work (aka homework) as well as online assignments (since this is what they call a hybrid class).

I have seven log in IDs for various systems I have to interface with, including e-mail, one of three (including paper) attendance systems, two grade books and one learning management system for professors.

I am expected to call each student if they don't show up. If that doesn't work, I have to send follow-up e-mails.

To make my life even more interesting, the course management system administrator merged two sections of the class (mine and the day section) into one class. They've finally separated us, but the students are still confused.

This is a good experience...of what not to do.

Stay tuned!

Learning something new

Well, since our specialist Dr. E-I is on vacation and we won't have his clinic this week at the Hotel, he left me with some work to do writing a grant.

Hopefully, I can convince the All Mighty Money Granting organization to send us some for a new project.

We'll see...

Frittering...

I should be doing something productive, but I'm not. I was busy orienting a new nurse who got to spend the day with me in the SU.

It looks easy, but it's not. At least, she got some experience in what might be useful in my world.

And right on cue, I had a couple of folks I had to do walk-in support for today. I told her it only happens every so often...

I didn't even have to call them. They just found me. It's fun.

That is all. Enjoy your week!

Spring break diversions

Yes, to keep the vacation atmosphere around here for one little boy: let's go out to eat more than usual. At least that part seemed like a vacation, even when you're staying home, and the parents are working.

I decided if I ever want to be a nursing instructor when I grow up, I ought to take some more education classes before I run out and get a terminal degree. I've been checking out MOOCs (Massive Open Online Courses) from all over the world here. It seems like a better option than handing over my checkbook for every class.

I actually found a nice course by Curtis Bonk (yes, it's his real name) about using technology in teaching on one of the sites. I knew of a few, but the MOOC list has many I had never even heard of at all.

Professor Bonk has some interesting viewpoints.

1. You need critical friends, web buddies, e-mail pals in online classes.

2. Your blog will be there 100 years later. What you post today might be usable tomorrow. Your digital history may be available for centuries. (Wow was my first thought). The professor mentioned a friend who published the Come and see Africa blog. The author's died in 2010 in a car accident. Her blog remains.

This tidbit of that course provided a lot of food for thought today.I can only imagine what rehab nursing will be like in 100 years, and what would they think of this blog?

Today, I read an article that people are still trying to keep rehab hospitals relevant, when the pointy haired policy wonks want to send everyone to a skilled (nursing home) care facility for rehab.

Only time will tell...enjoy your night wherever you are.

I need a t-shirt that says

"I survived jury duty". I did. I did. I did.

What did I miss in the years I did not get called and picked to serve on a jury? Not much.

A few things I learned though, were very important.

1. Don't let your lawyer clown it up on the opening arguments. He/she should be reasonable and convincing, but bouncing binders in front of the jury to get their attention is not the way to do that. It gave me a headache.

2. Tell the truth. Or at least be expected to use the same story over and over. You know that oath "thingy"? Yes, it applies to you.

3. Related to #2, never swear that you never use the phone. There are records.

4. Don't hire one of your own employees to serve as your "expert witness". It is a little thing called conflict of interest for him/her to participate.

5. Don't repeatedly say your client knows nothing about business, because he/she has been at it for a few years...like 40. Despite everything, the business is solvent, so who's at the wheel?

6. Always be explicit. Some folks, for whom English is a second language, may not understand things that are implied, especially in e-mails.

7. Don't use easels to display e-mail quotes that you've circulated ad nauseum in the courtroom. I got tired of looking at your not-so-hot quotes on foam board.

And finally, one of the most important things I learned from jury duty:

Take every moment you can to enjoy a moment outside in the sunshine. You will never get enough of those. Criminals and crazy relatives tend to stick around, but sunshine doesn't, so enjoy it while you can.

More to come...

Learning something new

I've taken care of post-transplant patients, but lately, we've gotten a few pre-transplant patients at the Hotel.

So I went to the library to find some information. First of all, the International Transplant Nurses Association has a wealth of information about transplantation topics and patient education. Like rehab nurses, transplant nurses deal with a wide variety of subjects while caring for patients.

In addition, some things vary for patients based on their rating or score for whether they are eligible (or need) a transplant. Liver transplant patients hear about their MELD scores, heart patients may know what their Seattle Heart Failure Model or other score can affect how and when they get a transplant and how their doctors treat their heart problems before they get transplanted.

Why does this make a difference? Goals, folks, goals. Rehabilitation is big on how patients can (reasonably) meet their goals on admission and discharge. We don't just want them to progress while they are here. They need to continue it as time goes on.

Needless to say, working in rehab is never boring. There's always something new to learn.

Stay tuned!

The things you learn with children

My child, Bubba, is a character. He's spent his afternoon after soccer, singing around the house: church songs, and even Adele.

He's also having a grand old time trolling the internet on the iPad we got recently. (I won it at MegaConference). When he wasn't busy playing a map game of the NCAA tournament, he was checking YouTube and looking at videos of other kids.

He also learned about genetic diseases when he happened upon a video of a kid with a rare skin disease. We looked it up and found out that is now survivable. He was most impressed that the little girl we saw doesn't live too far from RehabLand.

Now it's a golfing math game, so he wanders to and fro, but when supervised, he has fun and learns something, too.

More to come...spring break is still young.

Have to have a goal after grad school hell is over

Mine: learn to play that black bass guitar that's been sitting idle for over a year. This is one of the songs I want to play with a couple of my friends.

Maybe I could start a nurse version of the Rock Bottom Remainders....hmmm.

'Tis a happy Friday, indeed

See I didn't run away forever! I'm back. It was wonderful traveling to a place that is so unlike the Hades RehabLand has become in the last week. I sure miss outdoor air conditioning.

I didn't have to go to work today, but being the type A personality I am, I had to go see something in my office. First, I spilled my coffee all over and made a huge mess. Then I found it.

At 1150 something last night, one of the service chiefs read her e-mail. She found out what I was going to share with the bigwigs when I got back to work, because they sent her an e-mail.

Yes, yours truly won a prize. Mostly bragging rights, but big enough. I won the top poster contest at Mongo nursing conference. Not just a regular local, state or regional outfit...nosirree, I won a prize in the big leagues, almost Olympics: an international conference.

What was my reaction? Shock really. I hope no one taped it, because at first, I couldn't see the screens at the front (since I was sitting with my new traveling partner Lucita in the back having a good time) with my poster, my name and my employer, Madison General Medical Center on it, either.

My advisor actually gave me the stand in certificate, since they're sending the printing of the real one to Geneva or somewhere and it will come in 6-8 weeks. "RehabRN, you're shaking" she said. "Sorry," I replied. "I just can't believe I won. I went through hell to get to go to this conference."

And she knew that I did. I was rejected by every level of official I talked to at Madison and elsewhere in order to get funding to go to this conference--local, state, district, service line--you name it. Madison couldn't give me time off because my presence was not "of substantial benefit to Madison." (Yes, that's what the Chief Educator said) But, there I was with the lady who gave me the courage to keep going. She got me partial funding, and once I saw the program where she and several other PublicU instructors would be there, I told her, "I don't care. You got me some money. I'm going. I'm going to meet Bob (the other instructor)."

However, in a long career, SK has always looked to make nursing better. And I'm damn proud I could return the favor by winning a big prize in the name of PublicU. Bob even gave me a hug. (He's a prince, really.)

And as Kay, one of my local mentors told me to do, I said hello on her behalf to several of the superstar people (she gave me a list of who I should talk to). They were a bit startled that a nobody like me would seek them out, but since they all know her, they laughed once I relayed her message.

"That's something Kay would do...send a student with a message." one said, chuckling. "Tell her we miss her when you get back to RehabLand."

And so I did. Kay just smiled.

Happy Friday all wherever you are. Dreams sometimes do come true. Stay on them like glue until they do!