Pills, possibilities and picadillos

Ah, what a week it's been. Starting off with Pi Day on Monday, I feel as if I've been sprinting everywhere. Spouting might have been correct, though. After I had my lunch and ordered a new computer (which was absolutely crazy--for both the discount and the credit card hold), I showed my friend K. the new office, since she's rarely over anymore. I look up, and there it is: a huge leak on one of the ceiling tiles.

Since my office is in an older part of the Hotel, leaks are not that uncommon. After three days, moving from this room to that room, they finally finished the search for the leak. They found it in one of the radiator lines upstairs. I was ecstatic that the leak was repaired and I didn't have to wonder if the tile would come crashing down while a person was visiting me.

The CDC also published guidelines this week about opioid prescriptions. Our folks in the SU hope it works. They had another unruly customer in the building who required a two person assist, I mean escort out of the building by security. On top of that, we have a very troublesome patient, who's behavior is escalating. It's making things difficult for the staff.

For picadillos, Google says I must remind all of my European visitors that we use cookies here on Blogger. I don't use the data, so I hope you don't mind.

Despite all the mess, today is St. Patrick's Day. I celebrated by wearing my green and eating corned beef and cabbage at the lunch one organization had for the staff  and patients at the Hotel. I remember that without those Irish ancestors (or some like these) I probably wouldn't be here today.

More to come...

Dear Manglement

Yes, it is rough when no one wants to do your job. With guaranteed bonuses taken away because your performance sucked last year, yes, I really do feel for you.

It's terrible to come into work and be coddled with free snacks, coffee, etc., and your own reserved parking space at our multiple locations. I'm not really surprised with your recent actions of not notifying the campus here at Madison regarding security events, since you have a stellar track record to uphold.

Even though, RPIA, our former chief nurse, (and the rest of you who are still left) knew we were under a bomb threat at our Washington location one beautiful March day, you didn't "bother" anyone to pass that info along, because, "You know, the police will handle it." It was nice of you all to evacuate the building, just in case with RPIA.

Yesterday, we figured something was up when our retired veteran air traffic controller patient noticed an odd helicopter pattern down the street near a strip mall after therapy. He and Mr. Z., another patient who is a retired police officer made a few phone calls. As usual, no one bothered to notify us peons at the Hotel that a strong armed robbery occurred just a few blocks away and the helicopter pattern was due to the police tracking the suspect.

Just remember...we take care of those who take care of us. You might not like the next patient satisfaction (or employee) survey.

Sincerely not,

RehabRN

Ah, memories!

I was reading online and found a link to these NCLEX questions. The scenarios are the "what would you do" management ones. I love those.

For fun I decided to read them, and see how they'd be answered at the Hotel. The selected questions are located at this link: http://www.rnpedia.com/practice-exams/nclex-exam/nclex-practice-exam-management-care

Here's what would happen (or has happened) at the Hotel for the ones I selected. See if your place of employment is the same.

Remember nursing students: you have to answer as if you work at NCLEX Hospital, not at the Hotel or your current hospital. Your mileage may vary, but you'll get the answer right.

1. RE: substance abuse/unfit to work We've had our share of people who shouldn't come to work for a number of reasons. Frankly, I'm all about sending them home if they don't need to be there. Unfortunately, some of my coworkers, do not feel the same way, and contribute to everyone else doing double work so someone else isn't "found out".

Can you say "dysfunctional family"? I knew you could.

7. RE: abuse complaints. Please, please, please don't call the police FIRST, young'uns. I've seen this one in person and the manager ended up leaving and one of our students was basically run off the unit, because he/she did not use common sense.

Assess, mitigate, and notify your chain of command first.

8. RE: dates and patients. Yes, I do tell them it's inappropriate to ask me, a married woman, out on a date, psych or not. I'm here doing a job, which does not include interviewing the next Bachelor/Bachelorette candidates.

9. RE: client calling out asking for help all the time. This is great information, but good luck implementing it, if you don't have a cooperative crew. I remember many a night when some of my evening characters constantly badgered me (and often the rest of the staff) no matter what I told them.

Just remember: dementia and sundowner folks will keep you hopping on evening shift, kids. Don't forget: evenings do get quiet and dark, and that's when things like to fall apart.

11. RE: the surgeon and the chart. Remember: just say no. If he's on your facility medical provider list, he can look for himself. If he chooses to do so (which violates hospital policy in a great many places), it will be logged and he'll have some 'splainin' to do as Ricky Ricardo used to say.

15. RE: visiting hours. Here again, is another example of using common sense. If your family is quiet, calm and respectful, it makes this easier. Model it and they'll do it, too.

Don't be a Nurse Ratched. Taking care of the patient and his/her family (and well-being) really IS your job, no matter when visiting hours are.

Things not to do as a nurse, February edition

Yes, the fun never stops in RehabLand. Days ago, the State Board sends out renewal notices and today, they send out their regular newsletter.

Guess it's a reminder to answer those questions correctly.

We have plenty of our regulars: lapsed licenses and drug testing abuses. Here's the ones from this edition that you really need to put on your "DO NOT" list, students (and any other RNs for that matter...).

1. Do not attempt to substitute blue mouthwash.
Yes, we all know that certain forms of morphine smell just like some of the mouthwashes on the market, but stealing pain meds from terminally ill patients, is, was, and ever shall be unforgivable.

It will also cost you your license (there were actually two mouthwash switchers in this edition from RehabLand State Board of Nursing).

2. Don't go to a party, get wasted, then trespass.
This is also a problem, especially when you are convicted.

3. Do not share your Pyxis/Omnicell/drug dispenser password.
One person lost his/her license for this (and diverting narcs), but my question is, what happened to the idiot who shared the password?

Here at the Hotel, you would be fired for violating the information security policy.

Speaking of policies...follow them.

4. Don't assess the patient after a violent incident involving security.
This nurse was reprimanded for leaving that lil' old task to someone else. If your facility states you will assess following any altercations you must.

Besides, it's a lawsuit waiting to happen. Remember: you're considered in a position of power.

5. Don't just "borrow" a retiring physician's prescription pad.
When you are from a little town, people talk. And those pharmacists are smart. Hence the reason why they didn't fill any of your prescriptions.

And finally, my personal favorite:

6. Don't go offroading in the company car.
This applies to anyone really, not just nurses, unless of course your company car is an off-road vehicle and/or your job demands it.

Home health RN was out on his/her regular route seeing patients when he/she ran off road and damaged the axel of the car, requiring towing. Luckily, no one was hurt, but since this is a recordable incident while on duty, HHRN was required to submit to a drug screen.

As you may have guessed, he/she flunked (positive for marijuana). Remember kids, buzzed driving, driving while high (or getting high during working hours) is really NOT a good thing.

What not to do as a nurse postscript

Normal nurse: you obey the law, because your state can (and will) revoke your license if you don't.

Our nurse: was dodgy and always on his/her cell phone. Now we know why. Must have been to the lawyer or the bail bondsman or someone else.

Security came recently and escorted him/her off the premises.

Never a dull moment at the Hotel.

Yes, it's here!

The weekend, the weekend, the weekend.

It was a pretty productive week with a little weirdness added in for good measure. (What is that full moon for, anyway?) Yes, if you want to use the VPN client  for Hotel work, you have to have the blessing of the Information Security Officer. It would have been nice if they'd have told my doc that before he/she left with a computer without access. (I got to play "scramble" to get things done.) I love HIPAA!

I got most of the work I'd started completed by the end of the week and lined up even more. For entertainment, we bet each other sodas (my favorite is Dr. Pepper) on the number of folks Dr. Q. would discharge by today. He was hoping for 6, but we did get 4. I guessed 5, so Mike, our nurse manager, won the prize, a Mountain Dew from me and two other folks who participated.

Now to face laundry and teach Dahey how to use his birthday present (an iPhone).

The fun never ends.

Stay tuned!

My nightmare

Shooting outside rehab hospital (from Washington Post)

It is my nightmare because some of my coworkers remember when the same thing happened on one off-hours shift at the Hotel. It happened on one of our sister units and our folks were dispatched to respond.

Even though no patients were involved in our incident, the mere thought of it brings shivers down my  spine. I am happy as a clam when security comes by for their regularly scheduled panic button check.

Because I hope and pray that it never, ever happens again.

Boys will be boys

And idiots sometimes. You could tell the moon was full recently, since we had so much juvenile antics lately.

Scenario #1
Patient X doesn't like Patient Y. Patient X decides to duke it out with Patient Y in front of the table in the dining room. Security is called. Patient X gets a ticket, and will be considered for discharge soon. Patient Y fell down, so this causes tons of paperwork mayhem for Ella, our harried night charge nurse, who is late giving report, since she's filling out incident reports, info for security, fall reassessments, patient assessments, and calls to the on-call MD. Word spread fast around the unit, since one of our characters says to Mr. Y. when he saw him today, "I heard you had an exciting time earlier."

Scenario #2
Patient Z, one of our resident COPDers was scheduled for discharge recently. Patient Z likes it at our place, so he turns off his oxygen to make us think he's "sick". Try as he might to sabotage his discharge, we figured out that Z could indeed reach the oxygen valve from his perch in bed, and yes, he did turn it off. He got crazy, so the chiropractor came down at the boss's request and gave him a mini-adjustment, the specialist gave him his specialty consult, and finally, three hours late, his transportation showed up.

Scenario #3
Patient A tells our student nurse, who's doing an assessment for her master's program, that, yes, he is indeed still smoking weed. Despite everything, we have to keep him for a while. Patient A has developed a new problem and we cannot simply discharge him for non-compliance. So far, no one's found his stash.


So needless to say, I was happy, happy, happy to be going home after a long day. Stay tuned for more excitement. You never know what will happen at the Hotel Rehab.

Shufflin' through...

The full moon blues...it's always something interesting at the Hotel.

Recently, the character we sent to Saint Suburbia got intubated. Just makes you wonder why we take people back to rehab in the first place, when they're too sick to be with us. Can you say making a full house?

Mr. Demented was demented again and so loud, security came by to make sure we were taking care of him. Nice. Maybe the boss will move him to the other quiet area of the unit, where he won't disturb security...and everyone else going in or out of the building. Makes that poster welcoming visitors to our 'quiet, restorative environment' look a bit off.

If I ever get my wish of a genie in a bottle, it's aerosol Ativan for all, including staff!

And...I can't say it enough...thank you, thank you to all the folks with links to this blog, especially AtYourCervix. Want one? Go right ahead. Let me know so I can link to you, too.

I guess it is true...if you post it, they will come!

More to come...stay tuned!

Welcome back!

Things you always want to see on your first night back from vacation:

1. Patient who is given a bottle of magnesium citrate, just as your shift starts. Load up the pads, towels and cleaning supplies.

2. Patient who goes from obnoxious all day to threats to assault to taking a swing. Security!

3. Patient who remembers your name and yells it out every single time you walk past his/her room, just to see if you'll come in.

Maybe I should have just given him the night shift charge nurse's name, instead.