Hit the nail on the head

This could have easily been the theme of my week this week.

1. Yes, slacker coworker, when you sit in our weekly meeting and chart, instead of participating, you look like an idiot. When a patient with a LOS of 25 days and you really know NOTHING about him or her and they are your assigned patient, I only have one question. Why in Hades didn't you read THE CHART?! 

I know, rocket science...

2. The boss finally decides that the hallway consults are causing issues with continuity of care. Yes! That only took a year to convince him/her. We shall see what happens...

3. Thank you jo at Head Nurse for the link to this Suzanne Gordon article. Yes, communication is vital, and lack of it is deadly.

So far no Ebola in the Hotel Rehab and our specialty docs like it that way. We will keep praying it gets contained.

It's one souvenir from Dallas I'd prefer not to get on my next connecting flight.

Stay tuned...

Irony or Day two of the JC

Yes, one of the executive secretary's must get a "communication" bonus, because we're getting a recap every day (with emoticons and gifs...I wish I were kidding) that the Joint Commission is at our hospital.

Kinder, friendlier hospital? I don't think so.

But after another day of digging, sorting, and moving things around in the files for another upcoming audit, I discovered some very interesting things.

1. Some people think they can BS their way through everything. Including three months of work, where they didn't really do much.

That should be an interesting conference for the slimy critter whose nose is tilted so high that she'd drown in a rainstorm.

Have fun 'splaining,  honey. It was nice knowing you.

2. Some data is really a mess. I'm so glad it's not mine. I did the best I could with it, and passed it along.
 
3. Don't mess with a big Army veteran in a red truck. Thanks D for keeping that guy from running me over in the parking lot! (Quitting time is scary in our neck of the woods some days!)

4. Read something light and fluffy to destress when you get home. My favorite today was the classic blog, Fmylife. Just when you think your work day blows, you read about someone else's craziness.

My favorites today involve lack of anatomical knowledge and the good old general crazy character.

Ahh! I feel better already. Back to the iTunes and going through the years.

Enjoy your moments wherever you are. At least, JC can't visit EVERYONE this week.

Stay tuned...

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

Demotivating employees

Ah, spring is in the air (for the moment) here in RehabLand, and the hospital administrators (aka PHBs) have emerged from their coccoons, er lounge chairs, to start rabble rousing the troops and demotivating away.

How can they do that you say? Well, here are some stories (I wish they weren't true) on how they do this.

NOTE: the names of all parties and sexes, etc., have been centrifuged to protect the guilty and the innocent, since I don't want the HIPAA police to come carry me away.

1. Medical personnel are allowed $xxxx per year for continuing education. (Not nurses, though). But, good luck, Ms. Overworked MD trying to use yours. You're not properly certified yet, so your slug compatriot MD gets your share. Call HR and file a complaint.

2. Allied health person gets invited to a national conference to speak. Your boss, who's been at the place forever, fills out all your appropriate paperwork. In the meantime, you sign up to present and pay your conference fee, hotel and airfare.

You get an e-mail that you've been disapproved, but when your boss tries to appeal to the higher-ups, he doesn't get the dignity of a response. Nice. So much for having seniority. You can't even take off unless someone with more seniority lets you have the time. Go file an EEOC complaint.

And my personal favorite...

3.  Become an advance practice nurse, get certified, speak at a national conference, and then submit your request for one lousy conference (subsidized by a private foundation) because you need more education to take care of new patients we have on the unit. All you want to get are your days off as official absence.

Get rejected because the "man with the plan" says we "can't afford to give you days off to learn" at the premier (and also free, since you got it paid for) conference in the world.

Reminds me of this Dilbert scenario...stay tuned for more to come!

PHB: You may have heard that our company has been accused of unethical business practices.
Alice: Is it the falsified product safety reports?
Wally: Is it the false stories planted in the media about our competitors?
Dilbert: Is it the crime family connections?
PHB: What?! Are you saying those are considered unethical too?!? Good God, this thing is just snowballing!

Just because

Just because I could...

I got one nurse's assignment changed, even though I wanted to him/her suffer, since the lazy a$% is off the next two days. Why? Because I like the patient, and he asked nicely. Slacker Nurse was really a pain over the last few days, and even though he/she had a lower acuity assignment, he/she was perturbed about not texting friends every 10 minutes or so per usual.

I helped one of our students (Student 1) find some research articles related to a patient. And yes, kids, this is considered business-related use of the internet at the Hotel. Student 1 said, "I always feel weird doing that. What if a call light rings?"

"Go answer it and come back to your research when you have time, " I said. Simple. Patients always come before any research. Period. Besides, most of those happy patients didn't ring the light much the last night when I worked with you.

I got Student 2 some networking info from a nurse I never met in another state. Connection? A national  nursing organization and Facebook. Since the job market is so crappy, I don't mind paying back the help I got myself when I was a Almost Done Nursing Student. (Thankfully, the market was great way back then!)

I got one of our patients his/her favorite snack. I brought it in myself.

I got everyone's care done in a timely matter one night recently. Why? I wasn't herding cats that night, i.e. dealing with primadonna doctors and nurses, as well as crabby patients.

Just because, I like to do the unexpected. It really messes some folks up. At least, it keeps them on their toes.

Stay tuned...

A break in the action

Since I had one here in the SU (I'm only here for a day...) I thought I'd get this latest one out while I was thinking of it and since the last two patients just cancelled due to weather (the "too wet" excuse, of course!).

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Dear Gen Y Coworker:

Yes, this is a gravy job. You make way more money than in your previous job as a driving instructor (who had personal experience with DUIs). This job means you can take all sorts of groovy trips every freaking month because of your 12 hour shifts and regale all the old people with them, since they view you with a sense of awe and contempt.

But please stop telling me how "boring it all is" today. I'm tired of answering all your call lights while you text the latest paramour about when you're leaving to gas up the car and pick him/her up.

And just a tip, asking to leave early, "just because" won't work with the charge nurse. You'd need to think of something else, like that "almost perforated appendix" story from a month ago.

Don't forget your AAA card in case your rider can't change a tire, or look cute enough to stop traffic.

Sincerely not,

RehabRN

Points to ponder

Dear Newbie Wannabe BSN:

Yes, you really must study if you want to pass your nursing research test. Please, however, do not continue studying when your patients keep ringing the call light. Get up and answer it.

No, it is not okay to take a timed test that is way longer than your break time. Please kindly do this on your days off, since you have two to three each week with your compressed schedule.

Dear Slacker RN:

Not doing your work until the last minute when everyone is ready to go home is not fun, nor an emergency on my part. Don't expect me to jump in and help, especially when you've spent the night goofing off and working on origami with the Slug.

One of those famous slogans really is true: Your mother does not work here. Please clean up after yourself.

Sincerely not,

RehabRN

Weekend...still?

It surely seemed like Sunday yesterday, even if it was a hopping day. I ran with people, ran with call lights, ran, ran, ran, all shift.

I did squeeze in time to get my preceptee's goodies out and we had a small impromptu party before some of the staff left for the day. She enjoyed it.

So needless to say, I was glad I was nearly out the door when WannaBeHippeeSlacker RN complained about how she was busy all night. I was not about to spend one second of my own time to berate her, when I had run all night myself.

A little work (and all finished by the end of the night with no OT) never killed anyone.

More to come...stay tuned.

A different atmosphere

One of the nurses I work with mentioned it is a different environment when certain people we work with don't come to work. She is absolutely correct.

Imagine my world for a moment. NOTE: this illustration below has several grains of truth and will be distorted enough to protect both the innocent and the guilty.

First, we have the "lunch ladies". These nurses remind you of the lunch ladies from grade school. They often wear matching uniforms and if they had them, they'd have those hairnets on, too. They're perfectionists and they like to run various aspects of the shift a certain way (as if they were still in their kitchens) and you'd better like it, or feel their wrath. The wrath, you ask? Why they whisper a lot, which irritates the charge nurse. They bugged me at first, because I really got tired of their furtive glances, then the whisper, whisper that goes on at the other end of the report area, but I got used to it. Later, they may tell me who they're whispering about, and I ask them to talk to that person. Sometimes it works, sometimes it doesn't.

Next, we have the GI Joes. GI Joe #1 takes care of his patients, does his stuff and is exemplary. He wants a long career and is working to become an RN one day, one class at a time.

GI Joe #2 has been around forever, most likely has untreated PTSD and another psych disorder or two, and can be both a good worker and an absolute nightmare. This changes from moment to moment, depending on who took the last cup of coffee from the nurses' station pot, to whether his favorite sports team is winning, to whether Mr. X. just rang his call light and asked him for ice. Sometimes this merry-go-round is exhausting. We always hope he takes the meds he has before coming to work.

Finally, we have the slacker brigade. Often, they have slacking competitions to see who can do less work. The Slug leads the brigade. He/she makes an effort to get as many phone calls as possible on a shift, start jobs that he/she doesn't finish (it's easier that way), and takes long lunch breaks. Since he/she's getting all those phone calls, he/she's always on the unit, but don't expect much. A phone call or Facebook game could be missed while some actual work gets done.

A couple of our newer nurses have also joined the slacker brigade. Their mission: stay in close contact with latest boyfriend of the moment by escaping from the unit to see boyfriend(s) on the parking lot, in full view of many of their patients, staff and visitors, or just sit in a very far off location and take phone calls, send text messages and update your status on Facebook out of paging distance. One has even made boundary crossing his/her favorite sport, by cruising through certain patients' rooms and asking them to get him/her snacks/treats/crafts whenever he/she can.

For me....I try to stay invisible. If I'm invisible, I'm less of a target. Some days are more on target than others. I'm still learning to cope with them. I like taking care of my patients and when I take care of them, they don't call me as much. When they do, I take care of their issues right away.

Finally, I always follow my mentor G's advice: start the shift by saying to yourself, "This is going to be a good day/evening/night." If you say it enough, believe it, and go out and act like it will, it will. Even if it turns into the night from Hell, keep reminding yourself. It can make things better for you and your coworkers.  If all else fails, remember, this shift too, will pass and let it go once you are gone.


 

Crazy, crazy day

I ran and ran again today, but at least, things were a little calmer than yesterday. Some people remembered that I helped them out a lot, so they helped me on a couple of things. It was nice. We had two call-ins, so the boss called one of our night people who was off and she came in pronto. I was happy because she took one of my assigned people, so I only had two patients and the med cart.

The Slug was in and she was slacking away as usual. She had to do one admission, but after that, when the boss left for his meeting, she took her 2 hour lunch while the rest of us scrambled to set up and/or feed our people who needed it. She does not get it that the time you take to run to X sandwich shop on your lunch hour is part of your lunch hour (which isn't really an hour--it's just 30 minutes).

Nope, she takes that time (anywhere from 15-30 minutes) and doesn't count it when she comes back and sits on her derriere. She started eating at 1215, and I ate my sandwich, and she didn't leave the lunch room until 1345. This did not include the time it took her to go get her lunch. This was just the time I observed. Management looks the other way.

Besides that, I just pray I work a shift that she doesn't because I get tired of these antics and all the "emergency" calls she gets. One of her callers actually sounded indignant today because I told him she was at lunch. "Well can't you just go get her?" "Well, no. I'm busy taking care of patients." I told him. (I was getting ready to give some meds and the secretary was at lunch. No one else was in sight.) I put the idiot on hold and I overhead paged her, even though I knew exactly where she was. I figured she needed the exercise to walk over to the phone, and I could go do something else.

I had my same two patients as yesterday. Mr. S. needed a new Foley (a special one at that--16 FR with 30cc balloon Coude) and I put it in as soon as it arrived on the unit. We change indwelling catheters once a month and then, per policy, we send a UA and C&S to the lab when we're done.

Mr. S. was supposed to get a loaner wheelchair so he could get up, but the PT couldn't get his configured right away because she was too busy. Mr. S. was very understanding, though. His neighbor, Mr. HIJ #1, who recently moved to this room since he got a special bed, was as demanding as ever, but I kept him relatively quiet. He wanted me to get him a soda, but he got distracted doing some crafts, so he didn't even worry about it.

I ran back and forth giving the meds on the last run, which at 1600 really isn't too bad. People were streaming in and out of the latest group meeting in our main gathering area, so I had to chase some of them. I got everything straightened up and passed on to C., who was taking my med cart. I got out of there as fast as my legs could carry me without running. P and I walked out the door as a camera crew was coming in to film a story. P. told me, "Stay here long enough and you'll be on TV, too! I've been on one show already. With those powder puffs, I felt like Oprah!"

Even though, it was gray and cloudy, it was good to escape. Off tomorrow and back to evenings on Thursday...stay tuned.

How to know the moon is full

Listen up, all you nursing students, although you may have thought meteorology has nothing to do with nursing outside of being listed before it in the class schedule, the full moon can make a difference on your unit.

In my short time as a student and so far as a nurse, I've heard from psych to labor and delivery to LTC nurses that the change in the phases of the moon brings out the strange and unusual more than you'd think.

Well, since yesterday was the full moon, here's a few of the fun things that happened at Madison.

1. The crazy people get crazier. Yes, lil' ol' Mr. K. keeps forgetting he's a quad, even when he's reoriented, and in between, he even acts lucid. Last night's installment: he kept wanting to put on his pants and get up, so he kept ringing his call light. Not even the two Pepsis (he loves Pepsi so much they could use him in ads) I brought in as a bribe kept him quiet.

I'm starting to like the idea of aerosolized Haldol for not just patients, but some of my coworkers.

2. Your coworkers get edgy. When I asked about Mr. K. and his light buzzing, I remarked, "Wow, has he been quiet all night?" since Mr. K. did not buzz once while I was sitting at the nurses' station (which was not long). The Slug, true to her pain in the backside self replied, "You've been smoking crack."

Nevertheless, I blew her off, since I spent most of my night actually on the floor with patients, while she sat by the phone and played secretary in between her med passes. It's actually better for her to sit by the phone because whenever you work with her, because you'll get about 20-25 calls a night and 99% will be for her. It's just a whole lot easier not being at the desk so you don't have to be her secretary.

3. The normally quiet people decide they need something...now! Mr. H. decided to do this last night before the end of shift. I guess he got tired of me going into his room and always giving his roomies their PRN pain meds. I've delivered meds on his hall for a while and this was the first time I've ever given him a pain med.

One of his roommates is a basket case. He's taking every psych drug, pain pill, and sleeping pill we'll give him. That's what happens when you can't deal with the life you've created on the outside. The roomie is having problems with his wife and infidelity again. The story gets better and better--he was with the other woman when he was injured and she is having his baby. Other Woman decided to let the wife know once he was injured. Said wife was really perturbed when he visited Labor Day weekend.

With real-life stories like this, who needs to watch a soap?

4. Although it's not related to the full moon here in our neck of the woods, the weather's been crazy. Ike's remnants flew through the midwestern US and left us with a whole bunch of water. Lots of low-lying areas around here that don't normally flood filled up really fast. We had fun taking not one but two detours to get to a family reunion yesterday. After the second one, I told Dahey to just go back home and take the route closest to our house, since that doesn't normally flood and it worked out well. I just wish we could have stayed longer at the reunion. It stunk having to leave and go to work.

One more evening, then back to days. Stay tuned for all the excitement.

TGIF, baby!

Oh, I rejoice! The weekend is here...and I'm not working down at Madison. Hooray!

The last three days have been fun, really, with ol' Mr. K. and Mr. J., especially since Mr. K. is getting his Haldol titrated, and having less hallucinations, but today was busy, even though at 1020, I was ahead of the game.

I was still driving the drug wagon as the med nurse on the most populous hall (we have 13 people here instead of the 11 on the other one...), but luckily, people weren't so agitated about how fast I got them their pain meds. Sometimes, the natives get a little restless down there...I really wanted to kill the Slug today, because she was being so onery and lazy about doing the accuchecks to which she was assigned. To relax, I sat in my car and ate lunch and charged my phone. I did not want to sit one minute in the lunch room with her, because I would have put my license at risk. (Going to Federal prison for killing her is not on my list of things to do right now!) It was lovely! It was only 15 minutes (I came in and checked my e-mail at the nurses' station for the other 15) but it was an oasis. I'm not going to detail everything, but I find that escape does have its advantages, especially when you're contemplating killing your co-worker for being such a slack.

The rest of the afternoon went well. Everyone got their pain pills, their Ativan and whatever fixed their ailments, including pillow fluffing, so they were happy. I got to hand over the keys to my med cart to K., instead of B., which was also a relief. He's another story, but I only deal with him on evenings, so I won't worry until next week!

Happy weekend! More later...stay tuned.