Is this the sign of things to come?

I had an interesting conversation with my coworker's boss (who's really my boss's boss) recently.

I got to tell he/she about the latest tribulations trying to make things work. He/she listened, then mentioned how I have no appropriate training.

What I wanted to say:

"Yes, remember that quality training I took last year? That's how I got qualified to lead a quality improvement project? I've taken this training five years ago, too."

"Your quality person? He/she's not been trained."

"Would you like to tell the Hotel boss that I can't finish this project?"

Unfortunately, I didn't. I'm stewing...and plotting my escape. Being unappreciated is annoying.

Stay tuned...

Nurses just do it

WiseOldRN stopped by my office today. Actually, he/she is on a schedule and comes by regularly. WORN has worked in an administrative job for over 15 years, but WORN is a proud diploma nurse licensed for many years, who could work "any service on any shift, leave and come back for more".

We have chats regularly and this week's was a doozy. WORN goes all over our hospital system so he/she has some tales. While I'm sure some are peppered with hyperbole, I know some of the characters involved so I'm aware that there is truth.

WORN started ranting when I brought up training. As a diploma nurse, WORN regularly went all over the hospital and worked everywhere. His/her last assignment (as a nurse) was in risk management and quality, but as WORN noted, the only place he/she didn't regularly work was case management. WORN figured being a registered nurse made him/her a case manager every day.

When nurses feel they don't have the skills, I remind them what the overall goal of the day is: managing their assignment. This can vary on the status of the patient, but in our world, bowel, bladder and skin are very important. When we forget about the little things: helping someone with a 4-5 day old beard shave (like I did on my lunch hour while visiting our satellite unit while his nurses charted) and comb his hair, it reminds us all that we are taking care of people, not just completing a task list.

Sure, we have plenty of tasks, but when we can't put care at the top of our task list, are we slowly but surely degrading the importance of having an RN care for each patient?

As WORN says, nurses just do it, if the patient needs it. We don't wait for a million other things, like policies, procedures, or unlicensed personnel.

We see what's in front of us, and do the work. We use that nursing process AND we care.

That's all for now. Gotta leave and take care of my patients. Hope you have a great day with yours, wherever you are.

You get what you wish for...

Or at least it seems that way right now. What a week!

For almost five years, I've been asking for help and/or equipment. While I can't get them to give me the help, in terms of personnel I want, I am getting equipment, so it's keeping me busy.

My favorite thing: I'm finally having days where I actually do the job I was hired to do for almost the entire eight hours I'm there (and sometimes then some...). The patient flow is something I have to work on, though. I follow the guidelines, but somehow, I always have a patient who wants to tell me more.

This week, I got to go to training that was cancelled many moons ago. It was interesting, even though I had to attend with my boss, who, with his/her MBA, knows everything. He/she succeeded in driving a lot of people nuts, which got me lots of sympathy from the folks I already know.

Finally, after working on my last patients this afternoon (and one emergency with a speech therapist), I got the e-mail I've been waiting for from the boss. He/she's recommending that the holdouts complete things they need to do to work with me in my clinic.

Five years is a short time where I work but almost a lifetime anywhere else. That e-mail made my week. I can only hope I'll get a few more wishes...

Happy weekend wherever you are. More to come...

We salute you

All of the front line health care personnel putting it on the line every day in today's environment.

This quote from a recent article about hazardous waste generated by Ebola patients was telling:

“It’s totally shocking,” Ms. Sharpe said. “It would take me anywhere from four to six weeks to train an employee to work in a high containment lab in a safe manner. It’s ludicrous to expect doctors and nurses to figure that out with a day’s worth of training.

Thank you, Ms. Sharpe. Hopefully, someone will listen and take care of the folks on the front lines, including all the staff who help take away all the remainders.

More to come.

It may seem like a no-brainer

But having patient input in developing a rehab hospital, really is a good thing. One large rehab hospital in Nebraska is actually using a design firm headed by a quadriplegic designer most of you know if you shop at a very large retailer.

Yes, it is really important. So when Madison opens its satellite unit at Washington, our chief NP, a rehab nurse from way back, was duly insulted when she heard this.

"Well, we will just ask a few people to pretend to be a para or a quad and check out stuff in the patient rooms." (I wish this paraphrase was a joke, but it's not).

No, not okay, says the NP. So she makes a few phone calls, and lo and behold, we have several former and current patients volunteering to do a dry run before the unit opens.

Maybe the Manglement will really get this patient engagement thing involves REAL patients, not pretend ones.

You never know...stay tuned!

More signs of dysfunctional workplaces

This is a great article with a list of those infamous traits. The following seemed to jump out at me based on everything going on lately.

Decisions are made at the highest level  possible.
Regardless of what it is, you have to check with your boss before doing it.  She also has to check with her boss. So does anything really get done? No. Not without a lot of stone rolling up the hill.

Delegating means telling somebody to do something, not giving them the power to do it.
The total antithesis of nursing, but reality sometimes.

Management approaches from the latest best-seller are regularly misunderstood to mean what we're doing already is right on the  mark.
"Seven Habits of Highly Effective People," "Good to Great" and "Who Moved My  Cheese?" all seem to boil down to, "quit griping and do more with less."

Or a Lean Six Sigma class...where the resources just don't happen to be allocated to your department.

Stay tuned...more to come

Reflections and observations

My reflections aren't going to be nearly as meaningful as these from atyourcervix, but here goes...

They don't say it in so many words, but the bigwigs are rationing access to training and travel at the Hotel. I had the pleasure of meeting with a committee recently set up following one of our illustrious inspections by random credentialing agency.

This committee is now auditing how the travel and training committee allocates funds and is structured. How was it before...let me just say this: we paid for "observation" at a resort in a tropical state. Why? Because one of the cyclical meetings that goes around the country was coming to the Hotel and this committee member needed to "observe" how the proceedings were held before we had them in our backyard.

I'm sure the observation was via chaise lounge with a mai tai...or could have been a whiskey sour. She "observed" a lot, and a few other people, including one of my coworkers, did most of the scut work, like running the planning committee, registration and volunteer section when the meeting came to the Hotel.

Now, as a result of the uproar from that "observation" (which the psych nurses say should have occurred in restraints) is that ANY training out of town has to be vetted for necessity, etc.

If you're new in your job and can get out of town training, you'll only be sent if your a manager level staffer.

The peons (who run the ship BTW) like me will just have to fend for ourselves.

Nice! How many more years am I stuck here since I took that puny sign on bonus to pay student loans? Can't wait until the chains are loosened.

The tales of woe

The word of my day was woe.

"Woe is me." I heard from the specialist who's complaining that the other specialist at X Hospital is bad mouthing him to our patients. Who tells specialist this tale? The patient. Specialist has taken care of patient forever, before he/she ever even went to X Hospital in our system. Patient told Specialist the truth, and he decided to tell me.

Kids, haven't you ever heard that maxim, "If you can't say anything nice, don't say anything at all."? "No surprise" I told our Specialist. "He (and his hospital) have done weirder things lately." Frankly, I'm surprised upper management isn't reigning them in yet.

It was woe for our staff, too. I couldn't believe it when I saw our home health nurse doing assessment documentation on a newly arrived patient. She's usually out on the road somewhere, but for some reason, she got called into an admission that should have been completed by the floor nurse.  Not sure why the boss let that happen, but I'm so glad it wasn't me!

There was woe for one of our patients' families. Said patient died over the weekend. We really liked him (at least most of us did). Rudy was a very opinionated character who almost made it to his speed limit birthday, but he had a heart attack and never regained consciousness. He and I got along very well. I was the person who set up his Fritos whenever he was on our unit (he was a Frito maniac).

Rudy told me he wasn't afraid to die because, during one of his many spates of illness, he had had a near death experience. "Heaven is beautiful", he told me. "I saw it and I really wanted to stay, but they told me I had to go back. I saw the Devil, too."

"Really?" I asked. "How did you know it was the Devil?"

"He looked just like the pictures...and he had a bottle of Jack Daniels, trying to get me to go with him."

"No way!" I said. He just shook his head yes.

So from then on, it was our inside joke about Jack Daniels. I told him one night when he spiked a temp late in the shift, "Rudy, I know Heaven was nice, but could you just wait to go there until my shift is over? And whatever you do, don't take the Jack Daniels." Rudy eventually recovered and we laughed about it.

Happily, all of Rudy's last year wasn't a tale of woe. Rudy got to see his grandchildren born and he was so proud. I saw him from time to time and I always gave him trouble. On his last visit to the unit, I told him he had the most seniority (as in he'd been coming to our unit for so long) on the unit, so he'd better help us train our new staff.

"And Rudy," I told him, "if they say you're mean and quit, I'm gonna call you up."

He just smiled. I opened the last bag of Fritos I ever gave him during that stay while his family looked on bemused. Sure we spoiled him sometimes, but he was like our family. I figured out in the last couple of years, I'd spent more time on the unit with Rudy than I have with my own family.

Rudy was a Marine through and through. He loved the Corps and educated me that the Marines wear scarlet not red.

And like the old Marine saying goes, I send it out today to Rudy, not Chesty this time: "Goodnight Rudy, wherever you are." I'm praying you're in Heaven where it's beautiful and not with the Devil and Jack Daniels.

Godspeed, dear friend. I'll miss you and all your Fritos, too.

Monday madness, part 75

Maxim of the day: If it can go wrong, it will. Don't take it personally.

Oh, the joy of coming to work to hurry up and get things done since I'm going to be in training, have to get subs for my appointments, and have to get people at the office in Nashville (who want to talk to our specialists) all to come together in the same room at the same time. Specialty Doc is just picky about that kind of stuff!

Well, I get my subs lined up and I get a call from the training guy. His room is not really his room so training is cancelled. Wonder what the consultant is going to charge for that...and will I be able to make the replacement date. Ugh!

Next, I go to plug in a fancy-schmancy piece of equipment and find the specialty outlet has been damaged. Funny, it just worked last week. Score one for the movers, who obviously aren't careful. Expensive equipment 0, Idiot movers 1.

And what day wouldn't be complete without a head-case specialist ('cause it is his specialty) going all prima donna e-mailing people hither and yon for an appointment I won't even be able to attend, since I'll be out of town. Thank goodness I got him under control quickly. I don't want him to make my sub cry (he's been known to be cranky and mean.)

At least, the patients I had to deal with today were pleasant. Amen to that!

More to come...stay tuned.

Thoughts after finishing customer service training

1. You need a medical professional (or rotating staff member) to teach this class. Bonus points though to our guy who actually quoted the Readers' Digest article jo was featured in...see the civvies actually read some interesting stuff!

2. I learned more about dealing with other departments than anything. That was the most valuable.

3. Can I solve all problems? No. Will I say the right thing? Hopefully. I put that card and magnet at my desk. Heaven help me when I'm loose on campus.

4. I'm hoping I might be able to use this information to get a panic button in my office. (Just in case I get a nuclear customer, like one of my classmates. I had one in a previous clinic job.)

5. And finally, thanks to Nurse K, I got this great link to Hood Nurse and here's her scenarios on how she'll put this valuable training into practice in the ER. You go girl!

If only I could use some of those ideas...enjoy!

Still tired...

So much work and training and conferences in the last week has left me exhausted!

Hung out with some of the folks at this conference. It was an amazingly interesting and fun time. Saw old and new friends from all over the country.

Stay tuned...

The show hits the road

So, I got my quickie orientation (which isn't really over, BTW, Boss) and now I'm off to training, 'cause Manglement said the network requires it, and you're going.

Doesn't bother me in the least...I love traveling! Bring it on. I'm excited about meeting more clinic monkeys like me.

Stay tuned!

Still alive...

And kicking, but busier than I ever thought. Training for a new gig at the Hotel is interesting, especially with construction going on. One day, I'll get a space that's mine for a while.

Whatcha gonna do...I'm just gonna stay, alive and kicking. More to come, so enjoy!

Transitions, part 1

How hard is it? Plenty, when you're dealing with Manglement at the Hotel.

Here's my transition plan as of this week:

1. Get e-mail from Second-in-command Assistant Chief Nurse Mangler:
Go right ahead and see X, since she's been running the clinic while we've been waiting for you to get hired. We'll let you know when your start date is later, because we're waiting for people to come back from sick leave and the new hires to start.

2. I discuss specifics with my department Nurse Mangler.
NM: "Sure. Set up time with X and let me know what's going on."

3. I call X, set up appointment, come in on day off. I have to do this since NM can't possibly let me leave for a minute to go up two floors to see X for one hour, even though some of his/her favorites park in the cafeteria three blocks away while on duty for longer time periods than that.

NM is okay with this plan and it's confirmed via e-mail and verbally by conversation in hall with several witnesses present.

4. Meet X on my day off and get items I need to set up for a learning plan in the Hotels' Learning System. Total time for this, including printout of manual: two hours. As a result of this meeting, also advise NM that I have to attend another quarterly department meeting this week before I work an evening shift.

NM: Fine, just get to work on time.

5. Now after investing this much time in meetings, learning plan setup, etc., NM tells me I will not be compensated for my time to attend meetings, etc., until I start in the new position (which is the same department, but a different "cost center" per accounting.) Otherwise, "if I let you off for comp time, you're stealing time from this unit." (yes, this was a direct quote)

6. WTF?! Express "concern about lack of compensation" with a straight face and proceed to assemble everything for HR.

7. Notify X that I will have to start training later, which sets off its own cascade of idiocy all the way up to the boss of the center.

8. Get call from center boss. Center boss says "hold tight and we'll straighten this out. You won't lose anything"

And they wonder why people are so frustrated! If this was not my dream job, I'd run straight out the door.

Stay tuned for the continuing saga, because drama at the Hotel is new everyday. 

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.

What happens when I'm off a weekend I should be working

1. Cooking. Steaks, tater, and I even tried a new Italian recipe. Oh, my! Sure I steered clear of the carbs, but with the heavenly scent of sage sauteed in brown butter, I could not resist the final product.

2. I worked on a project I've neglected for a long time for work. It has to be done by the end of the year. And now it will be. Much joy!

3. Finally, I've studied and studied some more. We don't have a test for another week, but I figure it can't hurt to prep a little earlier than usual. All-nighters were never my style, because I enjoy sleeping so much.

Which I also did and even took some naps...heaven!

Tomorrow, it's back to work, to the sister unit, to finish orientation. Before you know it, I'll be on my own.

Stay tuned...

Training down...now more

Yes, it's the end of my first week of training in the sister unit, and surprisingly, things are going well. The day was not jam-packed today, so I was able to get some extra work done.

First, I came in and worked with a trainer for the position I'll be doing. She's really good and I think I got notes on just about everything. I'm going to transcribe everything, so I get it done and so she can review it prior to my start.

Next, I got an hour of orientation from one of the main staffers. My job is to support him/her and several programs the SU runs. I understand the materials, but the actual process of getting people in and out is a bit different. It's rehab, but mainly similar to something you'd see in a mental health setting.

I'm really happy I'm a rehab nurse, or this would have all blown me out of the water by now. I also got the call today that I'm being featured in a nursing newsletter soon, and I've been appointed to a committee due to my  "leadership skills." I had a chuckle about that....I never feel like I'm leading anything but the poop cleanup parade. It's nice to feel wanted.

After that, it was a slow afternoon, so we did follow-up calls and paperwork. All in all, not a bad week at all. I will get to learn new skills, and hopefully, wow all the inspectors who'll be coming around in my first month. My boss will let me continue training on a regular basis until my start date. The grumblers on the floor are finally quieting down. I shouldn't take their grumblings personally, but I get really irritated when they direct their angry comments at me.

As Dahey says, expressing displeasure at the treatment I get is not a bad thing and needs to be done right away. Guess I've been used to being the whipping-boy, er, girl for too long.

And off I go into the weekend. There's plenty to do here at the ranch. Stay tuned!

Monday - Day 1.5

Back to the sister unit for training...and cramming for our inspection.

Should be an interesting day, so stay tuned.

Miracles never cease

The Slug got through his/her required customer service ninja training (I'm not kidding...) as a customer service leader.

WTF? Was he/she in charge of answering the phone?