Happy Nurses' Week!

In case you missed it, the yearly celebration of nurses has begun. We got the whole week covered at the Hotel with "fun" stuff in between work.

Since the theme for this year's celebration is "healthy nurse, healthy nation", maybe it is time for some nurse-centric play-by-play from yours truly.

Yes, the Hotel has some great facilities, so we are fortunate that a lot of the celebrations occur right by our unit, but the problem: many people don't attend. Why? Because they don't have time.

So consequently, if we could get ANYTHING we asked for this Nurses' Week, here's what would be on the list.

1. Unlicensed staff that actually listen, work, and communicate with the RNs. Too many of them on our unit have a bad habit of dissing the RNs. It needs to stop. Period.

We work together as a team. If you diss the RN you're assigned to on your shift, it's a rubber-glue scenario. You make yourself look bad, too.

2. How about the Captain Obvious question: if you want everyone to document everywhere, why not make it easier at the bedside?

Just saying! If you think logging in after walking 300 feet to the nurses' station, then opening the software, then logging in again, finding the patient, then starting your note is good, you haven't taken care of a bedside patient lately.

No, rehab supposedly has stable patients, but you really need things, like computers that accept the data from the beds, the scales, etc. without double charting.

3. Since I went big on #2, why not on this one. How about a fully stocked cabinet outside each room with the basics, a la TCAB projects of the not so distant past? It would have helped if they had planned this on the last remodel, but here's some food for thought.

Having supply staff actually supply it, would also be nice. If you can't do it outside every room, how about on every wing. Steps do make a difference in a workday (you could be charting, checking labs, etc.)

Finally, no matter where you practice, I wish you a very Happy Nurses' Week. Your work matters and you make a difference.

More to come...

Frights aren't just for Halloween

It's been scary in the Hotel Rehab lately, and it's not because of ghosts or Halloween. We've seen a lot of our folks get sick and go out on leave. Our latest one is the building greeter. Believe it or not, having a greeter is part of the overall improving patient and employee satisfaction.

M. our greeter, shows people where to go, gets wheelchairs, makes phone calls and does all sorts of stuff that I often don't have time to do for patients and visitors.

M's boss told us that he's getting surgery and may not be back for at least two months. I will certainly miss him and so will our patients. Some have even gotten grumbly when I can't do stuff for them because they were so used to having him around. Maybe this news will improve their behavior.

Our nurse practitioners had a major job analysis done throughout the hospital system. For some, the changes that will happen mean they'll have to go back to school. Ours are lucky, they shouldn't have to do that, but the work they can do will change. Not sure if our medical staff are really aware of what all they do. They will be aware soon.

Finally, I'm constantly reminded that not everyone who's in rehab is totally well. They do get sick, again, and they do die. It's sad and yes, sometimes frightening. Some cases are sudden and some are not. I'm really glad we have many options for hospice for our patients. One of my SU patients recently decided it was what he/she wanted.

A whole lot of interventions doesn't always equal quality of life.

I've got to stop here. The frog singing outside is making me crazy...and I'm tired.

More later...

Brrr!

The polar vortex has arrived. It arrived just at the start of the weekend. I have already fallen even in "slip-proof" nursing shoes. They don't help when it's also windy. I added some of these to my shopping list.

Some virus from the neighborhood has invaded. Dahey is recuperating and Bubba is acting a little out of sorts, despite my hand washing protocol and cleaning schedule. We've all had our flu shots, so hopefully, it's just something random. Another joy of winter!

I'm happy this week will be the last one I work this year. More to come in 2017. Stay tuned!

All in one day

I try to cram things into certain days, and others, I just use them to do administrative tasks in peace and quiet.

One day recently was a combination of both. I need peace and quiet to get things organized and completed in an efficient manner, so it worked out relatively well.

The first part of my day was great, until I got one of the patients who rarely stops in. He comes in occasionally. He really needs us more than he'll let on, and now that he's got a new health condition, it's obvious. To add insult to injury, while he's not homeless, he could very well be soon due to an issue at home. Homelessness is scary, but even more so when you are disabled.

When our meeting was finished, I actually think he learned something. I am hoping he'll see the need to get help. Technology is a great tool for this gentleman, but he needs to come see us, too.

As I run around the building, I often encounter folks who are visiting our outpatient clinics or other programs. Many of them never avail themselves of my area's services (it's optional).  I say hello and sometimes chat as I go by.

Friday, one of these characters liked what I wore to work (a sweater and dress pants). He rolled up and knocked on my door. I asked how I could help.

He said, "I just wanted to tell you I think you look more beautiful today than ever." Frankly, I was stunned by the compliment. We chatted some more about the services of the SU, but he declined as usual. I told him (as I tell all the patients), "If you change your mind, let me know."  and he rolled away smiling.

It made my week.

Hope you enjoy your weekend wherever you are and someone sees your beauty too!

I'm not hiding

I'm just dealing with fallout. Fallout related to the end of our hospital's fiscal year.

Some of the fun  meetings I've been subjected to:

1. Year end recap
Actually, I'll be forced to do that next month. Boss didn't show for this month's meeting (that's really a waste of time).

2. Meetings with my boss, coworkers and a provider who was forced to be there.
An hour of telling people what I do, what I am allowed to do, and why you telling me what to do isn't a good idea.

NOTE: my boss sat on the sidelines watching this car crash. He/she knows better.

I had fun by pointing out how I know what you know, and when I knew it, even though I'm not supposed to do your job.

3. "Scut work"
Said provider in #2 said he/she isn't going to do the work that other providers in our system do, because he/she can delegate that "scut work" to the NP.  BTW none of the scut work mentioned here is even done by an MD in our system.

NOTE: this "scut work" requires a physician or licensed independent provider to write an order. Our MDs are really "busy" not writing as many orders as they can, especially at odd hours.

My favorite excuse: "just blame the computer". This wreaks havoc for the nurses, especially when your facility supposedly "disciplines" providers for too many verbal or telephone orders.

I really wanted to ask what he/she normally does when not goofing off, but I bit my tongue.

The train is coming, so off I go. Enjoy your day wherever you are!

La rentree

No, I'm not a kid going back to school, but returning to work after escaping for a conference was very similar. I feel as if I was jarred out of a deep, restful sleep and thrown into a world that is constantly going and I'm running in, then looking forward to the time I can run straight out.

It's always nice to go to a conference just for nurses. People, for the most part, look at you, talk to you in the hall and are social. Some other disciplines (which will remain nameless...Freudian cough cough) often walk with darting glances because you might actually talk to them. We had lots of interesting sessions. I even gave one this year. One presenter brought her demo dog, as she was speaking about how to get a service dog and ADA guidelines.

Overall, I had a wonderful time. I may even look to turn my presentation into a journal article (one of the things on the bucket list). I'm fortunate that my subject is not typical rehab (bowel, bladder or skin), so I just need to sit down and do it.

This week, I get to interview new staff for the Hotel. It should be exciting. I just hope they can survive the Manglement.

Stay tuned...

Patriot day + 1 reflection

Yes, it's the 12th of September and I feel like 15 years ago and one day, were almost a blink of an eye, and a lifetime all at once.

I remember that day. Much is blurry, but the terror is real--the unknown, the ruthlessness, the destruction are unnerving. I still see that today.

I lived another life, and when I go near where I used to work on September 11, I even see people who used to work in my building. We're not friends, but I still recognize them. They still work at the same place. They've aged just like me.

But occasionally, I come in costume in my scrubs, when the local food trucks pull outside and I'm in the neighborhood. My job now warrants a weekly trip from one campus to another, so it's on the way back and I stop for lunch. The building have new names. The company I worked for has been bought out multiple times.

If I close my eyes, I still remember that life.

The world has changed, and so have I. I don't worry anymore about what could have been there. I realize that life is living and I'm doing it every day.

Fifteen years and a day, I pray still.

More later....

Monday on Tuesday

Yes, the day after a holiday sucks on so many levels. People who can't take it (or imbibed too much) take off.

Otherwise, it seems like any other Tuesday. Except today didn't seem like a day after a holiday or Tuesday. Today, after our regular weekly meeting, (which was blissfully short) had a terrible pall.

One of my favorite interdisciplinary team members, C. is dying. Dying as we had our meeting, and were talking about our current crop of rehab patients. It reminded me of one other time where I went into report and the boss told us, "As we speak Mr. Warhero is dying." He was right: Warhero died that night. To me, how small and insignificant the meeting seemed today.

I finally left the meeting (after our chaplain prayed for him/her) and it got a little better. I buried myself in a project or two. As a result, I had to look at the way things have been going over the past few years. Thankfully, they are getting better.  C. helped us to get where we are. C. helped inspire other folks in his/her discipline to do the same.  We are not where I want us to be for our little group in the Hotel Rehab (I thought we'd be there three years ago...) but we are closer.

I was sad for so many things when C. retired last year, due to health reasons. Sad that I could no longer go down the hall and see him/her. Sad that we'd never get to work together and get your rehab program where it rightly belonged. Sad that I knew this day would eventually come.

'Twas a pity it came so soon. Godspeed you on your journey, C, and may the angels greet you and lead you to paradise. You've earned it.

A profound statement

"You’re not where you work and your work is not you."  Howard Behar

Be true to yourself. Jobs will come and go.

Happy Birthday Bro!

Cramming in a few more things

It's that time of year, otherwise known as June, the due date month. Due date for presentations and my annual review (which I have to prepare feedback on every year, even if I don't get promoted.)

I have fun doing slide shows. Since we have to have everything we present approved in advance by legal, I have lots of fun. For a long time, I refused to use photos (I'd use free license cartoons, but no pictures). I decided this year that was dumb. For fun, I have added some old home ones with interesting captions. I'm actually in one, so I'm not technically picking on just relatives. And I don't have to ask for permission from anyone, which is helpful.

My annual review, unfortunately, doesn't include pictures. If it did, I could have a lot of fun.

Things I'd take pictures of to put in my review if I could:

1. The ethics consultation (no photo available) part. Can you photograph integrity? Maybe not, but our ethics chair looks like he came out of a film noir. (His photo would be  good in black and white).

2. The associate chief nurse looking befuddled when I explained that her simple project wouldn't be so simple.  It only took her a couple of years for her to believe that I actually knew my job. She thought another manager (who was directly assigned to his/her position with no experience) knew everything.

That look was priceless. I wanted to say "I told you so" but I didn't. Hindsight is 20/20.

3. The pie my coworkers and I bought after a long ride to take care of a patient in his/her home. The famous pie place was on the trip back. I'd have given our driver a gold medal, but it wasn't available.

I guess if they ever make us do a portfolio, I'll have to add more photos.

Hope you enjoy the rest of your week wherever you are. Friday will be here soon enough.

The little people

We finally found out where the VIP entourage went while they were touring Washington recently, and we were patiently waiting on the floor for them to stop by on our unit. The VIPs stood us up.

Since everything our hospital system does is now posted on Facebook, the photos told us where they went.

I'm used to being "cut" from the A list in my area all the time. Nurses are used to it. My bosses, he and she, are not.

It's not fun finding out you are the "little people" after you come to work when you really could be doing something better.

Life is full of small victories. Enjoy every minute.

More to come.

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...

Reality check

How many of you go to work sick? Raise your hands.

If I had a 100% rate, I would not be surprised. Nurses often come to work with illnesses for a variety of reasons. This article has one of the best arguments I've seen for a long time.

I have gone to work because I'm a master at assessment. I've had chronic health issues (nothing major) for years. My body is good at telling me what's wrong.

These are my rules:

1. If I have a fever and will be in regular contact with patients, I'm not going to work. Plain and simple. If I can't do paperwork that day and hide to avoid breathing on anyone, I'm out. I had nursing instructors beat this into me, I mean, reinforce this vigorously on my clinical rotations. As I know from my work in the SU, if you have a fever, you probably are infected with something. This red light is one you should not ignore.

Do everyone a favor. Don't share and stay home. This health system actually publishes an algorithm.

2. Diarrhea will also keep me home. If they only knew how busy our staff bathrooms are (and many times, it's not just staff using them).

3. If you have any other symptoms that are not normal or normal for you, i.e. vision or balance disturbances, you probably need to see what's going on first before coming to work.

My managers always love the "migraine with vertigo" call in (I've used it), but I don't care. You should like being able to keep affordable car insurance. If walking is a problem, driving will be, too.

Also, never take any open wounds (even paper cuts) for granted. If you can't cover them effectively, you need to consider staying home until you can.

I like my doctors. They know I won't bug them unless I think it's an issue for me and my patients. Be sure to have a PCP, so when you need them, you have them. I love mine because she likes nurses and always has our back (she has no problem talking to pesky nurse managers if needed).

To sum it up, if you're sick, don't buck it up. Take care of yourself so you can take care of your patients (and not contaminate your coworkers). You deserve to be well, and so do your patients and coworkers.

More later.

The Revenant

No, I was not mauled by a bear, but alas, I do realize that I've taken leave from here a wee bit too long.

Lots of stuff cooking, so I plan on adding some material soon.

The work of a rehab nurse is never done! Stay tuned.

RehabRN book club: The TGIF edition

Yes, dear readers, it's been a while. Books just take forever anymore, especially when I spend an inordinate amount of time with my new baby computer, trying to get everything where I want it. Online backups are wonderful, yet slow.

However, I must say, I've found some good stuff to read. As I may have mentioned earlier, Brief by Joseph McCormack is a keeper. If you're a fan of the Elements of Style, it's more concept than rule. It really does give practical advice. I'll be buying one (since I got threats from the library if I didn't return it).

My most recent finish (on Wednesday) was Presence by Amy Cuddy. To me, there's a lot to like in this book. As a rehab nurse, you'll be cheering for Amy because she's a rehab patient who's made it (she had a DAI for all of you who are interested.) As an escaped business person, she went to work at Harvard Business School and changed up a lot of things with her research. Overall, Amy's book is stories of how presence changes things (see her TED talk for the rest of the story).

Trust me, I'll be posing it up before my next set of meetings. Why not?

Have a great weekend! Enjoy every minute.

Kids these days

I feel like an old lady reading this article, or perhaps, rightly so, like a person from another century. This is a non-nursing publication, but I hate to say this could have been about some folks (and some spots) at the Hotel.

I know startup companies (from reading, and hearing from my friend's kids who have one, not experience) often allow booze at work. That's not too shocking, probably because I did once work in an environment where we talked of imbibing all day, and we actually did it after work ("product testing").

However, who'd a thunk that you'd have to tell people not to have sex in public parts of your office building.

Different strokes. Ugh!

Stay tuned.

Snow day

Bubba was out of school. On the same day he became a teenager. Alone in a house with cupcakes, which made for some interesting text message conversations, complete with photos.

Alas, since nurses don't get snow days or much downtime (most of us, anyway), I went to work. It was quiet. By 0800, when the clinics are busiest, we barely had two people show up. Thank you RehabLand Snow Removal folks. You cleaned, but people forget how to drive when temperatures are low and the pavement refreezes. Slip and slide accidents were everywhere.

I kept busy. I had a few folks who couldn't come in call me, so I helped them with what I could over the phone. I stocked my rooms, I visited patients in their rooms. I did training, since it's that time of year for competency renewal.

After lunch, we started seeing more people in the Hotel. It never got to the usual levels, but a little variation in our routine was nice.

Hope you have time to breathe (and maybe even think) in your day today, wherever you are.

More later.

New Year's resolutions

Raise your hand if you hate them. (raising hand)

If we can't get them to stick in January, will they ever? Probably not. Experts claim habits form in about three weeks.

Anyway, here goes. I'm going to try to hit the ones on this BuzzFeed list and my own.

1. Exercise more. Yes, I do need to get up and move around more, even when I don't feel like it.

2. Eat less sugar. Those candies and cupcakes really messed me up on the scale.

3. Drink more water.

4. Keep a gratitude log. I even found one for my phone: Gratitude365.

5. Develop a career resolution list for 2016. I have to work on goals for my review at work, so I might just start early.

Hope you enjoy your year wherever you are.

Stay tuned...

Consumer reports

That was my day today. Providing patient information for Dahey to share with folks at work who recently found out their boss has cancer. Despite everything, he feels good, but is not cleared to return to full duty. He's bored and they found some paperwork for him to do. He'll have to car pool, so it should be interesting.

I also got some information I made in a complaint against a business from the state office that handles those. Nothing significant, but it was nice to know that the process highlighted that the vendor was, at the very least, very "liberal" with the truth. If I could only rent a billboard and not be sued, or borrow this guy, because his sentiment is mine, too.

So glad Monday is over. I'm waiting for all this precipitation to end!

Stay tuned...
 

RehabRN book club: post script

I'm still working on my list (somewhat) but I went out and actually met an author. Oncology nurse Theresa Brown was discussing her latest book, The Shift.

I started reading the book while I was awaiting the program to begin. The crowd was not rock star huge, as it often is for kids' authors or politicians, but the room was pretty full. There was not a lot of current nurses, but plenty of retired ones, and a few doctors sprinkled in.

It's not a huge book, so it won't take a ton of your time to read. When you think that it almost was never published, you realize the gravity of the attitudes about health care and the work of nurses. The author mentioned that it really was a sales job to the book folks to prove that, yes, there would be enough things happening in twelve hours to put in a book.

Surprisingly, once the editors saw the preliminary stuff, they realized she was on to something: providing a glimpse into the life of a nurse on the medical oncology floor.

Suzanne Gordon was right when she said this about what nurses do.

What do nurses do? They save lives, prevent complications, prevent suffering, and save money.

This book proves her right on all those points. Amen, sister!