I am now an RN BSN AP who works for the OPBB which is a part of the DPLM-CH. Consequently, as part of my orientation, I have been reading a whole new set of manuals. Yesterday, I was in the P&P section of the online LAM, reading CC 11,016, which addresses the billing requirements of the CMS, formerly the HCFA, which is a division of HHS. It deals with ABN’s, ICD-9-CM’s, LMRP’s and NCD’s. It took me a bit of time to grasp all of this. Ultimately, I even found some things beneficial.
I have also made a trip to the CPL. I found that very fascinating and wish I would have had that opportunity before I transfused any blood components as a staff nurse. Now, I notice the CPL has made a few revisions that took effect August 9. I am totally discombobulated that WBC will now be known as TNC! HELP! Yes, I really mean HELP! That is about as monumental as changing cc to ml!
In the course of my day, I often travel to these places: BB, SPD, HIM, SIM, PSR, CD, and, of course SP&D where I get a marvelous CCC! Should you come to visit, K. & I are located at MH, GL, at the OPTR, which is just past POCT. If you reach IDTU, you missed us.
I have a concern that the time will come when none of us will be able to speak, write, spell or understand the King’s English. We will exist in a world of acronyms without understanding one another. Mental gridlock. It is no wonder the JACHO, ISBH & HIPPA, to mention a few, list communication as the number one issue on their radar.
Perhaps, those of you who TT&T have no problem being acronymized. Am I TOOOILF? RUOKWT? LMK.
Sherry
Sherry Holden, BSN, RN Associate Partner, 4South, IU Hospital
It has been just about a month since I last made an entry and announced that I was making a major move. I’m in the process of settling-in: not settled. I have learned a lot about myself in this process, and bits and pieces about a whole lot of other “things.” For instance, there are “things” in life that are pretty absolute. “Things” that don’t co-exist: night and day, up and down, in and out, front and back, life and death... Play with that for awhile and you will realize that you cannot mix and match, you must choose. So, here is my new dilemma: IN-patient and OUT-patient! Hello brain-freeze! Hello melt-down! Hello, Alice! Am I in-side-out or up-side-down? And, where is that Walrus when you need to “talk of many things!”
Comfort zones are wonderful places. That zone might exist in the midst of chaos but it is what one knows and it is OK. Somehow you make it work almost to the point of discomfort. Since man landed on the moon, I have been an IN-patient, multi-specialties nurse except for a clinic stint somewhere in the 70’s. When I abruptly moved, I went all OUT and entered the OUT-patient zone: initially, a new type of chaos for me. I think after comparing IN and OUT to the point of driving my preceptor totally daft, we have settled on this as the trigger point: “Dorothy, you are not in Kansas anymore!”
In reality, this has been a whirlwind month. I have been challenged. I am learning something new every day. (A word to new grads: We survive! We are resilient.) I am having fun. I enjoy the people I have met and I have embraced a wonderful new patient population. Synergy is alive and well on my radar. Out-patient Synergy! WOW! And, I used to think I knew something about blood... merely a drop in the bucket! It is exciting OUT here. The challenge for me is that I’m not IN there.
So, I have moved my cheese. Literally. During this change, I decided I would try new cheese with my new move. I have discovered a magnificent stout Stilton-blue from Britain and a fabulous slice of nursing in a remote corner of the basement in Methodist Hospital.
Sherry
Sherry Holden, BSN, RN Associate Partner, 4South, IU Hospital
Regardless of the “sense and non-sense” and endless interpretation of Lewis Carroll’s writings, I have always enjoyed a certain segment of the poem The Walrus and the Carpenter which is tucked away somewhere in the adventures of Alice Through The Looking Glass. The poem has been around since the 1870’s and I learned it from my grandmother and passed it on to my children. My grandchildren will not be spared. I have not done any great in-depth analysis of the poem, as many have, but often repeat these lines: The time has come, the Walrus said, To talk of many things: Of shoes..and ships..and sealing wax.. Of cabbages and kings.. And why the sea is boiling hot And whether pigs have wings.
We could have a great talk about sealing-wax. In my mind, I would love to see it make a comeback. However, the time has come to talk of many other things: Of early mornings that become endless days.. Hallways that are racetracks.. Opportunities, timing, choices. Bundles and sets Of Policies, Protocols, Politics & Patient Care Fear of falling; Fear of not falling; Fear of Failing; Fear of Succeeding; Fear of You Anagrams: ITYK Input, output, opinions, ideas, place Of crossroads, decisions, direction, self-evaluation Oh, we could talk of many things! But, someone has to listen! Is that me or you?
And, we could talk of life. Of times when roads diverge and we are compelled to stop and carefully analyze the complex maze of direction choices on the map before us. And, we could talk about what Alice really saw in the Looking Glass! Well, this is what I see: the cheese is moving, pigs are flying, the oysters are dead and after 17 years on 4-medicine, I’m moving to the Mother Ship. Why? Because the Walrus said, “The time has come”!
What is in your Looking Glass?
Sherry
Sherry Holden, BSN, RN Associate Partner, 4South, IU Hospital
In ethics, some concepts and themes repeat themselves over and over again: truth telling, trustworthiness, integrity to name a few. Maybe the reason for the repeat performances is because although the concepts are not hard to understand, sometimes they are hard to apply.
I can remember making a big mistake as a child and being faced with the choice to tell my parents and suffer the consequences, ignore it, cover it up or try to pin it on someone else (usually one of my siblings).
The worst part was knowing deep down inside that I had to tell someone what I had done. It always takes courage to admit a mistake, but being accountable for my actions means I have integrity. People can count on me to do the right thing even when it is hard.
Integrity has to be nurtured when you work in a field like health care where the stakes are high. Who in their right mind wants to relive the feeling of having to tell their parents they made a mistake, especially if the mistake caused harm to someone else?!
We have a code of ethics to remind us, even when it is hard, that we have made a promise to the people in our care that we will try to do the right thing. We will be answerable and responsible for our actions.
Our Culture of Safety survey results suggest that individuals experience apprehension when faced with reporting errors or concerns, yet to maintain a “Just Culture,” apprehension or not, we are obliged to come forward.
Mnemonics are popular because they can help remind people what to do in situations where stress may cloud judgment. Sometimes we all need a little Cultivation of our Professional Responsibility, CPR.
A colleague of mine created something that might help you the next time you have to tell a difficult truth. Remember the CODE: Courage to be moral, Obligations to honor, Danger to manage and Expression and actions. The space between knowing what is the right thing to do and acting is bridged by courage.
Lucia D. Wocial, PhD, RN Clarian Health Nurse Ethicist
IU 4-Medicine is an eclectic mix of humanity: both patients and staff. A few days ago, I was prompted to think about our diversity based on a conversation I had with an elderly patient. He was 76 years old and hospitalized for diagnostic studies. I asked him where he was from and he replied, “Tennessee” and then proceeded to tell me the name of a very small town he was sure I wouldn’t remember. He was right, I don’t! Then I asked, “How did you get to IU from Tennessee?” He replied, “I have LIVED in Indianapolis for 68 years. You asked me where I was FROM!” Point taken. There is a distinct difference between where we are from and where we live.
Since I have been transplanted many times, I have always been curious to know where people are from. Over the years, I have learned a lot about the people, cities, towns, and states where I have lived from patients and staff. Once a man responded to that query by saying, “Well, I am Kentucky breed and Indiana feed!” One of my favorite encounters occurred several years ago at IU when I asked an intern, Dr. Khan, where he was from. His reply, “Where do you think I am from?” My response: “Some place very far East of here.” To my surprise, and his great pleasure, he replied, “Mongolia!” Without hesitation, I told him we were probably related. Then I gave him a great explanation of the westward migration of Mongolians centuries ago. Many of them went to the area of the Ukraine where my mother’s family lived. Consequently, it was very probable we had family ties. Naturally, he thought I was very strange. Thereafter, whenever he came to the unit, I referred to him as “Cousin Kahn” and he always smiled in disbelief. I’d like to think that he has told this story over time from his angle - still smiling in disbelief.
So, where are you from? I posed this question to some of my colleagues and got these responses: Indianapolis, Gary, Avon, Hope, South Bend, Linton, Evansville, Terre Haute and C-ville. (You have to be an insider to know that Indiana town.) Chicago, IL; Bettendorf, IA; Lagos, Nigeria; Manila, Philippines; Cincinnati, OH; Milwaukee, WI; Kampala, Uganda; Bangkok, Thailand; Kansas City, KS; Hastings, MN; San Paulo, Brazil; Addis Abba, Ethiopia; and I am from Valley City, ND - some people consider that a foreign country with its own language! Really, no passport needed. Finally, one nurse admitted being from “Heaven.” I suspect she is one person who really can go home again!
Our journeys have brought us to this place from the North, South, East, and West. We all have stories to tell of the roads we have traveled. My curiosity wonders why we are all here at this place and time - individually and collectively? As a staff, we exist only for a brief period of time. This month, some people are going and new people will come. Soon we will be a different mix and our identity will change. Who are we, and where are we going?
In the scheme if it all, my great hope is that we do not miss one another along the way.
Sherry
Sherry Holden, BSN, RN Associate Partner, 4South, IU Hospital
What does May in Indiana mean? The Indianapolis 500 race of course! Racing cars are on everyone’s minds, as we keep a close eye and ear on the results of Poles and Bumps and the Race itself. Races are fun to watch and of course cars are essential for most of us for transportation. At the same time, cars are also a source of toxins that can wreak havoc upon the individual who encounters them.
Starting with their fuel, cars are filled with fluids that can harm you. Gasoline is a hydrocarbon, which if swallowed and aspirated, can result in hydrocarbon pneumonitis. The end result can be devastating or even fatal. How might someone swallow gasoline?
Usually people do this when they are siphoning fuel from one vehicle to another. The moral of this is to never siphon orally! Motor oil and transmission fluid are also hydrocarbons, but because they are so much thicker than gasoline, they are much harder to aspirate, so are less likely to be a problem.
Other automotive fluids that are poisonous are radiator and windshield washer antifreezes. Radiator antifreeze contains ethylene glycol, while windshield washer antifreeze contains methanol. Both are extremely toxic in extremely small (teaspoons) amounts. Ethylene glycol can cause kidney failure, while methanol can cause blindness, and both can cause death, if very much is ingested. Brake fluid is similar to the antifreezes in toxicity.
How do people accidentally swallow these fluids? The most common error they make is to drain the fluid into a handy pop can or cup, which they then mistake for the can or cup that contains their drink. They take a big swig from it and unfortunately, one swig is enough to be a problem. Young children see the can sitting there and sip from it too – and can also wind up with serious problems.
Fortunately most hydrocarbon exposures don’t end up as aspiration pneumonitis and we have very effective treatments for both methanol and ethylene glycol exposures. Still, the best treatment for any exposure is Prevention. Don’t siphon gasoline or any automotive fluids. Drain automotive fluids into clearly marked waste containers and never use beverage containers for drainage purposes.
Enjoy May and Race Fans……. start your engines!
Gwenn
Gwenn Christianson, MSN, RN, CSPI Senior Partner and Team Leader Indiana Poison Center, Methodist Hospital
Clarian Health has traditionally celebrated National Nurses Week at its downtown Indianapolis hospitals with an extensive lineup of events, activities, get-togethers and giveaways.
It used to start in late April and run through the end of May, usually capped with a day or two for nurses and nurse leaders at the Indianapolis Motor Speedway, watching cars practice or compete for spots in the famed Indy 500 race.
Of late, we’ve taken a second (and third) look at our celebrations and asked ourselves: Do umbrellas as gifts and offers of free makeovers really make nurses feel appreciated for the work they do? Do they want to take time away from their families and friends and spend it with us – their employer – at an event we stage after hours to say thanks for a job well done?
More and more, we’ve realized that it’s not the gift or event that counts. It’s the motivation and the thought behind it. Is it genuine? Is it meaningful? Is it appropriately thanking those you intend to thank?
Last year, we changed our Nurses Week lineup and substituted some new things and got rid of some old habits in hopes of instilling a new way of thinking among our professional nursing staff.
For example, in lieu of a small gift for each nurse, we opted for charity and asked our nurses to identify nurse-led or nurse-inspired programs operating at our hospitals so that a significant donation could be made in the name of nursing, in honor of Nurses Week.
One program RNs identified was “Got You Covered” at Methodist Hospital’s Emergency Department, which provides sweatpants and sweatshirts to patients who don’t have clothing to wear after they are treated and released. A nurse started it; a nurse still runs it; and nurses KNOW it makes a difference to patients. We were happy to donate money to that cause in the name of great nurses at Clarian.
We’re doing the same thing again this year, and already, triple the number of nurse-led or nurse-inspired programs have been identified as potential recipients of a Nurses Week donation. That’s a step in the right direction, I think.
I believe, as does Clarian, that nurses are at the heart of health care. Nurses Week is an opportunity to say thanks to nurses who do the work of heroes, but it’s also an opportunity to think differently about how we recognize and appreciate that work … every day of the year.
Lydia Ostermeier, MSN, RN, CHCR Director of Nurse Recruitment, Retention, Workforce Development, Resource Allocation & Customer Service losterme@clarian.org 317-962-1886
I took my 21/2 year old grandson to the library last week. Our library has a great children’s area. It has a big play area with a train table, a Lego table and a puzzle area.But he wasn’t interested in any of those – he wanted to play with my purse!Fortunately he was more interested in my car keys than any of the other contents.
Purses, book bags and other items you use to carry items you use daily, are all sources of potential poisons for the children in your life.Let’s take a look inside the average bag & see what should be avoided.
Makeup – generally not a problem
Perfume – contains alcohol, small amounts cause local irritation
Visine®,Afrin® etc – allergy nasal sprays & eye drops – extremely toxic in small amounts, can cause extreme sleepiness, respiratory depression and bradycardia
Medicine – whatever you are taking – remember, Child-Resistant Caps are just that – Resistant, not Child Proof!The average 2 year old can remove them after a few minutes work.
Inhalers – albuterol or other inhalers – can be a problem if used excessively
Tylenol®, Advil® - or other OTC pain killers – can always be toxic if a little one gets too much of them
Cough drops – choke hazards
Tums® – safe, choke hazard
Gum – Despite what you may have heard, swallowing gum does not cause “gum balls” to develop in your stomach.However, eating large amounts of sugar-free gum may cause diarrhea, because most of those gums are sweetened with sorbitol, a laxative.
Nicotine gum – potentially quite toxic. Eating 1 piece of nicotine gum is the equivalent of eating one cigarette, which is a problem for a small child
Cigarettes – one cigarette is potentially toxic
Tobacco Dissolvables® – Orbs, Sticks, Strips – one of these is equivalent to one or more cigarettes and children tend to eat several, since they look like candy
Cigarette lighters – contain butane, which is a hydrocarbon and can cause pneumonitis
Matches – large amounts can cause kidney problems
Sunscreen – not toxic but eating some may cause a child to vomit, since it has a slimy texture
Insect Repellent –most contain DEET, which is quite toxic. If a small amount of repellant is ingested it will cause only local irritation, but if a large amount is ingested it can cause seizures
Hand Sanitizer – contains ethanol, small amounts cause local irritation
Batteries – small button sized batteries are a risk if swallowed, because they can lodge in the esophagus without causing symptoms. All batteries can be a problem if ingested
Coins – the larger the coin the greater the risk if ingested because they can become stuck in the esophagus
Cold sore meds – often these contain camphor, which can cause seizures if enough is ingested
Hair Spray – contains ethanol, small amounts cause local irritation
Mace – greatest risk is being accidentally sprayed with the mace, which causes immediate pain and tearing and can cause respiratory irritation
Keys – not toxic, but not good for your teeth!
Cell Phone – pieces can come off & be a choke hazard
Pens & Pencils – may make a mess but are not toxic
So, keep your bag “up and away” from children and be aware of what dangers lurk inside.If you suspect a poison exposure has occurred, don’t wait, call the IndianaPoisonCenter at 1-800-222-1222 right away!
Gwenn
Gwenn Christianson,MSN, RN, CSPI Senior Partner and Team Leader IndianaPoisonCenter, MethodistHospital
Clarian Health has a long-standing practice of only hiring nurses who are graduates of schools of nursing that are accredited by the National League for Nursing Accrediting Commission (NLNAC) or Commission on Collegiate Nursing Education (CCNE).
Some people may wonder why this practice is important. I can tell you from experience there are several reasons, but most important among them:
Accredited programs have established standards for nursing education, curriculum and faculty.
Accredited programs consistently prepare nurses to care for Clarian’s high-acuity patient population.
Before enrolling in nursing school, be sure to check whether the program is accredited and consider whether your employer of choice makes hiring decisions with that in mind. It could have an impact on your ability to find a job you want after graduation.
And bear in mind that even though a school claims to be accredited, YOU need to verify from where that accreditation comes. Being accredited to teach HIGHER EDUCATION COURSES is NOT the same as being accredited to teach NURSING PROGRAMS. There is a difference!
If you have questions about which nursing schools are accredited by NLNAC and CCNE, check out these Web sites for an up-to-date list:
A Light exists in Spring Not present on the Year At any other period - When March is scarcely here
A Color stands abroad On Solitary Fields That Science cannot overtake But Human Nature feels.
Part of human nature seems to be the overwhelming urge to touch and feel, to smell and taste, all that is a part of nature. Now that the days are growing longer and the weather is growing warmer, we find ourselves going outside to play or to relax and too often our encounters with Nature are somewhat less than benign.
I am thinking specifically of plants, and the almost irrepressible urge to eat them felt by some young children. And why not? Plants, and flowers in particular, are pretty, brightly colored, smell good – why wouldn’t they be something good to eat? And when you think of all of the plants we strongly encourage our children to eat – broccoli, lettuce, peas, beans, celery, squash, tomatoes, peppers – every color, shape and size under the sun – why should they see any difference in a leaf of lettuce vs. a leaf of a hickory tree? Why would yellow pepper strips be any different from yellow river reeds?
What plants are a problem? Well, the list is so long that there is no way I can cover it all in one short blog. If you want the entire list, you can get it by going online to www.clarian.org/poisoncontrol and downloading it, or you can call IPC at 1-800-222-1222 to request a free information packet be mailed to your home. I will talk about just a couple of poisonous plants below. Some of the more common landscaping plants that are toxic include Yews, Holly, Azaleas, and Rhododendron. Flowers include Lily of the Valley and Foxglove, as well as Morning Glory, Wisteria, and Delphinium. “Wild” plants that can be trouble include: jimson weed, nightshade, water hemlock, and acorns.
So, what do you do if an exposure occurs? First, make sure the child is awake and breathing normally. If not, call 911. If the child is OK, take a clean wet cloth and wipe their mouth out, removing all plant material. Wash their face and hands well with soap and water. Get a good sample of the plant (leaves, stems, berries, flowers – all of the different parts), then bring the child and the plant to the phone and call IPC at 1-800-222-1222. We will help you obtain a plant ID and have the child appropriately cared for, most often safely at home.
What can you do to prevent or prepare for an exposure? There are two main things:
Know what is in your yard!! Get a good plant guide or a knowledgeable friend or neighbor and go around and identify each plant, shrub, flower and tree in your yard. Label them with indelible markers. Make a map showing where each one is and the name(s). Remember, you may not be home when the exposure occurs, so relying upon your memory alone is not a good method!
Only buy non-toxic plants. Check the list of non-toxic plants. If the plant isn’t listed on our short list, does that mean it’s OK? NOT AT ALL! It just means we didn’t have room to include it. Call IPC BEFORE you purchase, with the common and scientific (Latin) name of the plant and we can look it up and tell you whether it is safe to have around little children. Don’t rely upon what birds or other animals eat – children aren’t birds and what birds can safely eat can sometimes be very dangerous for children!
Enjoy the lovely weather, while it lasts, and have a safe & happy Spring!
Recruiting great nurses is extremely important to us. So we want the application and interview process to give us a good idea of who you are and what you expect from a nursing position. We try to keep the process as simple as possible. Below is what to expect when applying to Clarian for a nursing position.
The application process (should take no more than 15-20 min.):
Find a position(s) you want at www.calltochange.org/nursing or www.clarian.org/clarianjobs.
Click through until you reach the online application.
Complete the application and upload your resume.
Follow the instructions to complete the Health Care Selection Survey. (This is a tool we use to gauge how you will fit at Clarian – taking into account your personality, experience, etc.)
When this is done, you will receive an automated reply by e-mail, saying we’ve received your application.
The interview process:
We call ALL qualified applicants WITHIN 2 WORKING DAYS. If we don’t feel you’re a good fit at Clarian, you will receive an e-mail response.
When your recruiter calls, you will discuss career goals, experience, expectations, etc. Your recruiter might also recommend other openings that might suit you well.
Your recruiter will schedule an interview with the unit manager (usually within a couple of days). You may have two or more interviews scheduled, depending on your experience and qualifications.
Your recruiter will coordinate every aspect of the interview process. Typically, on the day of your interview, you will meet your recruiter at the Nurse Recruitment office, where you will go over general employment and benefit details. Your recruiter will then personally escort you to your interview(s).
Within a couple days (maybe sooner) you will have a response. You will either be given a formal job offer, recommended for a shadowing day, or told why you are not being offered the position.
We have some of the best recruiters in the business, and their entire job is to treat you professionally and with respect. We work hard to find and recruit the best nurses available. If you’re one of the best, we can’t wait to talk with you.
Good luck in your interviews!
By Lydia Ostermeier, MSN, RN, CHCR Director of Nurse Recruitment, Retention, Workforce Development, Resource Allocation & Customer Service losterme@clarian.org 317-962-1886
Lydia became a nurse to have a challenging and rewarding career, which she has happily pursued at only Wishard Hospital and Clarian since obtaining her RN licensure.
"Nurses can make or break a patient’s hospital experience – you have to keep a smile on your face and your chin up at all times even in the most difficult of circumstances."
Lydia has previously served as a Neurosurgery ICU staff nurse, a Director of Staffing, and a Clinical Manager at University Hospital in Indianapolis.
I just finished a 12-hour shift. Maybe it’s the cold, cold weather, maybe it’s the post-holiday let-down, maybe it’s the phase of the moon… but there were an unusual amount of suicide attempts for the day shift today. Most intentional ingestions happen on evenings and nights.
(All details below changed to protect confidentiality.)
I talked to two concerned moms with distraught daughters. One was a 13-year old girl who took 10 Ibuprofen after her boyfriend broke up with her. The other was a 24-year old lady with a history of bipolar disorder and post-partum depression who took a double-dose of her Elavil®, “but wanted to take the whole bottle.” Fortunately, mom had wrestled the bottle away. I also spoke with the ER nurse caring for an 18-year old girl “whose parents are out of the picture” and who was brought in by her live-in boyfriend after they had an altercation. She had drunk half a bottle of Nyquil® and taken four tablets of Benadryl® – because she “wanted to go to sleep.”
Now, none of these sound like very serious ingestions to most people – they aren’t ingestions of hundreds of pills, they aren’t particularly toxic substances in the amounts ingested, and none of the patients were having significant symptoms when we were called. Still, each patient was referred to the ER for (or the ER was advised to provide) a thorough medical evaluation – on the general theory that a person who is upset enough to intentionally take an overdose can’t be relied upon to be the most accurate historian. Psychiatric evaluation was also recommended.
At some point you may encounter a friend, relative or acquaintance that has made a suicidal gesture. The circumstances (a teenage romance, the baby blues, a squabble with a boyfriend) may not seem very significant to you. The exposure itself may not seem particularly toxic. Of course, we recommend that you call Indiana Poison Center and let us help you determine what to do in each circumstance.
I encourage you to treat these events EXTREMELY SERIOUSLY for these reasons:
Although the “motive” may seem “insignificant” in your eyes, if the patient has judged it to be an adequate reason for an attempt, disastrous results may occur.
You don’t really know what has been ingested or the quantity involved and you shouldn’t wait to find out what may develop.
If initial suicidal attempts are ignored or minimized, subsequent attempts may be more aggressive.
What happened with these three young ladies? All three were medically evaluated and medically cleared. All were evaluated by the respective Crisis Teams at their facilities. Two were admitted for in-patient psychiatric care and one was referred back to her current therapist for on-going out-patient therapy. Were these ER evaluations worthwhile? Absolutely. They were a very effective method to establish physical stability and acquire an entry to the mental health system.
Someone may call on you for help. Be sure you are listening.
Monday was a Mad-Hatter Day; a perpetual swirl of activity. I had a patient who verified throughout the day the reason I am not a psych nurse; a very bizarre admission; a very productive discharge; and one who taxed my vocal chords for twelve hours. Nonetheless, she turned out to be the highlight of my day.
Miss M. is 75 years old. She has progressive COPD and was admitted for a severe Upper Respiratory Infection - tough combination. In addition to her hearing loss, her eyesight is compromised due to cataracts and glaucoma. In this case, my Synergy mindset was thinking discharge-predictability-involvement in care. Every opportunity I had throughout the day, I asked questions that would allow me to have insight into that plan of care. I learned she has four doting daughters, two spoiled grandsons, a parrot and two dogs. She lives with one of her daughters in a situation that is very comfortable for both of them. She is tethered to oxygen but can do a few jobs at home in the course of the day, including caring for the animals. She is fiercely independent, has a wonderful sense of humor and a very realistic concept of living and dying. In time, she should be good to return home. I felt pretty smug about having a discharge plan ten minutes before it happens: one little accomplishment for me.
Per usual, at the end of my shift, I was re-hashing the day, looking for the positive, the negative, and the possibilities that could make things better for the next shift. Then, like a ton of bricks, a moment of “latent curiosity” hit me: I wonder what the parrot says? Miss M. is very attached to her parrot. She has had him for a long time. Dogs can yip and cats make a lot of weird sounds, but a parrot talks - a much better companion for a life of limitations. You can bet, if I get another opportunity, I’m going to know what the parrot knows.
Sometimes, we think we are asking all the right questions, when in reality we are missing the obvious.
Over the past 42 years, I have spent more than 20 of them working! That seems an interesting reality to me on several levels. As a family, we have dealt with the “designated holiday” and have never really missed Christmas, we have just planned a bit differently. And, the years I was not scheduled to work were always grand and glorious!
I have also discovered that the work place has never disappointed me at Christmas. In some dysfunctional way, our units become family and we create a certain atmosphere for every holiday. Over the years, the decorating crews seem to jump out of some magical box and think they are Disney Designers and create a festive atmosphere for all of us. And, the food fairies think we need a month of sugar to survive. People have great food traditions, other than my Beef Brownies. AR should be a pastry chef in her next life and KT’s husband just needs to open a cookie shop! I was at work very late last night and was more than tempted to take the entire box under cover of darkness. Those night people party with too much flare as it is and I’m a little behind on baking. I’m thinking a dash of Grinch activity would have been fun. This morning I’m regretting I didn’t do the deed! I think we should do a holiday cookbook next year on 4-Medicine. JS makes a mean cheesy potato thing and MS is always concocting something unique! What a tasteful idea! I didn’t make it to the boss's Christmas Party this year, but I’m sure it was another good gathering. Next year I’m going to take the string game so all my colleagues will verify that I really am an unusual and fun-loving person.
This was also a special year of sharing on 4-medicine. SW is a person who has a heart as big as the universe. She orchestrated a memorable Christmas for one of our staff who is having a difficult health year: food, gifts, money, cards… the staff response was over-whelming. Why do I work on 4-medicine? Pretty obvious.
Those that work on Christmas Day give the gift of caring on a plane very few understand. It is a gift of sacrifice and love; hand delivered to those in need. The nurse-patient bond on Christmas is only understood on a heart-level and I have some very fond memories of years past and the people who have touched my life. Priceless.
When I sign off, I’m headed to Walkerton. Grand-babies and my children, who are still kids at Christmas! It is going to be wild! Christmas through the eyes of a child gives a whole new meaning to the word JOY, so I’m preparing to be blessed.
Have you ever thought about how many nurses take care of a patient at Clarian Health? If I sat down and thought about it, there are so many nurses working to make the patient’s stay tolerable and manageable, it boggles the mind.
Upon being admitted to the hospital, the patient is utilizing the various nursing roles and is unaware of the amount of skill, experience and education that is behind their care. Although the bedside nurse is who the patient relates to, it is those other nursing roles that support the bedside nurse.
These are the roles that come to my mind that one patient may have at his/her disposal during a complex hospital stay:
Bedside nurse
Charge nurse
Unit Manager
Director
CNO
CNS – various depending how many co-morbidities the pt has
NPs - various depending how many co-morbidities the pt has
WCON
Ancillary nurses
Nurses in the Information Services department
Nurse Ethicists
I am proud to be a nurse and be part of a profession that nourishes and encourages growth.
Last week, Methodist had an employee celebration and silent auction to really begin the Christmas season. To put it succinctly, it was a blast! Over the course of eight hours, employees from all over the hospital made their way down to the conference center to eat breakfast and lunch, listen to a live band, and walk around looking at over 200 items to bid on. The silent auction was held to begin the events for our new capital campaign, which will help fund our new critical care tower, to be built over the next five years. 21st century medicine cannot be practiced in patient rooms designed even 10 years ago. Critical care requires more space for each room. Today’s improved patient care is a result of more highly skilled professionals, more sophisticated equipment, more intense treatments and better pharmaceuticals. Critical care patients often require all of these – in the same room at the same time. Additional space also reduces the risk for and spread of infection, and provides greater privacy and comfort for seriously ill patients and their families. Upon the tower’s completion, all critical care beds will be single patient rooms. So the beauty of this day was the employees received a fun day, while the campaign got off to a terrific start!
The “early present” for me was the time spent greeting, laughing and visiting with all of the “friends” who came down to see us. It is just amazing how a little music, food, and the company of others can liven up a day, and put everyone in a great mood. We had a representative from an outside company there, who at one point genuinely said to me, “I go to a lot of hospitals. It is amazing that a hospital as large as this one can have people that know each other so well and treat each other like family that are so happy to see each other.” And she was right. I told her it is why people stay here so long, because it is just like a family, we take care of each other, and have genuine affection for each other. She said that was very easy to see. We listened, as the time for the auction neared its conclusion, to a few mild threats about the items up for bid, from one good-natured employee to another. That was half the fun, too. Those of us working for the day did not mind at all, because the reward was making people happy. It truly was a gift.
As a manager of a pediatric hospital there are many things that warm my heart. This past week my heart was warmed by my most wonderful pulmonary team that decided instead of adopting a Christmas family they would adopt the families of Riley Hospital and serve them two meals in our Ronald McDonald House. They served over 80 families lasagna, pie, garlic bread, and salad. These items were donated from all members of the pulmonary team who performed a most fabulous job.
It brings to mind that teamwork and togetherness on units is essential to patient care and creating a caring environment. There was one father that even began crying as the staff made his plate, covered it in foil, and assisted him back to where his child was sick, so he could eat with his wife and child. He could not believe that the healthcare workers that do so much for them already would go above and beyond to do more for them in their time of need. I have to say, I am so blessed to have an amazing team here at Riley and this is yet another example of what it means to work for Clarian and Riley, and to be the best nurse you can be.
People often ask me what is at the core of a great team. I have thought about this a lot. It seems to take a lot of things to make a great team: hiring the right people, having enough equipment, good patient ratios, and collaborative MDs. Though at the core of all of this, what rises higher than any other is relationships. It is truly the job of the manager to aid in bringing a group of people together to form a relationship between their co-workers.
When staff have a vested personal interest in each other they enjoy helping one another as well. Recently I pulled my 100 member team of pulmonary staff together for a team building workshop. Over and over I kept hearing of how much they cared for one another. They have an amazing team and this seemed to be the common theme for all of them and why they had such a great team. Relationships with each other and their manager - what a great concept.
Thinking through the Studer initiatives that Clarian has been undergoing gets a lot of flack about prescriptive questions. At the core of these questions and themes for leaders to use, you can see it is developing a relationship with the staff and getting to know them on a more personal level. This is also what aids patient satisfaction. It is not always about being the best staff member, but it is the lasting relationship you leave with your patients. At times we focus so much on the clinical side we forget to establish the relationship with each other and our patients. If everyone could take away to get to know someone on a more personal level every day, what a preeminent organization we would become.
How much fun was it to be a part of Girl Power last weekend?! Clarian sponsors this high-energy, fun event. It is aimed at giving young girls ages 7-14 a sense of empowerment, improved self-esteem, and just a better sense of what it means to be a strong, independent young woman. That alone is worth the effort to go and work all day. About 1000 girls were there enjoying the many things the day had to offer. Such things as a cooking demonstration, fencing, dancing galore with Radio Disney, hula hoop contests, building birdhouses, listening to Tamika Catchings of the Fever, jump rope demonstrations that defied gravity, and then there was my station.
We had a close up and personal look at germs…cooties…bugs…call them what you will, but it was all about hand hygiene. At first the kids were ever so slightly grossed out when I told them we were going to put on a special lotion that would fluoresce their hand germs when we looked at them under a special light. Then they couldn’t help but smile, and wanted to see what we could find. I loved it. After that we washed with alcohol-based hand sanitizer and looked again at the difference. It was a small but powerful science experiment, especially at the height of cold and flu season. I figure anything I can do to contribute to knowledge, empowerment, and a smile about cooties is a day well-spent. I am glad to be a part of a team that values this unique opportunity to care for children in a very different, diverse way.
Lydia became a nurse to have a challenging and rewarding career, which she has happily pursued at only Wishard Hospital and Clarian since obtaining her RN licensure.
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