Nursing

Some people go into nursing because they want to care for people. I went into nursing because its funny.

Monday, July 2, 2012

I have just managed to interview about 5 million people for a couple of positions I have open and I have some suggestions for anyone job hunting.

1. Please don't make your interviewer wonder why you are there. If you're not really interested in the job, don't schedule an interview. If you can't make the interviewer believe that you are REALLY interested in the job, don't take their time. No one is going to hire you just because you "need a job".

2. Look professional. Your tattoos and piercings and leather may look really cool when you are out with your friends, but in a professional environment, it is not cool.

3. Bring multiple copies of your resume. It makes you look prepared and helps the interview go better. Also bring copies of your references.

4. Talk to your references first. Make sure they know they might get called and ask them what they might say about you.

5. If you need time to think about an answer, that's ok. Tell the interviewer you'd like a second to think about it and then do.

6. If you don't know the answer, you better have something to offer. Telling the interviewer that you don't know, but you would be happy to ask xyz, look it up, do a little research, whatever and get back to them is fine. Don't just say "I don't know." You need a back-up plan for what you don't know.

7. Yes, you have faults and yes, you have had problems with coworkers or bosses. Think about those things before the interview because you will probably be asked and saying that you don't have faults or that you have never had a problem just makes the interviewer think you are not honest.

8. If you have a problem with your work history, address it up-front and honestly. If the interviewer is left to think about it later, they aren't going to give you the benefit of the doubt.

9. Be friendly. For goodness sake, if you can't crack a smile, don't interview.

10. Let the interviewer know that you are listening. Answer the question asked. Don't just give the answer to another question. And give examples that show you understand.

Category: Nursing

Nurse stories

Sunday, November 6, 2011

I FINALLY went out and got the current Reader's Digest with the 50 things nurses won't tell you in it. I was so excited because I know there are some wonderful nurse bloggers who contributed. I'll post links to all their blogs this week. I can't wait to follow their blogs. Frankly, I can't wait to read the article.

Nurses have such wonderful stories. I guess that's why I'm a nurse. Stories are fantastic. Stories are the stuff of memories and fun. I love telling stories and reading stories. I love good storytellers. And when your job is to take care of people in their worst moments for 12-hour long days, how could you avoid telling wonderful stories.

So, I'm going to enjoy the article and the blogs...right after I get the kids to sleep...and take out the trash...and clean the kitchen...and get some exercise...and practice the banjo...and do the laundry... and...well, be a single mom who turns into a mild-mannered nurse by day.

Category: Nursing

Working with doctors

Monday, March 28, 2011

As a nurse, one of the less fun parts of my profession is often working with the doctors. I know, I know. I've heard the stories about Enron executives. Oh, I know you think lawyers are bad. And, I know what you think of third-world dictators, but frankly none of them can hold a candle to the pain-in-the-assedness of some doctors.

Let me be clear. Not all doctors are awful. Some of my best friends are doctors. (Ha!) Honestly, though, some doctors are pretty cool.

But some doctors truly, honestly believe that they are truly better than everyone else. And these uber-people can make a nurse's life hell.

I'm there to help people. Well, actually, in my current position, I'm there to fire people and take the heat for not making budget. But, my staff are there to help people. Nursing is a giving profession. But, I think spending a few years of your life having your mother tell all your relatives, "my child is a DOCTOR" makes you a taking person.

Dealing with some doctors is like dealing with a tantruming 3-year-old with a better vocabulary and no time-out. It can be just as painfully irritating and since this is someone else's 3-year-old, there's not really anything you can do about it. It's exhausting.

As a nurse, I just chalked it up to bad behavior and moved on. God complexes are not my problem. But, as a manager, it can be really irritating.

I just love spending an hour in a staff meeting telling my staff to respect each other just to have a doctor come along right after and stand in the hall putting my employees down with them right there and patients listening. I just live for the days when I discipline an employee for yelling at another staff member only to have the doctor come along and yell at someone else.

It appears that a large number of medical schools completely ignore professionalism and common decency. It's good there are nurses as buffers with patients. If some of these doctors had to spend more than 5 minutes in a room with a patient, we would truly have a health care crisis in this country.

I think we have to work together. I think the only way to combat this epidemic of rudeness is to remind doctors that being a doctor is a profession, much like lawyer or dictator. It is not a redefinition of a person to deity status. I don't know of a single Church of MD.

So, let's band together. When your kid tells you they are going to be a doctor when they grow up, remind them that's just not "nice". Give them a cookie when they play "mine operator" or "civil engineer" instead.

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Category: Nursing

Baby surprise

Wednesday, January 26, 2011

I used to be a labor and delivery nurse. I love labor and delivery. Hours of not being able to make someone happy followed by a few minutes of excitement followed by a few minutes of bliss and then the other person sleeping. Hmmm...now that I'm divorcing, maybe I need to go back to labor and delivery. It reminds me of marriage in certain ways.

Some of my best experiences came as a labor and delivery nurse. Some of my most amazing knowledge came as a labor and delivery nurse. I can end a "charlie horse" in between contractions. I can get a sluggish baby to move. I can get a breech baby to turn more often than a doctor doing a version. Admittedly, a lot of that knowledge comes from working at a tiny hospital in the country.

At one hospital I worked at, the other nurses called me the "baby yeller". Baby whisperer would be nice, but that's not really my style. You see, in labor and delivery, they have a little buzzer that you put against women's bellies to basically scare babies who aren't moving into moving. I hate the buzzer. In the country, we didn't have a buzzer. I just put my face up to a woman's belly and yell, "hey baby, move!" It works. The baby moves. Save a little cash and try this one at home.

Some of my most terrifying experiences came in labor and delivery too. Babies and their Mamas can be unpredictable and just when you think you've got one figured out, they surprise you.

One hospital I worked at had this particular woman who constantly came in thinking she was in labor. Starting at about 5 months, she came in at least once a week "in labor".

Pregnancy is uncomfortable, even painful. If you haven't felt labor before, and frankly even if you have, it can be hard to tell the difference between the aches and pains of pregnancy and those of labor. But, after 3 months of these visits, the nurses were trying to be proactive.

One of the standard recommendations for people who are pregnant is tylenol and a warm bath. Sometimes your uterus just exercises itself to get ready for the big event and taking a tylenol and a warm bath can convince your uterus to relax for a while.

The nurses told this woman over and over, "rather than running in to the hospital when you think you're in labor, give us a call first. Take a tylenol and a warm bath and see how you feel." She ignored the nurses and continued to come in.

Finally, this woman was really tired one day. She had been into the hospital two days in a row and wasn't excited to come in again, so she called. At the nurse's suggestion, she took a tylenol and a warm bath.

And she had the baby in the tub.

Most people should just go with their gut instinct on things. Some people should not.

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Category: Nursing

I make the worst patient

Saturday, January 22, 2011

As a nurse, there are few things more irritating than the patient who seems to be wasting my time.

They come in with pain or fever and haven't tried ibuprofen or Tylenol. They insist on an immediate appointment for things that have been going on for weeks. They tell the medical assistant or nurse one thing and the doctor something totally different. And they are hypercritical of my staff.

The other day, I got to be a patient. I had something nasty going on with my toes. I won't go into that.

Anyway, the problem had been going on for weeks, so I called for an immediate appointment. Of course, I hadn't tried Tylenol or ibuprofen. I was really critical of the staff. And, I forgot a few things, so my story changed when the doctor came in.

If I were the nurse, I would be totally annoyed with me. Will this change how I interact with my patients? Don't be silly.

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Category: Nursing

Loving my job

Saturday, December 11, 2010

It seems to have become the norm for people to hate their jobs. Society has settled on this idea that we all hate what we do, but we are all looking to be fulfilled in our work. I don't really understand this. It seems counterproductive.

Frankly, I think nursing is one area that really breaks the mold. There are nurses that hate their jobs, but I think that has a tendency to make for terrible nursing care.

On the other hand, most people go into nursing because they like helping people and it helps them feel fulfilled. Most areas of nursing also allow you to go home at the end of the day and leave work behind. You don't have to be chained to your Blackberry on vacation if you're a nurse. So, you work to live, but you also live to work. What a perfect balance.

My work life has become something a bit different. One of the managers I work with said to me last night, "you're a nurse?" It seems I have gone so far over to the dark side of management that I have left the nursing part behind. Oh, I still do a little nursing care in my clinic, but really only in a pinch. I like it and I want to do more of it, but right now I am able to focus on the budget, the policies, and the management role. And, I love it.

Working as a manager for an organization that gives a lot of support and a lot of autonomy is fantastic. I love my job with a passion. Wonderfully, the feedback I get is that they love me there too. I don't think I have felt this satisfied by a job in a long, long time. It is so nice to have this time in my career be so wonderful. I'm busy, really busy. I'm a bit overwhelmed. But, when all else in my life is a little crazy, it is wonderful to think about work and have my head on straight.

Recently, I was handed a new challenge. It seems that while we have improved everything else in my clinic, we are suddenly not appearing "friendly" enough. Huh. I have to find a way to help my staff appear more "friendly" and "cheerful". How odd. I see the gaping hole in my management style now. How do I do that?

Knowing I get a lot of support from the hospital, I started calling people. What an amazing group! All of a sudden, we have this crazy plan for helping my staff become more "friendly." Initially, I thought it was going to be awful. How do you tell people they aren't friendly enough without making them more surly?

It turns out that you send them on field trips and help them do fun things to learn about their personalities. So, over the next couple of weeks, as an official management technique, I will be sending my staff to Starbucks and to In 'N Out Burger. I'll have them all sit around in a room and discover what "color" they are. I'll buy them lunch a couple of times. And, I'll reward them with gifts. At the end, they will hopefully be more "friendly".

I think this is a stunning idea. I can see how free food and gifts and talking about themselves would make them more friendly. It will certainly make us all happier. I love management!

Category: Nursing

Socialized medicine - would we still have to deal with billing?

Tuesday, November 30, 2010

As a nurse manager, I often help my patients deal with medical billing. I know that it can be frustrating and confusing. I still get confused and I have a lot more information at my disposal. I think it is truly sad that we have a cottage industry in people who make money trying to help other people deal with billing and insurance questions. I don't imagine more rules through Congress will help. My guess is that the only way to get this thing fixed is to have a 10-year-old cut through the crap and write our health care policy from scratch.

Today, I called billing again to help two patients deal with some issues. This time, the billing person told me that I would need a release of information form signed by the patient before she could give me any information on the account. What?!?!?

I repeatedly told this person that I was a) part of the care team for these patients, b) handling a billing issue (both of which allow me information under the HIPPA law without a release), and c) I was ALREADY looking at the account and had in fact given her all the information off the account to look it up while I was on the phone with her. I was reading the physician notes to her so we could address the problem.

She persisted. She kept telling me I had to get a release signed by the patient to give me the information.

Uh...I'm not somebody's aunt Millie, looking for information on someone's diagnosis so I can gossip. I am calling on behalf of the patient and doctor to solve a billing issue! She has my information in the patient's account as addressing the billing questions before.

So, the very person assigned to handle billing doesn't understand the basic HIPPA law covering insurance issues in healthcare. Helpful. No wonder my patients are struggling.

People complain about members of Congress not reading the thousands of pages of the new law. What about the people in health care and insurance who are charged with making the new law work for patients and providers? Not one of them has read it and it seems that our entire medical billing system is working on gossip.

When we define our payments on a version of the "telephone game", how do we expect to maintain high levels of care?

Category: Nursing

Patient lost

Saturday, September 25, 2010

As a potential patient, you never think of the possibility of getting "lost" by your health care providers. And, maybe, just maybe, it is just me. But, I lose a surprising number of patients. How scary is that?

One night, when I worked at a smaller hospital, I was the nursing supervisor. I got called to labor and delivery. The patient had come in bleeding, but when they went to drug test her, she left. Just left. Clearly unsafe. Then, I got another call, a patient had escaped from the psych unit. He didn't get very far. He ran past the elevator and down the hall. They successfully herded him back. Later that night, I got a call from the Med/Surg unit. A 45-year-old man in for a suspected heart attack had ripped out his IV, pulled off his telemetry leads, and left via the stairwell.

I called the security guard to make sure the guy wasn't face-down in the parking lot. The security guard came running down the hall and skidded to a stop, flipped out his notebook and demanded a "description." Uhh....brown hair and bleeding from an IV site? Oh yeah, and wearing nothing but a hospital gown.....

In the morning, I met the new CEO of the hospital for the first time. He asked me how my night went. That guy probably never forgot me.

But, even in my clinic, we have problems sometimes. People coming to an outpatient clinic have to be able to get there and back. As a result, it is assumed that they do not need significant care. Sometimes, this is not so true.

Not too long ago, we had a patient walk out of the clinic and just leave. He was found a few hours later just wandering the grounds.

More recently, we lost a patient who was on his way to the bathroom. He passed the bathroom, entered another clinic through the back entrance and went into a construction area in this other clinic. There, he pooped. Quite the mess. I still have some work to do on my relationship with the manager of that clinic.

Overall, I think that when people come to the hospital for care, escape should not be forefront in their minds. But, I have been a patient in a hospital and I can totally understand.

Category: Nursing

Coughing fit

Friday, September 17, 2010

Ok, there is no way around it. I'm sick. I've been sick for DAYS. My kids got sick at daycare last week and came home and gave it to me. An upper-respiratory virus, aka "cold".

Last weekend, I was a zombie. This week, I seem to be getting better and worse in waves. My voice is gone. I sound terrifying. Me talking is like listening to a braying donkey. I scare people, and I work in a hospital.

No one is more afraid of sick people than doctors and nurses. I can't take the whole week off, although I think I've taken most of it off. But, I have to work. So, I come in to work. If I were working directly with the patients, my boss would send me home. But, I'm the boss and I'm trying to confine myself to my office to avoid the patients.

People keep asking me if I've seen a doctor. Yeah. I see them every day and they stay very far away from me while I'm sick.

So, today I got hungry and headed on down to the cafeteria. No big deal. I ordered my lunch and then walked to the soda fountain to get a drink. And had a coughing fit.....

I coughed, and coughed, and coughed. And the entire hospital probably thinks they had Typhoid Mary in their midst. I kept coughing through my whole visit to the cafeteria. Waiting for my food. Getting my drink. Paying for my food. I coughed and coughed. And coughed. And not little gentle coughs. No. Braying donkey coughs with tears streaming down my face and my whole face turning bright red and those horrible choking sounds when you cough for too long. Gagging and deep breathing and trying to take a drink. This was a very un-pretty coughing fit.

The worst part is that there is nothing I could do. I tried drinking my drink. I tried holding my breath. I tried everything and I just coughed and coughed. And there I am, with my name tag on, in the middle of a hospital cafeteria. I'm lucky I got out of there before someone grabbed a wheelchair and pushed me to the ER.

The only thing more mortifying would have been if I had peed my pants in the middle of the coughing fit. After two kids, you just never know. Or...if I had actually hacked up a lung right there in the cafeteria. That would have been a story for all time.

Instead, I slinked back to my office to eat my lunch. When I got to my office, there were two bags of cough drops on my desk. Clearly the cafeteria was not my only problem area today.

Category: Nursing

Commendation letter

Wednesday, August 18, 2010

Nurses deal with a lot of people who end up in the hospital for reasons less related to injury than to ongoing mental disease. Sometimes, this can really ruin a shift. Sometimes, it can make your day. And sometimes, you're just left scratching your head.

I got a commendation letter from one of my patients. It wasn't for me, per se. It was for my whole clinic. It was five pages long, written in barely intelligible capital letters, and had my name at the top.

The letter outlined that he thought we were the best clinic ever and some reasons why that included the downfall of health care under Obama, his aborted interview with Barbara Walters, and the federal offenses committed by the health care system I work for. It also included some shout outs to people for reasons I don't completely understand and a history of his health care that also seemed to include a history of some sort of police investigation.

Normally, when I get thank-you letters, I make sure to pass the information on to the people who were involved. When I get letters of complaint, I make sure to notify risk management and any other departments that need to know. Although this letter was labeled as a commendation letter, I'm not entirely sure which category this falls under. So, I took it to my boss.

"What do I do with this?"

"Don't you have a file for these?"

Okay, I guess I haven't been a manager long enough and it really shows. I'm thinking, "I have a file for letters from patients, but this seems to fall outside of that file somehow."

I told her that the letter was addressed to me, but also technically to her. She said, "okay, you've shown me the letter, now go put it in the file."

I keep bothering this poor woman who is my boss. Why do I keep doing that? I think at the moment, with what is going on in my life, I just can't sort out what is important and what isn't. Hopefully, I won't be writing my own letters soon.

Category: Nursing

Hi. I'm Shelly and this is Isis, my introduction to the world of parenting. I'm not claiming to be a Parenting Expert. In fact, I'm mostly laying claim to my parenting failures. Failure is what happens when you try to do everything RIGHT as a parent. Yet, somehow, she is turning out to be a fairly cool little person....who throws crayons.