Download The 3 Awesome Medical Billing Templates
Check out these amazing 3 new Medical templates that I found online. For more templates you can easily do a search on google and choose a design that fits your best.
Check out these amazing 3 new Medical templates that I found online. For more templates you can easily do a search on google and choose a design that fits your best.
“Alexa”… My patient yells loudly while showing me this new “friend” of hers during my weekly visit to fill her medication box. I stare at the little black hockey puck looking thing on the table next to her and watch it light up blue. “Tell me a joke,” my patient says smiling excitedly looking at the table and then back up at me waiting to see my response. The hockey puck turns blue again and a robotic female voice now chimes out, “How do you know if you are a pirate?” A slight pause while my patient remains smiling in anticipation… “You just arrrrr,” Alexa finishes. My patient laughs loudly and turns towards me while tapping my leg with her cane, “ Aint that a trip?” she says while still laughing. I have to admit it was nice to see her so happy as I do not recall that I ever really had and this Alexa thing was kind of cool from what I could tell, although I did not know much about it. I had heard of it before from a few of my friends and had seen the advertisements about a million times as I like many are on Amazon much too frequently but this was my first introduction. My patient usually sits quietly in her living room chair awaiting my weekly visit as for the most part, I am the only visitor. She cannot see well anymore so she can’t read which she once greatly enjoyed. Her arthritis now keeps her from knitting which was another favorite past time that she can no longer do. I had recently thought about calling her doctor to discuss depression as most of her days are spent alone. I had noticed of late that she was becoming more and more anxious and withdrawn and it concerned me. I have seen this many, many times in this profession so I was intrigued by this little hockey puck and wondered what else it could do along with bringing a smile to a lonely ladies face.
About two weeks later while visiting another patient, I met Alexa again. A patients daughter had just installed the larger version of her which she set up to control her Dad’s (my patient) lights so he wouldn’t fall when walking to the bathroom at night. Much like my first patient he also seemed very excited to tell me about this Alexa gadget lady during my next few visits. He showed me how she played any song that he wanted and could also tell him the weather and the news. Similar to my first patient Alexa seemed to bring some excitement and companionship to another quiet home. I couldn’t help but wonder; could technology alleviate some of the loneliness we find so often in our elderly population?
Studies by the Centers for Disease Control and Prevention (CDC) estimate that 7 million American adults over the age of 65 experience depression each year. The symptoms of depression vary from person to person. In seniors, some of the most common symptoms include:
feeling sadness or “emptiness”
feeling hopeless, cranky, nervous, or guilty for no reason
sudden lack of enjoyment in favorite pastimes
loss of concentration or memory
either insomnia or too much sleep
eating too much or eating too little
suicidal thoughts or attempts
aches and pains
There are so many factors that contribute to depression and loneliness. For our elders, some of these are disease and illness along with possibly the lack of close family and the passing of friends. Also distressing are the limitations of a now aging body and a decreased level of independence possibly having to rely on others causing one to feel burdensome. Although Alexa won’t replace family and friends or solve all of these issues, she does seem to provide some distraction and amusement along with being just plain useful and fun. I have recommended Alexa to quite a few patients family members who have made the purchase for their loved ones and are quite pleased. I recently made the purchase myself, and after realizing I can play the whole soundtrack to the movie Dirty Dancing… I’m hooked! Thank you, Amazon. Job well done… as usual.
BIKINI BREAK (a pause from all things nursing)
I have taken a bit of a break blogging for a moment to pursue a long overdue goal that I had started about 20 years ago in which I didn’t reach the finish line. Now being 42-years-old the clock was ticking as my body is sadly aging (a tear runs down my cheek as I type those horrific words) which makes this particular goal a bit harder to achieve now then it would have been for the 22-year-old who started it all of those years ago. My 22-year-old self could run on empty and didn’t have two jobs, a family and a small gaggle of animals to care for. Oh, the glory days… How I long for them sometimes. If I only knew then what I know now, I still probably wouldn’t have changed anything anyway as I was having so much fun.
I have been training like a beast for a little over a year and just competed in the WNBF’s “World'” show which is their largest bikini competition to date. I have been into fitness and all things health for a very long time, and although I had taken the occasional hiatus when a girl just had to have some fun, I always come back to my home away from home… The gym, the place that grounds me and keeps me accountable. I am grateful that my mother signed up my chubby 18-year-old self with an affinity for vanilla cupcakes at Bailey’s Total Fitness Gym all of those years ago. Along with my slight cupcake addiction, I was also a fixture at HomeTown Buffet and China Roma with my then boyfriend, and it was becoming a real issue as evidenced by my increasing pant size and decreasing self-esteem.
After walking that stage at the John Hancock Theatre in Boston and seeing the complete transformation of my body while spending the last year channeling my inner Rocky Balboa to grind out every last rep deliriously laughing, starving, crying and questioning over and over why the hell am I doing this at times, I came to the same conclusion that I did roughly 18 years ago when I was in my last semester of nursing school.. I am doing this because it’s mine. I chose it, and I pursued it. I will see it through, and no one can take it away from me. Back then I was saying a variation of those words while trying to wrap my head around the cardiovascular system. I had a hard time with that one as evidenced by my barely passing grade on that exam. This time I found myself repeating the mantra as I was staring at a block of fudge at the cash register in the grocery store while picking up another two pounds of white fish and asparagus as that was about all I could eat towards the final countdown to show day.
I stayed the course and saw it through. I did cardio twice a day, lifted until I couldn’t lift anymore, sprinted in the cold, cut and cut and cut my diet again and did every and anything my trainer told me. And when he said ” trust the process,” I did. Ok, well I didn’t always trust, but I did what he said anyway with resentful hesitation (shout out Damico Fitness). On show day I slapped on my clear high heels, and the tiniest custom made bikini (how does so little fabric cost so much?) and walked on that stage. I felt nervous, scared then relieved and like a million bucks because I did it. Can I now add BC (bikini competitor) to my credentials? … Because I honestly feel that I should be able to. This was one of the hardest things that I have ever done if not the hardest. It has changed me and has made me so much stronger. It is so important to pursue our goals. I think many of us have had the same ones since childhood. Know this… They are attainable, no matter how silly, (I paid nearly 3k to learn the 80’s hair band Poison’s Every Rose has it’s Thorn on the guitar) hard, exhausting or pointless they may seem….. they are yours. Go for your dreams one baby step at a time, and like a staggering, exhausted Rocky Balboa right before you’re about to give up, take your final swing for the knockout then grab the microphone and yell to all who are listening or yell to yourself, “Yo Adrian I did it!” I did.
It is astounding to me how little diet education we as nurses provide to our patients across healthcare. Nearly each and every disease process has a nutritional component that depending on if adhered to properly or even partly can greatly affect the outcome for our patients. Implementation and compliance to many prescribed diets in relation to their disease decreases hospitalizations, increases life expectancy and sometimes even reverses the very diagnosis the diet is prescribed for. But how can a patient stick to a nutritional plan if they have not been educated on it effectively or if at all?
The greatest issue I found as a certified nurse nutritionist is that patients who had documented education and verbally stated that they were educated numerous times on their diseases such as CHF, COPD, and Diabetes to name a few, lacked understanding of the education provided. One of the first things we learn about patient education in nursing school is not only to provide teaching based on how your patients best learn, but to also assess the patient’s level of understanding. Otherwise, how do we know they have learned?
So what is the barrier to progress here and why aren’t we teaching enough and if we are why so often is it not effective? The main reason I am quite sure without having any need to research this is time. Time is our number one issue in almost every aspect of nursing, and that is something I do not see changing for the foreseeable future. Proper education takes time and this is the number one thing that we lack in the nursing profession. Who the heck has the time?
So how can we simplify nutrition education for our patients in the little time that we do have while also teaching it effectively?
Before reviewing all different diets and foods to eat, avoid etc. First, assess the basics… Can your patient read a food label? This is the number one issue I have found while going into patients homes and providing nutrition education and assessment. Needless to say, I was shocked. These patients had been instructed for years on their dietary needs by multiple professionals and they did not know how to read or understand a food label. How can they do anything without learning this basic first step? They were either never instructed or instructed poorly without demonstrating what they learned. Teach-back is so important. I sometimes find that being in this profession we often assume people know things that seem fairly simple and obvious to us. That isn’t always the case so it is best to never assume.
SAVE SOME TIME AND SOME BREATH
All too often we start talking or providing handouts etc. and we don’t even know what the patient already knows. We are not the diagnosing clinician so these patients have been hopefully instructed on at least something dietary along the way. Also, they could have had a family member with the same disease or they may have obtained information on the subject from a number of different sources. Ask them what they know and have them teach it to you. See if what they know is accurate and then you can move on to instruct on only the knowledge that they lack. Time saver!
Before you assume your patient is just non-compliant and give up, which is a situation we occasionally find ourselves in, assess if it’s true non-compliance that is the issue or is it not really a choice at all? It is of vital importance to assess your patient’s living and socioeconomic status in regards to dietary education. If your patient is not the one in their home that does the food shopping then your teaching may need to include the shopper. You also have to consider financially your patient may not be able to adhere to a diet very easily. Modify your teaching to fit the client’s lifestyle.
SMALL GOALS AND POSITIVE REINFORCEMENT
The saying Rome wasn’t built in a day applies to many things and you can apply it very often in patient education. In fact, if you don’t have this thought process you will become frustrated very easily. People are resistant to change, that’s a fact. It’s difficult for anyone to break habits or rituals that they have had for years. Sometimes a patient will never change their lifestyle or choices and that is their right. Other times, although rarely, you will take a patient from A to Z and they will completely embrace and comply with the needed changes. Often it is somewhere in-between. I have found that if you set small goals with the patient that are more realistic and obtainable you will have much more success. When the small goal is achieved you as a nurse feel like you have done your job and the patient feels good that they are making progress. I once could only get a CHF patient to give up ramen noodles and buy only low sodium deli meat. That was it. But these two things were staples in her diet for years. This was a big deal to her and it was a success for me. Yes, she was still eating other foods with too much sodium and would never elevate her lower extremities or weigh herself but none the less it was a huge accomplishment and I was sure to let her know it.
Do you teach diet to your patients as often as you should or could?
Rumor has it nurses have a tendency to be co-dependent. Shocking? I think not. I mean look at the profession that we have chosen… Is it strange that more than just a few of us have a need to be needed or have a slightly abnormal desire for people to depend on us? Before we delve deeper, let’s first take a look at what the “fuzzy” definition is of a codependent person, specifically if that person is a nurse. This isn’t exactly black and white but the best description I can find is below.
• A tendency to place the needs and wants of others first and to the exclusion of acknowledging or addressing ones own.
• Difficulty adjusting to changes at work or at home (electronic MARs, administrative changes, staffing shortage).
• Difficulty in asking for help or for what you need (orientation, training, personal time).
• Workaholism (working back to back shifts).
• Taking on more than you can handle professionally and personally.
• A pattern of relationships with needy or unstable people.
It’s obvious that people who have a tendency towards codependent behavior and who have a need to be needed may be drawn to professions in the medical field and also some other professions such as social work or law enforcement to name a few; but aren’t we expected to be codependent? Isn’t that what our patients and their families, as well as hospital administrators and just plain old society, expect from us? If we weren’t slightly codependent would we offer to stay and work extra when asked constantly? Or when a horribly sick patient is giving up and caring less and less about themselves, isn’t it a little bit of our codependency that kicks in and cares for them and about them even more than they do for themselves for the time being. Doesn’t this character defect that we are said to have benefit the people we are both looking after and working for? I wonder if we all became incredibly mentally healthy and codependent free would hospitals function as well? And also, would the patient satisfaction rating go plummeting down? I’d bet yes.
Unfortunately, codependency while it may benefit hospitals and patient satisfaction ratings to varying degrees for some time, inevitably, it will cause harm to us and have negative effects in the long run which will not benefit anyone, least of all ourselves. Nurse burnout is a real thing and a codependent nurse is going to burn out a lot faster. The codependent nurse may be a rock star in the profession initially, however, after a few years we won’t be good for anyone unless we learn to practice some self-care. So how do you know if you’re codependent? Here is a little quiz in addition to the characteristics listed above to see if you are a part of the club.
Read the following statements and choose the most honest answer: 1–rarely true, 2–often or sometimes true, 3–almost always true.
Brush up those math skills and add up the numbers associated with your answers. This isn’t an official diagnostic tool but just a friendly tool to see if maybe it’s time to take a compassionate look at yourself.
(9–14) Highly Healthy—You have a calm confidence and appreciation of self. You may have moments of doubt or worry, but you also have a strong base of self-worth and trust in others. You can savor intimacy and ask for help. While no sane person enjoys watching another suffer, you can appreciate that your role in their suffering is never the sole cause, nor are you their savior. You can be present and balanced for both your own and others’ hard times.
(15–21) Room to Grow—You have moments of clarity, peppered with stress. You may find that when alone you can sense being a whole, fulfilled human being, but when around certain people, you can’t hear your inner voice as well and feel a bit shaken. You may be sensitive, unsure of yourself or wanting attention. You may feel pulled in many directions when someone you care about is hurting. Be aware of all of these reactions. I invite you to ask yourself: when (someone else) does (something), how do I feel? Or, when I believe (a stressful thought about myself, someone else or a situation), how do I feel and what do I do?
(22–27) Help is Out There—You have some things going on that would cause most anybody some emotional stress. Not only can this be internally and spiritually damaging, but nothing exists in a vacuum. Are your relationships with other people all that you want them to be? Do you feel, or understand, happiness? What role do other people play in your life? If you are looking to change your behavior and not burn out too early in your career think about speaking to a therapist. There are also codependents anonymous groups in various locations. You can find a meeting near you at http://CoDA.org
A great book: Codependent No More: How to Stop Controlling Others and Start Caring for Yourself by Melody Beattie.
1 in 3 people today have been personally affected by the disease of addiction per current statistics. I happen to think it’s even more than that. If you are fortunate enough to have escaped either struggling with it personally or being close to someone who has, then you are quite lucky. Addiction is now an issue of epidemic proportions as evidenced by broadcasts, stories, podcasts etc. that flood media outlets on a daily basis. Unless you live completely off the grid you cannot help but know about this growing problem. Every day the local, as well as national news, seems to be airing a new video of people overdosing. Images of lines of people in front of methadone clinics waiting for their dose in an attempt to manage their addiction come across the screen nightly.
We see the addictions effects for ourselves every day. Clinics are popping up in every major city or town. Marijuana is becoming legal or already is in many states. What about the warehouse liquor stores popping up on every corner? We don’t discuss this as much as alcohol is legal; however, alcohol kills more people than all other drugs combined. And sadly we are abusing it more than ever. Addiction in the world today is obviously a real problem. I think we can all agree on that. And the stereotype of what an addict looks like is changing. We used to think of addicts as people who are living under a bridge or squatting in some abandoned building who are dirty, homeless and strung out. Or someone who has multiple DUI’s swigging out of a bottle in the gutter. These examples are the minority percentage of those suffering from the horrors of this affliction as most can blend in quite nicely; at least for awhile. I think collectively, society is slowly starting to realize that addiction comes in all shapes, sizes, colors, professions, and gender. Socioeconomic status isn’t necessarily a factor in addiction either. An addict could very well be the person who appears to have it all together and the last person that you would ever guess was one.
Professionals in the medical field, including nurses, are not immune. In fact, nurses are at greater risk of abusing substances than the average joe. One would think a nurse would “know better” as they are well aware of the risks associated with using these substances. They also see addictions disastrous effects consistently in their career. So why would they take the risk? It’s hard to say, as everyone has a different story, but there could be a few contributing factors.
Nurses not only are at greater risk for substance abuse but they are also at risk for depression. In fact, they are two times more likely than the average person to suffer from depression which is something to consider. Again, in regards to depression just like addiction, nurses know the signs and symptoms as well as the risk factors of this disease so why aren’t they recognizing it when it’s staring at them in the mirror? One possibility is that it is very hard to be objective when it comes to ourselves. Nurses may have excellent assessment and critical thinking skills when it comes to their patients, but that can fall by the wayside when they are looking within. Another thought is that the signs and symptoms of depression are similar to those that can be dismissed as “just a bad day on the job,” at least for awhile. Fatigue, stress, trouble sleeping and anxiety nurses can easily attribute these things as being par for the course in their career many days. Nursing is a stressful job and extremely overwhelming at times, often you find that you can’t help but take it all home with you. Is it depression or is it just the career that you have chosen? This is not always easy to decipher and easier to disregard until you can’t anymore and maybe you find yourself managing by self-medicating.
But we know better than that. Don’t we?
Maybe we know so much as nurses that some of us can become less afraid of it. We administer these medications constantly. Maybe some of us lose that healthy “fear” of these powerful drugs because we have an ongoing relationship with them. Nurses aren’t the stereotypical junkies shooting up with dirty needles, coping some unknown substance in an alley way from god knows who. We as nurses have access to pharmaceuticals that are regulated. These drugs come in crisp, clean packaging directly mixed or filled by a licensed pharmacist. We have access to clean paraphernalia. We know the mechanisms and actions of these drugs. We are experts in the half lives, the side effects and everything in-between. Maybe here in lies a bit of a temptation to dance with the devil because we know the devil so well.
Where do you turn if you are in the medical field and looking for help for an addiction?
This is a real problem. A nurse or licensed medical professional suffering from addiction will find there is a lack of available help while active in their career. There is also a greater need for anonymity for us as well, which may cause us to further spiral, as it is well known successful treatment is achieved most often from the support of others who have been through it or a licensed professional who specializes in the issue. Going it alone has an extremely low success rate. Many hospitals and hospital entities that employ nurses offer employee assistance which does offer counseling, but I was shocked to learn after reading an excellent article on the website CRACKED, that a nurse actively employed who reports struggling with addiction may be reported, as that is a mandatory reporting situation.
Medical professionals knowing this will obviously be deterred to seek help which in turn will continue to put themselves and the lives of their patients in danger to protect their livelihood. Massachusetts has a program through the board of nursing called SARP, substance abuse rehabilitation program, that is for nurses turned in by an employer but nurses can also voluntarily enter. It’s a five-year program with mandatory meetings and drug testing where in at the end nurses are free and clear to work unrestricted.
What is the answer to this problem? Noone knows for sure and it’s unlikely there is only one. What are your thoughts on nurses and addiction?
“Show respect even to people who don’t deserve it; not as a reflection of their character, but as a reflection of yours.” David Willis
“Yo Nurse!” you hear again coming again from room 311. You walk in and there he is in all of his glory, your patient from a little town called Hellsville 😈 (population to many to count). You took care of him last night and the night before. Round three here you go. “Ain’t it time for my dressing change? You’re late!” He says arrogantly. Why yes it is, you say wishing you had a clever retort but you got nothing. I will be right back. You smile back gritting your teeth. I just need to gather some supplies. “Well I hope you do a better job than last night.” I sure will try my best (eye roll). You turn and walk out of the room mumbling expletives under your breath. God, another whole night of this, you think. How am I going to deal?
In this wonderful profession that we have chosen, who is our clientele? It’s People. Lots and lots of people. People from all different walks of life and people from all sorts of different life circumstances. And not only that but it’s people who also aren’t feeling well.
This can make for from pretty tough situations. Hey look, People can be wonderful. But Let’s face it, they also can be, as I am sure you have discovered somewhere along the line, completely and utterly awful. It all just depends.
And, add to that, we as caregivers are people too. We can be pretty great and also, not so great, depending on the day. And…… on top of that, we see so many of the same situations in the medical field over and over that we can become desensitized, which can also cause a challenge in a patient nurse relationship. Every day is different and every one is different. It’s all a crap shoot. Sometimes everything just flows and other times absolutely nothing seems to go right.
Modify Your Body Language. It Starts With You……..
I am well aware I can look stand offish, and I also suffer from something called RBS (see definition below). I have to make modifications at times ( if I catch myself). You may have to also……..
Look at how you’re standing. Are your arms crossed? Are you smiling and listening to your patient or are you thinking about the 10,000 other things that you have to do? Are you making eye contact? Or are you looking out in the hall to see if the pizza delivery guy arrived at the nurses station yet because you haven’t eaten since you can’t remember when?
People know when you are disinterested and distracted and they want to be heard. Let’s start by looking at ourselves and what we can change to make a better impression to get off to a good start.
Find Empathy Somewhere. C’mon You Can Do It.
Even when the patient is so mean and awful and you find yourself having to dig way down deep just to try and be civil. Think about where they may have come from and/or how they must be feeling. Maybe they are afraid and lonely. Or maybe they have or have had an awful life. You just don’t know unless you have walked in their shoes. You do not have to be a doormat to horrible behavior, but try and think for a moment of what they may be experiencing or have experienced in their past.
I realize that this can be extremely difficult sometimes but try not to take their behavior personally. They do not even know you so how could they hate you this much? They may be acting out because of an underlying issue like fear of being sick or anxiety over being in the hospital. Not being home and overall loss of control. Take a breath before you react. You are the professional, act like it, or pretend to at least.
Let Them Be Heard
At least for a relatively fair amount of time. We all know some people could trap you there for eternity. But try if you can to stop rushing around for a minute. Appear as though you are interested and really try and listen. You may come to a better understanding of your patient and that may make caring for them a lot easier. You may get more of an insight to some other things going on. You also may connect on some level. You’d be surprised.
You have to protect yourself and your time. It is unacceptable for anyone even if it is a patient to be abusive and you have a right to PROFESSIONALLY not put up with it. You can start by telling the patient that it isn’t necessary to speak to you a certain way or yell etc. Let them know that you are trying to help. If it continues you may need to discuss with your manager. Don’t be afraid to ask the other nurses to switch off caring for the patient during the next shift that you work. That’s how we stay sane…. Rotate the PITAs.
Let It Go
This is your patient. Not your family or friend. Try and not take this home with you. It isn’t worth it. It won’t be your last bad apple of the bunch so go home and put your feet up, pour a glass of wine or a cup of tea and pat yourself on the back because you are a survivor…… You’re a nurse.
Definition: RBS is a current slang term for “Resting Bitch Face”.
Definition: PITA literally stands for “Pain In The Ass”. It’s a code nurses use to warn their fellow nurses about an uncooperative patient or relative.
Example: The patient is very sweet but his wife is a PITA.
1. Nursing school is nothing like doing the job. I think that they make the schooling so ridiculously awful to maybe weed out the people that shouldn’t be in the profession.
2. Realize you have to pay your dues. We all have to start somewhere. Usually it’s med surg but not for everyone. Being a new grad is scary and hard, but you need this time to gain experience and develop your critical thinking skills to make you the best nurse that you can be.
3. Put a little water in the commode before you empty it! I learned that one the hard way when I emptied a giant BM in the toilet and a monster splash occurred. Man down. I was hit! Gross…… Almost quit right there.
4. Do not reposition a heavy patient yourself. I don’t care how young and strong that you think you are. All it takes is one wrong move and there goes your back and your livelihood.
5. If you cannot picture yourself in a court of law to testify to why you did something than don’t do it. I once had a Doc write an order for an obscene amount of Xanax to be administered PRN for a patient that I was caring for. And yes, the patient wanted it, all of it, although she could barely keep her eyes open. When I questioned the order his response was, “She takes this at home and she will get her hands on it anyway.” I went to my manager and refused to give it. It was enough to put down an elephant. Advocate for your patient but also yourself. It’s your license.
6 Don’t be afraid to ask for help or admit that you don’t know something. This is not the career to pretend that you know something that may get someone hurt or worse. Check your ego at the door. These are people’s lives you’re dealing with. You need to have some inkling of what you’re doing.
7. #6 Being said…. Know when to fake it. Sometimes you are going to have to appear confident and twist the truth a little. A patient who is getting an IV started doesn’t want to have a nurse do it who has never done it before. You need to exude confidence because believe me, they spot a newbie a mile away, and they will have no problem calling you out when they see that you’re nervous. In certain circumstances when the patient asks “Have you done this before?” your answer is always yes. They do not need to know it was a dummy in the lab or on an orange that you did it on. We all have to do these things a first time.
8. Realize that you cannot completely overhaul a patient and fix all of their issues. Rome was not built in a day. Some of your patients you will never make any progress with. I once got a CHF patient to stop eating Ramen Noodles but that was all she would agree to do. Hey, it was something…
9. Practice self-care. When you are not taking care of yourself it makes it extremely difficult to take care of others.
10. Realize that 99% of the population has a psychiatric diagnosis of some sort whether diagnosed or not. In this career, you are dealing with A LOT of people with A LOT of issues.
11. Treat home health aides and ancillary staff VERY VERY well or you are going to be VERY VERY sorry.
12. Be accepting of what type of nurse that you are. But also, realize you have to be a chameleon in this gig. I for one am not the most coddling and nurturing person by nature. I started out my career on a post-operative surgical floor and it was my job to get people’s pain controlled and then up and motivated when that was the last thing that they wanted to do. That is what I am good at. But also, you have to be flexible and realize when a tough love type of care giver is needed or when a softer more caring approach is called for such as the case with a terminal cancer or a hospice patient.
13. Invest in good shoes. You rarely will sit down…. Like ever.
14. Stop yelling! Just because a patient is old does not meant that they cannot hear. Don’t assume. I was speaking very loudly to my elderly patient once who then turned to me and nicely said, “Sweetie I know I am old but I can hear just fine.” I felt stupid.
15. Go with your gut! I cannot tell you how many times I have had a patient where I just knew something was wrong but in assessing them they were seemingly ok. After you’re in this career for a while you can spot something coming. Send them to the Doc or call the Doc to assess or make a suggestion.
16. The saying sadly is true. If you didn’t document it, it didn’t happen. Yes, documenting is AWFUL, but you need to cover your ass period.
17. Realize that medicine is a science created and managed by humans and guess what? Humans are flawed. You will make mistakes. We all do. Learn from them and move on.
18. Leave work at work. Or you will burn out very fast.
19. Patients get sick and die. Your patients may get sicker and some will die. That’s a fact, and there may have been nothing that you could have done differently. This is life.
20. Know when to move on. You can do so many things in this profession. I never understood why I would see a crabby miserable old nurse who has never left the med surg floor after starting their one-hundred years ago. It’s ok to try new things. You will probably need to maybe even many times over the length of your career.
21. Let the 99-year-old with CHF have the salt shaker. I mean….. C’mon.
22. Go to the bathroom and take your lunch. Patients can wait…
23. An extra five minutes will save you time. I was told this a long time ago as a HHA and it stuck with me. If you take an extra few minutes explaining what you are going to do with a patient and hearing their input on it, it will help you in the long run. No one likes to be pushed around and feel like they have no control over what’s about to happen to them. They are sick and in your care. They already have lost some control.
24. Double check and then check again and then have someone else check. If you do not know something (like a drug you are going to give for example) or are unsure of a dose prescribed or a procedure to be done… look it up, call to clarify and/or have another nurse double check with you. You can never be too sure.
25. Don’t forget to laugh. Some of the funniest things happen in the medical field that none of your non-medical friends will ever understand. Laugh and laugh some more at all of it and don’t forget to laugh at yourself.
Scenario 3: Never Assume!
….. It’s the end of the day and you’re headed to see your last patient who is a new admission. You’re tired and very relieved, as the directions to the home are easy, peasy and the referral which you skimmed this morning didn’t look so bad. Praise Jesus, or whoever you praise… You pull up to the home and sit in your car a bit, now reading the paperwork thoroughly. It appears to be just a dressing change to a small wound from a cat scratch to the patient’s right foot. The patient was seen at her PCP office a few days ago and she has no real significant past medical history to speak of. Less documenting… Yay! It is noted that the patient is alert and oriented, lives alone, and is very independent….. AND…… Wait for it…….. She only takes a baby aspirin daily! You have just struck admission gold you lucky dog. What a great way to end the day, you think to yourself, smiling from ear to ear as you grab your nursing bag and start happily climbing the stairs up to the house two at a time, with a pep in your step because it looks like you will be out of here in no time. Cha-Ching!
And….. Then you woke up from the dream that you were having. How could you be so naive? What is this, amateur hour? You know better than this!
Ding Dong… It’s the visiting nurse, you say as you pop your head in the door. “Come in,” a voice calls out from inside, along with a coughing, hacking, convulsing type of fit. You become a bit nervous now as this doesn’t sound very good. Opening the door wider, you walk in and loudly (always loudly) start to say, are you ok, but the words can barely escape your lips. You are completely overcome with a cloud of cigarette smoke so thick, that you can barely see in front of you. Your eyes start tearing and burning out of their sockets as you drop your nursing bag to the floor overwhelmed by the smell and slightly start becoming disoriented. You are completely overtaken by the smoke and are about to turn around and run to escape it… But then you hear, “Over here sweetie,” from the back of the home, along with a few more coughs and gasps. You blink a few times to see if your eyes have become acclimated to the environment, they haven’t. You could just leave and say no one was home right? I mean you have a right to life, a right to survive for god’s sake. It’s only natural to want to breathe! But you’re morality and the whole reason you got into this damned profession kicks in and you realize that you can’t leave because you’re a nurse and you care…. Or maybe you used to care, or you supposedly care. You have questioned this caring thing on occasion. But you do not have any time to debate this! The longer you’re here the less likely of your survival. You envision a giant ash tray in the back of the house with 5000 butts burning in it. I mean, who can smoke this much? You think to yourself. You remember you’re the nurse and cannot discriminate (I made a funny there). At least it can’t appear that you’re discriminating, and Joe Camel needs care to, you suppose.
I’m coming, you yell, now coughing and gasping yourself. You grab your bag off the floor and open the front door, stick your head out and take a giant breath. I’m going in, you say to yourself. God, why can’t anything be easy, you maddeningly think, as you start to blindly make your way to the back of the home. On your way, you hear a familiar hum and spot what looks like an oxygen concentrator (obviously Joe Camel is on O2) in the hallway and feel for the tubing. Maybe we will blow up today too…. Perfect ending to a perfect day, you say to yourself.
How anyone is surviving in this atmosphere is beyond anything explainable. It seems often in home care all that we have learned about the human body is tested. It consistently defies everything we have been taught.
Hello, you say again, continuing to follow the tubing to a closed door. Your make up is running down your face. You can feel it. You already have a noticeable wheeze and your breathing is becoming more intense and labored.
Instant emphysema….. Defying medicine daily.
Panic starts to set in. I’m going to die here, you think. “I’m in the bedroom sweetie.” the voice croaks with more coughing… You feel the door knob and hurriedly open it. You can see the outline of what you think is a person, in what appears to be a chair, seemingly right in front of you, but you’re not quite sure. The gray, sickly color of the smoke is almost the same color as the gray, sickly (possible) person in the chair. You then see the red end of a burning cigarette coming from the smoke cloud and obviously smoke isn’t smoking itself…… Or is it? Maybe you’re O2 Sat is so low that you hallucinating. You slap your cheeks and assume that this must be your patient smoking in the smoke and then let out the only two words you can now barely manage to muster as you are taking your last breaths on this planet and your organs are beginning to shut down…….. Open window, you say to the cigarette, gasping, as you start to bargain with God for another chance at life. “OK sweetie, open a window.” the cigarette says appearing suspended in air while moving slightly in-between coughs. You scan the room and see what appears to be a window. You assume this because the dripping color of yellow in this small square area is a bit brighter than the darker, runny stained yellow covering the rest of the room. You feel around and fling it open while simultaneously falling to your knees and then slamming your face against the screen, taking a few giant breaths. Smoke pours out of the room and the air begins to clear. You slowly become alive again. A few minutes later, and still on your knees, you cough out the last cough you can manage without a lung collapse and stick your hand out towards the patient, which you can now see is a little old lady; a little yellow, gray, leather shoe looking lady, but a lady none-the-less. Hello….. I am the visiting nurse, you say pulling your face away from the screen. Let’s talk about oxygen safety first, shall we….. cough, cough.
Scenario 5: You Can’t Always Believe What You Read…
The smoke has cleared a bit and you survived…. For now. You pull up a chair next to your patient and begin your assessment as you cannot get done with this day fast enough. So, you have a little foot wound from your cat I see, you start to say to your patient while looking down at her…… Oh my God! You shout, looking at what was once a leg…. maybe. Apparently, this patient’s cat is a ferocious tiger monster. The leg, (if that’s what you want to call it or half eaten, tiger mauled raw hamburger appendage) has +100 pitting edema and looks as red as the burning cigarette tip in the ash tray next to the patient. Her dressing is obviously on the floor and looking closer, it appears the tiger has been rubbing against the leg all day as the wound bed is covered with a thick layer of orange fur. The serous drainage is spilling over the threshold of the room into the hallway which you just walked through (note to self: burn shoes). This looks pretty bad, you say to your patient as you look around nervously for the tiger monster. Did your doctor give you anything to take for this when you saw him the other day? you ask. “Nope,” your patient states. “Not that I remember, and I am not going to the hospital!”
Of course, you’re not, you think to yourself. Life could never be that easy.
So…. What can you do? You call the PCP and after getting disconnected and being placed on hold for 20 minutes, then getting transferred to three different people and explaining the situation each time to each one of them, you are told you will get a call back, which you know that you never will. Or you may get the call next week. Little old leather lady doesn’t have a week. You then go on to change your patients dressing as ordered, but that then took much longer than expected because the monster tiger cat appeared and walked all over your sterile field (I use that term very, very loosely and laugh out loud as I write it). The beast then went on to take the last rolled gauze you have and is chewing it in the corner while giving you a death stare. You leave the monster be because, well, obviously you saw what it did to the leg that you’re wrapping now with a make shift rolled gauze of 4×4’s you McGyvered together with tape.
You complete the wound care (if that’s what you call it) along with vital signs and the rest of your head to flaming red, draining, ouchity, ouch, ouch, tree trunk with toes assessment. There were a few issues along the way, like when you asked to see the patient walk, because well, she doesn’t. And bathing….no dice there. What about toileting? Yup, sure, if you consider the recliner she is a fixated to a toilet.
Essentially, your patient sits in a chair all day refusing to go to the hospital dying a slow death, while her cat uses her as a scratching post and is happy to be there instead of the ED down the street. This description will be the start of your clinical note and you will find the start of quite possibly many of your clinical notes over your home care career.
Now the last part, as we save the best for last…… Let’s talk about your medications, you say, sounding hopeful. You’re in the home stretch. You just need the doc to call back sometime this century and next review her meds and how she takes them. You take a big gulp and say, the referral states you only take a baby aspirin, and well, you also have the oxygen……. while holding your breath awaiting a response. There is a long pause and you start to plead with God in your brain to let this be true… pretty, pretty, pretty please. Your patient smiles and points to a table across the room. “My meds are in there” she states. You look across the room to where she is pointing and notice a giant storage bin that in black sharpie has the words CHRISTMAS DECORATIONS on it crossed out and underneath is the word, MOM’S MEDS. You walk over slowly not wanting to lift the cover but you have to. It’s your job, damn it, you tell yourself, psyching yourself up. Maybe there is just a little bottle of 81mg aspirin at the bottom all by its lonesome self just rolling around right?
And then again, you woke up………..
Don’t get me wrong… you do sometimes get that, Golden Admission. But in home care, you have many challenges and need to improvise from time to time. My real point is that you cannot always trust what you read. It can be a very different picture in someones home. Sometimes it’s pretty and sometimes it ain’t.
Home Care…. Sounds as though it may be easy for any of you hospital kids that may be looking for something different, right? Maybe you’re looking for a change or are just so incredibly tired of the insanity of it all, and who can blame you? Hospital nurses work long hours. Then you’re stuck in a poorly ventilated building with patients who are getting sicker, heavier and crazier by the day. You have all of the staffing issues and your working holidays, and weekend/night rotations. You’re killing yourself. You go above and beyond to cover being so short staffed. And let’s not forget the endless charting. But you couldn’t forget that if you tried. Your hands are slowly starting to turn into claws from the repetitive pressing of the keyboard. Your temples pulsate and your head feels like it is in a vice. It’s worsening by the minute from all of the straining your eyes are doing while staring at a screen charting… charting… charting!
Eureka! Maybe home care is the answer. It would be such a nice change of pace, wouldn’t it? Driving around all day, you can stop and get a coffee or pop into the bank, maybe run an errand or two. You can even pick up your dry cleaning! You won’t miss another school play and can maybe make all the parent teacher conferences, not feeling like a bad parent for once. Your children may actually see you every day…… Sounds perfect, right?
Well, yes… these are the advantages and home care does offer these things. You do have autonomy. You can schedule your day usually in a way where you can do all the above mentioned. These definitely are the perks, and it is something to consider. Home care works well for people especially those with small children. I have found that management in home care is very understanding of family obligations as most of their staff are mothers. I did not have that same experience in the hospital I must say. So, home care may be for you…
But…… don’t forget that everything has a but….. And before you make that career changing decision, maybe we should take a little looksee at what home care may also be like at times… Here are just a few of the many challenges……. Buckle up.
Challenge #1: No More Sterile Environment. This is Their Turf on Their Terms.
Ding Dong……”It’s the visiting nurse,” you say, and enter the patient’s home after being invited in. Of course, the word home is a relative word and could mean different things to different people. For various reasons, consider that home for your patient may be one of the following, however, not limited to: a hotel room, shelter, half-way house, porch, sofa on a porch, mattress on a porch, mattress on a side walk, a shed, a car and even a school bus. Just to name a few. Interesting, right?
Let’s also not forget that not everyone lives the way that you do. But if you are a hoarder, recluse, with a love of collecting cats, then you may be slightly prepared for some of the more challenging households in this field. Better still….. If you are a hoarder, recluse with a cat collection, flea infestation and a love for putting doll heads in mason jars then you are even more prepared for this gig.
Now, these are the worst-case scenarios but they are very, very real. You will not be in your nice sterile hospital environment. You’ve been a little spoiled in this regard. You are in their environment. And that environment may be one filled with doll heads in mason jars. So, this comes with some interesting challenges. For example, you cannot go into someone’s home and tell them they cannot smoke. It’s their home. and they will be sure to let you know it. They can do what they want and live how they want within reason. My how the tables have turned on us.
Challenge #2: Getting to the patient’s home should be easy, right?
You also need directions to the home. Sometimes this may be as easy as go up two streets and take a left and it’s the big green house on the corner. Your GPS will effortlessly take you right to the door. Easy peasy right? Or, you may get something sounding like this:
“Go up the alley and then up the two flights of stairs over to the left after taking two rights. Watch out for the pit bull, he is vicious. Then, and if my neighbor comes out screaming, just ignore him as he is crazy. Next.. climb the fence and leap over the hedges. Don’t mess up my hedges! Also, sorry we didn’t shovel and by the way, we will never shovel. We can’t shovel and do not own a shovel. Shoveling is not an option for us. Now wade through the snow drifts and be careful of the two-inch thick unsalted ice covering the rotting stairs to the front door. Hopefully, you can find the stairs. If there is a woman at the end of the stairs hanging around, provide her with a secret hand shake (you are then instructed how to give the hand shake). Next, it is very, very important that you MAKE SURE that you call first, please! If no one answers call back ten times and let it ring. We will pick up after ten times. Be there right at 10 am as Wheel of Fortune is on at 11 and Days of our Lives comes on after that, so do not be late! Make sure to knock three times at the door as the doorbell doesn’t work and we will never fix it as fixing it is not an option for us.”
Reading the directions and two panic attacks later about the directions…..
You follow everything said to the letter. You are there right at 10 am. They know that you are coming, RIGHT AT 10, as they requested, RIGHT AT 10. You called to confirm this and then called again as you were walking up the alley calling the ten times as instructed and letting it ring. Your patient answers and you tell her you will be right there as you huff and puff while trudging through the snow drifts then faking out the pit bull with the bone that you stopped and bought, throwing it as far as you can while making a break for it and sprinting up the icy stairs. You feel a crunch under your boot and lose your footing, then fall and seemingly sprain your ankle after getting it caught in a hole in the rotting wood. Wearily, you start to get up and you now notice that the house which you hadn’t paid much attention to is clearly a haunted house of horrors, making your day that much better. You consider the possibility that you may never make it out alive. You think about turning back, but you’ve come so far! You drag your throbbing limb up the last few steps and reach for what is obviously a giant gargoyle door knocker. You tap three times on the door trying to catch your breath and are ready to give the secret handshake just in case there is a woman inside who asks for it, as she was not at the bottom of the stairs as stated, in the instructions; although she surely could have drowned and frozen to death in the ten feet of snow which had drifted there. No one answers the door. You are a thousand percent sure Pat and Vanna aren’t on yet because you can hear Maury Povich saying “You are not the father,” so loud coming from inside the house of terror that whoever was in their wouldn’t hear you if you bulldozed the house down around them. You look at your watch. Ugh! It’s 10:05. You knock again and again. No answer…. You call again and this time, of course, no one picks up, and you are on the 11th try.
Challenge #3: People are not Always Reliable or Sane and Kind of do Whatever the Heck They Want to do Sometimes….
Alrighty then….. Recap: Your patient isn’t answering the phone or the door and you are one step away from a total mental collapse. You next call the emergency contact listed in the record. They say hello and then begin to scream at you in alien they then start hysterically crying and hang up. But you persevere…. You call the patient 15 more times and knock again. Sometimes I picture that the patient is inside peeking out an upstairs window laughing at me as I am calling and knocking and looking at the time, about to have a nervous breakdown and mumbling gibberish to myself. I mean they must be right? Or, I think that I am on an episode of Candid Camera as this stuff doesn’t happen in life, right? Wrong!
You have no other option but to now call EMS per protocol and wait because maybe the patient has fallen inside the home or something worse, although you look in the window and notice through the cob webs and dead flies, what appears to be some white hair slightly overflowing the top of a ripped old recliner in front of a screaming Maury Povich on a giant TV screen. You assume this white hair is attached to a head but would not be shocked at this point about anything. You wonder if the patient is ok, or is it that she just cannot hear you. You know for certain that she cannot hear you over Maury. Nothing of this planet could hear you over Maury right now. You sit and wait, rubbing your now swollen, throbbing ankle. EMS arrives and you exhaustingly say hello while trying to explain the situation. One of the crew angrily shushes you saying, “We know!” He looks as if he wants to choke the life out of you as apparently, you are told, that they are at the haunted house of horrors daily. I would want to choke me too. Just then it becomes eerily quiet. The door slowly opens as the EMTs are going to attempt to get through and there is the patient. She looks around at all of you and then proceeds to yell at everyone. She shakes her cane and goes on to say, “No one was to come when the wheel is on! I have been waiting for an hour!” She next slams the door in everyone’s face and of course, the gargoyle door knocker falls on your other foot because, why wouldn’t it? You start to then rethink all your life decisions that got you to this point, as somewhere along the line you realize that you made a very big mistake. Now defeated and horrified at the possibility of coming back here tomorrow, panic sets in as you remember that you stupidly only brought one bone for the pit bull on the way in, forgetting that you need to also not die on the way out. Home Care Rookie Mistake…… You start to cry to the EMS guys and thankfully they take pity on you, as one of them shakes a bag of milk bones and says the best sentence that you have heard all day, “Let’s get the hell out of here.” You are relieved and happy that you won’t die yet today and follow them closely back through hell.
Home care like any job has its benefits and its challenges. It’s all about what works for you. I would not have been a proud home care nurse for as long as I had without loving many aspects of the job. I just want you to have all the facts friends. And, I know it may seem that I am exaggerating for effect, as I have been known to embellish from time to time…. And, well, yes….. I can honestly say that I am. But just a tinsey winsey bit, as the EMS folks are generally always pleasant…..
Stay tuned…. More to come.