Little_Mouse 4,506 Views
Joined Feb 28, '09.
Posts: 147 (29% Liked)
I found this on scrubsmag.com the other day and thought this might help give anyone struggling little piece of mind. Even though I have yet to even start nursing school, I found that this helped alleviate my fears of if I'm smart enough, capable enough, and so on since I have a bachelor's degree in a completely different field (econ and business) and have already had moments of doubting my ability to do this! After reading this I promptly saved it on my computer so that I can refer to it when I'm feeling low these next few years:
Here is the recipe for saving your sanity and maybe your career:
Refuse to panic. You can perk up some when the pressure is on, but panic tosses reason out the window. Tell yourself that you can do this. Take a deep breath. And then do it.
Stay connected to healthy co-workers. Ask for help when you need it. Build others up and hope some of that goodness comes back to you when you need it. Reach out to someone else who's having a bad day. It's amazing how that can arrest a downward spiral, in them and in you.
Keep the big picture in mind. Take a step back to ask yourself what's most important at that moment. Prioritize. Reassess now and then. But whatever you do, keep on keeping on.
Just say no to shutting down. Don't fall apart. Don't drop out. Don't give up. Don't quit.
Even if you have to regroup later, don't make any major decision in the midst of an emotional meltdown. Just a few minutes (or hours or days) can make a world of difference.
Borrow someone else's perspective (make sure they're trustworthy and in your corner) when yours is shot. Take time to process your emotions. Learn to set aside worries (write them down, talke to a trusted confidant, pray about them), and turn off the "endless loop"--that litany of all your faults and errors==that prevents you from sleeping or enjoying your time away from the job.
Jettison the tendency to beat yourself up--that helps no one! Determine that you will treat yourself well, no matter what. Make a nice meal. Take cookies to a neighbor. Cuddle with someone you love. Substitute a calming mantra for the barbed wire accusations of self-condemnation.
Make an action plan for yourself that will improve both your skills and your disposition. Learn the difference between who you are and what you do. Cultivate and show gratitude.
Look at each shift, not as another loop around the noose, but as a fresh start.
Try to connect in healthy ways with your co-workers and give them a chance to draw closer to you. Be aware that while each of your flaws shows up as a permanent aircraft carrier on your radar, othe rpeople are most concerned with their own lives and they see your errors as little blips that fall off their screen pretty quickly.
Do not embrace intentional hurt. Hold any criticism at arm's length. Examine the thoughts and extract anything helpful. Give the rest a vigorous toss the way you would a live hand grenade. Thank those who care about you for their concern and input. Thank even your foes for the truth tucked into their harsh words. It confuses them greatly.
At the same time, don't look to your job to validate your existence. Get your strength and personal affirmation from those you love.
this battle takes place in your head and in your heart. But the good news is that you are in charge of deciding who wins. Please, please, please, pick you!
Hope this helped someone Good luck to all of you! Your stories continue to inspire me every day. Oh, and janice_c67, I stress eat too haha. Chocolate chips and peanut butter anyone??
We all have bad days.
I remember when I was new, bright eyed, bushy tailed, rampantly sarcastic (look, some things never change, alright?) and I used to look about and wonder why in the world it never seemed like the most awesome of the awesome never had a bad day, a hair out of place, a drop of sweat on their brow, or their teeth set so hard they were gritted down to nubs.
I used to pray to be so unflappable. I used to dream of the time when I would be viewed through that blushing lens of being labeled the go-to, the machine, the reference, the "strong" nurse.
And then one afternoon, I'm roosting in the lounge with a pack of saltines and a glass of ginger ale (be sure to take care of your stomachs, my friends. Ulcers are no laughing matter), and this new nurse marches up to me and steals one of my saltines.
Okay, fair enough. That is one way to get my undivided attention.
Yet before I can question what spurred this random theft of my stomach appeasing snack, there is gesturing, crumbs speckling through the air like confetti and the firm demand, "Tell me what makes you so special?!" christened on the end of a pointing index finger.
The beauty of the OR? We let our eyes talk for us. And as I had a mouth full of saltine, I allowed for therapeutic silence and some good old fashioned eye contact.
She nibbled her cracker with a defeated sigh. "Nothing seems to faze you. You...you're just awesome."
So let me tell you what I told her: No, I'm not awesome. I just do what I do the same way every day. I still have a lot to learn. And yes, a lot fazes me. The rest? What you see? Well that's just acting.
I pretend, therefore I am.
It is in this spirit of leveling, of "dipping my hand" so to speak, that I will now tell you about my day of epicness so astounding, so thrilling, so riddled with KaBAM power, that you may have to avert your eyes or at the very least wear sunglasses:
My day began as any other, sans hair conditioner. Now, to some this doesn't sound like a big deal, but with my hair which hangs down to my rump, no conditioner generally equals doing battle with the equivalent of a premenstrual yeti suffering from a septic hang nail and a case of mange.
Hair finally subdued, dressed, etc etc, I attempt to leave only to lock my keys....all of my keys... securely in my house. Thank goodness this time I was actually dressed when it happened so I could go to my neighbor and fetch my emergency key.
Key fiasco squared away, off to work I go. Now at work, in fact, I'm still at work (yay for call), my journey (which the bards shall sing of for ages to come) continued thusly:
Coffee maker remains broken. I remain sad. Surgeons having screaming matches with anesthesia in the hall for reasons equaling something along the lines of: He won't give me my Slinky! A frisky patient attempted to goose my ta-ta <--yes that is a technical term. My favorite pen fell out of my pocket during a patient transfer and was discovered over in PACU when the patient kept complaining of "something poking my thigh".
A kidlet, who was supposedly NPO, spewing <--again with the technical terms, Spaghettio's all over and more importantly down my scrub top which lead to a demise of a well loved undergarment (huzzah for ace wraps) and a need for change of scrubs #1. And cue surgeon yelling at anesthesia. ::sigh::
My favorite trauma shears snapped in half while cutting through a patient's pants and, of course, the surgeon looks at me like I'm some nit-wit that had nothing better to do than set him up with a sure to implode pair of scissors. Later in that same case, while flipping the foley up in order to shift the patient over to the inpatient bed, the foley bag exploded, yes, that's right, exploded. You guessed it: demise of lower region undergarment and change of scrubs #2. By the way, if any of you are interested, the mesh pants commonly given to patients as dressing or in L&D are actually quite comfortable. Make a note of it. Moving along.
Blah blah blah, a case and a half later, I'm in the middle of a lap chole turned open, when I'm scuttling across the room, trip over the kick bucket (how in the world do you miss a bucket?! A bucket that you put there?!), and catch myself from falling by deploying my forehead against the wall as a make shift kick stand. Dragging my wounded pride with me, I managed to get everything for the field and things seem settled until I'm answering the surgeon's pager and he's giving me the eye. I'm annoyed and in no mood so after a hissed, "What!?" He gives a little jabbing motion with his chin and answers, "How are you liking the breeze?" The scrub tech is snickering, anesthesia is about a split second away from aspirating his mask and I am dumbfounded.
My friends, apparently under the strain of fighting gravity, my pants had exploded. I'm not talking ripped a little or split a seam or even became threadbare. I'm talking shredded like a pair curtains shut in with eighteen cats on a catnip bender. How in the world I didn't feel anything...I will never know.
But thank heaven for mesh pants.
And so here I sit, nibbling saltines and nursing a ginger ale and wanting you all to know: We all have days where we doubt, where we question, where we wonder why in the world do I do what I do.
We all have bad days.
But in the end we have to hang on, learn what we can, hike up our mesh pants, move forward and keep in mind that, if nothing else, it makes for an interesting story.
Keep the faith,
She knew what she wanted.
She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.
So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.
"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."
Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.
"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."
The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.
"I wish to die a peaceful, natural death."
She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.
"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."
Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.
"I wish nature to take its course, with only medication to prevent pain and suffering."
The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."
"Allow me the dignity we give to beloved pets. Let me die in peace."
I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.
Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.
"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."
She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.
And so was mine.
At the risk of jinxing everything, I'm going to say it: I never thought I'd find my perfect nursing job.
In fifteen years as an RN, I've held a grand total of thirteen jobs. Granted, some of them were part-time positions I worked along with other part-time or per diem jobs, but I have never held the same one for more than 2 1/2 years. I've bounced back and forth between bedside and management, hospital and LTC, geriatrics and OB; I've worked at the same hospital a total of three different times. (OK, one of those times was back when I was a CNA, but it still counts in my book.) I've held some jobs for two years and others for two months....left most of them voluntarily, but I've also been laid off due to injury, "encouraged" to resign, even fired (once).
In fact, the one commonality among all these different work situations is the determination with which I started them: with a couple of notable exceptions, each and every one was going to be The Last Job: the one I'd keep until retirement. I'd always plan to stay with it for ten, fifteen, thirty years or more until such a time as I saw fit (or could afford) to leave the workforce for good.
Reality check: the honeymoon period always ended, my brilliant performance and top-notch skills were soon taken for granted, and I became just another brick in the wall. Well, that was intolerable, so I'd get restless and irritable and my performance would become inconsistent; at that point it was all over but the shouting, as I would decide that I deserved better and renew my quest. Sooner or later, I'd find a new and improved workplace, interview well, impress the management in the early going.....and then the cycle would begin again.
Then, as luck would have it, I literally blundered into my current job in the fall of 2010. I was surfing the Internet and found two different places that interested me; being directionally dyslexic, I naturally got turned around during the drive and wound up in the parking lot at my second choice. So while I was there, I decided to apply......and when I left there after 8 that night, having not only interviewed with the administrator and floor supervisors, but eaten dinner and been introduced to the residents and family members, I had myself a new job. And, barring anything unforeseen, I'll leave my Shangri-La when I'm ready to hang up my stethoscope forever.
No, I haven't yet been here two years, so I can't say this is my longest tenure. It's a 30-mile commute each way, which gets old when it adds another hour and a half to my day; but I won't move to the city where I work, so I use the drive up to pray and meditate, and the drive home to decompress. The facility is a beautifully appointed assisted living community where many of the staff have been on board for five, ten, even 15 years....ever since the building opened.
My executive director---arguably the most decent man in the universe---has been there for six years, which is almost unheard-of in the industry. The floor supervisors have been there for almost as long, and their system for managing the med room and floor staff has remained largely untouched by me, as it's the most efficient and accurate I've ever seen. I don't have to deal with staff scheduling. I don't have to order supplies. I don't even get most of the after-hours phone calls.
That's not to say there aren't horrible, awful, terrible, no-good days. We have a few residents I'd like to bounce out on their ears, and a few more I want to keep but evict their families! There's too much drama thanks to the fact that 95% of our staff is made up of 20-something single moms (yep, lots of estrogen running amok here). Most of my job is administrative, so I sometimes miss the bedside role---my fingers itch whenever I watch the paramedics attempt an IV start on a resident in distress, and I have been known to change the wound vac dressing on a Stage IV pressure ulcer myself while waiting in vain for the home-health nurse to come out at five o'clock on a Friday night.
But the annoyances of this job are minimal, compared with the sorts of issues I've dealt with in previous positions; and even if they weren't, I'm too old and tired to want to compete in this economy with nurses who are decades younger and more technologically savvy than I. Besides, my old restlessness is gone......I just don't see the need to keep looking for the pot of gold that we all know doesn't exist at the rainbow's end.
More than that, I realize that I am never going to find a better situation than the one I'm in right now. I turned down a huge promotion last winter that would have meant more money and power, but somehow I knew that I'd wind up hating it because it involved so much travel, and then I'd want to come back to familiar territory.....which of course would have no longer been mine. I guess you don't get this far along in life to be completely stupid.
So nurses, if you haven't landed that "perfect" job yet, you might just want to put that search on hold, and go for "good enough". Trust me......you'll know you've found it when you're reading your morning newspaper and realize that you haven't checked out the classifieds in ages.
Carelessness can cost everything you have, your work, hope, dreams, and most especially your life. So it so imperative for every individual to become careful and vigilant especially people like us in the medical field because good health can be the best investment we have in order for us to exercise our profession successfully and effectively.
Way back 2006, I was a newly BSN graduate waiting for the result of my board exam to be released. And while waiting, I volunteered in a private hospital for me to enhance my knowledge and skills and have a pertinent experience needed for my application for work to a bigger hospital someday if ever I'll pass the exam. Little did I know that some unexpected things might happen to me during my stay here.
Well as a newly graduate, I am so eager to do first hand experience in handling different kinds of patient without the supervision of a CI. I am so active in attending patients such as interviewing them, giving medications, taking their vital signs and charting. I almost want to do everything. During the 8 hours duration of my duty, I spent more time staying at bedside of the patients. If there are procedures to do with the patients, I am volunteering to do it as long as I know it and I can. That's how eager and enthusiast I am during those days. My immediate superior is so happy to have me there. I encountered lots of patients here with different illness such as Dengue, Influenza, Stroke, Malaria, PTB and Vehicular Accidents to name a few. There is this particular patient who stayed longer in the hospital than others because of the severity of his case. He was a PTB patient with matching chest tube. Due to the severity of his case, we are monitoring his vital signs more frequently and check his tube placement. Sometimes, I was allowed to do the changing and cleaning his chest tube. We are wearing PPE such as mask and gloves when we attend to his needs and we also wash our hands after. But there were times that I forgot wearing mask when I go near the patient inside the isolation room and while taking his V/S, I only remember wearing it when I am about to finish. So careless of me eh. That's my duty routine everyday. Although it is tiring, it still feels good inside to see my patient reaching out to me for all their problems as if I can solve them all, haha. But more of it, their simple thank you brings a lot of joy in my heart. I really felt satisfaction in helping, caring, and nursing them. And I always end up teary-eyed every time I hear their sincere TY's .(So emotional eh)
Moreover, while I am making myself busy on my duty, I also keep on praying everyday for a positive result of my board exam. Then comes January 15, 2007, it is my day off and little did I know that this will be one of the happiest moments of my life because I learned that I pass the exam. As expected, my family, relatives and friends were so happy for me. Furthermore, after knowing that I've made it, I seriously start planning what I will do next. I know this is the beginning of the next level of my life. I told my parents that I will start looking for a real job in order to help them financially. Then eventually, I will apply for a work abroad after gaining enough experience for me to qualify to work abroad. I hoped, my parents hoped that I will be the one to help them escape poverty and help my other sibling go to school also. So I promised myself to do everything in my power to fulfill my dreams because I want them to be happy and I don't want to disappoint them. But my grandmother who was based in Australia has other plans for me. She wanted me to take IELTS exam because she plans to get me there. So I told myself, "this might be the first step to the fulfillment of my dreams so be it". Then I went to the city to review for my IELTS exam. But there are unexpected things that happened along the way. I didn't take the exam on the supposed date because of the delay of the financial assistance of my grandma. Perhaps miscommunication happened between me and my grandmother. I got disappointed and frustrated so I did not pursue my exam, instead I tried applying for work here and abroad because I really wanted already to be of help financially to my family.
I keep on passing to almost hospital here in the city and at the same time keep on hopping to different agencies for work abroad. And fortunately, I was lucky enough to pass an interview and exam for a work abroad. So I processed my necessary papers needed such as passports and authentications of my documents and lastly, I undergo medical exam. After my med exam, I was so happy because based on the situation, I am about to start attaining my dreams although it is not as exactly as I planned. But still I am happy and satisfied with the way things are happening.
But the worst thing is about to happen because one day, my agency contacted me and informed me that there is a problem to my medical exam. So I went to the clinic where I took my med exam to verify it. I still recall exactly what the clerk told me about the findings. "I am sorry Miss, you've got Undetermined PTB Activity on your X-ray, and you need to consult a doctor". I was stunned for a minute and I did not know how to react so I just got the result and walk out of the room speechless. When it fully sinks my mind the indication of this problem, I told myself "It can't because I didn't feel any signs and symptoms and I am healthy! Maybe they just made a mistake. I am in a denial stage. Then the next thing I know, I am already inside a church kneeling while crying and asking God "Why me Lord? What now? It's not fair? How will my parents react if I'll tell them? Surely they will be as hopeless as me." I no longer know what to expect in the future. I felt so devastated and numbed in pain that time. As if it is already the end of my world.
Although my parents are expecting that I am about to work abroad, I didn't told them immediately that I am not fit to work abroad. Instead I just told them that the result of my exam has been delayed and that my visa is not yet released. But I decided to inform them that there's something wrong with my med exam and that I need to complete a medication first. It also occurs in my mind that maybe it is better off if I will die than living in this world useless. I was really so hopeless that time but I come to realized that maybe God has a better plan for me that's why things like that happens. I began to hope again, besides I really don't want to lose hope because I am the only hope of my parents and I know they still needed me.
At present, I already have a job but I am still hoping that someday I can still work abroad. And as I look back I know where I possibly contracted my illness. It is during the days that I am so eager learn without taking enough precaution to my health. I called it my carelessness days. Even though I regret those days, I can no longer undo it so I might as well just leave everything to the mercy hand of the Lord. I know He has a better plan for me.
The lesson that I've got is that Good Health is one of the best gift that God bestowed on us so we need to do everything to preserve it because as I've said carelessness might cost everything we have. And one thing more, never hurry everything. We should develop a virtue of patience. Always put in mind that God knows best so never let our hope and faith fade in spite of many struggles and hardships we've been through. And lastly, in spite of what happened to me, I still love my nursing profession. I will never forget the good feeling that reigns in me every time I extend my care and help and most especially every time I see the thankful smiles of the ailing patients for the things I've done to them. So to all nurses out there, never lose hope and faith, treat every hardships and struggles as motivation for you to successfully attain your goal in life against all odds. I know this article of mine is quite boring, but as I finish writing this you don't know how happy I am to share this. And I know that in my heart, I already forget the pains that I've been through. Thank you for reading it.
Well I dont have any problems medicating people for pain heck I have had some major abd. surgeries myself and believe me I wanted my pain meds it just seems to me though that we have been giving really huge doses, and not to mention the headache pt. sat right in front of me after I medicated her, half knocked out eating her doritos and drinking her coke that her pain is still a 10, come on.
Depending on the area of the country you work may depend on the popularity of a certain drug. I do know Dilaudid has become a very effective and popular drug of choice for relief of pain.
It is believed that Hydromorphone displays superior solubility and speed of onset, a less troublesome side effect profile. It is thought to be 4-6 times stronger than morphine, but with a lower risk of dependency. Hydromorphone is, therefore, preferred over morphine in many areas ranging from the ongoing treatment of chronic pain syndromes, the emergency department to the operating room.
Hydromorphone lacks the toxic metabolites (e.g., norpethidine) of many opioids related to pethidine and some of the methadone and tends to cause less nausea than morphine. It is a common alternative for those tending to have hallucinations from fentanyl administered through dermal patches and other dosage forms. In addition to the above, hydromorphone usually proves to be the best alternative of choice to morphine and fentanyl in severe chronic pain, especially for severe breakthrough pain.
thats it, i just love my days off , i like working hard on my last shift and waking up having 3 days off its great, sleeping in , relaxing all day, going to the beach , or just sitting around all day with my two girls , heres to days off !!
ah, it never ceases to amaze me when kids come into my office nearly doubled over with a stomach ache and i'll gently suggest they use my bathroom and try to move their bowels... then lordy mercy they are miraculously cured! Some times it's like i'm performing miracles in here! lol
I wouldn't say I'm a leader, but I've received compliments for actually doing something when things go sideways. Some folks (even experienced ones) kind of freeze up and hesitate for a moment, particularly when it's a sudden and unexpected change. I'm one who generally jumps right into action without hesitation. I'll try to explain my thinking and how I avoid freezing up. The key in an emergency like this is team work. No one person can optimally manage a true emergency alone.
One model for decision making is the OODA loop (PALS has a modified version in its curriculum). In decision making you observe something, orient yourself to it, decide what to do, and act. The quicker you get from observing something (say low SpO2 and unresponsiveness) to acting the better off you're going to be. The best way to decrease that time is to consider what you would do in various scenarios. For example, know what you're going to do if your patient stops breathing. When you see the patient stop breathing don't think, just do what you've already programmed yourself to do. Thinking through how you'll respond to various emergency situations is one of the most important things you can do.
Always expect the worst and prepare for it. For example, if the patient's respiratory status is rapidly deteriorating it would be prudent to provide him with more O2 and prepare a BVM along with all the other interventions. Sure, you might not actually use it if less aggressive interventions (e.g. stimulation, repositioning, reversal of drugs such as paralytics or opiods, etc.) are successful, but it's better to be ready.
Intervene early and aggressively. If something's not right fix it before it becomes a disaster. For example, if you notice a disturbing trend in your patient's VS reacting early on and preventing it from turning into a code is ideal.
Don't be afraid to tell others what they need to do, esp. if it's your patient. Coordination is important. Someone needs to immediately assign roles.
Don't worry about looking like an idiot and allow it to paralyze you. Do your best to do the best thing for the patient. It's not about you, it's not about your coworkers; it's about the dude in the bed.
ETA: does this topic really belong in this subforum? It's less about formal leadership and more about how to take charge during emergencies.
Also, stop TALKING while I'm trying to give report to a group! It's distracting. So is saying hi to all the male employees while I am trying to do nurse to nurse report, the reason I don't like giving you report is that I end up staying half an hour later because you want to socialize!
Here is my most gross, yucky, disgusting nursing story!
I was working a night shift on a tele floor as a new Nurse.
We had this one poor old lady who was confused and was restrained as usual for her safety. She was our designated resident nightmare geri from hell, so she was placed near the Nurse's station.
So we are chilling out at the Nurse's station, chatting and trying to get through another night...
Suddenly, out of the corner of my eye, I see our lady in question standing in the dimly lit doorway of her room!
I instantly leap out and run to her. As I approach her, she appears to be falling towards me, so I meet her in a bear hug...my arms around her waste, and her arms around my shoulders.
As I catch the lady, I notice a very strong smell of feces, and I feel something warm on my hands, arms and shoulders...
My fellow heroes come in behind me, and as the lights are turned on, my worst fears are instantly realized.
Yes, I caught the poor old lady with a good old bear hung football catch, but I was also covered in the lady's feces.
As I look at her, she has feces smeared all over her arms and hands... (and even her face!)
And of course, now so did I!
Dogs are absolutely creatures of habit. They tend to freak out when routines are changed. She is probably feeling insecure to the nth degree.
Does she socialize with other dogs? When I had to change my shift a couple of years ago, I knew that my dog would have a hard time acclimating. I took her to "doggie day care" a couple of times a week just so she could socialize, get some nervous energy out and not be alone so much. That decision was worth every single penny I spent!
Remember that dogs are pack animals-they like to be around others. Taking her to the dog park or taking her to doggie day care even once a week would more than likely calm her nerves.
She might be shedding more than normal because we are at the change of season right now. The seasonal change coupled with her nervousness will no doubt produce more shedding than normal.
If you can play with her for about 20 minutes a day-real, hard nosed wrestling (if she enjoys that-mine sure does!), throwing the ball, and having your undivided attention for this short period of time will reassure her that you aren't going anywhere. When I put my dog in puppy school (PetSmart offers a puppy obedience class that was an absolute GODSEND when my girl was a pup), my instructor gave me this tid bit of advice when I was experiencing some changes that would disrupt her routine. It worked.
Kiss her on the nose for me! I love dogs more than I love people. Yeah, I am dead serious.
In the renal community life has changed drastically since the 1st January 2011 a new and dreaded word became the norm, the word which strikes fear into the hearts of our community is "Bundling".
So what does Bundling mean to you?
Wikipedia describes Bundling as...
Bundling, or tarrying, was the traditional practice of wrapping one person in a bed accompanied by another, usually as a part of courting behavior. The tradition is thought to have originated either in the Netherlands or in the British Isles and later became common in Colonial America, especially in Pennsylvania Dutch Country. When used for courtship, the aim was to allow intimacy without sexual intercourse.
InvestorWords.com describes Bundling as...
The practice of joining related products together for the purpose of selling them as a single unit. This is generally carried out when the seller thinks that the characteristics of two or more products and services are such that these products might appeal to many consumers more as a package than as individual offerings e.g. local and long distance services. Bundling arrangements usually feature a special pricing arrangements which make it cheaper to buy the products and services as a bundle than separately.
For a Renal Nurses bundling means the new way we get paid for providing dialysis for our patients.
The initial concept was decided upon by the 'powers that be', it was felt the way medicare/medicaid paid for services to the dialysis companies was outdated and needed modernizing.
It was thought by changing the way that the government pays for dialysis they could also control the way of improving quality of care provided to the patient by the dialysis companies.
Payment before was given regardless of whether companies provided adequate dialysis or not. Now everything is measured by achievement of certain standards of care!
Prior to 2011 dialysis companies could bill separately for lab work, medications, supplies etc. Now it is combined into one payment called 'bundling'. The payment for dialysis is now one amount, that amount depends on certain measurements being achieved for each patient. If they are not met then the already low payment is reduced by a percentage, which forces the dialysis companies to make sure each facility reaches these targets.
The payment is so low that Medicare/Medicaid patients receiving dialysis in Ohio are being dialyzed at a loss to the dialysis company.
The private pay insurance patients keep the units afloat, and financially viable!
Dialysis units now have to be extremely careful when documenting results. New patients certain hospital admissions & discharge diagnoses, co-morbidities can all increase payments to dialysis companies.
So in reality what does this all mean? It means cost cutting exercises every single day of every single month for the renal unit.
Cheaper supplies because this is a controllable cost, also educating and teaching staff to be more vigilant when using supplies.
Medications are costly so strict control of anemia is important as Epogen used to help control anemia is very expensive. Prior to 2011 Epogen was separately billable so it was given more freely, although renal units always tried to control anemia levels and had objectives to reach there was no financial pressure to control anemia. Once dollars became an issue renal units all over the country suddenly became very focused on controlling anemia by focusing on how to control anemia within a certain range.
Staff is the single most expensive commodity, so this year staff have been streamlined, in a effort to control costs. The renal community is small, staff are transient and the work is difficult.
Careful recruiting of new staff has become important, retention being top of the list.
Overtime is another area being focused on, although in my opinion I rarely see overtime unless warranted.
Training new staff is costly so if companies cannot keep staff then it is a vicious circle of training and losing. All sorts of pre employment tests are becoming utilized in the recruitment process in an effort to recruit the right staff.
Many new recruits have no concept of how busy, stressful and hard work, dialysis units can be. A lot of staff come into the job thinking it is an easy job after working in hospitals where the work can be a lot heavier. So when reality hits sometimes finding the doorway out is they way staff run! Although for me dialysis is in my blood so to speak and I have enjoyed a long and happy career as a renal RN.
Dialysis is far from being a 'cushy' number. The patients are chronically ill and like no other patients you have ever dealt with. They have to come to a dialysis unit 3 days a week for up to 5 hours of treatment each visit, these hours do not include the time spent travelling, waiting to get on to dialysis and the time spent after dialysis. They get very impatient and fed up if they are not on dialysis at their appointment time-in their mind they lose their whole day 3 times a week, so every minute is precious.
They are experts in their own care, they know what they like and they know they can transfer to the dialysis unit down the road if they don't get what they want.
So keeping your patient happy and content is a dialysis unit's main priority, not only because they deserve it but because a patient is a commodity.
You only get paid if the patient turns up for treatment, that seems obvious doesn't it?
To set up a dialysis machine, is costly if the patient doesn't show for treatment. You cannot charge anybody for the cost of getting the machine ready for the patient it is an immediate loss to the company. Staffing costs are huge, in my unit we can pay $100 per treatment in staffing costs alone, so if a patient doesn't turn up for treatment this can be higher because we don't get paid for no shows.
If you increase the amount of treatments per day they the staffing costs fall, some units in my company only have $67 per treatment staffing costs. So it is a daily battle to keep staffing costs down by increasing treatments and reducing the patients calling off. We attempt to reschedule the patients each time they fail to show for treatment but sometimes this is a losing battle.
Some patients are chronic no show patients, they frequently call off with almost no notice and by that time the machine is all ready to go!
This means everything has to be thrown away, empty chair no revenue.
These patients also tend to be the patients, whose lab results are poor, causing the reimbursement from Medicare/Medicaid to be cut.
These patients are also very non compliant, don't follow a diet, fluid restrictions and don't take meds correctly. This results in patients having frequent hospital admissions complaining of SOB, generalized edema, and very high potassium's which can be life threatening.
Dialysis units get penalized because of preventable hospital admissions. Education of the patient is of vital importance not only for their health but to ensure patients do not call off dialysis which as stated before is a huge loss of revenue.
Some companies will eventually give 30 days notice to a patient to find another unit if they are frequent no shows. They cannot afford to carry patients who's financial costs can cripple a unit especially if there are a lot of them.
It is too early to say if patient care has suffered by 'Bundling' I believe any financial cuts in health care will result in effecting the patients.
Loss of money means somebody somewhere suffers.
Loss of jobs, patient morale, staff morale-more pts = more work and less time for the individual patient.
Control of epogen not a bad thing as it is now known to have carcinogenic repercussions which some renal experts believe out ways the positive benefits
Oh, gosh. In my humble opinion, the healthcare industry has no business seeking advice from the hotel industry because the two entities exist for very different reasons.
The chef at the Ritz-Carlton will serve you a T-bone steak and a baked potato covered with several pats of butter, even if you have coronary artery disease. They'll also give the diabetic an entire cherry cheesecake. They'll also lead the COPD patient to a suite where smoking is allowed. It is imperative that hospital patients not think they're at the hotel. It undermines what healthcare workers do.
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