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I just read a disturbing article on nursing home closures due to recession-related financial crisis and/or Medicare/Medicaid funding cuts. With baby boomers growing older and closing in on the need for long term care, this couldn't come at a worse time. When did our elders become so dispoable in our society? This must be traumatizing for those who need care and heartbreaking for their families; not to mention the staff that must watch them forced back out into the world and then lose their jobs.

Nursing 101

I met my Nursing 101 teacher last night. 25+ years in nursing as an RN and totally dedicated to her art.

Other impressions of her:
-Detail oriented
-Patient care comes first
-Tough as a railroad spike
-Very firm but fair
-Challenging (Yay!)
-Knowledgeable.
-There will be no free rides in this class-- you will earn your grade.

Disagreements

    Everybody has certain things that just get under their skin. It touches every area of your life; personally, professionally, romantically.... Whether or not it happens is not in question. What you do about it and/or how you react to it is what matters. For example, I have a professional dislike for a certain home health nurse that has been working with one of my patients for the last couple of months. (In case you're not familiar with what home health nurses are, they care for critically ill, home bound patients.) She never remembers the name of my patient and so, always comes up with a similar but still totally incorrect name for them when she calls or faxes over order requests. At that point, it is up to me to correct her without letting my dislike bleed through. Instead of verbally thrashing her for this insensitivity, I politely remind her what my patient's name is and move on. There are other issues that add to my lack of respect for her, but this is the most fundamental one and bothers me most. I believe in knowing the names of all my patients, office workers, home health nurses, hospice nurses, nursing home and assisted care facility nurses, and then some. Why? There are multiple advantages and/or purposes for this.
    Most importantly, it builds a better relationship with whomever you happen to be working with. The faceless home health nurse you talk to every day on the phone, suddenly becomes "Stacy", a home health nurse that went the extra mile for one of your patients; perhaps because of her positive experience with your office. Or the pharmacist you call about your early stage Alzheimer's patient's recent med refills becomes "James", the pharmacist that calls the patient to pick up their refilled medicines or goes to the trouble of helping them set up a medicine tray so they remember what medicines to take what day. Did they do it because they were simply good at their job, or because they remembered discussing with you that this patient was an Alzheimer's patient and more prone to forgetting? Maybe they went above and beyond because they remembered you went above and beyond for your patient and they felt encouraged. It may be a combination of all these things. Life is rarely black and white; most often it is seen in shades of gray.
    It also occasionally helps improve patient care by giving feedback to heallthcare supervisors for their employee's notable behavior. For example, "Sarah",  the home health nurse that hasn't bothered to observe whether or not your dementia patient has been cleaning themselves regularly or only doing so every 3 days. You contact their supervisor and report this. As a result, Sarah is placed on probation and encouraged to review fundamental home nursing skills. Or "Gary", a home health nurse, notices his end stage Alzheimer's patient's medicine tray has not been getting refilled with their pain medications. As a result he investigates and finds out that your patient's adult child has been abusing these medicines instead of administering them to their sick parent and Adult Protective Services is called. You report Gary's care of the patient to a superior and as a result, he is recognized in his company for excellent patient centered care and given a raise.
    I could go on about this particular topic at length and may continue this discussion at another time, but for now I need wrap this up. My entire purpose for bringing the topic up at all came about because of a disagreement I had with a co-worker about this home health nurse yesterday. My co-worker happened to overhear me talking to one of my doctor's about the situation and basically said in her uncultured way that I shouldn't have any objections over this because I have made professional mistakes too. This is true, I have made mistakes since I have only been a medical assistant for 2 years and the feild is very new to me. However making the same mistake repeatedly instead of correcting poor work practices becomes a bad habit. When a mistake is noticed and pointed out, it is your responsibility to correct it. If you don't, your bad habit can no longer be considered a simple mistake. Bad habits kill patients. Lets imagine this hospice nurse has two patients, one being my patient, "John Doe" and another named "Jonah Doe" with a severe penicillin allergy. John Doe has a painful urinary infection and my doctor orders a shot of penicillin to clear it up. The nurse's other patient Jonah Doe gets the shot because she mixed up their names again. This nurse has just killed her patient. 

The Score

My first nursing module is complete. Here is the score:

Anatomy and Physiology I : A
Nursing Orientation: A
Drug Dosage Calculations: A

I'm so proud!

Next semester I take Anatomy and Physiology II and Nursing 101.

Delivery

I was up at 2 AM this morning to coach a patient I've been following at the practice. She gave birth to an adorable little girl with her father's features and her mother's face. It was such a rewarding experience and made me wistful to start doing regular doula work again instead of just coaching occasionally. I know I've forgotten some of the birthing techniques/positions for laboring mothers and that bothers me. Perhaps I can get recertified as a doula when I finish my LPN program, that'd be nice.
Well, I'd better go. I have work today and my anatomy+physiology final exam tonight. So far I am still vertical, but If I get out of school early this evening, I am going to go home and slip into sleep coma until morning.

Sep. 23rd, 2009

I am so exhausted today. Its finals week and I have 1 exam down and 2 to go. Tonight is my Freshman Orientation exam, which I still think is a waste and a pity. Ironically, medtical terminology was cut from the program this year and it is now sprinkled into the curriculum in our other courses.
Walk in flu clinic is today. We've had a higher volume of patients than usual, even this time of year, because of the swine flu paranoia. H1N1 isn't out yet, but nobody seems to be taking any chances.

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